Dissertations / Theses on the topic 'Fundamental Causes of Death'

Thesis (PhD (Physiological Sciences))--University of Stellenbosch, 2009.
ENGLISH ABSTRACT: OBJECTIVE – Oxidative stress increases flux through the hexosamine biosynthetic pathway (HBP) resulting in greater O-GlcNAcylation of target proteins. Since increased oxidative stress and HBP flux are associated with insulin resistance, we hypothesized that its activation leads to greater O-GlcNAcylation of BAD (pro-apoptotic) and increased myocardial apoptosis. RESEARCH DESIGN AND METHODS – To investigate our hypothesis, we employed two experimental models: 1) H9c2 cardiomyoblasts exposed to high glucose (33 mM glucose) ± HBP modulators ± antioxidant treatment vs. matched controls (5.5 mM glucose); and 2) a rat model of high fat diet-induced insulin resistance and hyperglycemia. We evaluated apoptosis in vitro by Hoechst nuclear staining, Annexin-V staining, caspase activity measurements and immunoblotting while in vivo apoptosis was assessed by immunoblotting. In vitro reactive oxygen species (ROS) levels were quantified by H2DCFDA staining (fluorescence microscopy, flow cytometry). We determined overall and BAD O-GlcNAcylation, both by immunoblotting and immunofluorescence microscopy. As BAD-Bcl-2 dimer formation enhances apoptosis, we performed immunoprecipitation analysis and immunofluorescence microscopy (co-localization) to determine BAD-cl-2 dimerization. In vivo overall O-GlcNAcylation, BAD O-GlcNAcylation and BAD-Bcl-2 dimerization was determined by immunoprecipitation and immunoblotting. 4 RESULTS – High glucose treatment of cells significantly increased the degree of apoptosis as revealed by Hoechst nuclear staining (54 ± 9%, p<0.01 vs. 5.5 mM), Annexin-V staining (43 ± 5%), caspase activity assay (26 ± 2%) and immunoblotting. In parallel, overall OGlcNAcylation (p<0.001 vs. 5.5 mM), BAD O-GlcNAcylation (p<0.05 vs. 5.5 mM) and ROS levels were increased (fluorescence microscopy – p<0.05 vs. 5.5 mM; flow cytometry – p<0.001 vs. 5.5 mM). HBP inhibition using DON and antioxidant treatment (α-OHCA) attenuated these effects while HBP activation by PUGNAc exacerbated it. Likewise, insulin resistant rat hearts exhibited significantly higher caspase-3 (p<0.05 vs. controls), overall O-GlcNAcylation (p<0.05 vs. controls) and BAD O-GlcNAcylation levels (p<0.05 vs. 5.5 mM). BAD-Bcl-2 dimer formation was increased in cells exposed to hyperglycemia [immunoprecipitation analysis and co-localization] and in insulin resistant hearts. CONCLUSIONS - Our study identified a novel pathway whereby hyperglycemia results in greater oxidative stress, resulting in increased HBP activation and increased BAD OGlcNAcylation. We also found greater BAD-Bcl-2 dimerization increasing myocardial apoptosis, suggesting that this pathway may play a crucial role in the onset of the diabetic cardiomyopathy.
AFRIKAANSE OPSOMMING: DOELWIT – Oksidatiewe stres verhoog fluks deur die heksosamien biosintetiese weg (HBW) wat in „n groter O-GlcNAsetilering van teiken proteïene resulteer. Weens die feit dat verhoogde oksidatiewe stres en HBW fluks verband hou met insulienweerstandigheid, hipotetiseer ons dat die aktivering hiervan tot groter O-GlcNAsetilering van BAD (pro-aptoptoties) en verhoogde miokardiale apoptose lei. NAVORSINGS ONTWERP EN METODES – Om die hipotese te ondersoek het ons twee modelle ontplooi: 1) H9c2 kardiomioblaste is blootgestel aan hoë glukose konsentrasie (33mM glucose) ± HBW moduleerders ± antioksidant behandeling vs. gepaarde kontrole (5.5mM glucose); en 2) „n hoë vet dieetgeïnduseerde insulienweerstandige rotmodel en hiperglukemie. Ons het apoptose in vitro deur middel van Hoescht nukleuskleuring geëvalueer, kasapase aktiwiteit bepalings en immunoblotting terwyl apoptose in vivo getoets is deur immunoblotting. Reaktiewe suurstofspesie (RSS) vlakke is deur middel van H2DCFDA verkleuring (fluoresensie mikroskopie, vloeisitometrie) bepaal. Algehele en BAD O-GlcNAsetilering is beide deur immunoblotting en immunofluoresensie mikroskopie bepaal. BAD-Bcl-2 dimeervorming bevorder apoptose, om BAD-cl-2 dimerisasie te bepaal is daar van immunopresipitering analise en immunofluoresensie mikroskopie (ko-lokalisasie) gebruik gemaak. In vivo is algehele OGlcNAsetiliering, BAD O-GlcNAsetiliering en BAD-Bcl-2 dimerisasie deur immunopresipitasie en immunoblotting bepaal. 6 RESULTE – Hoë glukose behandeling van selle het die graad van apotpose betekenisvol verhoog soos blootgelê deur Hoechst nukleuskleuring (54 ± 9%, p<0.01 vs. 5.5 mM), Annexin-V kleuring (43 ± 5%), kaspase aktiviteit assay (26 ± 2%) en immunoblotting. In parallel, algehele OGlcNAsetilering (p<0.001 vs. 5.5 mM), BAD O-GlcNAsetilering (p<0.05 vs. 5.5 mM) en RSS vlakke is verhoog (fluoresensie mikroskopie– p<0.05 vs. 5.5 mM; vloeisitometrie– p<0.001 vs. 5.5 mM). HBW inhibering deur van DON en van antioksidant behandeling gebruik te maak (α- OHCA) het hierdie effekte verlaag terwyl HBW aktivering deur PUGNAc dit verhoog het. Netso, het insulienweerstandige rotharte betekenisvolle hoë kaspase -3 (p<0.05 vs. kontrole), algeheel O-GlcNAsetilering (p<0.05 vs. kontrole) en BAD O-GlcNAsetiliering vlakke (p<0.05 vs. 5.5 mM) getoon. BAD-Bcl-2 dimeervorming is verhoog in hiperglukemies blootgestelde selle [immunopresipitering analise en ko-lokalisering] en in insulienweerstandige harte. GEVOLGTREKKINGS – Ons studie het „n nuwe weg geïdenifiseer waar hiperglukemie in groter oksidatiewe stres resulteer wat weer HBW aktivering verhoog en BAD O-GlcNAsetilering verhoog het. Ons het verder bevind dat groter BAD-Bcl-2 dimerisasie miokardiale apoptose verhoog wat voorstel dat hierdie weg „n belangrike rol in diabetiese kardiomiopatie speel.

The Src homology 3 domain (SH3) and cysteine rich domain (C1) 3 (Stac3) gene is a novel gene copiously expressed in skeletal muscle. The objective of this research was to determine the role of Stac3 in development, specifically in skeletal muscle. We achieved this objective by evaluating the phenotypic effects of Stac3 gene inactivation on development in mice. At birth homozygous Stac3 null (Stac3-/-) mice died perinatally and remained in fetal position with limp limbs, but possessed otherwise normal organs based on gross and histological evaluations. The primary phenotypes displayed at term in Stac3-/- mice were reduced late gestational body weights, increased prevalence of myotubes with centrally located nuclei and severe deformities throughout all skeletal muscles. At embryonic day 18.5 (E18.5) Stac3-/- mice displayed a 12.7% reduction (P < 0.001) in weight compared to wild type (Stac3+/+) or heterozygous (Stac3+/-) littermates while at E15.5 body weights and morphology were similar. At birth (P0) and at E17.5, Stac3-/- mice had 59% and 24% (P < 0.001) more myotubes with centrally located nuclei, respectively, than Stac3+/- or Stac3+/+ littermates. Stac3-/- mice also displayed increased myotube and myofiber cross sectional area at P0 (P < 0.001) and E17.5 (P < 0.05) with disorganized fiber bundling. Overall, these data show Stac3 is necessary for development of viable offspring and suggest Stac3 plays a critical role in fetal development where its primary phenotype is exhibited in skeletal muscle.
Master of Science

The study and practice of epidemiology and public health benefit from the use of mortality statistics, such as mortality rates, which are frequently used as key health indicators. Furthermore, multiple causes of death (MCOD) data offer important information that could not possibly be gathered from other mortality data. This study aimed to describe the interrelationships between various causes of death in the United States in order to improve the understanding of the coexistence of MCOD and thereby improve public health and enhance longevity. The social support theory was used as a framework, and multivariate linear regression analyses were conducted to examine the coexistence of MCOD in approximately 80 million death cases across the United States from 1959 to 2005. The findings showed that in the United States, there is a statistically significant relationship between the number of coexisting MCOD, race, education, and the state of residence. Furthermore, age, gender, and marital status statistically influence the average number of coexisting MCOD. The results offer insights into how the number of coexisting MCOD vary across the United States, races, education levels, gender, age, and marital status and lay a foundation for further investigation into what people are dying from. The results have the long-term potential of helping public health practitioners identify individuals or communities that are at higher risks of death from a number of coexisting MCOD such that actions could be taken to lower the risks to improve people's wellbeing, enhance longevity, and contribute to positive social change.

Fish farming is a million dollar business world wide, and fish is in fact the third mostimportant export product after oil/gas and metal in Norway. There are a lot of different aquaculture sites which produce fish along our long coast line and they all have somedifferences in the production rates and procedures. The fish farmer at these sites holdvaluable information about the production, which is almost impossible to derive onlyfrom empirical data.In this thesis we introduce Glaucus, a Case-Based Reasoning system which aims tohelp the fish farmers with their decision making when conduction sorting operations attheir aquaculture sites. The system is built in Java and uses the jColibri developmentframework for Case-Based Reasoning. It retrieves cases based on similarity function frommyCBR and jColibri in addition to custom made ones. The case base is generated fromreal world data and the case queries are populated by a combination of user input anddata from a database with continuous data flow.Our approach is just the beginning of what we hope will be a even greater journeytowards a complete decision support system that will meet the expectations of the fishfarmers.Keywords: Case-Based Reasoning, Machine learning, Fish farming, jColibri, myCBR

This thesis sets out to explain the causes and consequences of American mass media silence on the subject of civilian death in Iraq in the 2003-2012 war. The thesis finds the principal causes of silence to be: The embedding program, the need for fast, marketable, American-sourced "officialdom", the cultural-political shift to the right after 9/11 and the rise of Fox News, the takeover of advertising interests in media executive management, and various psychological causes including group diffusion of responsibility. The thesis finds the principal consequence of media silence to be dehumanization through omission, effecting widespread American public ignorance (and consequent apathy) of civilian death in Iraq. The concept dehumanization through omission is introduced in this thesis as a variant of traditional dehumanization that can be either intentional or naturally occurring. In this particular variant, the absence of like-identification across ingroups and outgroups, the absence of socially supportive affiliates interested in forming a humanizing counter-narrative, the denial of and disinterest regarding ingroup sin, the denial of event importance, the denial of individual agency, occasional overt dehumanization, sustained infrahumanization, and finally the assumption on the part of the American people that their media was vigilant against civilian death paired with that media's actual and complete absence of vigilance against death and against the delegitimizing and prevailing war narrative, form a dehumanization that is softer, quieter, and more elusive than overt propaganda, but which in all likelihood is just as fatal to those who suffer its consequences.

This thesis is based on a worldwide overview (meta-analysis) of prospective observational studies of blood pressure and cholesterol, involving a centralised collection of data on over one million individuals from 59 studies, which I have co- ordinated since its inception. Analytically, the aim has been to develop and to use appropriate statistical techniques to assess the age- and sex-specific associations of usual blood pressure and of usual cholesterol with cause-specific mortality. Since the data set is uniquely large, and because appropriate methods of analysis (with full account taken of the time-dependent nature of the regression dilution bias) have been developed and used, these associations have been established more reliably. An integral part of the methodological element of the thesis has been to investigate the systematic underestimation of associations between risk factor and disease that are obtained when only a single baseline measurement is used to assess levels of such risk factors (the regression dilution bias). The extent of this bias has been investigated in each study that had repeat measurements of risk factors during follow-up. One particularly novel aspect has been the emphasis on, and methods developed to account for, the regression dilution bias in several studies simultaneously and in an appropriately time-dependent way. This thesis illustrates the extent to which random error and inappropriate statistical analysis lead to misleading conclusions concerning the importance of blood pressure and blood cholesterol, particularly in premature death. Only by studying adequate numbers of deaths (136,000 deaths among 1 million adults during 13 million person- years of follow-up) and by using appropriate statistical techniques - taking proper account of (a) the regression dilution bias; (b) the full range of blood pressure and cholesterol; (c) the opposing effects of HDL.and the remaining non-HDL cholesterol; and (d) age at death - did it become possible to provide reliable results on the true relationships between blood pressure, cholesterol fractions and vascular and other causes of death. These analyses have demonstrated reliably that, as causes of IHD death in early middle age, blood pressure and blood lipids are three to five times more important than suggested by inappropriate analyses, with no clinically relevant inverse associations with cancer or other non-vascular mortality (except, surprisingly, COPD).

Background： Previous studies indicated that dietary habit or food-purchasing behaviors was associated with socioeconomic status. However, there is no study about potential association between social economic factors (individual and neighborhood levels) and dietary related mortality risks. Objective: 1) To provide population based information on food consumption pattern among Hong Kong people from a diversity of socio-economic background. 2) Investigate the dietary habits and different food related death in Hong Kong people who were 65 or over. 3) Investigate the association of socioeconomic factors and food related death at individual (SES) and neighborhood (SDI) level. Method: The subjects we recruited in a lifestyle and mortality (LIMOR)study forall deceased people aged 65 or older. The LIMOR data was conducted by The University of Hong Kong, School of Public health in the year of 1997. I got access to part of the data for my study from the leading investigator (Dr. Daniel SY Ho). Dietary habits were measured by using semi-quantitative food frequency questions on seven most commonly consumed food groups by Hong Kong residents: vegetables, fruits, soy and dairy products fish, meat and Chinese tea.Mortality in 1998 due to non-accidental causes (ICD9: 001—799) was examined. In my study, mortality due to specific categories of cardio-respiratory causes was regarded as the case and the due to pneumonia was regarded as the control. Binary logistic regression was used for assessment of odds ratio with adjustment for confounders. Result: Regular consumption of fruit was significantly (P<0.01) related to lower mortality due to COPD with adjusted OR =0.77 (95%CI 0.63-0.94) and regular consumption of vegetables was significantly(p<0.05) related to lower mortality due tocolon cancer with adjusted OR =0.58 (95%CI 0. 33-1.00). Milk consumption was significantly(p<0.05) related to higher mortality for both ischemicheart disease (adjusted OR=1.25; 95%CI 1.02-1.51) and COPD (p<0.01 adjusted OR=1.37; 95%CI 1.08-1.73) for people aged over 65. In my study, fish consumption was significantly (p<0.05) associated with lower mortality due to stomach cancer with adjusted OR=0.47 (95%CI 0.30-0.75). Meat consistently showed positive correlation with all f the causes of death, however, none of them were significant. Soy consumption was consistently and non-significantly shown to have a negative association with different causes of death, except COPD. Tea was negatively associated with COPD and hypertension, though none of them were significant. For those who lived in homeowner‘s scheme house, they were more likely (p<0.05) to have hypertension (OR=1.79; 95%CI 1.03-3.13). Also for people who lived in private houses, they were more likely (p<0.05) to died from IHD (OR=1.27; 95%CI 1.09-1.60) and colon cancer (OR=1.27; 95%CI 1.01-1.59) death. People who had primary (OR=1.45; 95%CI 1.12-1.86) and secondary and above education(OR=1.27; 95%CI 1.01-1.59) had a significantly (p<0.05) association with mortality due to colon cancer. People who had low SES and lived in high SDI area were less likely (p<0.05) to die fromischemic heart disease (OR=0.41; 95%CI 0.17-0.98). Conclusion: In Hong Kong, people who had higher education tended to consume more dairy products than lower education group and they were more likely to die from colon cancer. People who lived in private houses had higher consumption of dairy products than those lived in public estate and they were more likely to die from IHD and colon cancer. For people who had high SES, no matter which SDI areas they lived, they tended to have a more frequent consumption of fruit, bean, dairy products and meat than those oflow SES. People who had low SES and lived in high SDI area, as we considered as the poorest people, were less likely to die withischemic heart disease.
published_or_final_version
Public Health
Master
Master of Public Health

The sudden death syndrome (S.D.S.) emerged as a disease of broiler breeders in the late Seventies and developed into a condition of economic significance in Australia in the early Eighties. Mortalities up to 30% occurred in flocks at the commencement of lay. Visceral congestion was the only post mortem change of note in birds which died suddenly without premonitory signs, however myopathy was seen histologically in recumbent birds which were also present in affected flocks. Low plasma potassium and phosphorus levels were detected in birds in affected flocks, and a severe outbreak of the condition was terminated following potassium supplementation of the water. Blood samples were collected throughout the life of a broiler breeder flock, and it was found that plasma potassium levels were at their lowest levels at 24 to 26 weeks of age, the age of peak mortality rate due to the S.D.S. A basal ration compounded from vegetable protein sources was developed which, when fed to point of lay broiler breeders, resulted in deaths due to the S.D.S. Low plasma potassium levels were recorded in birds fed this ration. The basal S.D.S. inducing ration was supplemented with potassium and phosphorus in one trial, and protein, potassium and phosphorus in another. The higher protein levels did not reduce the incidence of the S.D.S. and may in fact have exacerbated the problem. Supplementation with both potassium and phosphorus was necessary to prevent the disease. It was concluded that a minimum of 0.63% total phosphorus (0.49% available phosphorus) and 0.49% potassium were required in the basal ration to prevent the S.D.S. A linear binomial model was developed based on the data from these two trials and this proved to be able to predict well the death rates due to the S.D.S. with respect to dietary potassium and phosphorus levels. The influence of medullary bone formation on plasma potassium levels was examined. Medullary bone is produced in sexually maturing pullets in response to increased blood levels of oestrogen and testosterone. Oestrogen and oestrogen plus testosterone, administered parenterally to point of lay pullets, led to significant depression in plasma potassium levels, but only those with the combined oestrogen/testosterone treatment produced substantial medullary bone (traces only were present in the oestrogen treated birds). Consequently, the medullary bone formation was not responsible for the drop in plasma potassium levels. The depression in plasma potassium levels was found to be in response to oestrogen administration, partly due to dilution of the plasma with fat and partly due to some other unknown effect. The feeding of purified rations deficient in potassium but complete in other respects, confirmed that adult broiler breeders established in lay have a very low (0.12%) potassium requirement to prevent deaths in short term trials. Point of lay pullets also had a similarly low requirement to prevent mortalities, however they appeared to need more dietary potassium to maintain plasma potassium levels similar to those found in birds fed the diets higher in potassium. A trial in which rations with two levels of phosphorus and four levels of potassium were fed in a factorial arrangement demonstrated that plasma potassium levels were related to dietary potassium (P < .05) and dietary phosphorus (P < .06). Mortalities due to potassium deficiency were greater in birds fed rations with lower phosphorus (P < .05). Comparison of tissue potassium levels between cases of the S.D.S. and frank potassium deficiency are drawn. In the S.D.S, birds die as a result of hypokalaemia and have post mortem signs and heart to body weight ratios indistinguishable from those dying from frank potassium deficiency. It was concluded that the S.D.S. is a disease entity in its own right and is a metabolic disorder rather than a simple potassium deficiency. The hypokalaemia is contributed to by a number of factors. These include dietary levels of potassium, dietary levels of phosphorus, physiological changes taking place in the bird at the time of sexual development and elevated ambient temperatures. The additive effect of these separate entities acting in concert depresses plasma potassium levels below a point compatible with life.

Although the risk of malformations in the offspring of diabetic mothers remains the leading cause of perinatal mortality, the pathogenesis has not been elucidated. The hypothesis of this study was that protein glycation and oxygen free radicals play a role in hyperglycemia-induced malformations. CD-1 mouse embryos (0-2 somites) were cultured under hyperglycemic conditions for 48 hours with the exogenous addition of anti-glycating agents and oxygen free radical scavengers. The exogenous addition of aspirin (ASA) and D-lysine reduced significantly the malformations and embryonic glycated protein levels. Salicylate, arachidonic acid (AA), and to a lesser extent, indomethacin also exerted protective effects, but with no effect on glycated protein levels. We hypothesize that ASA, salicylate and indomethacin are protective by exerting free radical scavenging action; and ASA and D-lysine are acting as potent anti-glycating agents. Moreover, we suggest that AA may have inhibited hyperglycemia-induced malformations through the protective action of prostaglandins against free radical damage. Serum media lipid peroxidation (LPO) was reduced in the ASA and indomethacin groups possibly due to either a direct free radical scavenging action and/or the inhibitory effects of these agents on cyclooxygenase activity thereby decreasing the oxygen free radicals produced by this enzyme system. On the other hand, AA was associated with an increased level of LPO in the serum media. As the evidence has shown, the cause of hyperglycemia-induced malformations appears to be multifactorial and no one agent can completely eliminate the problem, although protective action can be exerted at different levels of the glycation-free radical cascade of tissue damage.

Historical research involving the schism within the German Baptist Brethren Church in the 1880s has only been found within broad, general histories of the church. The explanations given by historians relating to the cause of the split have previously centered on individuals and the church publications between 1850 and 1883, and on contemporaries who argued among themselves about whether to adopt practices common among surrounding American religions and society. No known project has focused directly on the content within the publications as it relates to the way these brethren used the Bible and other religious and spiritual rhetoric to substantiate their arguments on either side. My research focussed on the Brethren periodicals during the decades between roughly 1850 and 1880. I selected four of the most prominent papers of the period: the Gospel Visitor, the Christian Family Companion, the Vindicator, and the Progressive Christian. Each of these periodicals contained arguments for or against adopting practices not previously accepted within the church. Within their pages I found that every argument, for or against a particular practice, was based on scriptural interpretation, or other religious commentary used to persuade readers.

Data on adult mortality are very limited in sub-Saharan Africa where only small proportions of deaths occur in health facilities. In such settings, ascertainment of causes of death from data obtained from relatives or associates of the deceased through interviews in surveys or longitudinal surveillance systems appears to be an attractive option. This technique, known as verbal autopsy (VA) is based on the assumption that important causes of death have distinctive symptoms and signs, and these can be recognised, remembered and reported by lay respondents, and that based on the reported information causes of death can be reached. The existing experience of VA for adult death is limited mainly to maternal deaths and the validity of VA for adult death is unknown. We developed a VA questionnaire, mortality classification system and "expert opinion" based algorithms for reaching diagnoses for adult deaths and tested their validity on deaths occurring at hospitals in Tanzania (n=315), Ethiopia (n=249) and Ghana (n=232). Hospital records of adult deaths occurring at study hospitals from June 1993 to April 1995 were collected prospectively. VA interviews were conducted by trained non-medical interviewers. Caused of death from VA data were reached by a panel of three physicians and by a computerised algorithm. The validity of VA was assessed by comparing the VA diagnoses with hospital diagnoses. Specificity of VA fell below 95% only for few common causes of adult death. Sensitivity and kappa of VA for all common causes of adult death were low and this suggests that the accuracy of VA at the individual level is low. However, the misclassification of causes of death was bi-directional and the number of false positive and false negative diagnosis for most common causes of adult death tend to be similar. Thus there was robust agreement between the true and VA estimates of cause specific mortality fractions of common causes of adult death and VA is useful for assessing cause specific mortality fractions of common causes of adult death.

The purpose of the study is to fill the gap in the literature regarding sibling bereavement. This study explored how sibling bereavement from unnatural causes of death affects surviving siblings. Bereavement affects millions of Americans every year. Most grieve naturally, but some experience complicated grief or depression. Many studies address parental and spousal bereavement, but few focus on sibling bereavement. This study fills that gap in the literature so that mental health care professionals and the general public understand what bereaved siblings experience after the death of a sibling. The study was a phenomenological study using social constructivism as a theoretical lens to explore how sibling bereavement affects surviving siblings. Open-ended interviews were collected from 10 bereaved siblings. Those interviews were then transcribed and categorized using a 7 step process to review and organize all relevant statements. Results of this study shows that sibling bereavement can be a life changing event for surviving siblings affecting all aspects of life and leaving unanswered questions and feelings of guilt. Participants also state they felt overlooked after the death leading to delayed grief. Participants concluded that sibling grief is subjective, so any treatment plan should be catered to the individual based on their relationship to the deceased sibling and the role the sibling played. This study can bring about positive social change by helping mental health care workers understand sibling bereavement better so that they may help those suffering from complicated grief following the loss of a sibling.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES
The main objective of the work is to investigate the right to a dignified death as a true fundamental right of the individual. The premise is that if national and international legislation protects the right to a dignified life, as can be seen from the systematic and teleological reading of articles 5 and 225 of the Federal Constitution and international documents such as the Universal Declaration of Human Rights, one must recognize the right to the dignified life in all the phases of existence of the subject, even when it is in terminal phase. In order to develop the study, the principles of bioethics and biolaw, the concepts of euthanasia, orthothanasia, assisted suicide and dysthanasia, as well as palliative care were analyzed. The role of the State as guarantor of the right to life was also analyzed, but also as a guarantor of freedom and autonomy in the private matters. Emblematic cases have been investigated in order to observe the current stage of discussion and legislation in Brazil and in the world. The right to a dignified death, whether through voluntary euthanasia or assisted suicide, is an unfolding of the right to a dignified life and can be exercised by those who are aware, informed of their clinical conditions and options, privileging the autonomous decision of the subject to submission to certain medical treatments and procedures and regarding the duration of life, which can be foreseen in the instrument called advance directives. If life is a right it can not become a real burden
O principal objetivo desta pesquisa é investigar o direito à morte digna como verdadeiro direito fundamental do indivíduo. Parte-se da premissa de que se a legislação nacional e internacional protegem o direito à vida digna, como se depreende da leitura sistemática e teleológica dos artigos 5º e 225 da Constituição Federal e de documentos internacionais como a Declaração Universal dos Direitos Humanos, deve-se reconhecer o direito à vida digna em todas as fases de existência do sujeito, mesmo quando ele está em fase terminal. Para desenvolver o estudo foram analisados os princípios da Bioética e do Biodireito, os conceitos de eutanásia, ortotanásia, suicídio assistido e distanásia, bem como dos cuidados paliativos. Analisou-se também o papel do Estado como garantidor do direito à vida, mas também como garantidor da liberdade e da autonomia na esfera privada. Foram investigados casos emblemáticos a respeito do assunto, para se observar o estágio atual da discussão e da legislação, no Brasil e no mundo. O direito à morte digna, seja por meio da eutanásia voluntária ou do suicídio assistido, é um desdobramento do direito à vida digna e pode ser exercido por aquele que tem consciência, está informado de suas condições clínicas e opções, privilegiando-se a decisão autônoma do sujeito a respeito da submissão a determinados tratamentos e procedimentos médicos e a respeito da duração da vida, o que pode ser previsto no instrumento denominado de diretrizes antecipadas. Se a vida é um direito, então, não pode se transformar em verdadeiro fardo

Although funerals are seen as universal rituals to honor the death of a loved one, their value in facilitating the grief process is not known. The present study explored the relationships between cause of death, feelings and attitudes toward the funeral, and subsequent bereavement adjustment.

The study aims to describe the external causes of death (ECD) mortality, specifically suicide and traffic death in Estonia 1970-2002 in relation to the political and economic development with a special focus on the unemployment and alcohol use impact. This analyse bases on the Statistical Office of Estonia and other governmental institutions published information. The highest mortality rates occurred for traffic accidents 1990-91 and for suicides 1994-95. Middle-age man excess ECD mortalityoccurred in early 1990s with the greatest politico-economic changes accompanied by high psychosocial stress before the population could acquire appropriate coping strategies. Impact of the first main reforms on the population health has been ascertained. Price liberalisation was followed by immense inflation and real wage fall in early 1990s. Privatisation and monetary reform influenced on the basic living security of the population. People faced unexpected living difficulties as work and dwelling insecurity, decreased real income, insufficiency to meetessential expenditures, declined living standard, social status loss, population stratification and inadequate social protection. Unemployment was just introduced and did not play a significant role for the high mortality. Traffic accidents’ fatal consequences decreased with growing GDP as cars and roads became safer however accidents’ number did not decrease. Western cars appearance euphoria could influence more than alcohol consumption. It could plausibly increase accidents but the reason and role of alcohol consumption in the intentional actions needs more information. Suicide could have been influenced mainly by social and traffic accidents mortality mainly by environmental factors. Earlier findings about the unemployment and alcohol consumption impact on the transition’s high injurymortality have not been confirmed by the current study. Current paper provides framework within population worsening health factors during politico-economic changes could be better understood. The strongest impact on Estonia’s population health could come from transition’s political and economic reforms influencing dwelling and incomesecurity. Low salary and low purchasing power could hurt a human dignity even more than possible unemployment

ISBN 91-7997-094-X

Tolerance-based stem cell transplantation using sub-lethal conditioning is being considered for the treatment of human disease, but safety and efficacy remain to be established. In order to study these two issues, we first established that mouse bone marrow recipients treated with sub-lethal irradiation plus transient blockade of the CD40-CD154 costimulatory pathway develop permanent hematopoietic chimerism across allogeneic barriers. Our conditioning regimen of 6 Gy irradiation, a short course of anti-CD154 mAb and 25 million fully allogeneic BALB/c bone marrow cells consistently produced long-term, stable, and multilineage chimerism in C57BL/6 recipients. Furthermore, chimeric mice displayed donor-specific transplantation tolerance, as BALB/c skin allografts were permanently accepted while third-party CBA/JCr skin allografts were promptly rejected. We next determined both the safety and efficacy of this protocol by infecting chimeric mice with lymphocytic choriomeningitis virus (LCMV) either at the time of transplantation or at several time points afterwards. Infection with LCMV at the time of transplantation prevented engraftment of allogeneic, but not syngeneic, bone marrow in similarly treated mice. Surprisingly, infected allograft recipients also failed to clear the virus and died. Post-mortem study revealed hypoplastic bone marrow and spleens. Hypoplasia and death in these mice required the combination of 6 Gy irradiation, LCMV infection on the day of transplantation, and an allogeneic bone marrow transplant but did not require the presence of anti-CDl54 mAb. Allochimeric mice infected with LCMV 15 days after transplantation were able to survive and maintain their bone marrow graft, indicating that the deleterious effects of LCMV infection on host and graft survival are confined to a narrow window of time during the tolerization and transplantation process. The final section of this thesis studied the mechanisms of graft rejection and death in sublethally irradiated recipients of allogeneic bone marrow and infection with LCMV at the time of bone marrow transplantation. Infection of interferon-α/β receptor knockout mice at the time of transplantation prevented the engraftment of allogeneic bone marrow, but the mice survived. Therefore, IFN-αβ is involved in the development of marrow hypoplasia and death, whereas a second mechanism is involved in blocking the development of chimerism in these mice. Through the use of depleting mAb's and knockout mice we demonstrate that three types of recipients survived and became chimeric after being given sublethal irradiation, anti-CD154 mAb, an allogeneic bone marrow transplant and a day 0 LCMV infection: mice depleted of CD8+ T cells, CD8 knockout mice, and TCR-αβ knockout mice. Our data indicate that the mediator of bone marrow allograft destruction in LCMV-infected mice treated with costimulatory blockade is a radioresistant CD8+ NK1.1- TCRαβ+ T cell. We conclude that a non-cytopathic viral infection at the time of transplantation can prevent engraftment of allogeneic bone marrow and result in the death of sub-lethally irradiated mice treated with costimulation blockade. The abrogation of allogeneic bone marrow engraftment is mediated by a population of CD8+ NK1.1- TCRαβ+ T cells and the mediator of hypoplasia and death is viral induction of IFN-αβ.

BACKGROUND:Heart failure is sometimes incorrectly listed as the underlying cause of death (UCD) on death certificates, thus compromising the accuracy and comparability of mortality statistics. Statistical redistribution of the UCD has been used to examine the effect of misclassification of the UCD attributed to heart failure, but sex- and race-specific redistribution of deaths on coronary heart disease (CHD) mortality in the United States has not been examined.METHODS:We used coarsened exact matching to infer the UCD of vital records with heart failure as the UCD from 1999 to 2010 for decedents 55years old and older from states encompassing regions under surveillance by the Atherosclerosis Risk in Communities (ARIC) Study (Maryland, Minnesota, Mississippi, and North Carolina). Records with heart failure as the UCD were matched on decedent characteristics (five-year age groups, sex, race, education, year of death, and state) to records with heart failure listed among the multiple causes of death. Each heart failure death was then redistributed to plausible UCDs proportional to the frequency among matched records.RESULTS:After redistribution the proportion of deaths increased for CHD, chronic obstructive pulmonary disease, diabetes, hypertensive heart disease, and cardiomyopathy, P<0.001. The percent increase in CHD mortality after redistribution was the highest in Mississippi (12%) and lowest in Maryland (1.6%), with variations by year, race, and sex. Redistribution proportions for CHD were similar to CHD death classification by a panel of expert reviewers in the ARIC study.CONCLUSIONS:Redistribution of ill-defined UCD would improve the accuracy and comparability of mortality statistics used to allocate public health resources and monitor mortality trends.

This dissertaion comprises three related papers.
The first paper reports a historical cohort mortality study which was carried out among 21,744 electrical utility workers in the province of Quebec. A total of 1582 deaths were observed at the end of follow-up (1970-1988). A job exposure matrix (JEM) was used to estimate the exposure to 60 Hz electric, magnetic, and pulsed electromagnetic fields (PEMF) from the code of the last job held by each worker. The results showed no evidence of excess of cause specific or general mortality relative to provincial death rates in the cohort overall. The ratios of Standardized Mortality Ratios (SMRs) as estimates of rate ratio (RR) in the exposed relative to the background group were also calculated. Statistically significant RRs were found for pancreatic cancer for electric fields (RR = 2.8, 95% Confidence intervals (CI) 1.13-7.01) and for lung cancer for PEMF (RR = 1.56, 95% CI 1.05-2.25). Deaths caused by accidents and violence showed significant RRs for electric fields (RR = 2.16, 95% CI 1.59-2.92), magnetic fields (RR = 1.76, 95% 1.29-2.39) and for PEMF (RR = 1.96, 95% CI, 1.40-2.71). Occupational accidents related to power lines explain for some of the excess of deaths from accidents and violence. There was a small non-significant association with magnetic fields for leukaemia (RR = 1.52, 95% CI 0.45-4.47) and brain cancer (RR = 1.59, 95% CI 0.57-4.31), but the results for these two sites were based on small numbers.
The second paper reports a case-cohort study to investigate a previously suggested association between exposure to electric and magnetic fields and suicide. Forty-nine deaths from suicide between 1970 and 1988 were identified in the above-mentioned cohort and a sub-cohort comprising a one percent random sample was selected from it. Cumulative and current exposures to electric fields, magnetic fields and PEMF were estimated for the sub-cohort and cases through the JEM. For cumulative exposure, rate ratios (RR) for all three fields showed mostly small non-significant increases in the medium and high exposure groups. The most elevated risk was found in the medium exposure group for electric field-geometric mean (RR = 2.76, 95% CI 1.15-6.62). The results did not differ after adjusting for socioeconomic status (SES), alcohol use, marital status and mental disorders. There was little evidence for an association of risk with exposure immediately prior to the suicide. Small sample size (deaths from suicide) and inability to control for all potential confounding factors were the main limitations of this study.
The third paper reports a study of validity attributing magnetic field exposure by using a worker's last job. This was done by comparing, in a sample of the cohort, estimates obtained using last job with those obtained using full work histories. The correlation between indices based on last job and those based on all jobs varied between 0.75 and 0.78. The study showed that the last job was particularly good in identifying the highest exposed individual. The results are most likely to be generalizable to other industries in which highest exposed jobs are also skilled jobs.

Grief and causal attribution are two of the most commonly observed reactions to early miscarriage, yet little is known about these reactions or whether a relationship exists between them. This exploratory and descriptive correlational study examined the maternal grief intensities, the causal attributions, and the relationship between them in a convenience sample of 15 women who spontaneously aborted at 16 weeks' or less gestation. Women responded to both a written questionnaire and a semi-structured Interview at 6 to 10 weeks post-miscarriage. Their responses Indicated both current and retrospective reactions to their miscarriages. Responses were analysed using nonparametric statistics and content analysis. Maternal grief Intensities were found to vary widely at the time of the miscarriage, but all decreased significantly 6 to 10 weeks later. All women reacted to their miscarriage with attribution-seeking behaviors. The explanations most women formed were comprised of more than one causal attribution. Attributions were observed to have four distinct characteristics. Causal attributions were found to be either philosophical or physically oriented; to be organic, non-specific or maternal/self-blaming In origin; to be either dominant or non-dominant, and/or to refer to causalities immediate or prior to the physical event. At the time of the miscarriage a positive correlation between grief Intensity and maternal/self-blaming attributions and between grief Intensity and philosophical attributions was found. These relationships were not observed 6 to 10 weeks later. A positive correlation was found between grief intensity and attributions to maternal emotions at both the time of the miscarriage and 6 to 10 weeks later.
Applied Science, Faculty of
Nursing, School of
Graduate

Les statistiques de mortalité permettent à l'OMS de mesurer l'ampleur des problèmes de santé dans les pays. Leur fiabilité est fonction de la qualité du certificat de décès. Il ressort que plus de 25% des données des pays Africains ne sont pas utilisables. La principale raison de ce déficit d'information serait la non-performance des systèmes et outils d'enregistrement des données. Notre travail avait pour objectif d'étudier un modèle d'enregistrement des décès qui tienne compte à la fois des normes de l'OMS et des réalités de l'Afrique. Nous avons cherché à savoir comment la certification des causes de décès pouvait améliorer la production des statistiques de mortalité en Afrique. Comme méthodologie, nous avons utilisé une recherche interventionnelle combinée à une démarche projet et à une approche épidémiologique. L'étude a eu comme résultat la conception et l'implémentation d'un modèle à trois scénarii de déploiement en fonction du niveau d'équipement des établissements de soins en TIC et en personnel qualifié. Le système a été validé et implémenté au CHU de Bobo Dioulasso. Les acteurs ont été formés et le dispositif fonctionne depuis le 1er janvier 2014. Une première évaluation du modèle a été réalisée après trois mois de fonctionnement. La mise en place d'un comité de suivi et d'un plan annuel de formation, l'implication du Ministère de la santé et de l'Organisation Ouest Africaine de la Santé, l'assistance technique de la Direction Générale de la Modernisation de l'Etat Civil et du CepiDc (France) sont des éléments d'appropriation, de pérennisation et d'espoir. Cependant, l'enregistrement des décès survenus hors des hôpitaux reste un autre défi à relever
Mortality statistics are basic data the WHO employs to measure health problems in different countries. However, their reliability depends on the quality of death data collected by different doctors. It appears, however, that over 25% African data are of no use because they are not available on time or lack quality. The main reason for this lack of information could be the nonperformance of data logging systems and tools. Our work aimed at investigating a death registration model taking into account both WHO's standards and the realities of Africa. We tried to understand if certification of death causes could improve mortality statistics production in Africa. Our methodology was based on a combination of interventional research, project process, and an epidemiological approach. The study resulted in the design and implementation of a three scenarios model, depending on ICT equipment and qualified staff level of health care facilities. The system has been validated and implemented in the University Hospital of Bobo Dioulasso. All the actors were trained and the device operates since January 1st, 2014, after the training of the actors. A first evaluation of the model was performed after three months of operation. The establishment of a monitoring committee and of an annual training plan, the involvement of the Ministry of Health and of the West African Health Organization, the technical assistance of CepiDc (France) and of the General Directorate for Modernization of Civil Status, are elements of appropriation, sustainability and hope. However, deaths registration outside hospitals remains an active challenge

INTRODUCÃO: As doenças crônicas representam desde a década de 60 a principal causa de mortalidade nas capitais brasileiras. As doenças crônicas são consideradas como decorrência do envelhecimento da população e um atributo do sexo masculino e das camadas sociais mais ricas. Várias linhas de pensamento, as classificam com causas inevitáveis de morte, ou seja impassíveis de qualquer tipo de intervenção. OBJETIVO: restringindo-se a faixa etária entre os 35 e os 64 anos para estudo da mortalidade precoce foram feitas as seguintes perguntas: 1. a mortalidade precoce pela doenças crônicas é maior no Brasil do que em outros países? 2. a força da mortalidade precoce por doenças crônicas no Brasil é a mesma para o sexo masculino e para o sexo feminino? 3. o cálculo do impacto da eliminação de cada causa na mortalidade geral pelo método do risco competitivo de Chiang é superior ao uso clássico dos coeficientes de mortalidade ajustados para a idade? 4. existem diferenças regionais significativas na magnitude e tendência temporal na mortalidade precoce pelas doenças crônicas? 5. qual a relação entre o padrão de mortalidade pelas doenças crônicas e os diversos indicadores sociais e econômicos de cada cidade? DELINEAMENTO: estudo ecológico com dados secundários DADOS: foram estudados os óbitos compilados pelo Ministério da Saúde de oito capitais de áreas metropolitanas: Belém (BE), Recife (RE), Salvador (SA), Belo Horizonte (BH), Rio de Janeiro (RJ), São Paulo (SP), Curitiba (CT), Porto Alegre (PA) no período entre 1979 a 1989 com destaque no quadriênio 1984-87. As causas [entre parênteses o código CID-9] estudadas foram a mortalidade geral, todas as doenças do aparelho circulatório (390-459); doença isquêmica do coração (410-414); doenças do coração [agrupamento composto de doença isquêmica do coração (410-414), insuficiência cardíaca (428), hipertensão arterial (401-404)]; doenças cerebrovasculares (430-438}; todas as neoplasias (140-239); câncer da traquéia, dos brônquios, pulmão (162); câncer da mama feminina (174}; câncer do cólon e do reto (153-154); câncer de endométrio e ovário (182-183); câncer da próstata (185); todas as neoplasias, exceto câncer de pulmão; diabetes melito (250); doenças respiratórias obstrutivas [doença pulmonar obstrutiva crônica (490-496), incluindo a asma (493); cirrose hepática (571). A população foi a determinada nos Censos Demográficos de 1980 e 1991. Os anos intercensitários foram estimados por interpolação linear. Os indicadores sociais foram os obtidos no Censo de 1980 sendo escolhidos a proporção de analfabetos do sexo masculino, a proporção de analfabetos do sexo feminino, diferença entre a proporção de analfabetos do sexo masculino e a proporção de analfabetos do sexo feminino; a porcentagem de mulheres formalmente ocupadas; o salário mínimo médio; a cobertura de água encanada; a cobertura da rede de esgoto; a proporção de casas com mais de dois moradores por cômodo e a proporção da população com renda familiar superior a cinco salários mínimos. MÉTODOS: foram selecionadas para estudo as capitais de áreas metropolitanas: 1. para a comparação internacional foram calculados coeficientes de mortalidade com intervalos decenais na faixa etária dos 45 aos 64 anos, com ajuste de idade com população-padrão estipulada em estudo internacional para todas as causas; doenças do coração; doença isquêmica do coração; doença cerebrovascular; câncer de pulmão e por todas as neoplasias, exceto a de pulmão no quadriênio 1984-87. 2. para o estudo de comparação por gênero, por cidade brasileira e para correlação de associação com os indicadores sociais e econômicos foram calculados por sexo, os coeficientes de mortalidade com intervalos qüinqüenais na faixa etária dos 35 aos 64 anos de idade. Foram calculados os coeficientes ajustados por idade utilizando a população brasileira do Censo de 1991 como padrão e o risco competitivo de cada causa de morte listada acima (exceto doenças do coração e outras neoplasias, exceto as de pulmão). O quadriênio 1984-87 foi utilizado para as principais comparações. Foi calculado o impacto da eliminação de cada causa básica na mortalidade geral na faixa etária estudada utilizando tábua de vida com cálculo de risco competitivo de Chiang 3. a tendência histórica dos coeficientes anuais de mortalidade foram plotados em gráfico com cálculo do alteração anual por intermédio de regressão linear simples. 4. para verificar a associação dos coeficientes de mortalidade e do impacto da eliminação da mortalidade com os indicadores sociais foi utilizado o teste de correlação por postos de Spearman. RESULTADOS: 1. a comparação internacional [entre parênteses, em ordem decrescente o(a)s cinco primeiro cidades/países] mostrou que a) mortalidade geral masculina (RJ, PA, RE, CT, BH) e feminina (RE, SA, CT, BH e RJ) das mais elevadas; b) a mortalidade proporcional da somatória \"cardiovascular+câncer\" foi sempre menor nas cidades brasileiras do que entre os países e, variou no sexo masculino de 62 por cento (PA) a 45 por cento (SA) e no sexo feminino de 69 por cento (RJ) a 56 por cento (BH, SA, SP). A doença cerebrovascular foi a entidade nosológica cuja participação relativa foi sempre maior nas cidades brasileiras; c) as doenças do coração apresenta no sexo masculino (HUNGRIA, RJ, FINLÂNDIA, PA E POLÔNIA) valores intermediários e no sexo feminino (RJ, CT, HUNGRIA, PA E INGLATERRA & GALES) em padrões elevados. d) as doenças isquêmicas apresentam o mesmo padrão das doenças do coração tanto no sexo masculino (FINLÂNDIA, HUNGRIA, INGLATERRA & GALES, PA, RJ) como no feminino (RJ, CT, HUNGRIA, PA, INGLATERRA & GALES). e) doença cerebrovascular apresenta valores elevados tanto para o sexo masculino (CT, BH, RJ, BE, HUNGRIA) f) o câncer do pulmão, da traquéia e do brônquios tem valores intermediários para baixos no sexo masculino (HUNGRIA, POLÔNIA, ITÁLIA, HOLANDA, EUA), embora PA apresenta coeficientes elevados para média brasileira e, para o sexo feminino valores baixos (DINAMARCA, EUA, CANADÁ, INGLATERRA & GALES, HUNGRIA) g) o conjunto de todas as neoplasias, exceto a de pulmão apresenta valores intermediários para elevados para o sexo masculino (FRANÇA, HUNGRIA, PA, POLÔNIA, CT) e para o feminino (DINAMARCA, INGLATERRA & GALES, HUNGRIA, RE, PA) 2. o cálculo do risco de morrer mostrou no sexo masculino (RE, RJ, PA, BH, CT, SA, SP, BE) e no feminino (RE, SA, BH, CT, RJ, BE, SP, PA) ordem diferenciada como a observada em SA e PA; somente a eliminação das doenças do aparelho circulatório alterariam significativamente o ordenamento do risco de morrer entre as cidades. 3. o impacto da eliminação de uma causa na mortalidade geral apresentou valores que variaram no caso a) das doenças do aparelho circulatório no sexo masculino de 39.9 por cento (CT) a 31,5 por cento (RE) e no feminino de 44,1 por cento (RJ) a 33,6 por cento ;b) para a doença isquêmica no sexo masculino de 17,0 por cento (CT) a 8,3 por cento (SA) e no feminino de 14,3 por cento (RJ) a 5,9 por cento (BH); c) para a doença cerebrovascular no sexo masculino de 12,0 por cento (CT) a 6,2 por cento (SP) e no feminino de 16,3 por cento (RJ) a 10,7 por cento (BH); d) para todas as neoplasias no sexo masculino de 16,9 por cento (PA) a 9,7 por cento (RE) e no feminino de 27,2 por cento (RJ) a 19,6 por cento (BH); e) para o câncer de estômago no sexo masculino de 3,7 por cento (BE) a 0,8 por cento (RE) e no feminino de 7,9 por cento (BE) a 1,1 por cento (PA); f) para o câncer de pulmão no sexo masculino de 4,9 por cento (PA) a 1,8 por cento (RE) e no feminino de por cento (PA) a 1,0 por cento (SA, BH, RE); g) para o conjunto câncer de próstata e cólon-reto de 3,6 por cento (CT) a 0,6 por cento (RE); h) para o conjunto câncer de mama/endométrio-ovário/ cólon-reto de 11,1 por cento (PA) a 2,4 por cento (BE); i) para as doenças respiratórias obstrutivas no sexo masculino de 3,6 por cento (PA) a 1,5 por cento (SA) e no feminino de 4,5 por cento (CT) a 1 ,4 por cento (RE); j) para o diabetes melito no sexo masculino de 2, 7 por cento (BH) a 1 ,3 por cento (BE) e no feminino de 6,4 por cento (SA) a 3,0 por cento (BE); k) para a cirrose hepática no sexo masculino de 9,1 por cento (RE) a 3,2 por cento (SA) e no feminino de 4,8 por cento (RE) a 1,8 por cento (SP); 4. a comparação entre o cálculo do impacto da redução de uma causa específica na mortalidade geral e os coeficientes ajustados por idade mostrou coeficientes de Spearman com significância estatística para a maioria das entidades nosológicas, exceto para as doenças do aparelho circulatório (masculino), as neoplasias (feminino), a doença isquêmica (ambos os sexos) e o câncer de estômago (ambos os sexos) apresentaram valores positivos, porém sem significância estatística. A doença cerebrovascular (ambos os sexos), o conjunto câncer de mama/endométrio-ovário/cólon-reto e o conjunto câncer da próstata e cólon-reto apresentaram coeficientes de correlação muito baixos. 5. A tendência da mortalidade por todas as causas no período 1979-89 variou a cada ano no sexo masculino de -0,84 por cento (CT) para +15 por cento (RJ) e no feminino de -0,96 por cento (CT) a -0,15 por cento (RJ); as doenças do aparelho circulatório variaram no sexo masculino de -0,84 por cento (CT) a +2,50 por cento (RE) e no feminino de -0,96 por cento (CT) a +0,33 por cento (RJ); doença isquêmica variou no sexo masculino de -0,88 por cento (BE) a +6,08 por cento (RJ) e no feminino de -0,88 por cento (BE) e +2,86 por cento (RJ); a doença cerebrovascular variou no sexo masculino de -0,74 por cento (CT) e +6,62 por cento (BH) e no feminino de -0,97 por cento (CT) e +5,15 por cento (RE); as neoplasias malignas variaram no sexo masculino entre -0,93 por cento (CT) e +0,49 por cento (RE) e no feminino -0,94 por cento (CT) a +1,60 por cento (PA); o câncer de pulmão variou no sexo masculino de -0,84 por cento (CT) a +2,88 por cento (RE) e no feminino de -0,85 por cento (CT) a 25,54 por cento (SA). O conjunto neoplasia maligna da próstata e cólon-reto variou de - 0,92 por cento (8E) a +4,52 por cento (SP); o conjunto neoplasia maligna da mama/endométrio-ovários/ cólon & do reto variou de -0,83 por cento (BE) a +1 ,01 por cento (PA); as doenças respiratórias obstrutivas variaram de -5,98 (PA) a +2,63 (RE) para o sexo masculino e no feminino entre -1,53 por cento (RE) +7,87 por cento (CT); o diabetes melito para o sexo masculino variou entre -6,27 por cento (CT) e +2,63 por cento (RE) e feminino entre -0,78 por cento (SP.) e +2,09 por cento (BH) e, a cirrose hepática variou no sexo masculino entre -0,73 por cento (BE) e +6,83 por cento (SA) e no feminino entre -0,97 por cento (BE) e +2,01 por cento (RJ). 6. comparação com os indicadores sociais em análise bivariada usando correlação de Spearman: a) coeficientes-sexo masculino: a mortalidade geral não apresentou nenhuma correlação significativa; os cânceres apresentaram uma relação inversa com o analfabetismo e com a freqüência de casas com mais de dois moradores por cômodos e positiva com a cobertura de água; o câncer de pulmão, correlação negativa com o analfabetismo feminino e o diferencial de analfabetismo masculino-feminino; o câncer de próstata e cólon-reto com o analfabetismo feminino; o câncer de estômago não apresentou qualquer associação com significância estatística; as doenças do aparelho circulatório e a doença isquêmica tiveram associação negativa com a freqüência de casas com mais de dois moradores por cômodos; as demais causas não apresentaram associação significativamente estatística com os indicadores sociais. b) coeficientes- sexo feminino; o câncer de pulmão apresentou associação negativa com a proporção de homens e mulheres analfabetos; o câncer de mama e associados apresentou relação negativa com a freqüência de casas com mais de dois moradores por cômodos e positiva com a cobertura de água encanada. c) impacto da eliminação-sexo masculino; todos os cânceres tiveram associação negativa e a porcentagem de analfabetos homens e mulheres; o câncer de pulmão teve associação negativa com a porcentagem de mulheres analfabetas e o diferencial masculino-feminino de analfabetismo. d) impacto da eliminação-sexo feminino; os cânceres tiveram correlação negativa com o diferencial masculino-feminino do analfabetismo; o câncer de pulmão teve correlação negativa com o analfabetismo masculino e feminino e o diferencial masculino-feminino do analfabetismo. 7. a análise qualitativa a partir do sentido dos coeficientes de correlação para mostrar associação com indicadores de pobreza. a) sexo masculino- a mortalidade por todas as causas associação com o analfabetismo e a porcentagem de mulheres na força de trabalho; o diabetes melito apresentou o mesmo comportamento; a cirrose hepática mostrou correlação com todos indicadores da pobreza; a doença cerebrovascular também apresentou relação positiva com a pobreza, sem a mesma força que a cirrose; b) no sexo feminino - a mortalidade por todas as causas com a pobreza é mais nítida do que no masculino; as doenças do aparelho circulatório associam-se com o analfabetismo; as neoplasias associam-se com a maioria dos indicadores de pobreza; a cirrose hepática, o diabetes melito e a doença cerebrovascular pela ordem se destacam como causas associadas à pobreza. c) o impacto da eliminação e os indicadores sociais e econômicos mostraram associações diferente das encontrada entre os coeficientes; a cirrose hepática para ambos os sexos é a causa mais relacionada à pobreza; sucedida pelo câncer de estômago com os indicadores relacionados à renda e às condições hídricas; o diabetes melito apresenta a correlação com o analfabetismo e a doença lsquêmica associa-se negativamente com os indicadores econômicos (salário mínimo médio e renda familiar). CONCLUSÕES: 1. a comparação internacional dos coeficientes de mortalidade ajustados para a idade entre os 45 e 64 anos no quadriênio de 1984-87 mostrou que nas cidades brasileiras a importância das doenças crônicas é tão ou mais importante do que os Estados Unidos da América, o Canadá, a Austrália e os países europeus ocidentais. A maior semelhança nos padrões de mortalidade foram com os países do Leste europeu; as doenças cardiovasculares são o maior destaque entre as mulheres, principalmente a cerebrovascular. 2. apesar de existir correlação entre os coeficientes de mortalidade por gênero nas cidades, os coeficientes de mortalidade, o impacto da eliminação, as tendência temporais e os determinantes sociais são diferentes no sexo masculino e no feminino; a doença cerebrovascular é mais importante no sexo feminino com impacto da redução é maior entre as mulheres; a cirrose hepática e o câncer de pulmão é mais importante entre os homens; dos cânceres associados a dietas ricas em gorduras, o câncer de mama e associados é de importância maior do que o equivalente masculinos; o diabetes melito apresenta maiores coeficientes entre as mulheres; 3. o impacto da eliminação de uma causa básica na mortalidade geral mostrou ser um instrumento mais preciso do que os coeficientes e, discordou do posicionamento dos coeficientes: nas doenças do aparelho circulatório (masculino), todas as neoplasias (feminino), doença cerebrovascular (ambos os sexos), câncer de estômago (ambos os sexos), câncer de mama & associados e câncer de próstata e cólon-reto. 4. há diferenças entre as cidades na distribuição geográfica, não se obtendo o mesmo posicionamento por doenças entre duas cidades; as cidades - divididas entre as ao norte (BE, RE, SA, BH) e as ao sul (RJ, SP, CT, PA) tiveram o seguinte comportamento: a) ao sul, para o sexo masculino, as três principais causas são a doença isquêmica do coração, a cerebrovascular e a cirrose hepática e ao norte uma inversão entre a as duas primeiras causas, porém em Recife a doença isquêmica é a principal causa e a cirrose hepática a segunda e a doença cerebrovascular a terceira. b) o diabetes melito entre os homens das cidades ao norte ocupa um posicionamento mais elevado do que no sul, provavelmente pelo excesso de mortes em indivíduos do tipo insulina-dependente; c) entre as mulheres, não existe um padrão bem estabelecido norte-sul como entre os homens, embora a doença isquêmica do coração seja mais importante no sul do que norte. 5. as tendências de mortalidade são muito variáveis de cidade para cidade e de doença para doença e, devido ao pequeno tempo de estudo é difícil detectar um padrão específico de evolução temporal. No sexo masculino, PA e SP apresentam o mesmo comportamento, exceto o aumento da mortalidade geral nesta última cidade por causas externas; RE e RJ também apresentam comportamento parecido entre os homens, principalmente devido à doença Isquêmica e à cerebrovascular. 6. a questão da afluência ou da pobreza na relação com a mortalidade é complexa; somente a mortalidade por câncer de pulmão e o câncer de mama conseguiram estar nitidamente caracterizados como doenças da afluência; mostraram associação com a pobreza, a cirrose hepática, o diabetes melito e a doença cerebrovascular para ambos os sexos; as doenças do aparelho circulatório e todas as neoplasias no sexo feminino apresentaram relação com a pobreza.
BACKGROUND: Chronic diseases have been the main cause of mortality in the Brazilian metropolitan areas since the sixties. Chronic diseases are considered as a typical male and affluerrt people disease and their increase due to the fact that Brazilian is getting older. AIM: We studied the age strata from 35-years-old to 64-years-old to analyze the chronic disease-related prematura deaths. The questions are the following: 1. ls chronic disease-related prematura deaths higher in Brazil than abroad? 2. ls the strength of the prematura mortality higher in males than in females? Which is the best indicator for prematura mortality: age-adjusted rates or the impact of deaths elimination by Chiang\' method? Are there geographic or temporal differences in chronic diseases mortality rates among Brazilian metropolitans areas? 5. Which are the social and economics determinants of chronic diseases -related prematura deaths? DESIGN: ecological study with secondary database. DATABASE: We studied the deaths from the official mortality statistics from eight metropolitan areas: Belém (BE), Recife (RE), Salvador (SA), Belo Horizonte (BH), Rio de Janeiro (RJ), São Paulo (SP), Curitiba (C1), Porto Alegre (PA) from 1979 to 1989. Deaths causes analyzed were ali causes; ali circulatory diseases (ICD-9:390-459); ischemic heart disease (410-414); heart diseases pschemic heart disease (410-414) plus heart failure (428) plus , hypertension (401- 404)]; stroke (430-438); ali cancers (140-239); lung cancer (162); breast cancer (174); colon and rectal cancer rectum (153-154); endometriun and ovarian cancer (182-183); prostate cancer (185); other cancers, except lung cancer; diabetes melitus 250); obstructive respiratory [chronic obstructive pulmonary disease (490-496), induding asthma (493)]; cintlosis (571). The population was determined from the National Brazilian Census in 1980 and 1991. The other years were determined by linear irrterpolation. Social and economics indicators were extracted from the 1980-Census. We had chosen the rate of male illiteracy, the rate of female illiteracy, the difference between f emale and male rate illiteracy; rate of female workers; minimum wage; piped water; ove~ing rate (more than 2 people living in one room) and the rate of familiar income. METHODS: We have selected the main cities of Brazil 1. to compare with other courrtries, we used the age strata from 45 years-old to 64 years-old irrto the period 1984-87 with a irrtemational standard population to calculate the mortality rates. We compared ali causes of mortality, heart diseases, ischemic heart diseases, stroke, lung cancer and others cancers except lung cancer. 2. we analyzed in the population between 35-years-old and 64-years-old for both sexes, the correlation of mortality rates and the impact of death elimination with gender, geographic, temporal, and socia!-economic pattems among cities. 3. the mortality rates trends were plotted and the annual gap was calculated by linear regression model. 4. we used Spearman rank test to study the correlation between age-adjusted mortality rates and socialeconomics indexes and the impact of death elimination with them, RESULTS: 1. the irrtemational comparison shoo.ved that a) ali causes mortality amona males (RJ, PA, RE, CT, BH) and female (RE, SA, CT, BH e RJ) is very high; b) the prooortional mortality for \"cardiovascular plus cancer\" was allrvays lower in Brazilian cities than abroad. H ranged among Brazilian cities for men from 62 per cent (PA) to 45 per cent (SA) and for women from 69 per cent (RJ) to 56 per cent (BH, SA, SP). Stroke was a disease with proportional mortality higher in Brazil than in other courrtries.; c) heart diseases mortality rates for Brazilian men was ranked (Hungary, RJ, Finland, PA and Poland) in the medium and among women (RJ, CT, Hungary, PA and England & Wales) in the top. d) ischemic heart diseases showed the same pattem of heart diseases for men (Finland, Hungary, England & Wales, PA, RJ) than for women (RJ, CT, Hungary, PA, England & Wales). e) stroke had high rates for males (CT, BH, RJ, BE, Hungary) and the highest among females. f) luna cancer shoo.ved low rates for men (Hungary, Poland, ltaly, Holland, USA), although PA had the highest rates among Brazilian cities; for women showed lower rates (Denmark, USA, Canada, England & Wales, Hungary) g) the other cancers, except lung cancer had medium to the top values for males (France, Hungary, PA, POLAND, C1) and the same pattem for females (Denmark, England & Wales, Hungary, RE, PA) 2. the probability of death showed for men (RE, RJ, PA, BH, CT, SA, SP, BE) and for women (RE, SA, BH, CT, RJ, BE, SP, PA) an importarrt rank differential as observed in SA and PA; only the elimination of ali drculatory diseases would change the probability of deaths ranking among Brazilian cities. 3. the impact of elimination specitic-death in the general mortality showed variations a)for ali drculatory diseases for males from 39.9 per cent (C1) to 31,5 per cent (RE) and for females from 44,1 per cent (RJ) to 33,6 per cent ;b) to ischemic heart diseases for males from 17,0 per cent (C1) to 8,3 per cent (SA) and for females from 14,3 per cent (RJ) to 5,9 per cent (BH); c) to stroke for males from 12,0 per cent (C1) to 6,2 per cent (SP) and for females from 16,3 per cent (RJ) to 10,7 per cent (BH); d) for ali cancers, for males from 16,9 per cent (PA) to 9,7 per cent (RE) and for females from 27,2 per cent (RJ) a 19,6 per cent (BH); e) to gastric cancer, for males from 3,7 per cent (BE) to 0,8 per cent (RE) and for females from 7,9 per cent (BE) to 1,1 per cent (PA); f) to lung cancer, for males from 4,9 per cent (PA) to 1,8 per cent (RE) and for females from per cent (PA) to 1,0 per cent (SA, BH, RE); g) to prostate cancer/ colon and rectum from 3,6 o/o (C1) to 0,6 per cent (RE); h) to breast cancer/endometrium & ovarianlcolon & rectum from 11,1 per cent (PA) to 2.4 per cent (BE); Q for ali obstructive respiratory diseases for males from 3,6 per cent (PA) to 1,5 per cent (SA) and for females from 4,5 per cent (Cl) a 1,4 per cent (RE); j) to diabetes mellitus for males from 2.7 per cent (BH) to 1,3 per cent (BE) and for females from 6.4 per cent (SA) to 3,0 per cent 10 (SE); k) to cintlosis for males from 9,1 o/o (RE) to 3,2 per cent (SA) and for females from 4,8 per cent (RE) to 1 ,8 per cent (SP); 4. comparing the impact of death elimination by a specific cause in the general mortality and age-adjusted mortality rates showed Speannan rank correlation coefficient with statistical significance for the majority of diseases, except for ali circulatory diseases (male) and for ali cancers (female), to ischemic heart disease (both sexes) and gastric cancer (both sexes) had positive values, without statistical significance. Stroke (both sexes), breast cancer/endometrium & ovarian/colon & rectum and prostate cancer/colon & rectum had correlation coefficients very loW. 5. The trends of ali causes mortality during 1979-89 varied annually for males from -0,84 per cent (Cl) to +15 per cent (RJ) anel for females from -0,96 per cent (Cl) to -0,15 per cent (RJ); ali circulatory diseases varied for males from -0,84 per cent (Cl) to +2,50 per cent (RE) and for females from -0,96 per cent (Cl) to +0,33 per cent (RJ); ischemic heart disease varied for males from -0,88 per cent (SE) to +6,08 per cent (RJ) anel für females from -0,88 per cent (SE) to +2,86 per cent (RJ); a stroke varied for males from -0,74 per cent (Cl) to +6,62 per cent (BH) anel forfemales from -0,97 per cent (Cl) to +5,15 per cent (RE); ali cancers varied for males from -0,93 per cent (Cl) to +0,49 per cent (RE) anel for females from -0,94 per cent (Cl) to +1 ,60 per cent (PA); lung cancer varied for- males from -0,84 per cent (Cl) to +2,88 per cent (RE) anel for females from -0,85 per cent (Cl) to 25,54 per cent (SA). Prostate/colon & rectum varied from -0,92 per cent (BE) to +4,52 per cent (SP); Breast /endometrium & ovariurnl colon & do rectum varied from -0,83 per cent (SE) to +1,01 per cent (PA); ali obstrudive respiratory diseases varied for males from -5,98 (PA) to +2,63 (RE) anel for females from -1,53 per cent (RE) + 7,87 per cent (Cl); diabetes mellitus for males from -6,27 per cent (Cl) to +2,63 per cent (RE) and. for females from -0,78 per cent (SP) e +2,09 per cent (BH) and cintlosis varied for males from -0,73 per cent (SE) e +6,83 per cent (SA) and for females from -0,97 per cent (SE) e +2,01 per cent (RJ). 6. the comparison with social inelicators by bi-variate analysis with Spearman correlation rank showed: a) rates-male: ali causes deaths had no correlation; ali cancers showed an inverse relationship with illiteracy anel ovefCI\"()\'Mjing anel a positiva relationship with piped water; lung cancer had a negativa correlation with female illiteracy and the geneler gap of illiteracy; prostate cancer/ colon & rectum had an inverse correlation with female illiteracy; ali circulatoiy diseases anel ischemic heart disease had an inverse association with ovefCI\"()\'Mjing; the other causes of mortality did not show any kind of correlation with social inelicators. b) rates- female; lung cancer showed negative association with male anel female illiteracy; breast cancer had an inverse relationship with ovefCI\"()\'Mjing anel a direct relationship with piped water. c) imoact of elimination- mate; ali cancers had an inverse correlation with mate and female illiteracy; lung cancer had negativa association with female illiteracy anel geneler gap illiteracy. d) impact of elimination- female; ali cancers had an inverse correlation with geneler gap illiteracy; lung cancer had an inverse correlation with female anel male illiteracy and the gender gap illiteracy. 7. qualitative analysis based on correlation test was perfon:ned to verify the association with poverty (or affluence). a) male sex- ali causes and diabetes were associated with illiteracy; cintlosis had a positiva correlation with ali inelicators of poverty; stroke had the same pattem of dntlosis, but with less strength; b) female - ali causes had a more significam association with poverty than for males; ali circulatory diseases had an association with illiteracy; ali cancers had an association with the majority of inelicators of poverty; cintlosis, diabetes and stroke are the basic causes more associated with poverty. c) the impact of elimination and the social inelicators had a different pattem of correlation than that obseJVed with mortality rates; dntlosis for both sexes was the cause with the more strength correlation with poverty; it was succeed by gastJic cancer with income anel sanitary indicators; diabetes had a relationship with illiteracy and ischemic heart disease had an inverse relationship with minimum wage and familiar income. CONCLUSIONS: 1. the intemational comparison of age-adjusted mortality rates in the age strata 45-years-old to 64- years-old during the period 1984-87 showed that Brazilian cities had been a high mortality pattem of chronic diseases, so important or more than in Europe or United States. The Brazilian pattem of mortality is similar than Eastem Europe; ali cardiovascular diseases among Brazilian women were more important than other diseases, mainly stroke. 2. an important geneler gap was detennined for ali chronic diseases in the intemational comparison, impact of elimination, temporal trends and social inelicators; stroke and diabetes were a more impressive cause of death among women than in men; cintlosis and lung cancer were more important among men; 3. the impact of elimination of a specitio-death in the general mortality showed that it should be a better inelicator than mortality rates; there was a disagreement between the cities rank for ali circulatory diseases (mate), for ali cancers (female), stroke (both sexes), gastric cancer (both sexes), breast cancer anel prostate cancer/colon & rectum. 4. the cities localized in the north (SE, RE, SA, BH) anel in the south (RJ, SP, CT, PA) had a pattem as foiiO\'Ning: a) in the southem cities for males, the main causes are ischemic heart disease, stroke and cintlosis In the northem cities there were an inverse position between stroke and ischemic heart disease b) diabetes for male is more important in the north than in the south; c) among women there was not a specific geographic pattem like that obseJVed among men, except for ischemic heart disease that is more important in the south. 5. mortality rates trends showed different pattems among cities anel diseases. 6. the relationship between poverty (and affluence) with mortality is complex; only lung cancer and breast cancer had a typical affluent pattem; in contrast, cintlosis, diabetes and stroke (for both sexes); ali circulatory diseases and ali cancers (forwomen) _ had a poverty pattern

Four hundred and thirty-eight participants who had lost a close friend or family in the last 2 years completed questionnaires regarding their experiences with the funeral. Results indicated individuals emotionally close to the deceased person reported higher levels of participation in funeral rituals and greater levels of bereavement adjustment. Those emotionally distant from the deceased person reported greater satisfaction with the funeral. Individuals who viewed the deceased person as a central figure in their lives had greater participation in the funeral. Those who viewed the deceased person as a peripheral figure had higher levels of bereavement adjustment. Additionally, those who viewed the death as unpreventable reported greater satisfaction with the funeral, and had higher levels of bereavement adjustment.

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This paper intends to explore the ambiguity of the term passion, as lack or as excess, in correlation with love in the relationship mother-child, coming particularly from the autism. Therefore, a broader journey was necessary, that is: on the subject's structuring and its vicissitudes. We began from a clinical case in which a mother, apparently marked by the a-pathy, takes his son and makes the analyst uncomfortable. The maternal failure is, thus, called in question. In what measure does the maternal apathy contribute to take the child to a psychopathology as serious as the autism, impeding him from constituting as a subject? And more: and the opposite? The excess, that is, the passion, would not have consequences? Would not it contribute also to this? Suddenly the clinic itself gives us subsidies to articulate the research. No longer the apathy, but the passion in its excessive and deadly aspect. How understanding two so different aspects of passion ? This way, several strings apparently different are being tied until we reach the conclusion that, between passion and "maternal love", there is an abyss. This research is over or it is interrupted here, when it can only move forward making a deeper study of the female subjectivity question
Este trabalho se dedica a explorar a ambigüidade do termo paixão, como falta ou como excesso, em correlação com o amor na relação mãe-criança, partindo particularmente do autismo. Para tanto, fez-se necessário um percurso mais abrangente, ou seja: sobre a estruturação do sujeito e suas vicissitudes. Partimos de um caso clínico em que uma mãe aparentemente marcada pela a-patia traz seu filho e produz incômodo na analista. O fracasso materno é, assim, questionado. Em que medida a apatia materna contribui para levar a criança à psicopatologia tão grave como o autismo, impedindo-a de constituir-se como sujeito? E mais: e o seu oposto? O excesso, ou seja, a paixão também não teria conseqüências? Eis que a própria clínica nos dá subsídios para articular a pesquisa. Não mais a apatia, mas a paixão em seu aspecto excessivo e mortífero. Como compreender duas presentificações da paixão tão diferentes? Desta forma, diversos fios aparentemente diversos vão se amarrando até chegarmos a conclusão de que entre a paixão e o amor materno há um abismo. Esta pesquisa termina ou se interrompe aqui. No momento em que só pode avançar com o aprofundamento da questão da feminilidade

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Este trabalho pretende examinar os diversos modos de findar presentes, prioritariamente, na obra Ser e Tempo, do filósofo alemão Martin Heidegger. Assim, será necessário abordar, primeiramente, a proposta heideggeriana de uma ontologia fundamental para, a partir daí, podermos explicitar, em detalhes, a constituição deste caractere existenciário: o “ser-para-a-morte”. Doravante, faremos uma análise destes modos do findar, tendo como referência suas variáveis, como o “cessar-de-viver”, o “findar”, o “deixar-de-viver” e o “ser-para-a-morte”, ponto principal deste trabalho. Também será abordado o modo pelo qual o Dasein chega à compreensão de sua morte, por meio do desvelamento de seu ser proporcionado pelo despertar de uma tonalidade afetiva fundamental. Por fim, faremos um breve apêndice para traçar uma possível relação entre o conceito de ser-para-a-morte e a noção de apelo-da-consciência, cujo objetivo é averiguar as aplicações ônticas da compreensão da morte enquanto possibilidade-de-ser iminente, certa e intransferível.
This paper intends to examine the various modes of ending present, mainly, in the work Being and Time, of the German philosopher Martin Heidegger. Therefore, it will be necessary to approach, first of all, the Heidegger’s proposal for a fundamental ontology to make possible to explain thenceforward, in detail, the constitution of this existential character: the “being-towards-death” (Sein-zum-Tode). Henceforth, we will make an analysis of these modes of ending with reference to their variables, such as “perishing” (Verenden), “ending” (Enden), “demise” (Ableben) and “dying” (Sterben), main point of this paper. It will also be approached the mode by which Dasein reaches the comprehension of its death, through the unveiling of its own being provided by the awakening of a ground mood (Grundstimmung). Lastly, we will make a brief appendix to draw a possible relation between the concept of being-towards-death and the idea of conscience as a call (Gewissensruf), whose aim is investigating the ontical applications of death’s comprehension as imminent, certain and nontransferable possibility-of Being.

BACKGROUND: Organ transplantation is one of the best modalities for treating fatal organ failure. Despite the success of this procedure, an increasing incidence of cancer in this population has drawn the attention of public health officials in recent years. OBJECTIVES: The overall objective of this study is to conduct a detailed examination of adverse health outcomes among Canadian organ transplant recipients, with an emphasis on cancer incidence and mortality. METHODS: This project employed a retrospective cohort follow-up study design, whereby Canadian Organ Replacement Registry records were linked to the Canadian Mortality Database and the Canadian Cancer Registry Database. The study population consisted of more than 16,000 solid organ transplant recipients registered between January 1, 1981 and December 31, 1998. This study was designed to assess the risks of developing cancer, overall and site-specific, in transplant recipients in comparison to the general Canadian population using Standardized Incidence Ratios (SIR), Standardized Mortality Ratios (SMR), and Proportionate Mortality Ratios (PMR). In addition, Cox and logistic models were used to assess the effects of various risk factors on cancer incidence and mortality in transplant sub-populations, while cumulative incidence was used to study the patient survival pattern. Lastly, Population Attributable Risk (PAR) was used to quantify the impact of organ transplantation on cancer incidence and mortality. RESULTS: Among major causes of death, the highest PMRs are due to genitourinary diseases, followed by endocrine, nutritional and metabolic diseases, and infectious diseases. SIRs indicate that cancer incidence and mortality were relatively lower than that observed for other major causes of death, and slightly higher than that observed in the general Canadian population. Lastly, logistic regression results indicate that age, year of surgery, and smoking status were significant risk factors in mortality due to all causes, while the Cox regression model shows that age, sex and year of surgery were significant risk factors for cancer incidence. Overall, the PAR in this cohort was very minimal, indicating that the risk in mortality and cancer incidence due to organ transplantation is negligible. CONCLUSION: Life threatening diseases such as those of the genitourinary system, as well as endocrine, nutritional and metabolic diseases and infectious diseases are leading causes of death. Future research should be directed at ways of reducing incidence and subsequent mortality due to these causes.

Master of Arts (Research)
This thesis examines a ledger which listed all the causes of death in Darlinghurst Gaol, Sydney’s main gaol, from 1867 to 1914 when the gaol was closed and all the prisoners were transferred to the new Long Bay Gaol at Maroubra. The ledger lists the name of the deceased prisoner, the date of their death, the age of the prisoner at the time of their death and the cause of death along with any special comments relevant to the death where necessary. This ledger was analysed in depth and the death rates and diseases causing the deaths were compared to the general population in New South Wales and Australia as well as to another similar institution namely Auburn Prison, the oldest existing prison in New York State and the general population of the United States of America (where possible). Auburn Prison was chosen because it was the only other prison in the English speaking world (British Empire and United States of America) that had a similar complete list of deaths of prisoners in the same time frame – in this case beginning in 1888. The comparison showed that the highest death rates were in the general population of the United States of America (statistics on New York State alone could not be found) followed by Auburn Prison followed by the general population of Australia then the general population of New South Wales (the latter two were very similar) and the lowest death rates were in Darlinghurst Gaol. The analysis showed that individuals were less likely to die in the main prison, compared to the relevant general population in New South Wales and New York State despite the fact that 8 – 9% of these prison deaths were due to executions, a cause of death not encountered in the general population. This thesis explores the reasons why mortality rates were lower in prison despite the popular perception was that Victorian era gaols were places of harshness, cruelty and death (think of the writings of Charles Dickens, the great moralist writer who was the conscience of the era) compared to the general free population.

Aim: To determine whether antecedents or combinations of antecedents are associated with stillbirths that are currently considered to be unexplained. Background: Between 1980 -1993 in Western Australia. 2569 babies were delivered stillborn. No sufficient cause of death could be identified for 1291 of these babies. This is a significant health issue that warranted further investigation. The objective of such a review was to provide baseline evidence that could be used to recommend the development of preventative strategies such as health promotion programs that could be implemented to potentially reduce or prevent the number of unexplained stillborn babies. The development of such strategies required a detailed analysis of the antecedents to currently unexplained stillbirth.

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O indicador Anos Potenciais de Vida Perdidos (APVP) representa uma alternativa metodológica para análise da mortalidade precoce e das iniquidades em saúde. Este estudo aliou o indicador APVP às técnicas de análise espacial, com inclusão do estimador bayesiano empírico, para o estudo da mortalidade precoce decorrente do grupo das causas externas e seus principais agrupamentos, no Estado de São Paulo, em 2000 e 2010. Os anos potenciais de vida perdidos decorrentes da mortalidade por causas externas apresentaram variações significativas, no Estado de São Paulo, entre os anos 2000 e 2010. Foram contabilizados 31.190 óbitos, que determinaram 1.190.308,5 APVP e taxa de APVP padronizada de 3.274,05 APVP/100 mil habitantes para o grupo das causas externas em 2000 e, em 2010, 20.226 óbitos, 676.702 APVP e taxa de APVP padronizada de 1.729,07 APVP/100 mil habitantes, com reduções no período de 35,15%, 43,15%, 47,19%, respectivamente. As variações foram observadas nos dois gêneros, sendo mais expressiva no gênero masculino. A maior redução de APVP se deu na mortalidade por agressões e os maiores incrementos deram-se nas quedas e nas lesões autoprovocadas intencionalmente. Em 2010, em número absoluto de APVP, os acidentes de transporte passaram a representar o principal grupo, seguidos das agressões e das lesões autoprovocadas intencionalmente. Entre os anos de 2000 e 2010, as taxas de APVP padronizadas do grupo das causas externas e agrupamento das agressões apresentaram maior redução nos homens, os acidentes de transporte apresentaram incremento nos homens e discreta diminuição nas mulheres, as lesões autoprovocadas intencionalmente apresentaram acréscimo maior nos homens em relação às mulheres, nas quedas o incremento maior foi observado nas mulheres e os afogamentos apresentaram redução semelhante. Observou-se aumento na idade de ocorrência do óbito, nos gêneros masculino e feminino,...
The Years of Potential Life Lost (YPLL) is an alternative methodology for the analysis of early mortality and health inequities. This study allied YPLL with spatial analysis, including the empirical bayesian method for the study of early mortality caused by a group of external causes and their main groupings in the State of São Paulo in 2000 and 2010. The YPLL caused by mortality from external causes showed significant variations in the State of São Paulo between 2000 and 2010. This study accounted 31,190 deaths, which determined 1,190,308.50 YPLL and standardized YPLL rate 3,274.05 YPLL/100 thousand inhabitants for the group of external causes in 2000 and, in 2010, 20,226 deaths, 676,702 YPLL and standardized YPLL rate of 1,729.07 YPLL/100 thousand inhabitants, with reductions in the period of 35.15%, 43.15% and 47.19%, respectively. Variations were observed for both sexes, more significantly for men. The largest YPLL reduction occurred in mortality from homicides and the largest increments were in falls and suicides. In 2010, in the absolute number of YPLL, transportation accidents represented the main group, followed by homicides and suicides. Between 2000 and 2010, standardized YPLL rates of the external causes group and grouping of homicides showed greater reduction for men, transportation accidents showed an increase for men and a slight decrease in women, suicides showed greater increase in men compared to women, the highest increase in falls was ...

Orientador: Luana Carandina
Banca: Jair Lício Ferreira Santos
Banca: Maria Lúcia Lebrão
Banca: Ana Teresa de Abreu Ramos Cerqueira
Banca: Paula Araujo Opromolla
Resumo: O indicador Anos Potenciais de Vida Perdidos (APVP) representa uma alternativa metodológica para análise da mortalidade precoce e das iniquidades em saúde. Este estudo aliou o indicador APVP às técnicas de análise espacial, com inclusão do estimador bayesiano empírico, para o estudo da mortalidade precoce decorrente do grupo das causas externas e seus principais agrupamentos, no Estado de São Paulo, em 2000 e 2010. Os anos potenciais de vida perdidos decorrentes da mortalidade por causas externas apresentaram variações significativas, no Estado de São Paulo, entre os anos 2000 e 2010. Foram contabilizados 31.190 óbitos, que determinaram 1.190.308,5 APVP e taxa de APVP padronizada de 3.274,05 APVP/100 mil habitantes para o grupo das causas externas em 2000 e, em 2010, 20.226 óbitos, 676.702 APVP e taxa de APVP padronizada de 1.729,07 APVP/100 mil habitantes, com reduções no período de 35,15%, 43,15%, 47,19%, respectivamente. As variações foram observadas nos dois gêneros, sendo mais expressiva no gênero masculino. A maior redução de APVP se deu na mortalidade por agressões e os maiores incrementos deram-se nas quedas e nas lesões autoprovocadas intencionalmente. Em 2010, em número absoluto de APVP, os acidentes de transporte passaram a representar o principal grupo, seguidos das agressões e das lesões autoprovocadas intencionalmente. Entre os anos de 2000 e 2010, as taxas de APVP padronizadas do grupo das causas externas e agrupamento das agressões apresentaram maior redução nos homens, os acidentes de transporte apresentaram incremento nos homens e discreta diminuição nas mulheres, as lesões autoprovocadas intencionalmente apresentaram acréscimo maior nos homens em relação às mulheres, nas quedas o incremento maior foi observado nas mulheres e os afogamentos apresentaram redução semelhante. Observou-se aumento na idade de ocorrência do óbito, nos gêneros masculino e feminino, ...
Abstract: The Years of Potential Life Lost (YPLL) is an alternative methodology for the analysis of early mortality and health inequities. This study allied YPLL with spatial analysis, including the empirical bayesian method for the study of early mortality caused by a group of external causes and their main groupings in the State of São Paulo in 2000 and 2010. The YPLL caused by mortality from external causes showed significant variations in the State of São Paulo between 2000 and 2010. This study accounted 31,190 deaths, which determined 1,190,308.50 YPLL and standardized YPLL rate 3,274.05 YPLL/100 thousand inhabitants for the group of external causes in 2000 and, in 2010, 20,226 deaths, 676,702 YPLL and standardized YPLL rate of 1,729.07 YPLL/100 thousand inhabitants, with reductions in the period of 35.15%, 43.15% and 47.19%, respectively. Variations were observed for both sexes, more significantly for men. The largest YPLL reduction occurred in mortality from homicides and the largest increments were in falls and suicides. In 2010, in the absolute number of YPLL, transportation accidents represented the main group, followed by homicides and suicides. Between 2000 and 2010, standardized YPLL rates of the external causes group and grouping of homicides showed greater reduction for men, transportation accidents showed an increase for men and a slight decrease in women, suicides showed greater increase in men compared to women, the highest increase in falls was ...
Doutor

As informações sobre mortalidade materna constituem uma importante fonte de dados para estudos epidemiológicos, demográficos e para o planejamento, gerência, vigilância e avaliação das múltiplas intervenções intersetoriais, desde os níveis mais simples até os mais complexos, na perspectiva de reivindicar os direitos das mulheres à vida no mundo e entre elas o direito à maternidade segura. O presente trabalho discute as causas múltiplas de morte materna, isto é, as causas básicas segundo a 9a Rev. e 10a Rev. da Classificação Internacional de Doenças (CID) e as causas associadas, verificando o número de diagnósticos, sua tabulação e associações de causas, segundo a 10a Rev., nos atestados de óbito refeitos baseados em informações obtidas prospectivamente de quatro fontes: - atestado de óbito obtido no Programa de Aprimoramento das Informações em Mortalidade no Municfpio de São Paulo (PRO-AIM), - entrevistas domiciliares, - prontuários hospitalares e - laudos de necropsia dos Serviços de Verificação de Óbito (SVO) e Instituto de Medicina Legal (IML), quando disponíveis. Assim, mostram-se as características epidemiológicas e analisam-se os fatores de responsabilidade e evitabilidade das mortes de mães residentes e ocorridas no Município de São Paulo-Brasil, no perrodo de 01 de dezembro de 1993 até 31 de maio de 1994. ed 31.224 atestados de óbito revisados, foram registrados 2.286 casos de óbitos de mulheres de 10-49 anos e 37 casos de morte materna, registrados pelo PRO-AIM/9a Rev.-CID. Encontramos, após o estudo, 52 casos de morte materna/9a Rev., e 69 casos/10a Rev., portanto ocorrendo uma morte materna a cada 3,5 dias/ 9a Rev.-CID e a cada 2,6 dias/10a Rev.-CID· Resultando em um coeficiente de morte materna de 48,04 x 100.000 nascidos vivos. Das causas básicas em ambas Revisões-CID, verificaram-se: 60,9 por cento mortes maternas obstétricas diretas (MMOD), das quais: 1)- abortos 23,8 por cento ; destes 60,0 por cento provocados; 2)- hemorragias 21,4 por cento ; destas, 55,5 por cento hemorragias pós-parto; 3)- outras causas diretas 21,4 por cento ; compreenderam embolias, complicações anestésicas e cirúrgicas; 4)- transtornos hipertensivos 19,0 por cento ; destes 50,0 por cento foram eclâmpsias e 5)- infecções 14,3 por cento ; predominaram as infecções puerperais. As mortes maternas obstétricas indiretas (MMOI), 14,5 por cento , predominaram as cardiovasculares. Com a 10a Rev., nas mortes maternas não obstétricas (MMNO), 13,0 por cento , predominaram os acidentes de trânsito 66,7 por cento , seguidos por homicídios e suicídio. As mortes maternas tardias (MTT), 11,4 por cento , com predomínio da Sindrome de Imunodeficiência Adquirida (SIDA) 75,0 por cento , seguida de Diabetes mellitus e Coriocarcinoma. A concordância foi de 42,3 por cento das causas básicas das mortes maternas obstétricas (MMO), entre atestados originais(AO) e atestados refeitos (AR) pela 9a Rev. (três algarismos) e de 36,4 por cento pela 10a Rev. (três caracteres). Esta diferença é explicada pelo incremento de caracteres no Cap. XI/10a Rev. e a concordância do total de mortes maternas (MM)/10a Rev. é 36,2 por cento . A média de diagnósticos nos atestados originais (AO) foi 2,9, verificando-se diminuição em relação à dos anos anteriores e 6,8 por atestado refeito (AR). Discute-se a necessidade de se incrementar uma linha adicional (d) na I Parte do atestado de óbito. Para as mortes maternas (MM), foram encontradas as causas associadas: 1-Causas terminais: 1 a- Cap. X-Doenças do Aparelho Respiratório 47,8 por cento ; 1 b- Cap. XVIII-Sintomas, Sinais e Achados Anormais de Exames Clínicos e de Laboratório, não Classificados em Outra Parte 17,4 por cento ; 1c- Cap. XIX-Lesões, Envenenamentos e Algumas Outras Conseqüências de Causas Externas 14,5 por cento . 2- Causas conseqüenciais intermediárias: encontrou-se 2a- Cap. XIX-Lesões, Envenenamentos e Algumas Outras Conseqüências de Causas Externas 78,3 por cento ; 2b- Cap. III-Doenças do Sangue e dos Órgãos Hematopoéticos a Alguns Transtornos lmunitários 56,5 por cento ; 2c- Cap. XVIII- Sintomas, Sinais e Achados Anormais de Exames Clínicos e de Laboratório, não Classificados em Outra Parte 40,6 por cento . 3- Causas contribuintes: 3a- Cap.XV-Gravidez, Parto e Puerpério 43,5 por cento ; 3b- Cap IX-Doenças do Aparelho Circulatório 26,1 por cento . 3c- Cap.III- Doenças do Sangue e dos Órgãos Hematopoéticos e Alguns Transtornos Imunitários 23,2 por cento . Das mortes maternas (MM), 53,6 por cento foram declaradas e 46,4 por cento não foram declaradas. Do total de mortes, ocorreram: 81.2 por cento nos hospitais, 11,6 por cento na via pública e 7,2 por cento nos domicílios. Das características das falecidas: as mortes maternas (MM) corresponderam a mulheres procedentes de outros estados, com menor grau de escolaridade, do lar, com salários muito baixos. A maioria com mais de quatro gestações e intervalo de gestações menor que dois anos. A maioria teve controle pré-natal (CPN) e mais de quatro CPN. A via de parto: 63,2 por cento cesarianas, 34,2 vaginal e 2,6 por cento forceps. A maioria de recém-nascidos (RN) nasceu viva e com peso acima de 2500 gramas. As mortes maternas ocorreram em 42,0 por cento no puerpério; 40,5 por cento na gravidez; 11,6 por cento entre 43 dias-até um ano após termo da gestação e 5,8 por cento no intraparto. Usaram anticonceptivos os 33,3 por cento de casos. Em 13,0 por cento houve dificuldades no transporte aos hospitais; 41,1 por cento procuraram mais de um hospital para obter atenção e a maioria morreu em Unidade de Terapia Intensiva (UTI). A opinião dos familiares acerca do atendimento, em sua grande maioria - acharam que a paciente não foi bem atendida e responsabilizaram o médico. Quanto à responsabilidade das mortes maternas (MM), verificamos: 65,2 por cento fatores de ordem profissional; 56,5 por cento hospitalar; 24,6 por cento da paciente e 24,6 por cento não determinados. Verificamos quanto à evitabilidade das mortes maternas: 69,6 por cento mortes evitáveis, sendo das hospitalares 76.8 por cento ; e destas, 92,1 por cento de mortes maternas obstétricas diretas (MMOD). A analise das causas múltiplas das mortes maternas, melhora a avaliação dos fatores de responsabilidade e evitabilidade, permitindo direcionar as medidas preventivas. Recomenda-se seu uso no Sistema de Vigilância Epidemiológica da Morte Materna(SVEMM) e nas atividades dos Comitês de Morte Materna.
The information on maternal mortality is an important source of data for epidemiological and demographic studies; planning, policy and evaluation of multiple interventions that garantee to all women a safe motherhood. The present research carried out between 1st Dez. 1993 - 31st May 1994, discusses in details the multiple causes of maternal mortality in São Paulo city, according to the underlying causes of death in the 9th and 10th Revisions of the International Classification of Diseases (ICD), verifying the number of diagnostics, tabulations and associations of causes in the 10th Rev. of ICD . It utilizes prospectively 4 sources of data: the original death certificate obtained from the Programme for Vital Registration and Statistics deaths in São Paulo city (PRO-AIM), home interviews, hospital records, necropsy exams (when avaliable), showing the epidemiological characteristics of the maternal deaths and analysing the factors responsible for the deaths, and wich of them could be avoided. From the 31224 revised death certificates there were 2286 causes of death of women from 10-49 years of age, and 37 cases of maternal death registered at PRO-AIM/ICD-9. We found 52 cases of maternal death in ICD-9 and 69 cases of death in ICD-10, resulting in a maternal mortality rate of 48.04 per 100.000 live births. According to ICD-9 there was one maternal death every 3.5 days and according to ICD-10 there was one maternal death every 2.6 days. The underlying causes of deaths in ICD-9 and ICD-10 were: 1- Direct maternal death- 60.9 per cent , 1 a- abortion -23.8 per cent (60.0 per cent unsafe abortion), 1 b- haemorrhage -21.4 per cent (55.5 per cent post-partum haemorrhage), 1 c- embolism, anesthetic, surgical complications, etc. 1 d- hypertensive disorders -19.0 per cent (50.0 per cent eclampsia), 1e- infections -14.3 per cent (predominance of puerperal infections). 2- Indirect maternal deaths -14,5 per cent (most of the causes were cardiovascular disorders). The underlying causes of death in ICD-10 were: 1- Non-obstetrical causes of death -13.0 per cent , 1a- traffic accidents -66.7 per cent , followed by suicide and homicides. 2- Late maternal mortality -11.4 per cent , 2a- AIDS -75.0 per cent , followed by Diabetes mellitus and Coriocarcinoma. There was an agreement of 42.3 per cent in ICD-9 and 36.4 per cent in ICD-10, in relation to the direct and indirect underlying causes of death, comparing the original deaths certificates obtained from PRO-AIM, and the revised deaths certificates obteined from PRO-AIM, home interviews, hospital records and necropsy exams. This difference can be explained by the number of characters in Chapter XI/CID-10. The agreement for total maternal mortality in ICD-10 is 36.2 per cent . The mean number of diagnostics in the original death certificate is 2.9 and in the revised death certificate is 6.8. We propose the addition of another item in the first part of the death certificate (d tine). The associated causes of maternal mortality were: 1- Terminal, 1 a- Chap. X-Diseases of the respiratory system -47.8 per cent ; 1b- Chap.XVIII- Symptoms, signs and abnormal clinicai and laboratory findings, not elsewhere classified -17.4 per cent ; 1 c- Chap. XIX-Injury , poisoning and certa in other consequences of external causes -14.5 per cent . 2- Intermediary causes of maternal mortality, 2a-Chap. XIX-Injury, poisoning and certain other consequences of external causes -78.3 per cent ; 2b- Chap. III-Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism -56.5 per cent ; 2c- Chap. XVIII-Symptoms, signs and abnormal clinical and laboratory finding, not elsewhere classified -40.6 per cent . 3- Contributory causes of maternal mortality, 3a Chap. XV-Pregnancy, childbirth and the puerperium -43.5 per cent ; 3b- Chap. IX- Diseases of the circulatory system -26.1 per cent , 3c- Chap III-Diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism -23.2 per cent . Fifty three point six percent (53.6 per cent ) of the maternal deaths were registered in the original death certificate, bout 46.4 per cent were not registered. From all of these deaths: 81.2 per cent were in hospital, 11.6 per cent in the street, 7.2 per cent at home. The characteristics of the maternal deaths were: women coming from other States of the Federation; low maternal education; women not working outside home; low income; more than 4 gestations; less than 2 years interval of gestations and more than 4 antenatal care visits. According to the type of delivery, 63.2 per cent of the women delivered by cesarean, 34.2 per cent had normal deliveries and 2.6 per cent had forceps. Thirteen percent (13.0 per cent ) of the women did not get transport to go to a hospital; 33.3 per cent utilized contraceptives; 41.0 per cent went to more than one hospital to get medical attention; 42.0 per cent of the women died during the puerperium; 40.5 per cent of the women died during pregnancy; 11.6 per cent of the women died in the period between 43-365 days of after pregnancy and 5.8 per cent of the women died during labor. The majority of the babies were born with a weight higher than 2.5 Kg. The relatives of the women that died, did not appreciate the quality of the attendance of the medical doctors. We conclude that among the factors responsible for the maternal mortality in São Paulo city: 65.2 per cent are related to professional factors, 56.5 per cent hospital factors, 24.6 per cent patients factors and 24.6 per cent undetermined factors. Sixty nine point six percent (69.6 per cent ) of the deaths could be avoided, 76.8 per cent of the deaths were at hospital level and 92.1 per cent of these hospital deaths were direct causes of deaths. The analysis of the multiple causes of maternal death improve the evaluation of the factors of responsability and preventability allowing the implementation of preventive measures. We recommend its utilization in the Epidemiological System of Vigilance of Maternal Mortality (SVEMM) and in the activities of the Maternal Mortality Study Committee.

L’objectif de cette étude était d'étudier les différences de mortalité régionales en Ukraine, les structures par causes de décès et les tendances à différentes échelles spatiales. Tout d'abord, des contrastes géographiques nets ont été mis en évidence : pour les hommes, entre l'ouest et l'est de l'Ukraine, et pour les femmes - entre l'ouest et le sud-est. L’étude des disparités régionales en fonction de l’âge révèle que les régions les plus avancées sont caractérisées par une diminution de la mortalité chez les personnes les plus âgées. Dans les grandes villes, pour la plupart des causes de décès (à l'exception du cancer et des maladies infectieuses) vivre dans une grande métropole est un avantage pour survivre. Le cas de la ville de Slavoutytch qui avait particulièrement souffert de l'accident de Tchernobyl a fait l’objet d’une analyse spécifique. Deuxièmement, une attention particulière a été portée aux schémas régionaux de mortalité par causes médicales de décès et a montré que les régions ukrainiennes se trouvent à différents stades de la lutte contre les maladies dégénératives. Enfin, les particularités de la dynamique de deux dernières décennies ont été étudiées. Pendant cette période l'espérance de vie a connu une forte baisse, suivie d’une stagnation, puis d’un début de reprise. Ces évolutions se sont accompagnées d’une transformation des schémas régionaux de mortalité par cause. Ces changements, qu’ils soient majeurs ou plus modestes n’ont pas été réellement identifiés par les pouvoirs publics et aucune avancée sanitaire décisive ne s’est produite dans aucune des régions de l'Ukraine. Il n'y a eu ni stratégies, ni mesures ou réformes efficaces mises en œuvre pour permettre une amélioration substantielle de la santé de la population
The aim of this study was to investigate regional mortality differences in Ukraine, cause-of-death patterns and trends at different spatial scales. First of all, general contrasts were established: for males between the west and east of Ukraine, while for females between the west and south-east. Study of regional disparities in respect of different age groups revealed that regions that succeeded the most are those characterized by decreased mortality at older ages. As for big cities, for the most of cases of death (except cancer and infectious diseases) living in a big metropolis is an advantage to surviving. The special case of the city of Slavutych that suffered the most from Chernobyl accident was studied. Second, special attention was given to regional patterns of mortality for different medical cause of death, and which showed that Ukrainian regions are at different stages in the fight against man-made and degenerative diseases. Lastly, peculiarities of dynamics over last two decades were investigated. During this period life expectancy has experienced a sharp decrease, followed by stagnation, and recovery. This evolution was accompanied by transformation of regional cause-specific mortality patterns. These changes, larger and smaller, were not actually accounted for by public authorities and no important breakthroughs happened in any Ukraine region. There were no efficient strategies, measures or reforms implemented that would allow substantial improvements in the health of the population

O estudo das causas múltiplas de óbitos permite conhecer a extensão real das estatísticas de mortalidade, minimizando a subestimação dos dados de mortalidade por asma. O objetivo desta pesquisa foi avaliar a tendência das taxas de mortalidade por asma informada em qualquer linha ou parte do atestado médico da declaração de óbito, no município do Rio de Janeiro, no período de 2000-2009. Os dados foram obtidos no Sistema de Informações de Mortalidade (SIM), no período de 2000 a 2009, nas Declarações de Óbitos (DO) registradas com CID-10 J45 e J46, de residentes do município do Rio de Janeiro, com um ano ou mais de idade. Foram calculadas taxas de mortalidade padronizadas por idade, nas seguintes faixas etárias: 1-4 anos, 5-34 anos, 35-59 anos, 60 e mais anos, considerando-se asma como causa básica e como causas múltiplas, segundo gênero para cada ano do período. Para análise de dados foi utilizado a técnica de regressão linear. No período de 10 anos a asma foi causa básica em 67,2% dos óbitos que mencionaram asma. A subestimação da mortalidade por asma como causa básica, foi igual a 48,7%. A taxa de mortalidade padronizada por asma como causa básica declinou de 2000 a 2009 de 2,22 para 1,72/100.000 habitantes em 2009, (β= -0.06, p=0.017) e como causas múltiplas passou de 3,45 para 2,82/100.000 habitantes (β= -0.11, p=0.005). A análise segundo gênero evidenciou um declínio mais acentuado entre os homens, cuja taxa de mortalidade por asma como causa básica padronizada passou de 1,58/100.000 em 2000 para 0,59/100.000 em 2009 (β= -0.08, p=0.007); como causa múltipla a taxa diminuiu de 2,49/100.000 em 2000 para 1,11/100.000 em 2009 (β= -0.14, p<0.00001). Entre as mulheres a taxa de mortalidade passou de 2,79/100.000 em 2000 para 2,72/100.000 em 2009 como causa básica e de 4,29/100.000 em 2000 para 4,32/100.000 em 2009. A regressão linear segmentada, realizada em dois períodos, de 2000 a 2004 e 2004 a 2009, não foi estatisticamente significativa (2000 a 2004: β= -0,16, p=0,131 e 2004 a 2009: β= 0,04, p=0,630). Do total de óbitos nos quais a asma foi mencionada como causa múltipla 2,8% ocorreram na idade de 1 a 4 anos e 61% na faixa de 60 anos e mais. Quando a asma foi causa básica, as causas associadas mais frequentes foram as doenças do aparelho respiratório e nos óbitos em que foi classificada como causa associada destacaram-se como causas básicas as doenças do aparelho respiratório e circulatório. A magnitude das taxas de mortalidade por asma foi sempre maior nas mulheres comparado aos homens. A série histórica mostrou tendência ao declínio nas taxas de mortalidade, segundo causas básicas e múltiplas, com declínio entre os homens e estabilidade entre as mulheres. A mortalidade por asma foi subestimada quando considerada apenas como causa básica, o que poderia ser evitado com a utilização da metodologia de causas múltiplas nas estatísticas de mortalidade da asma.
The study of multiple causes of death makes it possible to know the true extent of mortality statistics, minimizing the underestimation of asthma mortality rates. The aim of this study was to assess the trends in asthma mortality rates in the city of Rio de Janeiro between 2000 and 2009. The data were obtained from the Brazilian Mortality Information System (SIM) and consisted of all deaths among residents of Rio de Janeiro aged one year or older, in which asthma was mentioned (ICD10 codes: J45 and J46) on any line or in any part of the death certificate (DO). Age-standardized death rates were calculated, in the following age-groups: 1-4 years, 5-34 years, 35-59 years, 60 years or older, where asthma was listed as the underlying cause of death and also as an associated cause of death, according to gender, for each year in the period. Linear regression was used for data analysis. In the 10-year period from 2000 to 2009, asthma was listed as the underlying cause on 67.2% of the death certificates on which asthma was mentioned. The underestimation rate of mortality from asthma as the underlying cause of death was 48.7%. The standardized mortality rates from asthma as the underlying cause of death decreased between 2000 and 2009, from 2.22 to 1.72/100.000 residents in 2009 (β= -0.06, p=0.017), whereas the mortality rates considering the multiple causes decreased from 3.45 to 2.82/100.000 residents (β= -0.11, p=0.005). The analysis according to gender revealed a more pronounced decline among men: standardized death rates from asthma (as underlying cause) reduced from 1.58 in 2000 to 0.59/100.000 in 2009 (β= -0.08, p=0.007); the mortality rates considering the multiple causes decreased from 2.49 in 2000 to 1.11/100.000 in 2009 (β= -0.14, p<0.00001). The mortality rates among women decreased from 2.79 in 2000 to 2.72/100.000 in 2009 (mortality from asthma), and from 4.29 in 2000 to 4.32/100.000 in 2009 (mortality with asthma). The segmented linear regression, carried out in two periods (2000 2004 and 2004 2009), was not statistically significant (2000 a 2004: β= -0.16, p=0.131 e 2004 a 2009: β= 0.04, p=0.630). Out of the total number of deaths from multiple causes, 2.8% occurred in the 1-4 years age group and 61% in people aged 60 years or older. When asthma was mentioned as the underlying cause of death, the most frequent associated causes were diseases of the respiratory system. And when asthma was listed as an associated cause, diseases of the respiratory and circulatory systems were found to be the most common underlying causes. Asthma mortality rates have always been higher for women than men. The time series identified a decreasing trend in mortality rates, considering both the underlying and multiple causes of death. The rates decreased among men and remained stable among women. Asthma-related mortality was underestimated when based solely on the underlying cause of death, which could be avoided by means of the multiple causes of death methodology.

RESUMO As informações sobre a mortalidade são tradicionalmente uma importante fonte de dados para estudos epidemiológicos, demográficos e para o planejamento em saúde. As estatísticas de mortalidade por causa são usualmente apresentadas segundo a causa básica de morte; a cada óbito corresponde uma só causa. Este método tem sofrido criticas devido a algumas de suas limitações, principalmente em relação às doenças crônicas quando, geralmente, estão presentes várias causas no momento da morte e apenas a básica é selecionada. As estatísticas de mortalidade segundo as causas múltiplas de morte se apresentam como um método alternativo para o estudo das causas de morte. A introdução dos computadores permitiu o desenvolvimento nos Estados Unidos de um sistema automático para classificar além da causa básica todos os demais diagnósticos mencionados nos atestados de óbito. Esse sistema, denominado ACME (Automated Classification of Medical Entities) amplia muito as possibilidades do uso das estatísticas de mortalidade e desde 1983 vem sendo utilizado no processamento de dados sobre os óbitos ocorridos no Estado de São Paulo. O presente trabalho discute a potencialidade do uso das causas múltiplas de morte para o estudo da mortalidade e apresenta algumas formas para a tabulação e a análise destas estatísticas exemplificadas com o arquivo de dados sobre os óbitos ocorridos em 1983 no Estado de São Paulo. Por meio da análise do número de diagnósticos informados na declaração de óbito mostrou-se um número médio maior dos mesmos em relação aos achados em trabalhos acadêmicos realizados com óbitos de períodos anteriores. 0 estudo das menções de todos os diagnósticos permitiu evidenciar a importância relativa maior de certas causas selecionadas como causa básica menos frequentemente. A análise das associações das causas de morte mostrou a importância do inter-relacionamento das doenças na determinação de morte e sugeriu outros usos das causas múltiplas. A distribuição conjunta das causas externas de morte com os dados sobre a natureza da lesão e a análise desta última segundo o sexo e a idade apresentam-se como nova perspectiva para a compreensão das mortes violentas. O levantamento e a discussão de questões metodológicas sugerem novas áreas de investigação para o estudo das causas múltiplas de morte
SUMMARY Informations about mortality are traditionally an important source of data for epidemiologic and demographic studies as well as for health planning. Mortality statistics based on causes have been derived from the underlying cause of death, implying that for each dead person only one cause is presented. These statistics have been criticised on account of their limitations, mainly when chronic diseases are considered and several causes are responsible for the death. Multiple cause mortality statistics represent an alternative method for the study of causes of death. The advent of computers made possible, in the United States, the development of an automated system for selecting the underlying cause of death as well as for coding all the reported conditions on the death certificate. This system, called ACME (Automated Classification of Medical Entities), greatly enlarges the possibilities of mortality statistics and it is used since 1983 to produce mortality data in the State of São Paulo. This thesis discusses the potential use of multiple cause of death for mortality studies and present some ways of its tabulations and analysis through examples which use the data file of death that occurred in 1983 in the State of São Paulo. The tabulation of the number of different diagnoses reported on the death certificate showed that its median number has increased when compared with the results of academic studies undertaken in other periods of time. The study of all mentions of the reported diagnoses depicted the greater importance of some causes of death infrequently selected as the underlying cause of death. The analysis of associations of causes of death revealed the importance of the combination of diseases to the determination of the death and allowed suggestions for other applications of multiple cause data. The cross tabulation of external causes of death with data related to the nature of injury and the analysis of the nature of injury by age and sex enhance new perspectives for the description and understanding of violent deaths. Methodological questions raised and discussed in this thesis suggest new areas of investigation for the study of multiple causes of death

Os óbitos de mulheres em idade reprodutiva correspondem a 16% do total de óbitos femininos em todo o Brasil, indicando a dificuldade dos serviços de saúde em implementar ações baseadas na atenção integral à saúde da mulher no Sistema Único de Saúde, sob o enfoque ampliado da assistência, incorporando a perspectiva de gênero. Objetivo: analisar óbitos de mulheres em idade reprodutiva, residentes em Ribeirão Preto-SP, no período de 2007 a 2009, com ênfase nas causas de morte. Método: foram analisadas 532 Declarações de Óbito (DO) de mulheres de 10 a 49 anos residentes no município de Ribeirão Preto/SP que foram a óbito no período de 2007 a 2009, obtidas por meio do Comitê Municipal de Prevenção da Mortalidade Materna para transcrição integral dos dados. As mortes foram classificadas em maternas declaradas, não maternas e presumíveis. Procedeu-se com a análise dos dados com o software STATA, codificação das causas de acordo com a CID 10 e seleção da causa básica de óbito. Resultados: Os principais grupos de causas de morte foram: neoplasias 137 (26%), doenças do aparelho circulatório 94 (18%), doenças infecciosas e parasitárias 67 (13%) e causas externas 65 (12%). As mortes por causas maternas representaram a antepenúltima causa de óbito. Foram identificadas, após análise dos campos preenchidos na DO, 467 (88%) mortes não maternas, 5 (1%) mortes maternas declaradas e 60 (11%) mortes maternas presumíveis. Conclusão: O padrão de mortalidade do município é semelhante ao do país, apontando a necessidade de incrementar ações nas três esferas de governo voltadas para a saúde da população feminina. Conhecer o perfil de mortalidade de mulheres em idade reprodutiva possibilita a compreensão de suas principais demandas e problemas de saúde oferecendo subsídios para o planejamento de ações focadas em reduzir mortes por causas evitáveis.
The deaths of women in reproductive age represent 16% of all female deaths in Brazil, indicating the difficulty of health services to implement actions based on comprehensive health care of women in the National Health System, under the approach extended care, incorporating a gender perspective. Objective: To analyze deaths of women in reproductive age residing in Ribeirao Preto-SP, in the period of 2007 to 2009, focusing on causes of death. Method: We analyzed 532 Death Certificates of women aged 10 to 49 years residing in Ribeirao Preto - SP who died in the period 2007 to 2009, obtained through the Municipal Committee for the Prevention of Maternal Mortality for transcription full of data. The deaths were classified as declared maternal, not maternal and presumed. Proceeded with the analysis of the data with STATA software, coding causes according to ICD 10 and selecting the underlying cause of death. Results: The main groups of causes of death were neoplasms 137 (26%), circulatory diseases 94 (18%), infectious and parasitic diseases 67 (13%) and external causes 65 (12%). Deaths from maternal causes represented the antepenultimate cause of death. Were identified after analysis of the fields filled in Death Certificates, 467 (88%) not maternal deaths, 5 (1%) declared maternal and 60 (11%) presumed maternal deaths. Conclusion: The pattern of mortality in the municipality is similar to the country, pointing to the need for increased action in the three spheres of government focused on the health of the female population. Knowing the profile of women mortality in reproductive age furthers our understanding of their main demands and health problems, offering support for the planning of actions focused on reducing deaths from preventable causes.

Background Monitoring levels and trends in premature mortality is crucial to understanding how societies can address prominent sources of early death. The Global Burden of Disease 2016 Study (GBD 2016) provides a comprehensive assessment of cause-specific mortality for 264 causes in 195 locations from 1980 to 2016. This assessment includes evaluation of the expected epidemiological transition with changes in development and where local patterns deviate from these trends. Methods We estimated cause-specific deaths and years of life lost (YLLs) by age, sex, geography, and year. YLLs were calculated from the sum of each death multiplied by the standard life expectancy at each age. We used the GBD cause of death database composed of: vital registration (VR) data corrected for under-registration and garbage coding; national and subnational verbal autopsy (VA) studies corrected for garbage coding; and other sources including surveys and surveillance systems for specific causes such as maternal mortality. To facilitate assessment of quality, we reported on the fraction of deaths assigned to GBD Level 1 or Level 2 causes that cannot be underlying causes of death (major garbage codes) by location and year. Based on completeness, garbage coding, cause list detail, and time periods covered, we provided an overall data quality rating for each location with scores ranging from 0 stars (worst) to 5 stars (best). We used robust statistical methods including the Cause of Death Ensemble model (CODEm) to generate estimates for each location, year, age, and sex. We assessed observed and expected levels and trends of cause-specific deaths in relation to the Socio-demographic Index (SDI), a summary indicator derived from measures of average income per capita, educational attainment, and total fertility, with locations grouped into quintiles by SDI. Relative to GBD 2015, we expanded the GBD cause hierarchy by 18 causes of death for GBD 2016. Findings The quality of available data varied by location. Data quality in 25 countries rated in the highest category (5 stars), while 48, 30, 21, and 44 countries were rated at each of the succeeding data quality levels. Vital registration or verbal autopsy data were not available in 27 countries, resulting in the assignment of a zero value for data quality. Deaths from non-communicable diseases (NCDs) represented 72.3% (95% uncertainty interval [UI] 71.2-73.2) of deaths in 2016 with 19.3% (18.5-20.4) of deaths in that year occurring from communicable, maternal, neonatal, and nutritional (CMNN) diseases and a further 8.43% (8.00-8.67) from injuries. Although age-standardised rates of death from NCDs decreased globally between 2006 and 2016, total numbers of these deaths increased; both numbers and age-standardised rates of death from CMNN causes decreased in the decade 2006-16-age-standardised rates of deaths from injuries decreased but total numbers varied little. In 2016, the three leading global causes of death in children under-5 were lower respiratory infections, neonatal preterm birth complications, and neonatal encephalopathy due to birth asphyxia and trauma, combined resulting in 1.80 million deaths (95% UI 1.59 million to 1.89 million). Between 1990 and 2016, a profound shift toward deaths at older ages occurred with a 178% (95% UI 176-181) increase in deaths in ages 90-94 years and a 210% (208-212) increase in deaths older than age 95 years. The ten leading causes by rates of age-standardised YLL significantly decreased from 2006 to 2016 (median annualised rate of change was a decrease of 2.89%); the median annualised rate of change for all other causes was lower (a decrease of 1.59%) during the same interval. Globally, the five leading causes of total YLLs in 2016 were cardiovascular diseases; diarrhoea, lower respiratory infections, and other common infectious diseases; neoplasms; neonatal disorders; and HIV/AIDS and tuberculosis. At a finer level of disaggregation within cause groupings, the ten leading causes of total YLLs in 2016 were ischaemic heart disease, cerebrovascular disease, lower respiratory infections, diarrhoeal diseases, road injuries, malaria, neonatal preterm birth complications, HIV/AIDS, chronic obstructive pulmonary disease, and neonatal encephalopathy due to birth asphyxia and trauma. Ischaemic heart disease was the leading cause of total YLLs in 113 countries for men and 97 countries for women. Comparisons of observed levels of YLLs by countries, relative to the level of YLLs expected on the basis of SDI alone, highlighted distinct regional patterns including the greater than expected level of YLLs from malaria and from HIV/AIDS across sub-Saharan Africa; diabetes mellitus, especially in Oceania; interpersonal violence, notably within Latin America and the Caribbean; and cardiomyopathy and myocarditis, particularly in eastern and central Europe. The level of YLLs from ischaemic heart disease was less than expected in 117 of 195 locations. Other leading causes of YLLs for which YLLs were notably lower than expected included neonatal preterm birth complications in many locations in both south Asia and southeast Asia, and cerebrovascular disease in western Europe. Interpretation The past 37 years have featured declining rates of communicable, maternal, neonatal, and nutritional diseases across all quintiles of SDI, with faster than expected gains for many locations relative to their SDI. A global shift towards deaths at older ages suggests success in reducing many causes of early death. YLLs have increased globally for causes such as diabetes mellitus or some neoplasms, and in some locations for causes such as drug use disorders, and conflict and terrorism. Increasing levels of YLLs might reflect outcomes from conditions that required high levels of care but for which effective treatments remain elusive, potentially increasing costs to health systems. Copyright (C) The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.

En 1977, Michael Lipton a présenté le concept de biais urbain comme cadre pour comprendre comment la plupart des politiques macroéconomique et microéconomique ont profité au surdéveloppement des zones urbaines et au sous développement des zones rurales. En Amérique latine, l'urbanisation et la baisse de la mortalité ont historiquement été positivement liées : la transition sanitaire dans la région a été amorcée dans les principales villes et s'est poursuivit plus rapidement dans les pays à urbanisation plus élevée. Cette recherche s'inscrit dans ce cadre et cherche des preuves sur : la persistance d'un avantage urbain dans la mortalité ; et des traces d'un « biais urbain » dans les schémas des causes de décès. En utilisant un échantillon de pays d'Amérique latine sur la période 2000-2010, j'applique des méthodes de décomposition de l'espérance de vie pour analyser les disparités dans les schémas de mortalité et les causes de décès lorsque les zones urbaines et rurales sont considérées séparément. En définissant l'urbain comme une catégorie de continuum au lieu d'un concept dichotomique, trois groupes spatiaux sont reconnaissables dans chaque pays. Les pays analysés sont le Brésil, le Chili, la Colombie, l'Équateur, le Mexique, le Pérou et le Venezuela. Les résultats indiquent que l'avantage urbain est persistant et que les écarts de mortalité entre les zones rurales et urbaines ont toujours favorisé les villes. Cet avantage urbain en matière de mortalité résulte de la baisse des taux de de décès par cause qui se prêtent à des interventions primaires rendues possibles par l'existence d'infrastructures publiques de base ainsi que par la fourniture de biens et services de base
In 1977, Michael Lipton introduced the Urban Bias Thesis as a framework for understanding how most macro- and microeconomic policy initiatives have historically benefited the over-development of urban areas and the underdevelopment of rural areas. In Latin America, urbanization and mortality decline have historically been positively related: the health transition in the region has been initiated in the main cities and has tended to proceed more rapidly in countries with higher levels of urbanization. This research looks for evidence on: the persistence of an urban advantage in mortality; and traces of an "urban bias" in the causes of death patterns in the region. Using a sample of Latin American countries over the period 2000-2010, I apply decomposition methods on life expectancy at birth to analyze the disparities in mortality patterns and causes of death when urban and rural areas are considered separately. Urban is defined as a continuum category instead of a dichotomous concept. Hence, three types of spatial groups are recognizable in each country. The countries under analysis are Brazil, Chile, Colombia, Ecuador, Mexico, Peru and Venezuela. The results indicate that the urban advantage is persistent and that rural-urban mortality differentials have consistently favored cities. This advantage in mortality comes as an outcome of lower rates for causes of death that are amenable to primary interventions, meaning they are made amenable by the existence of basic public infrastructures as well as by the provision of basic goods and services

L’objectif de cette thèse était d’investiguer différents choix méthodologiques, en particulier le choix du délai et la prise en compte des causes médicales de décès, dans l’élaboration des indicateurs de mortalité post-hospitalière visant à refléter la qualité des soins.Dans une première phase, les données médico-administratives hospitalières des bénéficiaires du Régime Général (RG) de l’Assurance Maladie décédés dans l'année suivant une hospitalisation en 2008 ou 2009 ont été appariées aux causes de décès (base du CépiDc). Le taux d’appariement était de 96,4%.Dans une deuxième phase les séjours pour lesquels la cause initiale de décès pouvait être qualifiée d'indépendante du diagnostic principal du séjour ont été repérés à l'aide d'un algorithme et d'un logiciel s'appuyant sur des standards internationaux. Dans une troisième phase, le modèle le plus souvent utilisé à l'international pour évaluer la mortalité intra-hospitalière (modèle « de Jarman ») a été reproduit et utilisé pour construire des indicateurs de mortalité par établissement à 30, 60, 90, 180 et 365 jours post-admission, pour l'année 2009 (12 322 831 séjours PMSI-MCO des bénéficiaires du RG).L’indicateur de mortalité intra-hospitalière s’est révélé biaisé par les pratiques de sortie des établissements (caractérisées par la durée moyenne de séjour et le taux de transfert vers d’autres établissements). Les indicateurs à 60 ou 90 jours post-admission doivent être préférés à l’indicateur à 30 jours car ils ont l’avantage d’inclure presque tous les décès intra-hospitaliers, limitant notamment les incitations à maintenir les patients en vie jusqu’à la fin de la période de suivi et/ou à cesser de leur dédier des ressources une fois ce terme atteint. L’utilisation des causes de décès en supprimant les décès indépendants change de façon négligeable les indicateurs de mortalité globale par établissement, toutefois elle pourrait être utile pour des indicateurs spécifiques, limités à certaines pathologies ou procédures.Des réserves quant à la pertinence de ces indicateurs ont été décrites (limites du modèle et des variables d'ajustement, hétérogénéité de la qualité du codage entre les établissements), mettant en évidence la nécessité de recherches complémentaires, en particulier sur leur capacité à refléter la qualité des soins et sur l’impact de leur diffusion publique. A ce jour, l’interprétation des indicateurs de mortalité par établissement nécessite la plus grande prudence
The main objective of this PhD work was to investigate different methodological options for the elaboration of post hospital mortality indicators aiming at reflecting quality of care, in particular to identify the most relevant timeframes and to assess the contribution of the causes of death information.In a first phase, the hospital discharge data of the French General health insurance scheme beneficiaries who died during the year following an hospital stay in 2008 or 2009 were linked to the cause of death register. The matching rate was 96.4%.In a second phase, the hospital stays for which the underlying cause of death could be qualified as independent from the main diagnosis were identified with an algorithm and a software relying on international standards.In a third phase, the method most widely used to assess in-hospital mortality (Dr Foster Unit method) was reproduced and used to construct hospital mortality indicators at 30, 60, 90, 180 et 365 days post-admission, on year 2009 (12 322 831 acute-care stays)..As in other countries, in-hospital mortality revealed biased by discharge patterns in the French data: hospitals : short length-of-stay or high transfer-out rates for comparable casemix tend to have lower in-hospital mortality. The 60-day and 90-day indicators should be preferred to the 30-day indicator, because they reflect a larger part of in-hospital mortality, and are less subject to the incentives either to maintain patients alive until the end of the follow-up window or to shift resources away when this length of stay is reached. The contribution of the causes of death seems negligible in the context of hospital-wide indicators, but it could prove its utility in future health services research about specific indicators limited to selected conditions or procedures.However, reservations about the relevance of hospital-wide mortality indicators aiming at assessing quality of care are described (limits of the statistical model and adjustment variables available, heterogeneity of the coding quality between hospitals). Further research is needed, in particular on the capacity of these indicators to reflect quality of care and on the impact of their public reporting. To date, the use of hospital-wide mortality indicators needs to be extremely cautious

Malignant tumours of the small intestine are rare. Age-standardised incidence in Europe is between 0.5-1.5 per 100 000. As the small intestine represents more than 90 % of the gastrointestinal mucosal surface, it is surprising that it gives rise to less than 2 % of gastrointestinal malignancies. The dominating histological subtypes are carcinoids and adenocarcinomas.

We used three population-based registries in Sweden to study survival, second malignant tumours, causes of death, and Crohn’s disease as a risk factor for small intestinal adenocarcinoma and carcinoid.

We evaluated tumour site, sex, age, and year of diagnosis as prognostic factors. For adenocarcinomas there was no difference in survival between duodenal and jejunal/ileal tumours. Women with jejunal/ileal adenocarcinomas showed higher probabilities of survival than men, while no such relation was found for duodenal tumours. Old age correlated with poor survival for duodenal tumours, and prognosis has improved in later years. For carcinoids, duodenal tumours had a more favourable prognosis than jejunal/ileal tumours. There was no difference in survival between sexes. Old age correlated with poor survival, and survival has improved in recent years.

Female patients with adenocarcinoma had increased risk of acquiring cancer in the genital organs and breasts, and both sexes had increased risks of second tumours in the gastrointestinal tract and skin. Men with carcinoid tumours had increased risk of prostate cancer. Both sexes had increased risk of malignant melanoma and malignancies of endocrine organs.

Patients with adenocarcinoma had increased risk of dying from malignant diseases other than the primary small intestinal cancer and from gastrointestinal disease. The cohort with carcinoid had higher than expected risk of dying from malignant disease, gastrointestinal disease, and cardiovascular disease.

Patients with Crohn’s disease had increased risk of small intestinal adenocarcinoma and carcinoid, and the risk has increased for patients diagnosed in recent years.

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Os casos de intoxicações não intencionais ou intencionais são comuns na história da Medicina Veterinária principalmente em animais de companhia como cães e gatos. A Medicina Veterinária Legal utiliza amplo conhecimento para fundamentar laudos técnicos que tem como função auxiliar processos judiciais. De acordo com o artigo 32 da Lei de Crimes Ambientais 9.605 de 12 de fevereiro de 1998, intoxicar animais é crime de maus tratos. O reconhecimento adequado dos sinais clínicos, lesões anatomopatológicas características dos casos de intoxicação que levam á óbito associados com os métodos de identificação laboratorial de toxicologia forense, são fundamentais para estabelecer um diagnóstico definitivo do agente tóxico. No presente trabalho objetivou-se ampliar os estudos na área de Medicina Veterinária Legal e identificar lesões anatomopatológicas decorrentes de intoxicação em cães e gatos. No período de 2009 a 2014 foram selecionados do arquivo da Faculdade de Medicina Veterinária e Zootecnia, UNESP - Universidade Estadual Paulista, Campus de Botucatu, Departamento de Clínica Veterinária, Serviço de Patologia Veterinária, 42 casos, sendo 31 (73,8%) cães e 11 (26,2%) gatos. Destes casos 21 (50%) apresentaram Boletim de Ocorrência e 22 (52,4%) realizaram exame toxicológico. A maior prevalência foi de intoxicações por carbamato. O exame necroscópico revelou que a as principais causa mortis foram insuficiência cardiorrespiratória e choque hipovolêmico. No exame histopatológico de fígado, rim e encéfalo as principais lesões observadas foram congestão, degeneração e hemorragia. Os órgãos apresentaram sinais de autólise e putrefação. As técnicas diagnósticas utilizadas são complementares e auxiliam o Médico Veterinário a elaborar laudos técnicos para processos judiciais nos casos de intoxicações criminais
The cases of poisoning no intentional or intentional are common in the history of the Veterinary Medicine mainly in animals of company as dogs and cats. The Legal Veterinary Medicine use these tools in the base of technical decisions to aid processes, involving crimes with animals. According to the Law of Environmental Crimes 9.605 of February 12 of 1998, poisoning in animals is considered crime of mistreatments. The appropriate recognition of the clinical signs, lesions anatomical pathological that characterizes the cases of intoxication that take to death associated with the methods of identification laboratorial of forensic toxicology is fundamental to establish a definitive diagnosis of the toxic agent. In the present work was made analysis of lesions relation of toxic agents and context of Veterinary Forensic Medicine in these situations. In period 2009 to 2014 are selected from the archive of Faculdade de Medicina Veterinária e Zootecnia, UNESP - Universidade Estadual Paulista, Campus de Botucatu, Departamento de Clínica Veterinária, Serviço de Patologia Veterinária 42 cases, 31 (73,8%) dogs and 11 (26,2%) cats. These cases 21 (50%) feature Boletim de Ocorrência and 22 (52,4%) are made toxicologycal exam. The highest prevalence ware intoxication for carbamate. The necropsy revealed that main causa mortis were cardiac respiratory insufficiency and hypovolemic shock. In histopathology of liver, kidney and brain the main lesions are congestion, degeneration and bledding. The organs show signs of autolysis and putrefaction. The diagnostic technics used are additional and help veterinarion to make reports for litigation in cases of criminal intoxication

Orientador: Noeme Souza Rocha
Banca: Elan Cardozo Paes de Almeida
Banca: Alexandre Hataka
Resumo: Os casos de intoxicações não intencionais ou intencionais são comuns na história da Medicina Veterinária principalmente em animais de companhia como cães e gatos. A Medicina Veterinária Legal utiliza amplo conhecimento para fundamentar laudos técnicos que tem como função auxiliar processos judiciais. De acordo com o artigo 32 da Lei de Crimes Ambientais 9.605 de 12 de fevereiro de 1998, intoxicar animais é crime de maus tratos. O reconhecimento adequado dos sinais clínicos, lesões anatomopatológicas características dos casos de intoxicação que levam á óbito associados com os métodos de identificação laboratorial de toxicologia forense, são fundamentais para estabelecer um diagnóstico definitivo do agente tóxico. No presente trabalho objetivou-se ampliar os estudos na área de Medicina Veterinária Legal e identificar lesões anatomopatológicas decorrentes de intoxicação em cães e gatos. No período de 2009 a 2014 foram selecionados do arquivo da Faculdade de Medicina Veterinária e Zootecnia, UNESP - Universidade Estadual Paulista, Campus de Botucatu, Departamento de Clínica Veterinária, Serviço de Patologia Veterinária, 42 casos, sendo 31 (73,8%) cães e 11 (26,2%) gatos. Destes casos 21 (50%) apresentaram Boletim de Ocorrência e 22 (52,4%) realizaram exame toxicológico. A maior prevalência foi de intoxicações por carbamato. O exame necroscópico revelou que a as principais causa mortis foram insuficiência cardiorrespiratória e choque hipovolêmico. No exame histopatológico de fígado, rim e encéfalo as principais lesões observadas foram congestão, degeneração e hemorragia. Os órgãos apresentaram sinais de autólise e putrefação. As técnicas diagnósticas utilizadas são complementares e auxiliam o Médico Veterinário a elaborar laudos técnicos para processos judiciais nos casos de intoxicações criminais
Abstract: The cases of poisoning no intentional or intentional are common in the history of the Veterinary Medicine mainly in animals of company as dogs and cats. The Legal Veterinary Medicine use these tools in the base of technical decisions to aid processes, involving crimes with animals. According to the Law of Environmental Crimes 9.605 of February 12 of 1998, poisoning in animals is considered crime of mistreatments. The appropriate recognition of the clinical signs, lesions anatomical pathological that characterizes the cases of intoxication that take to death associated with the methods of identification laboratorial of forensic toxicology is fundamental to establish a definitive diagnosis of the toxic agent. In the present work was made analysis of lesions relation of toxic agents and context of Veterinary Forensic Medicine in these situations. In period 2009 to 2014 are selected from the archive of Faculdade de Medicina Veterinária e Zootecnia, UNESP - Universidade Estadual Paulista, Campus de Botucatu, Departamento de Clínica Veterinária, Serviço de Patologia Veterinária 42 cases, 31 (73,8%) dogs and 11 (26,2%) cats. These cases 21 (50%) feature Boletim de Ocorrência and 22 (52,4%) are made toxicologycal exam. The highest prevalence ware intoxication for carbamate. The necropsy revealed that main causa mortis were cardiac respiratory insufficiency and hypovolemic shock. In histopathology of liver, kidney and brain the main lesions are congestion, degeneration and bledding. The organs show signs of autolysis and putrefaction. The diagnostic technics used are additional and help veterinarion to make reports for litigation in cases of criminal intoxication
Mestre

O litoral brasileiro apresenta a ocorrência de cinco das sete espécies de tartarugas marinhas presentes no mundo. A região da costa sudeste brasileira é uma área de alimentação de tartarugas verdes juvenis. Muitas ameaças; a grande maioria delas por ação antrópica estão diminuindo as populações de tartarugas marinhas, mas também causas naturais podem estar envolvidas. O presente trabalho tem por objetivo descrever os principais achados necroscópicos e histopatológicos de tartarugas verdes achadas mortas, ou que morreram no centro de reabilitação do Projeto Tamar na cidade de Ubatuba/SP. Como resultados, relações estatísticas foram encontradas entre achados macroscópicos e formas de captura, além de observar grande quantidade de animais acometidos pela presença de parasitas da família Spirorchiidae e suas lesões. Além disso, foi constatada a evidência de resíduos antropogênicos relacionados a presença de fezes compactas associadas a constipações ou obliterações no trato gastrointestinal. Algumas lesões sugestivas de infeções por agentes bacterianos também foram observadas, mas em menor proporção. Foi realizada a dosagem da concentração de cálcio e magnésio no líquido pericárdico, demonstrando maior concentração destes eletrólitos em animais achados mortos - presos em rede de pesca. Os resultados obtidos neste estudo podem representar uma ajuda para o clínico e determinar a presença de possíveis doenças emergentes nestas populações.
Five of the seven sea turtle species in the world gather into Brazilian coastline. The region of the southeast Brazilian coast is a feeding area for young green turtles. There are many threats, the vast majority of them are decreasing populations of sea turtles by anthropic action, but natural causes may also be involved. The present work had as purpose to describe the main necroscopic and histopathological findings in green turtles that were found dead or that were found dead at the rehabilitation center of Tamar Project in Ubatuba City/SP. As results, statistical relationships were found among macroscopic findings and catching methods, beside the observation of high quantity of animals stricken by the presence of Spirorchiidae family parasites and their lesions. In addition, the evidence of anthropogenic residues related to the presence of compact feces associated with constipation or gastrointestinal obliterations was verified. Some lesions suggests infections by bacterial agents were also observed, but in a small proportion. The dosage of calcium and magnesium in the pericardial fluid was determined, evidencing a higher concentration of these electrolytes in animals found dead trapped in fishing net. The results obtained in this study may represent a support for clinicians and it may determine the presence of possible emerging diseases in these populations.