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PubMed2005

[Trends in avoidable causes of infant mortality in Belo Horizonte, Brazil, 1984 to 1998].

OBJECTIVE: To analyze the infant mortality trend in a metropolitan area, from 1984 to 1998. The main focus was on avoidable causes of neonatal and post-neonatal mortality. METHODS: Sources of data were the Sistema de Informacoes em Mortalidade do Ministerio da Saude (SIM-MS) [Mortality Information System of the Ministry of Health] and Fundacao Instituto Brasileiro de Geografia e Estatistica (IBGE) [Brazilian Institute of Geography and Statistics Foundation] (official live birth and death records) for the metropolitan region of Belo Horizonte, in the State of Minas Gerais. A simple linear regression model was used to evaluate time-trends of mortality rates. Statistical significance of the inclination of the regression curves was considered for the p<0.05 level. RESULTS: During the 15 year period in question, the infant mortality rate declined from 48.5 to 22.1/1,000 live births. However, the most accentuated decrease was observed during the last four years of the study period. The post-neonatal group was greatly responsible for this decline both in the capital and in the other districts within the metropolitan region of Belo Horizonte. CONCLUSIONS: Although a significant decrease in the infant mortality rate has been observed, particularly in the post-neonatal mortality, it is still larger than the rates found in developed countries. Deaths due to perinatal morbidities as well as the group of causes represented by diarrhea-pneumonia-malnutrition still present an important potential for reduction. The authors discuss the role of the health services in improving the rates of these avoidable causes of infant mortality.

Brazil↗
PubMed1993

Consumption of meat and fruit in relation to oral and esophageal cancer: a cross-national study.

Using data from 59 countries, we conducted an international comparison study to identify nutritional predictors of age-adjusted oral and esophageal cancer mortality rates. Statistical models accounted for per capita tobacco disappearance data, alcohol consumption, and various measures of socioeconomic status. For oral cancer, stepwise regression results showed protective effects for milk/dairy products (B = -0.030, p < 0.0001) and cabbage consumption (B = -0.391, p = 0.01) and increased risk from vegetable oil (B = 0.072, p = 0.04) and excess animal fat calories (B = 0.344, p < 0.0001) as well as marginally increased risk from cereals (B = 0.008, p = 0.08). Results were obtained after accounting for all background factors, including sex (model R2 = 0.52). For esophageal cancer, stepwise results indicated protective effects for fruit (B = -0.046, p = 0.0006) and total caloric intake (B = -0.013, p < 0.0001) and increased risk from vegetable oil (B = 0.061, p = 0.04) and meat (B = 0.031, p < 0.0001) consumption (model R2 = 0.55). When analyzed separately by sex, results were similar, indicating that the risk factors are probably the same in both sexes, even though women consistently have fewer deaths, on average, from these cancers. On the basis of results from stepwise regression models, we also fitted general linear models for mortality rates of each cancer site, and results were similar in terms of magnitude and direction of effects. Although the evidence provided by this type of analysis using data aggregated by country is limited in terms of control for potential confounding effects and modeling of possible effect modification, an effect of high meat, animal product, or vegetable oil and low fruit and cabbage consumption is consistent with the known biology of these tumors.

Aged↗
PubMed2004

Survival after curative resection for rectal cancer by the end of the 20th century.

BACKGROUND: The aim of this study was to define the survival rates in patients with rectal carcinoma treated with curative resections. PATIENTS AND METHODS: Between 1993 and 1998, 54 patients with rectal cancer underwent curative resection by conventional technique. Tumour location, TNM staging and tumour differentiation were evaluated. Among the 54 patients, 14 underwent high anterior resection, 28 low anterior resection, 7 abdominoperineal resection and 5 underwent local excision. Survival rates were calculated using the Kaplan-Meier method and long-range analysis. RESULTS: Five-year survival was 70.4%. The survival rate statistically significantly decreased with increasing TNM tumour stage (p=0.009). Patients with poor differentiation of the tumour had the lowest 5-year survival (33%) compared to patients with moderate (72%) and good (78%) tumour differentiation. Sex and age did not affect survival. Location of the tumour in the distal end of the rectum and mucinous characteristics are poor prognostic factors affecting survival. CONCLUSIONS: Curative resection combined with chemoradiotherapy, whenever necessary, is accompanied with acceptable 5-year survival rates.

Adult↗
PubMed1990

Black/white comparisons of deaths preventable by medical intervention: United States and the District of Columbia 1980-1986.

Blacks in the US experience increased mortality (1113 versus 745 per 100,000 males; 631 versus 411 per 100,000 females) and decreased life expectancy (63.7 years versus 70.7 years for males; 72.3 years versus 78.1 years for females); compared to Whites. In an effort to determine if the excess mortality among Black Americans might be explained by differences in access or quality of health care services, we performed a race-specific analysis of conditions for which mortality is largely avoidable given timely and appropriate medical care. Using methodology proposed by Rutstein and Charlton, mortality due to 12 causes was evaluated including tuberculosis, cervical cancer, Hodgkin's disease, rheumatic heart disease, hypertensive heart disease, acute respiratory disease, pneumonia and bronchitis, influenza, asthma, appendicitis, hernias and cholecystitis. In the US, during 1980 to 1986, an average of 17,366 deaths and 286,813 years of potential life (YPLL) before age 65 were lost each year due to all 12 sentinel causes combined. Of these causes, hypertensive heart disease, pneumonia and bronchitis, cervical cancer and asthma accounted for the greatest number of deaths. The mortality rate for all 12 causes combined among Blacks was 4.5 times that of Whites. The highest relative rates among Blacks compared to Whites were observed for tuberculosis, hypertensive heart disease and asthma. The overall mortality rate in the District of Columbia for the selected causes was 3.7 times the national rate. Compared to national rates, statistically significant elevated rates in the District were observed for tuberculosis, hypertensive heart disease and pneumonia and bronchitis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1998

Effect of advance directives on the management of elderly critically ill patients.

OBJECTIVE: To evaluate the effects of advance directives on the management of elderly, critically ill patients. DESIGN: Retrospective chart review. SETTING: Teaching hospital medical/surgical, noncardiac intensive care unit (ICU). PATIENTS: The medical records of 401 patients, > or =65 yrs of age, admitted to the ICU between 1992 and 1995 were reviewed. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Advance directive statements included refusal of cardiopulmonary resuscitation (CPR), nutrition, intravenous medications, antibiotics, mechanical ventilation, and blood products. Nineteen (5%) patients had advance directives (study group). These patients were compared with 28 case-matched (age, Acute Physiology and Chronic Health Evaluation II score, and diagnosis) critically ill patients without advance directives (control group). We compared the following data: cost per day; number of surgical procedures; number of radiographic studies; number of central venous and pulmonary artery catheter insertions; number of complete blood counts, electrolytes, and cultures sent for laboratory testing; number of days in the ICU/hospital; and mortality rates. Statistical analysis was performed using the Student's t-test for independent means and the chi-square equation. For all observed parameters, quantitative and dichotomous differences between study and control groups were not statistically significant. Two patients received CPR, despite advance directive statements refusing this treatment. CONCLUSIONS: Few critically ill seniors have advance directives. As assessed by objectively documented information, the level of care delivered to elderly ICU patients is not affected by the presence or absence of advance directive statements. Medical personnel need to be aware of whether or not patients have advance directive statements, as unauthorized CPR was administered to 11% of the patients who died with advance directives.

APACHE↗
PubMed2003

[Survival of Aedes albopictus: physiological age and reproductive history].

OBJECTIVES: To study the longevity of Ae. albopictus populations in rural and urban areas in two different feeding conditions and to assess their physiological age and reproductive history. METHODS: Ae. albopictus larvae were collected in the Para ba Valley, (urban area) and Ribeira Valley (rural area), S o Paulo State, Brazil. In the laboratory, females were fed with sugar or blood and monitored daily. The day of death of each mosquito and other reproduction related characteristics were registered. Ovaries were dissected using Polovodova techniques and follicular development was examined according Christophers and Mer. Life tables were created and statistics analysis was performed for survival rates. Data analysis was carried out using Stata 7.0. RESULTS: Gonotrophic discordance was seen in both populations. Parous females developed terminal sacs. Nulliparous females had normal ovaries and in some cases dilatations were seen. Females fed with sugar showed higher survival rates. Statistical difference in survival rates was not observed in the populations of both areas. CONCLUSIONS: Parity status and physiological age of Ae. albopictus were not described using ovarioles analysis because they formed terminal sacs instead of dilations. Longevity of Ae. albopictus females was influenced by the food provided.

Aedes↗