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Perfis de morbidade nos diferentes territórios de adscrição da Estratégia Saúde da Família; Profiles of morbidity in different territories ascription of the Family Health Strategy

Fonseca, Lara Marina Almeida e
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 06/08/2012 PT
Relevância na Pesquisa
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A Atenção Básica (AB), através da Estratégia Saúde da Família (ESF), caracteriza-se por um conjunto de ações de saúde, no âmbito individual e coletivo, que abrangem a promoção e a proteção da saúde, a prevenção de agravos, o diagnóstico, o tratamento. A AB fundamenta-se em quatro atributos essenciais: atenção ao primeiro contato, coordenação do cuidado, integralidade e longitudinalidade, que operados, possibilitam o acesso, a produção do cuidado e a identificação do perfil da população do território de adscrição. Considerando que dentro do território municipal encontram-se grupos heterogêneos, com perfis e necessidades particulares, traçar as características sociais e as singularidades do adoecer dos territórios de adscrição das ESF pode permitir adequar os serviços da equipe a essas necessidades. O objetivo do presente trabalho epidemiológico, é caracterizar, através do perfil de morbidade e sócio demográfico, os grupos cadastrados nas diferentes equipes e territórios de implantação da Estratégia Saúde da Família, tendo como campo de estudo o município de Patrocínio/MG. Nele existem 16 equipes da ESF, das quais três localizam-se na área central, uma na área rural e 12 na região periférica da cidade (três estratos). A fonte de dados foi os prontuários de pacientes usuários destas unidades assistenciais. Após calculado o tamanho amostral em 596 prontuários...

Sobrevida e morbidade em prematuros com menos de 32 semanas de gestação na região central do Brasil

Castro, Márcia Pimentel de; Rugolo, Lígia Maria Suppo Souza; Margotto, Paulo Roberto
Fonte: Federação Brasileira das Sociedades de Ginecologia e Obstetrícia Publicador: Federação Brasileira das Sociedades de Ginecologia e Obstetrícia
Tipo: Artigo de Revista Científica Formato: 235-242
POR
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OBJETIVO: Avaliar a sobrevida e complicações associadas à prematuridade em recém-nascidos com menos de 32 semanas. MÉTODOS: Estudo prospectivo do tipo coorte. Foram incluídos os nascidos vivos, com idade gestacional entre 25 semanas e 31 semanas e 6 dias, sem anomalias congênitas admitidos em UTI Neonatal, entre 1º de agosto de 2009 e 31 de outubro de 2010. Os recém-nascidos foram estratificados em três grupos: G25, 25 a 27 semanas e 6 dias; G28, 28 a 29 semanas e 6 dias; G30, 30 a 31 semanas e 6 dias, e acompanhados até 28 dias. Foram avaliadas a sobrevida aos 28 dias e a morbidade associadas à prematuridade. Para análise dos resultados, utilizou-se o teste do c², análise de variância, teste de Kruskal-Wallis, razão de risco com intervalo de confiança (IC) e regressão logística múltipla, com significância em 5%. RESULTADOS: A coorte compreendeu 198 prematuros, sendo G25=59, G28=43 e G30=96. O risco de óbito foi significativamente maior em G25 e G28, em relação ao G30 (RR=4,1; IC95% 2,2-7,6 e RR=2,8; IC95% 1,4-5,7). A sobrevida encontrada foi, respectivamente, 52,5, 67,4 e 88,5%. A partir da 26ª semana e peso >700 g, a sobrevida foi superior a 50%. A morbidade foi inversamente proporcional à idade gestacional...

Prognostic factors in locally advanced colon cancer treated by extended resection

Vieira,René A.C.; Lopes,Ademar; Almeida,Paulo A.C.; Rossi,Benedito M.; Nakagawa,Wilson T.; Ferreira,Fabio O.; Melo,Celso A.
Fonte: Faculdade de Medicina / Universidade de São Paulo - FM/USP Publicador: Faculdade de Medicina / Universidade de São Paulo - FM/USP
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2004 EN
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25.95%
The impact of clinical, pathologic, and surgical variables on the postoperative morbidity, mortality, and survival of patients undergoing extended resections of colon carcinoma were evaluated. METHODS: The medical records of 95 patients who underwent extended resections for colon carcinoma between 1953 and 1996 were reviewed. In all cases, in addition to colectomy, 1 or more organs and/or structures were resected en bloc due to a macroscopically based suspicion of tumor invasion. The clinical, pathologic, and surgical parameters were analyzed. Overall survival rates were analyzed according to the method of Kaplan and Meier. Multivariate analysis was performed using the Cox proportional hazards model. RESULTS: Eighty-six patients were treated by curative surgeries and the remaining by palliative resections. Invasion of the organs and/or adjacent structures and regional lymph nodes was found microscopically in 48 and 31 patients, respectively. The median follow-up without postoperative mortality was 47.7 months. The 5-year overall survival rates was 52.6%. The 5-year overall survival rates for patients undergoing curative and palliative surgeries was 58.3% and 0%, respectively. The mean survival time in the palliative surgery group was 3.1 months. Multivariate analysis showed that Karnofsky performance status was strongly related to the risk of postoperative complications (P = .01)...

Hospital-based surveillance of malaria-related paediatric morbidity and mortality in Kinshasa, Zaire.

Greenberg, A. E.; Ntumbanzondo, M.; Ntula, N.; Mawa, L.; Howell, J.; Davachi, F.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica
Publicado em //1989 EN
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26.23%
Although Plasmodium falciparum malaria is a leading cause of paediatric morbidity and mortality in Africa, few quantitative estimates are available about the impact of malaria on childhood health. To quantify the impact of the disease in an urban African setting, we reviewed the paediatric ward and mortuary records at Mama Yemo Hospital in Kinshasa, Zaire. From June 1985 to May 1986, 6208 children were admitted to the hospital, 2374 (38.2%) of whom had malaria; 500 of those with malaria died (case fatality rate, 21.1%). During this same period, there were 10,036 paediatric deaths, 1323 (13.2%) of which were attributed to malaria; 823 (62.2%) of these occurred in the emergency ward prior to hospitalization. Minimum population-based malaria mortality rates were highest for children aged less than 1 year (4.0 per 1000 per year). Over 70% of children admitted with malaria and greater than 80% of children who died from the disease were less than 5 years old. The total number of paediatric admissions and deaths remained relatively constant between 1982 and 1986; however, the proportional malaria admission rate increased from 29.5% in 1983 to 56.4% in 1986, and the proportional malaria mortality rate, from 4.8% in 1982 to 15.3% in 1986. These increases were temporally related to the emergence of chloroquine-resistant Plasmodium falciparum malaria in Kinshasa. Malaria is therefore a major cause of paediatric morbidity and mortality in the city...

Collaborative studies of acute respiratory disease in patients seen in general practice and in children admitted to hospital. Aims, field methods and morbidity rates

Miller, D. L.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /11/1973 EN
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25.95%
Two collaborative studies of acute respiratory disease were organized, one in patients seen in general practice and the other in children admitted to hospital. The main aims were to study the epidemiology and clinical presentation of these diseases and of the viruses associated with them. The field methods used are described and analyses of the consultation rates in general practice and of hospital admissions in children are presented. Both consultations and admissions were most frequent by far in very young children, especially those under the age of 1 year, but the pattern of incidence for the various clinical categories differed with age. Lower respiratory illnesses were relatively much more frequent in infants and in adults over 65 than in intermediate age groups. Seasonal variations were slight for most upper respiratory tract conditions but pronounced for lower respiratory illnesses, especially bronchiolitis of infants which was epidemic each winter, and for influenza. Changes in the initial diagnosis in patients seen in general practice did not greatly influence the total morbidity pattern but the final diagnoses showed a substantial proportional increase in the number of cases of lower respiratory illness. The shortcomings of the field methods and clinical records available for use in the study and the reliability of the results are discussed.

Cardiovascular diseases and diabetes mellitus in Fiji: analysis of mortality, morbidity and risk factors

Tuomilehto, J.; Ram, P.; Eseroma, R.; Taylor, R.; Zimmet, P.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em //1984 EN
Relevância na Pesquisa
26.07%
Mortality and hospital admissions due to cardiovascular diseases and diabetes mellitus have been increasing in Fiji steadily over the past 20 years. These diseases were present more frequently in the Indian than the Melanesian population of Fiji, but recently the steepest rise in prevalence rates occurred among the Melanesian population. The underlying conditions that contributed most to increasing mortality and morbidity were hypertension and diabetes mellitus. In 1978, the proportional mortality from diabetes mellitus was 6.0% (9.0% in persons aged ≥ 40 years), and that from cardiovascular diseases was 30.3% (39% in those aged ≥ 40 years). Ischaemic heart disease was the main cause of mortality and morbidity among the Indian population. This analysis of mortality and morbidity data is supported by the findings of a population survey, which showed that the prevalence rates of diabetes and hypertension in 1980 among urban Melanesians were similar to those among Indians. Urbanization and a modern life-style seem to play an important role in determining the disease pattern in Fiji, which is following the patterns in many industrial countries.

Morbidity and Mortality among Infants Born to HIV-Infected Women in South Africa: Implications for Child Health in Resource-Limited Settings

Venkatesh, Kartik K.; de Bruyn, Guy; Marinda, Edmore; Otwombe, Kennedy; van Niekerk, Ronelle; Urban, Michael; Triche, Elizabeth W.; McGarvey, Stephen T.; Lurie, Mark N.; Gray, Glenda E.
Fonte: Oxford University Press Publicador: Oxford University Press
Tipo: Artigo de Revista Científica
EN
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Background: We examined correlates of infant morbidity and mortality within the first 3 months of life among HIV-exposed infants receiving post-exposure antiretroviral prophylaxis in South Africa. Methods: We conducted a prospective cohort study of 848 mother–child dyads. Multivariable Cox proportional hazards models were used. Results: The main causes of infant morbidity were gastrointestinal and respiratory infections. Morbidity was higher with infant HIV infection (HR: 2.61; 95% CI: 1.40–4.85; p = 0.002) and maternal plasma viral load (PVL) >100 000 copies ml−1 (HR: 1.87; 95% CI: 1.01–3.48; p = 0.048), and lower with maternal age <20 years (HR: 0.25; 95% CI: 0.07–0.88; p = 0.031). Mortality was higher with infant HIV infection (HR: 4.10; 95% CI: 1.18–14.31; p = 0.027) and maternal PVL >100 000 copies ml−1 (HR: 6.93; 95% CI: 1.64–29.26; p = 0.008). Infant feeding status did not influence the risk of morbidity nor mortality. Conclusions: Future interventions that minimize pediatric HIV infection and reduce maternal viremia, which are the main predictors of child health soon after birth, will impact positively on infant health outcomes.

What Are the Factors That Interplay From Normal Pregnancy to Near Miss Maternal Morbidity in a Nigerian Tertiary Health Care Facility?

Adeoye, Ikeola A.; Ijarotimi, Omotade O.; Fatusi, Adesegun O.
Fonte: Routledge Publicador: Routledge
Tipo: Artigo de Revista Científica
EN
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25.95%
Researchers in Nigeria examined the epidemiological characteristics and factors associated with maternal outcomes using a mixed method approach: a prospective case control study design involving 375 pregnant women who received maternal care from a tertiary facility and in-depth interviews reporting the experience of near-miss survivors. A generalized ordered logit model was used to generate the estimates of partial proportional odds ratios (and 95% confidence intervals) across categories of the outcome variable. Factors strongly associated with maternal morbidity were late referral of women, presence of complications at booking antenatal visits, low birth weight, and severe birth asphyxia. The nearmiss women were further characterized, and a low proportion (25%) had organ dysfunction or failure. The challenge of such diagnoses in resource-constrained settings raises questions about the appropriateness of using organ dysfunction criteria in developing countries.

Comparação de dois modos de ventilação não invasiva (ventilação assistida proporcional e ventilação com pressão de suporte) no pós-operatório de revascularização do miocárdio; Comparison of two noninvasive ventilation modes (proportional assist ventilation and pressure support ventilation) in the postoperative of coronary artery bypass grafting surgery

Silva, Fábia Diniz
Fonte: Universidade Federal de Uberlândia Publicador: Universidade Federal de Uberlândia
Tipo: Dissertação
POR
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As complicações pulmonares no pós-operatório de cirurgia cardíaca são as principais causas de prolongamento do tempo de internação, morbidade e mortalidade. A ventilação não invasiva (VNI) é empregada no pós-operatório no intuito de evitar ou reverter o dano pulmonar. O presente estudo teve como objetivo comparar dois modos de ventilação não invasiva utilizando ou ventilação com pressão de suporte (VPS) ou ventilação assistida proporcional (PAV) nos pacientes em pós-operatório de revascularização cirúrgica do miocárdio, avaliando-se a segurança, a percepção de dispneia, as trocas gasosas e qual dos modos é mais confortável para o paciente. Vinte e cinco pacientes foram randomizados em dois grupos; treze deles realizaram ventilação não invasiva no modo PAV e doze, na VPS. Foram obtidas gasometria arterial com o paciente respirando ar ambiente e radiografia de tórax antes de se iniciar o estudo e após a última sessão de VNI. Foram realizadas duas sessões diárias de VNI, com duração de 30 minutos cada, durante dois dias consecutivos. A frequência cardíaca e a pressão arterial foram aferidas antes do início da VNI, nos instantes 10 e 20 minutos e após cada sessão. A oximetria de pulso e a frequência respiratória foram medidas antes...

Physical activity, alcohol and tobacco use and associated cardiovascular morbidity and mortality in the Second Australian National Blood Pressure study cohort

Nelson, M.; Alkhateeb, A.; Ryan, P.; Willson, K.; Gartlan, J.; Reid, C.
Fonte: Oxford Univ Press Publicador: Oxford Univ Press
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
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25.95%
Mark Raymond Nelson, Amasy Namuk Alkhateeb, Philip Ryan, Kristyn Willson, Janette Gwendoline Gartlan, Christopher Michael Reid and On behalf of the Second Australian National Blood Pressure Management Committee

Effect of dialysis modality on survival of hepatitis C-infected ESRF patients

Bose, B.; McDonald, S.; Hawley, C.; Brown, F.; Badve, S.; Wiggins, K.; Bannister, K.; Boudville, N.; Clayton, P.; Johnson, D.
Fonte: American Society of Nephrology Publicador: American Society of Nephrology
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
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25.95%
BACKGROUND AND OBJECTIVES: Hepatitis C virus (HCV) infection is associated with increased mortality and morbidity in end-stage renal failure (ESRF) patients. Despite a lower incidence and risk of transmission of HCV infection with peritoneal dialysis (PD), the optimal dialysis modality for HCV-infected ESRF patients is not known. The aim of this study was to evaluate the impact of dialysis modality on the survival of HCV-infected ESRF patients. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: The study included all adult incident ESRF patients in Australia and New Zealand who commenced dialysis between January 1, 1994, and December 31, 2008, and were HCV antibody-positive at the time of dialysis commencement. Time to all-cause mortality was compared between hemodialysis (HD) and PD according to modality assignment at day 90, using Cox proportional hazards model analysis. RESULTS: A total of 424 HCV-infected ESRF patients commenced dialysis during the study period and survived for at least 90 days (PD n = 134; HD n = 290). Mortality rates were comparable between PD and HD in the first year (10.7 versus 13.8 deaths per 100 patient-years, respectively; adjusted hazard ratio [HR] 0.65, 95% CI 0.34 to 1.26) and thereafter (20 versus 15.9 deaths per 100 patient-years...

Validity of medication-based co-morbidity indices in the Australian elderly population

Vitry, A.; Wong, S.; Roughead, E.; Ramsay, E.; Barratt, J.
Fonte: Public Health Assoc Australia Inc Publicador: Public Health Assoc Australia Inc
Tipo: Artigo de Revista Científica
Publicado em //2009 EN
Relevância na Pesquisa
36.1%
OBJECTIVES: To determine the validity of two medication-based co-morbidity indices, the Medicines Disease Burden Index (MDBI) and Rx-Risk-V in the Australian elderly population. METHODS: In Phase I, the sensitivity and specificity of both indices were determined in 767 respondents from wave 6 of the Australian Longitudinal Study of Ageing (ALSA). Medication-defined index disease categories were compared to self-reported medical conditions. Correlation with self-rated health was examined and Cox proportional hazards models were used to assess the predictive validity for mortality. Phase II verified the predictive ability of Rx-Risk-V in a sample of 213,191 veterans from Australian Department of Veterans' Affairs (DVA) database. RESULTS: MDBI and Rx-Risk-V scores could be calculated for 28% and 73% of the ALSA sample respectively. Both indices had high specificities and low to moderate sensitivities compared to self-reported medical conditions. Total weighted scores were significantly related to self-rated health (p<0.001). Both indices were predictive of mortality (Hazard Ratio (HR) =3.690 (95% CI 2.264-6.015) for MDBI and HR 1.079 (95% CI 1.045-1.114) for Rx-Risk-V. The predictive validity for mortality of Rx-Risk-V was confirmed using DVA data (HR= 1.090...

Using linked clinical and hospital morbidity data to assess risk and outcomes of primary lower limb total joint replacement in elderly men.

Mnatzaganian, George
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado
Publicado em //2012
Relevância na Pesquisa
36.19%
Background: Osteoarthritis is the most common musculoskeletal disorder affecting elderly Australians and is a leading cause of lower limb total joint replacement (TJR). The incidence of TJR has risen substantially over the past two decades, reflecting the ageing population, and increases in the prevalence of risk factors such as obesity. Primary TJR is considered to be relatively safe with low rates of adverse outcomes, however, there is increasing evidence that elderly, and male patients who undergo the procedure may be at higher risk for postoperative complications and mortality. The retrospective cohort studies presented in this thesis used data, drawn from Health In Men Study (HIMS), that were linked with Western Australia (WA) linked data system to assess risk and outcomes of primary TJR in a large population-based cohort of men. The studies closely examined three issues - obesity, co-morbidities, and smoking - about which there is continuing debate in regard to their association with the risk of undergoing the procedure, and their roles as determinants of outcome of TJR. These risk factors are particularly important because they are amenable to modification. Objectives: The main objectives of this thesis were: 1. To validate WA hospital morbidity data (HMD) and to assess the performance of HMD-based co-morbidity adjustment methods in predicting mortality among men undergoing elective primary TJR. 2. To assess risk of undergoing elective primary TJR in elderly men. 3. To assess risk of adverse outcomes following elective primary TJR including: • in-hospital complications...

Does co-morbidity provide significant improvement on age adjustment when predicting medical outcomes?

Mnatzaganian, G.; Ryan, P.; Hiller, J.E.
Fonte: Schattauer Publishers Publicador: Schattauer Publishers
Tipo: Artigo de Revista Científica
Publicado em //2014 EN
Relevância na Pesquisa
36.17%
OBJECTIVE: Using three risk-adjustment methods we evaluated whether co-morbidity derived from electronic hospital patient data provided significant improvement on age adjustment when predicting major outcomes following an elective total joint replacement (TJR) due to osteoarthritis. METHODS: Longitudinal data from 819 elderly men who had had a TJR were integrated with hospital morbidity data (HMD) and mortality records. For each participant, any morbidity or health-related outcome was retrieved from the linked data in the period 1970 through to 2007 and this enabled us to better account for patient co-morbidities. Co-morbidities recorded in the HMD in all admissions preceding the index TJR admission were used to construct three risk-adjustment methods, namely Charlson co-morbidity index (CCI), Elixhauser's adjustment method, and number of co-morbidities. Postoperative outcomes evaluated included length of hospital stay, 90-day readmission, and 1-year and 2-year mortality. These were modelled using Cox proportional hazards regression as a function of age for the baseline models, and as a function of age and each of the risk-adjustment methods. The difference in the statistical performance between the models that included age alone and those that also included the co-morbidity adjustment method was assessed by measuring the difference in the Harrell's C estimates between pairs of models applied to the same patient data using Bootstrap analysis with 1000 replications. RESULTS: Number of co-morbidities did not provide any significant improvement in model discrimination when added to baseline models observed in all outcomes. CCI significantly improved model discrimination when predicting post-operative mortality but not when length of stay or readmission was modelled. For every one point increase in CCI...

Lower age at menarche affects survival in older Australian women: results from the Australian Longitudinal Study of Ageing

Giles, L.; Glonek, G.; Moore, V.; Davies, M.; Luszcz, M.
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em //2010 EN
Relevância na Pesquisa
25.95%
Background: While menarche indicates the beginning of a woman's reproductive life, relatively little is known about the association between age at menarche and subsequent morbidity and mortality. We aimed to examine the effect of lower age at menarche on all-cause mortality in older Australian women over 15 years of follow-up. Methods: Data were drawn from the Australian Longitudinal Study of Ageing (n = 1,031 women aged 65-103 years). We estimated the hazard ratio (HR) associated with lower age at menarche using Cox proportional hazards models, and adjusted for a broad range of reproductive, demographic, health and lifestyle covariates. Results: During the follow-up period, 673 women (65%) died (average 7.3 years (SD 4.1) of follow-up for decedents). Women with menses onset < 12 years of age (10.7%; n = 106) had an increased hazard of death over the follow-up period (adjusted HR 1.28; 95%CI 0.99-1.65) compared with women who began menstruating aged ≥ 12 years (89.3%; n = 883). However, when age at menarche was considered as a continuous variable, the adjusted HRs associated with the linear and quadratic terms for age at menarche were not statistically significant at a 5% level of significance (linear HR 0.76; 95%CI 0.56 - 1.04; quadratic HR 1.01; 95%CI 1.00-1.02). Conclusion: Women with lower age at menarche may have reduced survival into old age. These results lend support to the known associations between earlier menarche and risk of metabolic disease in early adulthood. Strategies to minimise earlier menarche...

The burden of acute respiratory infections in crisis-affected populations: a systematic review

Bellos, Anna; Mulholland, Kim; O'Brien, Katherine L; Qazi, Shamim A; Gayer, Michelle; Checchi, Francesco
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Publicado em 11/02/2010 EN
Relevância na Pesquisa
26.18%
Crises due to armed conflict, forced displacement and natural disasters result in excess morbidity and mortality due to infectious diseases. Historically, acute respiratory infections (ARIs) have received relatively little attention in the humanitarian sector. We performed a systematic review to generate evidence on the burden of ARI in crises, and inform prioritisation of relief interventions. We identified 36 studies published since 1980 reporting data on the burden (incidence, prevalence, proportional morbidity or mortality, case-fatality, attributable mortality rate) of ARI, as defined by the International Classification of Diseases, version 10 and as diagnosed by a clinician, in populations who at the time of the study were affected by natural disasters, armed conflict, forced displacement, and nutritional emergencies. We described studies and stratified data by age group, but did not do pooled analyses due to heterogeneity in case definitions. The published evidence, mainly from refugee camps and surveillance or patient record review studies, suggests very high excess morbidity and mortality (20-35% proportional mortality) and case-fatality (up to 30-35%) due to ARI. However, ARI disease burden comparisons with non-crisis settings are difficult because of non-comparability of data. Better epidemiological studies with clearer case definitions are needed to provide the evidence base for priority setting and programme impact assessments. Humanitarian agencies should include ARI prevention and control among infants...

Factors influencing postoperative morbidity, mortality, and survival after resection for hilar cholangiocarcinoma.

Su, C H; Tsay, S H; Wu, C C; Shyr, Y M; King, K L; Lee, C H; Lui, W Y; Liu, T J; P'eng, F K
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /04/1996 EN
Relevância na Pesquisa
26.1%
OBJECTIVE; Morbidity and mortality involved in the resection of hilar cholangiocarcinoma were reviewed retrospectively. The clinicopathologic and laboratory parameters that might influence the patient's survival also were re-evaluated. SUMMARY BACKGROUND DATA: Although much progress has been made in the diagnosis and management of hilar cholangiocarcinoma, long-term outlook for most patients remains poor. Surgical resection is usually prohibited because of its local invasiveness, and most patients can only be managed by palliative drainage. Recently, many surgeons have adopted a more aggressive resection with varying degrees of success. Several prognostic factors in bile duct carcinoma have been proposed; however, no reports have specifically focused on resected hilar cholangiocarcinoma and its prognostic survival factors using multivariate analysis. METHODS: The clinical records and pathologic slides of 49 cases with resected hilar cholangiocarcinoma were reviewed retrospectively. Twenty clinical and laboratory parameters were evaluated for their correlation with postoperative morbidity and mortality, whereas 31 variables were evaluated for their significance with postoperative survival. Variables showing statistical significance in the first univariate analysis were included in the following multivariate analysis using stepwise logistic regression test for factors affecting morbidity and mortality and Cox stepwise proportional hazard model for factors influencing survival. RESULTS: There were 5 in-hospital deaths...

The Entropy of Morbidity Trauma and Mortality

Neal-Sturgess, Clive
Fonte: Universidade Cornell Publicador: Universidade Cornell
Tipo: Artigo de Revista Científica
Publicado em 22/08/2010
Relevância na Pesquisa
25.95%
In this paper it is shown that statistical mechanics in the form of thermodynamic entropy can be used as a measure of the severity of individual injuries (AIS), and that the correct way to account for multiple injuries is to sum the entropies. It is further shown that summing entropies according to the Planck-Boltzmann (P-B) definition of entropy is formally the same as ISS, which is why ISS works. Approximate values of the probabilities of fatality are used to calculate the Gibb's entropy, which is more accurate than the P-B entropy far from equilibrium, and are shown to be again proportional to ISS. For the categorisation of injury using entropies it is necessary to consider the underlying entropy of the individuals morbidity to which is added the entropy of trauma, which then may result in death. Adding in the underlying entropy and summing entropies of all AIS3+ values gives a more extended scale than ISS, and so entropy is considered the preferred measure. A small scale trial is conducted of these concepts using the APROSYS In-Depth Pedestrian database, and the differences between the measures are illustrated. It is shown that adopting an entropy approach to categorising injury severity highlights the position of the elderly, who have a reduced physiological reserve to resist further traumatic onslaught. There are other informational entropy-like measures...

Correção de sub-registros de óbitos e proporção de internações por causas mal definidas; Correction approach for underreporting of deaths and hospital admissions due to ill-defined causes

Cavalini, Luciana Tricai; Ponce de Leon, Antonio Carlos Monteiro
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; Formato: application/pdf; application/pdf
Publicado em 01/02/2007 POR; ENG
Relevância na Pesquisa
36.18%
OBJETIVO: Propor técnicas de correção de sub-registro e redistribuição de causas mal definidas para o Sistema de Informações sobre Mortalidade e o Sistema de Informações Hospitalares do SUS. MÉTODOS: Para a correção de sub-registro foram utilizados os estimadores bayesianos empíricos de James-Stein modificados para eventos em áreas geográficas delimitadas, aplicadas nos municípios brasileiros, no ano de 2001. RESULTADOS: Em relação aos dados de mortalidade, obteve-se um acréscimo de 55.671 óbitos, resultando num percentual de correção de sub-registro de 5,9%, mais efetivo nas faixas etárias de menores de cinco anos (8,1%) e de 70 anos e mais (6,4%); nas causas perinatais (8,7%) e causas mal definidas (8,0%); e nos Estados do Maranhão (10,6%), Bahia (9,5%) e Alagoas (8,8%). A redistribuição das causas mal definidas de óbito modificou a estrutura da mortalidade proporcional das regiões Norte e Nordeste, com aumento da proporção de óbitos por doenças do aparelho circulatório e redução para as causas externas e perinatais. A redistribuição das causas mal definidas de internação não alterou a morbidade hospitalar proporcional. CONCLUSÕES: Os resultados da correção de sub-registro apresentaram consistência em relação aos achados da literatura...

Confiabilidade e viés do informante secundário na pesquisa epidemiológica: análise de questionário para triagem de transtornos mentais; Proxy informant reliability and bias in epidemiological research: analysis of a screening questionnaire for mental disorders

Santana, Vilma S.; Almeida Filho, Naomar de; Rocha, Cristina O. da; Matos, Adriana S.
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; ; ; ; ; Formato: application/pdf
Publicado em 01/12/1997 POR
Relevância na Pesquisa
26.02%
OBJETIVOS: Avaliar a confiabilidade e vieses na aplicação do Questionário de Morbidade Psiquiátrica de Adultos (QMPA) a informantes secundários comparando-os com informantes primários. MÉTODO: Foram estimados os índices Kappa para as questões do QMPA em uma amostra de 69 casais selecionados aleatoriamente em uma área da Região Metropolitana de Salvador, Bahia, Brasil. Analisaram-se a magnitude e direção dos vieses com base na variação proporcional da prevalência. Cada entrevistado foi avaliado como informante primário, quando respondia sobre seus próprios sintomas, e como informante secundário, quando respondia sobre o cônjuge. RESULTADOS: O uso de informantes secundários leva a estimativas de morbidade enviesadas, cuja magnitude e direção dependem do gênero do informante. Embora ambos, esposo e esposa tendam a subinformar a presença de sintomas do seu cônjuge, as esposas produzem informações mais confiáveis. CONCLUSÕES: Frente às limitações no uso de informante primários, as esposas ou donas-de-casa podem ser recomendadas como informantes secundárias na aplicação do QMPA em estudos da comunidade.; OBJECTIVES: To evaluate the reliability, magnitude and direction of the resulting bias in the application of a screening instrument for mental disorders by considering proxy informants in comparison to primary informants. METHODS: Data are taken from a general morbidity community-based survey carried out in 520 randomly selected households of an industrial area of the Metropolitan Region of Salvador...