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Fundamento: los accidentes constituyen cadenas de eventos y circunstancias que llevan a la ocurrencia de lesiones no intencionales. Son responsables de numerosas muertes cada año en el mundo. En el año 2019, los accidentes del tránsito y las caídas estuvieron entre las primeras 20 causas de muerte. En Cuba se erigieron como la quinta causa de mortalidad por todas las causas y edades en el decenio 2010-2019. Objetivo: caracterizar la mortalidad por accidentes en Cuba en el decenio 2010- 2019. Métodos: se realizó un estudio ecológico, longitudinal, descriptivo, de la mortalidad anual por accidentes en Cuba, a lo largo del decenio que comprende los años 2010 al 2019. Los anuarios estadísticos, publicados desde el año 2012 al 2022, por la Dirección de Registros Médicos y Estadísticas de Salud, del Ministerio de Salud Pública de Cuba, constituyeron la principal fuente de información. Para su procesamiento estadístico, los datos obtenidos fueron incluidos en una hoja de cálculo en Microsoft Excel y los resultados se expresaron en figuras y tablas. Resultados: las tasas brutas de mortalidad por accidentes en Cuba en el decenio 2010- 2019 se incrementaron de 43 a 49,9 por 100 000 habitantes, las más elevadas fueron por caídas: 23,7 en el año 2018 y 23,4 por 100 000 habitantes en el 2019. Los años de vida potencialmente perdidos por accidentes disminuyeron de 5,4 a 4,7 por 1 000 habitantes de 1 a 74 años. Conclusiones: en Cuba, en el decenio 2010- 2019, se observó un aumento en la mortalidad por accidentes a expensas de las caídas accidentales, estas con mayor frecuencia en el sexo femenino.

Copyright of Adicciones is the property of Sociedad Cientifica Espanola de Estudios sobre el Alcohol and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: cardiovascular diseases are the leading cause of death worldwide, each year more people die from one of these diseases than from any other cause. Objective: to identify the risk factors for the development of cardiovascular diseases in the Campo Alegre resettlement, Tierra Alta, Córdoba during 2020-2021. Methods: a descriptive study was carried out in which adults over 60 years of age residing in the resettlement were included. The variables studied were: age and sex, marital status, socioeconomic status, educational level, work status, household or personal income, health history and healthy lifestyle conditions such as high blood pressure, type 2 diabetes mellitus, physical activity , healthy eating and daily food ration, weight control, drug dependence, medical control and hypercholesterolemia. They were given a survey focused on knowing the risks exposed to cardiovascular disease. The data was stored in Excel and analyzed in SPSS Statistics 26. Results: minimum ages (60 years) and maximum ages (76 years and over) were obtained. It was possible to show that arterial hypertension prevailed in the population for both sexes, the educational level is related to the educational level of the population, a greater number of cases was found in the population without studies. Conclusions: the frequency of risk factors for cardiovascular diseases present in the population warns about the need to develop health promotion and disease prevention plans in this area of the municipality of Tierralta, Córdoba, since it has been shown that this entails to consequences in the quality of life of the elderly population.

Background: Diabetes Mellitus type 2 (DM2) constitutes a global public health problem with high morbidity and mortality rate. Studies reported cardiovascular disease as the main direct cause of death in diabetics, while others attributed it to respiratory diseases. However, in our setting, it is still a question. The objective of our study was to determine the main direct causes of death in diabetic patients of Peru. Material and Methods: Observational, descriptive study. We collected the data from the registry of the "Sistema Informático Nacional de Defunciones" (SINADEF) of Peru from 2017 to 2020. We selected the registries whose ICD-10 corresponds to DM2 to describe the characteristics of the deceased, the direct causes of death and the annual trend of the first five causes. Results: The main direct causes of death in diabetic patients were diseases of the respiratory system (28,0%), diseases of the circulatory system (25,4%) and certain infectious and parasitic diseases (15,0%). In addition, the most affected population was males (50,3%), older adults (76,4%) from the coast region (63,6%). The trend was increasing in the first five causes of death, with the greatest slope between 2019 and 2020 for diseases of the respiratory system (rate 1.40 and 2.96) and diseases of the circulatory system (rate 0.98 and 2.86). Conclusions: The main direct causes of death were diseases of the respiratory and circulatory system. The region with the highest number of deaths was the coast. The trend of the top five causes of death was increasing, with a greater slope between 2019 and 2020. [ABSTRACT FROM AUTHOR]

Background: maternal death represents one of the most notable events in the conflicts of sexual and reproductive health in the world. The high mortality from this cause in the world is unacceptable. However, estimates for determining the burden of maternal morbidity and mortality health are still limited.Objective: to determine the burden of mortality related to pregnancy, childbirth and the puerperium in Cuba between 2005 and 2018.Methods: a descriptive study was carried out, with national cross-sectional data and annual periodicity. The universe of study was made up of all the deaths that occurred during pregnancy, childbirth and the puerperium in the period 2005-2018, in Cuba (N = 831). The mortality ratio, years of life potentially lost due to mortality, the percentage, the average and the trend were calculated.Results: of the total number of deceased due to deaths that occurred during pregnancy, childbirth and the puerperium, 463 were due to direct death; 247 for indirect death; and 247, due to other deaths 121. The ratio averaged 48.8 deaths for every 100 000 live births. Years of life potentially lost were 42,582: 23,433 for direct deaths, 12,724 for indirect deaths, and 6,425 for other deaths.Conclusion: direct obstetric deaths were the most frequent and those with the greatest impact on life expectancy; while indirect obstetrician women showed a tendency to increase over time. For other deaths, women died at an earlier age.

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Suicide is a major global, national, and regional public health problem. The present investigation sought to characterise the suicidal population of the Atacama Region between 2010-2017. It also describes the cases with previous attempts detected by the Health System. The analysis is based on 266 registered cases classified as suicides by the Legal Medical Service in the studied period. The annual regional and city rates are described, and the cases are compared by gender, age, cause of death, marital status, work activity, nationality, date of death and presence of substances. The behaviour observed is similar to the national one, which reflects evidence of a predominance of single men with an average age of 38.8 years, of different trades, who preferably used hanging. The study underscores the occurrence of suicides in the period October-January. The study raises the need to go deep into this problem, considering socio-environmental variables to explain the detected differences between cities and analysing the local data to favour prevention. [ABSTRACT FROM AUTHOR]

Copyright of Revista Habanera de Ciencias Médicas is the property of Universidad de Ciencias Medicas de La Habana and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: complications during pregnancy, childbirth and the puerperium are the main causes of death in women of childbearing age. The study of the mortality burden derived from these complications is useful to quantify the impact of premature deaths on the population life expectancy.Objective: to describe the behavior of the maternal deaths burden due to direct causes in Cuba, between 2005 and 2018.Methods: descriptive study of annual series, cross-sectional. The universe was the total of direct maternal deaths (N = 463). The mortality ratio, years of life potentially lost due to mortality, the trend, the percentage and the average were calculated.Results: during the years 2005-2018, 463 women died in Cuba from direct obstetric causes. Premature deaths quantified 22897 years of life lost due to this cause, with a tendency to decrease over time and with an annual average of 1636 years of life potentially lost; on average, they stopped living for each deceased, 49 years. The group of complications related to the puerperium (6790) was the direct cause that generated more years of life lost.Conclusion: the causes with the greatest impact on life expectancy were complications related to the puerperium, other hemorrhages and ectopic pregnancy; but the women who died at younger ages were from abortion and puerperal infection. Puerperal infections, placental disorders, and other complications tended to increase over time.

The causes of mortality among rheumatic diseases vary widely between geographic areas and cannot be generalized, however, they are frequently associated with the aggressiveness of the clinical presentation and the secondary effects of the therapy used. The main purpose of this study was to characterize the causes of death in a group of patients with autoimmune rheumatic disease. For this purpose, a retrospective study was carried out over a period of 10 years (2009 to 2019), deceased patients were included from a referral centre in Guatemala City, the records were reviewed in search of demographic and clinical variables. In total, 185 deceased patients were identified from 898 admissions during that period, 85.9% were women and the main disease reported was systemic lupus erythematosus in 49.7% of the cases. Among the causes of mortality, infections were reported in 53% and those attributed to disease activity in 15% of cases. The main conclusion is that that most of the deaths were of infectious origin. [ABSTRACT FROM AUTHOR]

Introducción: la información sobre las causas de muerte es de gran importancia tanto para los países como para las instituciones sanitarias, en la medida en que contribuye a la evaluación y el seguimiento del estado de salud de la población y a la planificación de intervenciones sanitarias. El objetivo del estudio fue evaluar la proporción de causas de muerte mal definidas e imprecisas y su relación con el día de la semana y período lectivo de médicos residentes en el Hospital Italiano de Buenos Aires (HIBA) durante 2020. Métodos: se realizó un estudio analítico de corte transversal a partir de certificados médicos de defunción de pacientes fallecidos en el ámbito intrahospitalario, evaluando las causas de muerte mal definidas (términos médicos que no aportan información desde el punto de vista clínico y epidemiológico) y las imprecisas (no resultan lo suficientemente específicas como para identificar entidades nosológicas que permitan establecer acciones de prevención y control). Resultados: se analizaron 1030 certificados de defunción, con una proporción de certificados con causa básica de muerte mal definida del 2,3% (n =24), mientras que en el 17,4% (n =180) fue imprecisa. No se hallaron diferencias entre la proporción de causas básicas mal definidas y las imprecisas según el día de la semana o período lectivo. Al extender el análisis a todas las causas (básicas, mediatas e inmediatas), la proporción de causas mal definidas fue del 1,6% (n =40) y la de imprecisas del 51% (n =1212). Conclusiones: los resultados definen al HIBA como un centro de mediana calidad estadística en el registro de causas de muerte. Se concluye que es necesario mejorarla, para lo que resulta de interés la creación de un plan de capacitación y entrenamiento de los médicos en el grado y el posgrado.

Introduction: Human immunodeficiency virus (HIV) causes an infection that destroys host lymphocytes. Its advanced stage leads to Acquired Immunodeficiency Syndrome (AIDS) that brings with it a high morbimortality worldwide, becoming a pandemic of great concern for world health organizations. Materials and Methods: Observational, descriptive, ecological and retrospective longitudinal study. Data from the Department of Health Information Statistics, number of confirmed cases, deaths occurred in the Chilean population, by region, between the years 2016 and 2021 with basic cause of death HIV disease [AIDS] and the total number of tests performed were analyzed. Results: An increase is observed both in the number of examinations performed and cases diagnosed until 2019. Regarding mortality, a decreasing trend is described since 2016, with a punctual increase in 2019 both at national and regional level, by age range and sex. At the regional level, higher figures are identified in the northern and central macro-zones. Discussion: A decrease was evident in all regions during 2020 and 2021, possibly associated with a camouflage in their categorization. The Chilean population presents a higher mortality rate in the range of 40 to 44 years, unlike the world context where a range of 55 to 59 years is observed. In specific causes of mortality, the second place associated with malignant tumors stands out, being important to highlight the need for evidence focused on the early diagnosis of these pathologies. [ABSTRACT FROM AUTHOR]

Copyright of Revista Salud UIS is the property of Universidad Industrial de Santander and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The objective was to describe the characteristics of women’s deaths by violence according to autopsies performed at the Callao morgue from 2016 to 2018. The forensic records of 83 women were reviewed and it was found that women’s deaths by violence occurred most often in adulthood. Traffic accidents were found to be the most common cause. The most frequent location of the fatal injury was in the head segment. Most of the corpse removal took place on the public road. The district with the most cases was Callao. It is important that the authorities commit to creating, installing and following an action plan to prevent women’s deaths by violence in Callao.

Introducción: en Cuba las enfermedades del sistema cardiovascular se han considerado una de las principales causas de muerte materna, con valores muy elevados en contraposición con otros indicadores de salud. Conocer la esencia de este fenómeno es imprescindible para el manejo adecuado de las políticas que permitan disminuir este indicador. Objetivo: describir el comportamiento de la mortalidad materna en Cuba por causas cardiovasculares desde el 2013 hasta el 2019. Métodos: se realizó un estudio descriptivo longitudinal retrospectivo, que comprendió las muertes maternas por causas cardiovasculares en el período del 2013 al 2019. Se realizó un análisis de la tendencia de este indicador y una predicción del comportamiento del mismo para los años siguientes al período, a través de complementos del software Microsoft Excel. Se emplearon las tasas de mortalidad materna general y por causas como medida de resumen para el análisis estadístico. Resultados: la mortalidad materna por causas cardiovasculares tendió a la oscilación alrededor de la media en todo el período. Este indicador aumentó en un 10,3%. Las principales causas de muerte fueron las enfermedades del sistema circulatorio (65,5%) y los trastornos hipertensivos (34,2%). Se predijo un aumento de las tasas por estas causas para 2021. Conclusiones: el comportamiento de la mortalidad materna por causas cardiovasculares no tuvo un patrón específico en su tendencia, sin embargo existe una resistencia a la disminución. Se estimó un posible aumento para años venideros por lo que se recomienda una revisión de este problema por parte del Sistema de Salud. Palabras clave: enfermedades cardiovasculares; mortalidad materna; causa de muerte. Abstract Introduction:in Cuba diseases of the cardiovascular system have been considered one of the main causes of maternal death, with very high values in contrast to other health indicators. Knowing the essence of this phenomenon is essential for the proper management of policies that allow reducing this indicator. Objective: to describe the behaviour of maternal mortality from cardiovascular causes in Cuba since 2013 to 2019. Methods: a retrospective longitudinal descriptive study was carried out, which included maternal deaths due to cardiovascular causes in the period from 2013 to 2019. An analysis of the trend of this indicator was carried out and a prediction of its behaviour for the years following the period, through Microsoft Excel software add-ins. General and cause-based maternal mortality rates were used as a summary measure for statistical analysis. Results: maternal mortality from cardiovascular causes tended to oscillate around the mean throughout the period. This indicator increased by 10.3%. The main causes of death were diseases of the circulatory system (65.5%) and hypertensive disorders (34.2%). An increase in rates for these causes was predicted for 2021. Conclusions: the behaviour of maternal mortality due to cardiovascular causes did not have a specific pattern in its trend, however there is a resistance to the decrease. A possible increase was estimated for future years, so a review of this problem by the Health System is needed. Keywords: cardiovascular diseases; maternal mortality; death cause.

Introduction: The COVID-19 pandemic has been the largest in the current century and the reason for numerous scientific works. In Cuba, the Temporary Group of Pathological Anatomy has been established to study the autopsies of those who died from COVID-19 (more than 400). The medical death certificates, documents of inestimable value, in Cuba are repaired according to the results of the autopsies, to raise their quality. Objectives: To evaluate the results of autopsies with COVID-19 diagnoses, compared to medical death certificates. Methods: The diagnoses of causes of death of 65 autopsies of the year 2020 were evaluated with their medical death certificates. The diagnoses were processed in the Automated System for the Registration and Control of Pathology. Direct causes of death, basic causes of death, intermediate causes of death, and contributing causes of death were analyzed. The total agreement of both diagnoses was defined, partial agreement, diagnostic mismatch or discrepancy, and insufficient data. Results: Diagnostic discrepancies of basic and direct cause of death are 46.2 % and 60.0 % of all cases and 19.4 % and 64.5 % when COVID-19 was basic cause of death. The high figures for diagnostic discrepancies correspond to those reported in previous studies, both in clinical diagnoses and in medical death certificates. Conclusions: There are high numbers of diagnostic discrepancies compared with the results of autopsies with COVID-19 diagnoses, compared to medical death certificates.

Background: maternal death represents one of the most notable events in the conflicts of sexual and reproductive health in the world. The high mortality from this cause in the world is unacceptable. However, estimates for determining the burden of maternal morbidity and mortality health are still limited. Objective: to determine the burden of mortality related to pregnancy, childbirth and the puerperium in Cuba between 2005 and 2018. Methods: a descriptive study was carried out, with national cross-sectional data and annual periodicity. The universe of study was made up of all the deaths that occurred during pregnancy, childbirth and the puerperium in the period 2005-2018, in Cuba (N = 831). The mortality ratio, years of life potentially lost due to mortality, the percentage, the average and the trend were calculated. Results: of the total number of deceased due to deaths that occurred during pregnancy, childbirth and the puerperium, 463 were due to direct death; 247 for indirect death; and 247, due to other deaths 121. The ratio averaged 48.8 deaths for every 100 000 live births. Years of life potentially lost were 42,582: 23,433 for direct deaths, 12,724 for indirect deaths, and 6,425 for other deaths. Conclusion: direct obstetric deaths were the most frequent and those with the greatest impact on life expectancy; while indirect obstetrician women showed a tendency to increase over time. For other deaths, women died at an earlier age. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: complications during pregnancy, childbirth and the puerperium are the main causes of death in women of childbearing age. The study of the mortality burden derived from these complications is useful to quantify the impact of premature deaths on the population life expectancy. Objective: to describe the behavior of the maternal deaths burden due to direct causes in Cuba, between 2005 and 2018. Methods: descriptive study of annual series, cross-sectional. The universe was the total of direct maternal deaths (N = 463). The mortality ratio, years of life potentially lost due to mortality, the trend, the percentage and the average were calculated. Results: during the years 2005-2018, 463 women died in Cuba from direct obstetric causes. Premature deaths quantified 22897 years of life lost due to this cause, with a tendency to decrease over time and with an annual average of 1636 years of life potentially lost; on average, they stopped living for each deceased, 49 years. The group of complications related to the puerperium (6790) was the direct cause that generated more years of life lost. Conclusion: the causes with the greatest impact on life expectancy were complications related to the puerperium, other hemorrhages and ectopic pregnancy; but the women who died at younger ages were from abortion and puerperal infection. Puerperal infections, placental disorders, and other complications tended to increase over time. [ABSTRACT FROM AUTHOR]

BACKGROUND: Organic acidemias account for 30% of inborn errors of metabolism and can be fatal in the neonatal period. CLINICAL CASE: Newborn, born by emergency cesarean section due to placenta previa with maternal hemorrhage without infectious risk factors at 32 weeks of gestation, weighing 1970 grams. Nosocomial infection was diagnosed and due to the lack of response to antibiotics, a hemogram was requested, which reported, as outstanding data: hyperammonemia of 1920 M/L. He was left fasting and was started on high intravenous glucose, invasive ventilatory support, treatment with ammonium chelators and extrarenal depuration. Despite treatment, he died 13 hours after diagnosis of hyperammonemia on the fourth day of life. The biochemical study reported: elevation of 3-hydroxypropionic acid, methylcitric acid, propionylglycine in urine and propionylcarnitine and decrease of free carnitine in blood, which confirmed the diagnosis of propionic acidemia. Genetic analysis revealed a homozygous pathogenic mutation in the PCCB gene. Autopsy revealed: Enterobacter cloacae pulmonary infection and metabolopathy as cause of death. CONCLUSIONS: Propionic acidemia results from a deficit of propionyl-CoA carboxylase involved in the propionate metabolic pathway. It is an autosomal recessive disease, due to mutation in the PCCA and/or PCCB genes. The most frequent presentation is neonatal, with nonspecific symptoms in the first week. Thus, in the case of a neonate with nonspecific symptoms, with inadequate response to treatment, despite finding a cause that justifies the picture, a metabolic disease should be suspected. [ABSTRACT FROM AUTHOR]

Introducción: el análisis de la mortalidad hospitalaria permite evaluar la calidad de la asistencia médica. Las últimas publicaciones sobre mortalidad en el Hospital Infantil Dr. Robert Reid Cabral datan de 1997. Objetivo: conocer el comportamiento de la mortalidad en el Hospital Infantil Dr. Robert Reid Cabral durante el periodo 2013–2017 Métodos: estudio descriptivo. Se revisaron los libros de registro y actas de defunciones de los pacientes fallecidos en el Hospital Dr. Robert Reid Cabral durante el periodo 2013–2017. Resultados: 3,800 pacientes fallecieron, en promedio 760 fallecidos por año (margen 679-868).79.9 % con menos de 5 años de edad; las muertes en menores de 1 año de edad representaron el 61.3 % y en el periodo neonatal el 26.1 %. La Sepsis/Shock Séptico (43.4 %) y la Hemorragia Pulmonar (15.4 %) fueron los dos principales diagnós-ticos de defunción; el 34 % de los fallecidos presentaban una morbilidad asociada al diagnóstico de defunción y en el 40 % la morbilidad asociada era una malformación congénita. El 69.5 % fallecieron en la Unidad de Cuidados Intensivos Pediátricos o Neonatal y 40 % de los pacientes fallecieron antes de las 48 horas de su ingreso al hospital. Conclusión: el grupo etario de mayor mortalidad son los menores de 1 año de edad, se evidencia un alto porcentaje de muertes con enfermedad crónica y malformaciones congénitas asociadas. El hecho de que el 40 % de los pacientes fallecieran antes de las 48 horas de su ingreso, indica la condición de gravedad en que estos pacientes llegan al hospital.

Foundation: mortality and health of populations are phenomenon understood as a result of complex environmental, economic, social and individual interactions. Objective: to determine the potentially lost years of life cue to selected diseases in the Cienfuegos province in the triennium 2013-2015. Methods: a cross descriptive retrospective study was realized with a universe of 23291 deceased patients. The variables analyzed were age, sex and selected diseases (heart diseases, malignant tumors, strokes, influenza and pneumonia) and accidents, potentially lost years of life, trends and prognosis by months and confidence interval. The potentially lost years of life between 1 and 74 years old were calculated for both sexes which expressed the number of years not lived for all causes or for each one, as regards to the procedure for its calculation proposed by the World Health Organization. For the annual prognosis the years from 2009 to 2016 were included, for a better adjustment of the series using an autoregressive integrated model of the moving rate. Results: the highest number of potentially lost years of life corresponds to malignant tumors and heart diseases; the year 2014 had the highest figures due to these diseases with 17.3 and 11.5 lost years of life by every 1000 inhabitant’s from 1 to 7 years old respectively. The highest values due to strokes, influenza and pneumonia were found in 2015. Accidents had the highest number in the year 2014, during which 4.8 years of life were lost by every 1000 inhabitants from 1 to 74 years. Conclusion: the highest number of lost years of life corresponds to malignant tumors and heart diseases with 17,3 y 11,5 lost years of life by every 1000 inhabitants from 1 to 74 years respectively in the studied triennium.

The objective was to describe the characteristics of women's deaths by violence according to autopsies performed at the Callao morgue from 2016 to 2018. The forensic records of 83 women were reviewed and it was found that women's deaths by violence occurred most often in adulthood. Traffic accidents were found to be the most common cause. The most frequent location of the fatal injury was in the head segment. Most of the corpse removal took place on the public road. The district with the most cases was Callao. It is important that the authorities commit to creating, installing and following an action plan to prevent women's deaths by violence in Callao. [ABSTRACT FROM AUTHOR]

Introduction: Physical exercise is extremely beneficial to health; but in the case of athletes, intense sports training develops morphological and physiological changes in the heart. Many of these changes, called "normal or physiological", and other "abnormal or pathological" findings -which could suggest the presence of under lying cardiovascular disease- can be detected by an electrocardiogram. Objectives: To identify electrocardiographic disorders present in young high-performance athletes of a soccer club. Method: Forty male athletes were studied in the period January to June 2019. The athletes were evaluated by questioning, physical examination and electrocardiogram at rest. Results: A number of normal electrocardiographic findings -according to the international criteria for electrocardiographic interpretation in athletes- were found. Sinus bradycardia was the most frequent (60%). The isolated appearance of right axis deviation (>120°) and complete right bundle branch block were the only borderline findings. The presence of inverted T waves (10%), intraventricular conduction disorders (7.5%) and anomalous Q waves (5%) were the most frequent pathological findings. Conclusions: The twelve-lead electrocardiogram remains an important means of detecting physiological electrocardiographic findings related to sports training in high-performance athletes, as well as abnormal or pathological alterations that may be suggestive of cardiovascular disease, in addition to being triggering risk factors for sudden cardiac death. [ABSTRACT FROM AUTHOR]

Introduction. Every region in the world has an epidemiological trend of death by suicide that is particular and dependent on its sociodemographic and cultural aspects. Knowing the epidemiological characteristics of people who have died by suicide in the state of Yucatan is important for understanding the phenomenon and planning future preventive strategies. Objective. To describe the epidemiological characteristics of suicide mortality between 2013 and 2016. Method. Observational, descriptive study, retrospective longitudinal section, in which the epidemiological trends of mortality are analyzed. Results. In the period studied, Yucatan was among the states with the highest mortality rate due to suicide. Hanging was the most frequent method, followed by the use of agrochemicals. Together, these methods were employed by nearly 95% of those who died. Agrochemical use was associated with a greater likelihood of receiving medical care before death compared with other methods, particularly hanging (24.5 to 1.00). Discussion and conclusion. In this study, sociodemographic differences and factors associated with suicide were observed. Suicide methods are consistent with those observed nationwide and in countries with poverty and agricultural societies. Preventive measures to address this problem in the state could incorporate the epidemiological characteristics of the population with suicidal tendencies in Yucatan. Suicide in the state of Yucatan is an ongoing public health problem, which showed an annual increase in the period studied and a significant predominance in the month of May. [ABSTRACT FROM AUTHOR]

This study aimed to describe and analyze the birth and death certification process in a medicine-teaching hospital in Bogotá during 2014, regarding both the information flow and the quality of the reported death cause. A methodology was designed to monitor the quality and coverage of the birth and death hospital statistics. Seventeen final-year medicine students attending to their public health training took part in the data collection about 511 clinical records of non-fetal deaths, and excluding the deaths due to external causes occurring in 2014, (it accounts for 58% of all non-fetal deaths in the hospital during this year). Being granted access to the medical records of the deceased patients, the duly instructed students completed the death certificate forms and were supervised by different specialist teachers according to the diagnosis. The basic death cause attributed after the supervision was compared to the death cause originally certified by the hospital physicians in the online record system currently used in Colombia: RUAF-ND. The agreement in identifying the basic death cause was estimated and a gross matching of 80% was found, with a Kappa index between 57% and 95%, being all statistically above zero after grouping the basic death causes as per CIE10 chapter, and obtaining 6% of unusable codes in both databases. This study could be replicated in other medicine-teaching hospital in order to strengthen the medical student training in vital statistics while monitoring the quality of the birth and death records in the medicine-teaching hospitals. [ABSTRACT FROM AUTHOR]

A descriptive and cross-sectional study of the 9 211 dead patients due to all causes was carried out in Santiago de Cuba province during 2017, with the aim of describing the mortality profile in that period. In the series an increment of the general mortality was observed when compared to 2016; also, as main causes of death there were heart diseases, malignant tumors and cerebrovascular diseases. The municipalities that prevailed in the mortality profile were Contramaestre, San Luis, Songo-La Maya, Santiago de Cuba and III Frente, mainly due to heart diseases. On the other hand, the greatest risk of dying due to malignant tumors in the female patients obeyed to the localization in lung, breast and intestine, except in the rectum; in the men, in prostate, lung and colon, respectively. It is recommended to direct the efforts in health according to the stratified risk in this province.

A descriptive and cross-sectional study of the 9 211 dead patients due to all causes was carried out in Santiago de Cuba province during 2017, with the aim of describing the mortality profile in that period. In the series an increment of the general mortality was observed when compared to 2016; also, as main causes of death there were heart diseases, malignant tumors and cerebrovascular diseases. The municipalities that prevailed in the mortality profile were Contramaestre, San Luis, Songo-La Maya, Santiago de Cuba and III Frente, mainly due to heart diseases. On the other hand, the greatest risk of dying due to malignant tumors in the female patients obeyed to the localization in lung, breast and intestine, except in the rectum; in the men, in prostate, lung and colon, respectively. It is recommended to direct the efforts in health according to the stratified risk in this province. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Salud Pública is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

A descriptive and cross-sectional study of 89 patients, who died in "Dr. Joaquín Castillo Duany" Teaching Provincial Hospital, was carried out in Santiago de Cuba from September to November, 2016, aimed at identifying some biological and epidemiological elements present at the moment of death, as well as the variability in the clinicalpathological diagnostic coincidence. In the series, deaths were more frequent in women (55.0%), while hypertension was the predominant risk condition (56.0%) and bronchopneumonia the main cause of hospital mortality. A higher number of deaths was observed in the clinical services (87.0%), but the coincidence in the clinical-pathological diagnoses was more acceptable in the surgical specialties. Finally, some risk conditions could be identified at the moment of deaths, as well as diagnostic differences related to the direct causes of death that showed values higher than expected, reason why the review of certain assistance processes in this hospital institution was suggested. [ABSTRACT FROM AUTHOR]

Objectives: In many African countries, child mortality is higher in the rainy season than in the dry season. We investigated the effect of season on child mortality by time periods, sex and age in rural Guinea-Bissau.Methods: Bandim health project follows children under-five in a health and demographic surveillance system in rural Guinea-Bissau. We compared the mortality in the rainy season (June to November) between 1990 and 2013 with the mortality in the dry season (December to May) in Cox proportional hazards models providing rainy vs. dry season mortality rate ratios (r/d-mrr). Seasonal effects were estimated in strata defined by time periods with different frequency of vaccination campaigns, sex and age (<1 month, 1-11 months, 12-59 months). Verbal autopsies were interpreted using InterVa-4 software.Results: From 1990 to 2013, overall mortality was declined by almost two-thirds among 81 292 children (10 588 deaths). Mortality was 51% (95% ci: 45-58%) higher in the rainy season than in the dry season throughout the study period. The seasonal difference increased significantly with age, the r/d-mrr being 0.94 (0.86-1.03) among neonates, 1.57 (1.46-1.69) in post-neonatal infants and 1.83 (1.72-1.95) in under-five children (P for same effect <0.001). According to the InterVa, malaria deaths were the main reason for the seasonal mortality difference, causing 50% of all deaths in the rainy season, but only if the InterVa included season of death, making the argument self-confirmatory.Conclusion: The mortality declined throughout the study, yet rainy season continued to be associated with 51% higher overall mortality. [ABSTRACT FROM AUTHOR]

Copyright of West Indian Medical Journal is the property of West Indian Medical Journal (WIMJ) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objetivo. Describir la contribución de las causas de muerte evitable a la esperanza de vida en los municipios del Valle de Aburrá sin Medellín entre 1979 y 2004. Metodología. Las causas de muerte se clasificaron según el Inventario de Causas de Mortalidad Evitable. Para el cálculo de la esperanza de vida y su descomposición se estandarizaron las tasas según la población de Colombia 2005 del DANE. En la descomposición de la esperanza de vida se siguió el método de Arriaga. Resultados. En el Valle de Aburrá sin incluir Medellín, la esperanza de vida al nacer para los años 1979-2004 fue de 73.23 años. Para el período 1979- 1995, se perdieron 15.30 años de esperanza de vida, siendo la pérdida de 12.58 años de 1996-2004. Se destacó que las causas de muerte prevenibles relacionadas con la vacunación en las mujeres (0.0105 años) fueron relevantes por su aporte negativo a los años de esperanza de vida ganados. Conclusión. La estructura de mortalidad evitable del Valle de la Aburrá sin Medellín se afectó principalmente por las enfermedades constituyentes de los grupos de vacunación o tratamiento preventivo. Es necesario priorizar intervenciones en salud pública en las enfermedades con más alto aporte de los grupos de vacunación o tratamiento preventivo con el fin de evitar un cambio negativo significativo en los perfiles de mortalidad de los municipios y conocer cómo afectan la estructura de la mortalidad por causas y cómo ellas definen perfiles de mortalidad específicos.Objetivo. Descrever a contribuição das causas de morte evitável à esperança de vida nos municípios do Vale de Aburrá sem Medellín entre 1979 e 2004. Metodologia. As causas de morte se classificaram segundo o Inventário de Causas de Mortalidade Evitável. Para o cálculo da esperança de vida e sua decomposição se estandardizaram as taxas segundo a população de Colômbia 2005 do DANE. Na decomposição da esperança de vida se seguiu o método de Arriaga. Resultados. No Vale de Aburrá sem incluir Medellín, a esperança de vida ao nascer para os anos 1979-2004 foi de 73.23 anos. Para o período 1979-1995, perderam-se 15.30 anos de esperança de vida, sendo a perda de 12.58 anos de 1996-2004. Destacou-se que as causas de morte prevenibles relacionadas com a vacinação nas mulheres (0.0105 anos) foram relevantes por seu aporte negativo aos anos de esperança de vida ganhados. Conclusão. A estrutura de mortalidade evitável do Vale da Aburrá sem Medellín se afetou principalmente pelas doenças constituintes dos grupos de vacinação ou tratamento preventivo. É necessário priorizar intervenções em saúde pública nas doenças com mais alto aporte dos grupos de vacinação ou tratamento preventivo com o fim de evitar uma mudança negativa significativo nos perfis de mortalidade dos municípios e conhecer como afetam a estrutura da mortalidade por causas e como elas definem perfis de mortalidade específicos.Objective. To describe the contribution of preventable death causes to life expectancy in the Valle de Aburra municipalities without Medellin between 1979 and 2004. Methodology. Death causes were classified according to the inventory of Avoidable mortality Causes. For life expectancy calculations and its decomposition, rates were standardized according to DANE’s 2005 Colombian population. Arriaga’s method was followed in life expectancy decomposition. Results. In the Valle de Aburra not including Medellin, life expectancy at birth for the years 1979-2004 was of 73.23 years. 15.30 years of life expectancy were lost for the period between 1979 and 1995, loss being of 12.58 years for the period between 1996 and 2004. It was stressed that preventable death causes related with vaccination in women (0.0105 years) were important for their negative contribution to the gained life expectancy years. Conclusion. Avoidable mortality structure from the Valle de Aburra without Medellin was mainly affected by the vaccination group constituent diseases or preventive treatment. It is necessary to prioritize public health interventions in the diseases with a greater contribution to the to the vaccination groups or preventive treatment to avoid a significantly negative change in the mortality profiles in the municipalities and know how they affect mortality structure by causes and how they define specific mortality profiles.

Objetivos: Describir los patrones de codificación CIE-10 de las muertes directamente relacionadas con drogas ilegales (DRDI) en el Registro General de Mortalidad (RGM), evaluar la aplicabilidad del criterio europeo (que no considera X44) para extraer estas muertes del RGM y estimar la mortalidad DRDI en España corrigiendo la subestimación. Métodos: Se extrajeron las muertes DRDI del RGM para 1999-2007 utilizando los criterios europeo y español, se compararon ambas cifras y se evaluaron las diferencias temporoespaciales en los patrones de codificación. Se estimó la mortalidad DRDI estatal aplicando un índice corrector de subestimación, procedente de un registro específico, a las muertes extraídas del RGM. Resultados: Utilizando el criterio español en 1999-2007 se extrajeron del RGM 5.878 muertes DRDI, un 88,4% del capítulo XX, principalmente de X42 (48,4%) y X44 (38,8%), y el resto del capítulo V, principalmente de F19 (11,5%). El capítulo V supuso un 6,6% en 1999, un 24,6% en 2003 y un 8,0% en 2007. En 2005-2007 las comunidades que más utilizaron el capítulo V fueron Cataluña y Andalucía (34,9% y 30,1%, respectivamente). Con el criterio europeo se extraen bastantes menos muertes DRDI que con el español. La mortalidad DRDI corregida por subnotificación utilizando el criterio español pasó de 4,7/100.000 habitantes de 15-49 años de edad en 1999 a 4,1/100.000 en 2007. Conclusiones: En España, aplicar el criterio europeo para extraer las muertes DRDI da problemas, porque a cada muerte DRDI se le asigna un único código, que además en ocasiones es bastante inespecífico. Hay que adoptar criterios estatales comunes de codificación en línea con los europeos.Aims: To describe patterns of ICD-10 classification of illicit drug-induced deaths (DID) in the General Mortality Register (GMR), to assess the applicability of the European criterion (which excludes the X44 code) to extract these deaths from the GMR, and to estimate drug-induced mortality in Spain by applying a correction index for underestimation. Methods: DID between 1999 and 2007 were extracted from the GMR using the European and the Spanish criteria. Both data sets were compared, and differences in classification patterns by time and space were assessed. Estimations of national mortality from DID were calculated by applying a correction index for underestimation, derived from a specific mortality register, to the deaths extracted from the GMR. Results: Using the Spanish criterion, 5,878 DID were extracted from the GMR for 1999-2007, 88.4% within chapter XX, mainly X42 (48.4%) and X44 (38.8%), and the remaining within chapter V, mainly F19 (11.5%). Chapter V accounted for 6.6% in 1999, 24.6% in 2003 and 8.0% in 2007. Between 2005 and 2007, Catalonia and Andalusia were the autonomous regions showing greatest use of this chapter (34.9% and 30.1%, respectively). Substantially fewer deaths were extracted when the European criterion was used. When the Spanish indicator was used, the estimated DID mortality rate corrected by the underestimation index decreased slowly from 4.7/100,000 in 1999 to 4.1/100,000 inhabitants aged 15-49 years old in 2007. Conclusions: In Spain, applying the European criterion for extracting DID from the GMR created certain problems, because each DID is assigned a single code, which is sometimes non-specific. Common national criteria should be adopted, following the European criteria as far as possible.

Copyright of Biomédica: Revista del Instituto Nacional de Salud is the property of Instituto Nacional de Salud of Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Nursing UFPE / Revista de Enfermagem UFPE is the property of Revista de Enfermagem UFPE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Mortality statistics systems provide basic information on the levels and causes of mortality in populations. Only a third of the world's countries have complete civil registration systems that yield adequate cause-specific mortality data for health policy-making and monitoring. This paper describes the development of a set of criteria for evaluating the quality of national mortality statistics and applies them to China as an example. The criteria cover a range of structural, statistical and technical aspects of national mortality data. Little is known about cause-of-death data in China, which is home to roughly one-fifth of the world's population. These criteria were used to evaluate the utility of data from two mortality statistics systems in use in China, namely the Ministry of Health-Vital Registration (MOH-VR) system and the Disease Surveillance Point (DSP) system. We concluded that mortality registration was incomplete in both. No statistics were available for geographical subdivisions of the country to inform resource allocation or for the monitoring of health programmes. Compilation and publication of statistics is irregular in the case of the DSP, and they are not made publicly available at all by the MOH-VR. More research is required to measure the content validity of cause-of-death attribution in the two systems, especially due to the use of verbal autopsy methods in rural areas. This framework of criteria-based evaluation is recommended for the evaluation of national mortality data in developing countries to determine their utility and to guide efforts to improve their value for guiding policy.

Registration of births, recording deaths by age, sex and cause, and calculating mortality levels and differentials are fundamental to evidence-based health policy, monitoring and evaluation. Yet few of the countries with the greatest need for these data have functioning systems to produce them despite legislation providing for the establishment and maintenance of vital registration. Sample vital registration (SVR), when applied in conjunction with validated verbal autopsy procedures and implemented in a nationally representative sample of population clusters represents an affordable, cost-effective, and sustainable short- and medium-term solution to this problem. SVR complements other information sources by producing age-, sex-, and cause-specific mortality data that are more complete and continuous than those currently available. The tools and methods employed in an SVR system, however, are imperfect and require rigorous validation and continuous quality assurance; sampling strategies for SVR are also still evolving. Nonetheless, interest in establishing SVR is rapidly growing in Africa and Asia. Better systems for reporting and recording data on vital events will be sustainable only if developed hand-in-hand with existing health information strategies at the national and district levels; governance structures; and agendas for social research and development monitoring. If the global community wishes to have mortality measurements 5 or 10 years hence, the foundation stones of SVR must be laid today.

Objetivos: Analizar la evolución temporal y la distribución geográfica por sectores sanitarios de la mortalidad evitable en Cataluña. Material y métodos: Se analizó la mortalidad evitable según la clasificación utilizada en el Departamento de Salud de Cataluña por sectores sanitarios durante el período 1986-2001 y se agruparon las causas en tratables o prevenibles. Se calcularon las tasas de mortalidad estandarizadas por el método directo e indirecto y la razón de mortalidad comparativa para el grupo de tratables y prevenibles y para los 46 sectores sanitarios. También se calculó el promedio de cambio anual ajustado por edad mediante la regresión de Poisson de la mortalidad evitable y general. Resultados: El total de defunciones evitables fue 61.261 (el 7,3% de la mortalidad general). 10.623 (17,34%) se clasificaron como tratables y 50.638 (82,65%) como prevenibles. El promedio de cambio anual para las causas evitables fue del -2,43% (intervalo de confianza [IC] del 95%, -2,60 a -2,26), superior al -1,57% (IC del 95%, -1,61 a -1,52) de la mortalidad general. Las tasas fueron más elevadas para las causas prevenibles que para las tratables, aunque en ambos grupos se apreció un descenso de la mortalidad. El sector sanitario del Segrià destaca por presentar sobremortalidad en los 2 períodos y en los 2 grupos de causas. Cuatro sectores sanitarios presentan un aumento significativo de la mortalidad por causas prevenibles, pero ninguno por causas tratables. Conclusiones: En Cataluña, durante el período 1986-2001 se produce un descenso de la mortalidad evitable, mayor que el de la mortalidad general. La distribución geográfica muestra una gran dispersión, aunque se identifican claramente zonas en las que es necesaria la intervención preventiva.Objectives: To analyze time trends and geographical variation in avoidable mortality by health areas in Catalonia. Material and methods: Avoidable mortality was analyzed according to the classification used by the Health Department of the Regional Government of Catalonia from 1986-2001 for health areas and causes were grouped as treatable and preventable. Standarized mortality rates were calculated by the direct and indirect method and the comparative mortality figures were calculated for the treatable and preventable groups and for the 46 health areas. The mean annual change adjusted for age was also calculated using a Poisson regression of avoidable and general mortality. Results: The total number of avoidable deaths was 61261 (7.3% of overall deaths). 10623 cases (17.34%) were classified as treatable and 50638 (82.65%) as preventable. The mean annual change for avoidable causes was -2.43% (95% CI, -2.60 to -2.26), higher than the -1.57% (95% CI, -1.61 to -1.52) change for general mortality. The rates were higher for preventable causes than for treatable causes, although mortality decreased in both groups. The health area of Segrià was notable for its significantly higher mortality from both treatable and preventable causes in both periods. Four health areas showed a significant increase in mortality from preventable causes but none showed an increase in mortality from treatable causes. Conclusions: In Catalonia, the decrease in avoidable mortality was greater than that in general mortality from 1986 to 2001. The geographical distribution shows wide dispersion but allows areas requiring preventive interventions to be identified.

Two surveys of maternal mortality conducted in Egypt, in 1992-93 and in 2000, collected data from a representative sample of health bureaus covering all of Egypt, except for five frontier governorates which were covered only by the later survey, using the vital registration forms. The numbers of maternal deaths were determined and interviews conducted. The medical causes of death and avoidable factors were determined. Results showed that the maternal mortality ratio (MMR) had dropped by 52% within that period (from 174 to 84/100 000 live births). The National Maternal Mortality Survey in 1992-93 (NMMS) revealed that the metropolitan areas and Upper Egypt had a higher MMR than Lower Egypt. In response to these results, the Egyptian Ministry of Health and Population (MOHP) intensified the efforts of its Safe Motherhood programmes in Upper Egypt with the result that the regional situation had reversed in 2000. Consideration of the intermediate and outcome indicators suggests that the greatest effect of maternal health interventions was on the death-related avoidable factors "substandard care by health providers" and "delays in recognizing problems or seeking medical care". The enormous improvements in these areas are certainly due in part to extensive training, revised curricula, the publication of medical protocols and services standards, the upgrading of facilities, and successful community outreach programmes and media campaigns. The impact on the utilization of antenatal care (ANC) has been less successful. Other areas that remain problematic are inadequate supplies of blood, drugs and equipment. Although the number of maternal deaths linked to haemorrhage has been drastically reduced, it remains the primary cause. The drop in maternal mortality in the 1990s in response to Safe Motherhood programmes was impressive and the ability to tailor interventions based on the data from the NMMS of 1992-93 and 2000 was clearly demonstrated. To ensure the continuing availability of information to guide and evaluate programmes for reducing maternal mortality, an Egyptian national maternal mortality surveillance system is being developed.

OBJECTIVE: To determine the association of different feeding patterns for infants (exclusive breastfeeding, predominant breastfeeding, partial breastfeeding and no breastfeeding) with mortality and hospital admissions during the first half of infancy. METHODS: This paper is based on a secondary analysis of data from a multicentre randomized controlled trial on immunization-linked vitamin A supplementation. Altogether, 9424 infants and their mothers (2919 in Ghana, 4000 in India and 2505 in Peru) were enrolled when infants were 18-42 days old in two urban slums in New Delhi, India, a periurban shanty town in Lima, Peru, and 37 villages in the Kintampo district of Ghana. Mother-infant pairs were visited at home every 4 weeks from the time the infant received the first dose of oral polio vaccine and diphtheria-pertussis-tetanus at the age of 6 weeks in Ghana and India and at the age of 10 weeks in Peru. At each visit, mothers were queried about what they had offered their infant to eat or drink during the past week. Information was also collected on hospital admissions and deaths occurring between the ages of 6 weeks and 6 months. The main outcome measures were all-cause mortality, diarrhoea-specific mortality, mortality caused by acute lower respiratory infections, and hospital admissions. FINDINGS: There was no significant difference in the risk of death between children who were exclusively breastfed and those who were predominantly breastfed (adjusted hazard ratio (HR) = 1.46; 95% confidence interval (CI) = 0.75-2.86). Non-breastfed infants had a higher risk of dying when compared with those who had been predominantly breastfed (HR = 10.5; 95% CI = 5.0-22.0; P < 0.001) as did partially breastfed infants (HR = 2.46; 95% CI = 1.44-4.18; P = 0.001). CONCLUSION: There are two major implications of these findings. First, the extremely high risks of infant mortality associated with not being breastfed need to be taken into account when informing HIV-infected mothers about options for feeding their infants. Second, our finding that the risks of death are similar for infants who are predominantly breastfed and those who are exclusively breastfed suggests that in settings where rates of predominant breastfeeding are already high, promotion efforts should focus on sustaining these high rates rather than on attempting to achieve a shift from predominant breastfeeding to exclusive breastfeeding.

OBJECTIVE: Fewer than 3% of 4 million annual neonatal deaths occur in countries with reliable vital registration (VR) data. Global estimates for asphyxia-related neonatal deaths vary from 0.7 to 1.2 million. Estimates for intrapartum stillbirths are not available. We aimed to estimate the numbers of intrapartum-related neonatal deaths and intrapartum stillbirths in the year 2000. METHODS: Sources of data on neonatal death included: vital registration (VR) data on neonatal death from countries with full (> 90%) VR coverage (48 countries, n = 97 297); studies identified through literature searches (> 4000 abstracts) and meeting inclusion criteria (46 populations, 30 countries, n = 12 355). A regression model was fitted to cause-specific proportionate mortality data from VR and the literature. Predicted cause-specific proportions were applied to the number of neonatal deaths by country, and summed to a global total. Intrapartum stillbirths were estimated using median cause-specific mortality rate by country (73 populations, 52 countries, n = 46 779) or the subregional median in the absence of country data. FINDINGS: Intrapartum-related neonatal deaths were estimated at 0.904 million (uncertainty 0.65-1.17), equivalent to 23% of the global total of 4 million neonatal deaths. Country-level model predictions compared well with population-based data sets not included in the input data. An estimated 1.02 million intrapartum stillbirths (0.66-1.48 million) occur annually, comprising 26% of global stillbirths. CONCLUSION: Intrapartum-related neonatal deaths account for almost 10% of deaths in children aged under 5 years. Intrapartum stillbirths are a huge and invisible problem, but are potentially preventable. Programmatic attention and improved information are required.

OBJECTIVE: To evaluate how often coding changes between and within revisions of the International Classification of Diseases (ICD) complicate the description of long-term trends in cause-specific mortality. METHODS: Data on cause-specific mortality between 1950 and 1999 for men and women aged 60 and older were obtained from Denmark, England and Wales, Finland, the Netherlands, Norway and Sweden. Data were obtained by five-year age groups. We constructed a concordance table using three-digit ICD codes. In addition we evaluated the occurrence of mortality discontinuities by visually inspecting cause-specific trends and country-specific background information. Evaluation was also based on quantification of the discontinuities using a Poisson regression model (including period splines). We compared the observed trends in cause-specific mortality with the trends after adjustment for the discontinuities caused by changes to coding. FINDINGS: In 45 out of 416 (10.8 %) instances of ICD revisions to cause-specific mortality codes, significant discontinuities that were regarded as being due to ICD revisions remained. The revisions from ICD-6 and ICD-7 to ICD-8 and a wide range of causes of death, with the exception of the specific cancers, were especially affected. Incidental changes in coding rules were also important causes of discontinuities in trends in cause-specific mortality, especially in England and Wales, Finland and Sweden. Adjusting for these discontinuities can lead to significant changes in trends, although these primarily affect only limited periods of time. CONCLUSION: Despite using a carefully constructed concordance table based on three-digit ICD codes, mortality discontinuities arising as a result of coding changes (both between and within revisions) can lead to substantial changes in long-term trends in cause-specific mortality. Coding changes should therefore be evaluated by researchers and, where necessary, controlled for.

INTRODUCCÍON: La Mortalidad Materna (MM) muestra diferencias en las condiciones de salud y de vida de las poblaciones, constituyéndose en un buen indicador socio-económico, así como de la cobertura y calidad de los servicios de atención a la mujer en edad fértil. Las estadísticas oficiales de salud no revelan la magnitud del problema de la MM debido al subregistro que posee esta causa de muerte. Dicha falencia se señala especialmente para los países subdesarrollados. Se estima que la República Argentina no escapa al fenómeno del subregistro. La provincia de Santa Fe en el año 1994 decidió incorporar a su Certificado de Defunción un ITEM específico para la causa Muerte Materna con el fin de corregir el subregistro. OBJETIVOS: El objetivo principal de este estudio fue evaluar los cambios que registró la Razón de Mortalidad Materna (RMM) en el período 1988-2001, como consecuencia de la introducción del "ITEM 33" referido a la Muerte Materna, en el Certificado de Defunción de la Provincia de Santa Fe a partir del año 1995. MATERIAL Y MÉTODOS: Se revisó la bibliografía respecto del subregistro de la MM. Se estudió la ocurrencia de la MM en la Provincia de Santa Fe en el período 1988-2001. Se analizaron los cambios producidos por la presencia del "ITEM 33" en el Certificado de Defunción de la Provincia de Santa fe en el período 1995-2001. RESULTADOS: Se observó un aumento en las cifras absolutas de MM y por ende de las razones de MM (41 %) en el período 1995-2001, a diferencia de la tendencia descendente de este indicador tanto a nivel nacional como a nivel provincial en el período anterior (pre "ITEM 33"). Se observó además, una modificación en la distribución de las muertes respecto a su incidencia en los grupos etáreos. Otro dato de interés es que se modificó la frecuencia de las patologías que originaron la muerte (causa de muerte) siendo el Aborto la causa más frecuente, a diferencia de los períodos anteriores donde aparecía la Hipertensión Arterial ocupando el primer lugar. CONCLUSIÓN: La introducción del "ITEM 33" en el Certificado de Defunción de la Provincia de Santa Fe produjo modificaciones importantes en los datos sobre MM. Estas modificaciones pueden ser atribuidas a la disminución del subregistro, ya que no se encuentran razones valederas para pensar en un aumento real en la ocurrencia de muertes maternas. Por lo cual se concluye que: este instrumento de recolección de datos permitiría corregir el subregistro y obtener datos de mayor calidad que, en consecuencia, posibiliten la implementación de políticas y programas de salud basados en datos que reflejen la verdadera situación sanitaria.INTRODUCTION: Maternal Mortality (MM) shows differences in population health and life conditions, therefore it becomes not only a good socioeconomic indicator but also an indicator of health service providers and health care service quality in the assistance to women at reproductive age. Official Health Statistics do not reveal the size of MM problem due to the under-report that has this death cause. This deficiency or lack of data is highly marked especially in underdeveloped countries. It has been estimated that Argentina is not out of this under-report problem. In 1994, the Province of Santa Fe decided to add a specific ITEM to the Death Certificate for Maternal Death cause with the aim of amending the under-report. OBJECTIVES: The main objective of this study was to evaluate changes that Maternal Mortality Ratio (MMR) registered between 1988 and 2001 as a consequence of adding the "33 ITEM" regarding Maternal Death to the Death Certificate of the Province of Santa Fe from 1995 on. MATERIAL AND METHODS: Bibliography was reviewed as regards the MM under-report. The MM occurrence in the Province of Santa Fe was studied from 1988 to 2001. Changes produced by the 33 ITEM appearance in the Death Certificate of the Province of Santa Fe during the period 1995 - 2001 were analyzed. RESULTS: It was seen an increase in the MM absolute figures and therefore, an increase of MM ratios (41 %) from 1995 to 2001, unlike the lowering trend of this indicator both at national level and at provincial level in the previous period (pre "33 Item"). Besides, it was seen a modification in death distribution in relation to its incidence among diferent age groups. Another important detail is that frequency of pathologies leading to death (death cause) was modified, being Abortion the most frequent cause unlike the previous periods in which Hypertension was first in the rank. CONCLUSION: The "33 ITEM" addition to Death Certificate of the Province of Santa Fe brought about important MM data modifications. These modifications should be attributed to the decrease of under - reporting since there is no valid reason to think of a real increase in maternal death occurrence. Thus, as a conclusion, this instrument for collecting data allows to amend the under-report and obtain higher quality data, which consequently bring the possibility of setting up health policy and programmes based on data showing the real health situation.

Fundaments: The critically ill patient has an important place in the assessment of the quality of the medical assistance since around 5 % of all females who reach a full term pregnancy without potential risk factors, become this kind of patients due to different causes. Objective: To characterize the obstetric patient in a critical state in the period that covers January 1 st 1991- December 31 st 2001 in Cienfuegos province. Method: Correlational Descriptive-retrospective study carried out at the ICU of the Clinico-Surgical University Hospital ¨Dr. Gustavo Aldereguía Lima¨ in a 10 year period and includes the 323 critically ill obstetric patients who were admitted at that ward. The variables under study were: mother´s age parity, type of labor, past history, surgical procedures, cause of admission at the ICU, patients state at discharge and cause of death. Results: 59,1 % of the patients were aged 20-29 years . The patient´s past history was related to hypertension and bronchial asthma. The procedure most widely used was the cesarean section followed by hysterectomy as emergency. The principal cause of admission at the ICU was hypovolemic shock, pre eclampsia - eclampsia and sepsis. The major amounts of patients were discharged alive. Only 8 % died. There was a predominance of direct maternal death, highlighting among them haemorrhage and hypertension in pregnancy.