Basic Cause Of Death Research Articles

Mortality trends from hypertension in Mexico by socioeconomic region and state, 2000-2008

To determine mortality trends from hypertension in Mexico nationwide, by state, by socioeconomic region, and by sex and to establish an association between education, state of residence, and socioeconomic region with mortality from hypertension in 2000-2008. Records of mortality associated with hypertension for 2000-2008 were obtained from the National Information System of the Secretariat of Health. This information is generated by the National Institute of Statistics, Geography and Informatics through death certificates issued throughout the country. International Classification of Diseases, 10th Revision, codes corresponding to the basic cause of death from hypertension were identified. Rates of mortality nationwide, by state, and by socioeconomic region were calculated. The strength of association (obtained by Poisson regression) between states where individuals resided, socioeconomic regions, and education with mortality from hypertension was determined. The seven socioeconomic regions were elaborated by the National Institute of Statistics, Geography and Informatics and include the 31 states and Mexico City according to indicators that are related to well-being such as education, occupation, health, housing, and employment. Individuals who did not complete elementary school had a higher risk of dying from hypertension than people with more or no education [relative risk (RR) 1.462, 95% confidence interval (CI) 1.442-1.482]. Mexico City, Oaxaca, and region 7 had the strongest association with dying from hypertension [Mexico City: RR 2.6, CI 2.1-3.2 (2000) and RR 2.5, CI 2.1-3.1 (2005); Oaxaca: RR 2.4, CI2.0-3.0 (2006) and RR 2.7, CI2.3-3.3 (2008); region 7: RR 1.58, CI 1.45-1.72 (2000) and RR 1.25, CI 1.17-1.34 (2008)]. Age-adjusted mortality rates per 100 000 inhabitants who died from hypertension increased from 15.7 to 18.5 between 2000 and 2008, taking the world population age distribution as standard. Mortality was higher in women than in men and in individuals who did not complete elementary school than in those with more or no education. The strongest associations were in Mexico City, Oaxaca, and region 7.

Causes of death in Serbia since the mid-20th century

The structure of the leading causes of death in Serbia has considerably changed in the last half century. Diseases which presented the main threat to the population a few decades ago are now at the level of a statistical error. On the one side are causes which drastically changed their share in total mortality in this time interval, while others have shown stability and persistence among the basic causes of death. Acute infectious diseases "have been replaced" with chronic noninfectious diseases, due to the improvement of general and health conditions. One of the consequences of such changes is increased life expectancy and a larger share of older population which resulted in cardiovascular diseases and tumors to dominate more and more in total mortality. Convergent trends in the structure of the leading causes of death in Serbia from the middle of the 20th century are the reasons why there are considerably fewer diseases and causes with a significant rate in total population mortality at the beginning of the 21st century. During the 1950s, there were five groups of diseases and causes which participated individually with more than 10% of population mortality (infectious diseases, heart and circulatory diseases, respiratory diseases, some perinatal conditions and undefined states) while at the beginning of the new century there were only two such groups (cardiovascular diseases and tumors). Identical trends exist in all European countries, as well as in the rest of the developed world. The leading causes of death in Serbia are cardiovascular diseases. An average of somewhat over 57.000 people died annually in the period from 2007 - 2009, which represents 55.5% of total population mortality. Women are more numerous among the deceased and this difference is increasing due to population feminization. The most frequent cause of death in Serbia, after heart and circulatory diseases, are tumors, which caused 21,415 deaths in 2009. Neoplasms are responsible for one fifth of all deaths. Their number has doubled in three decades, from 9,107 in 1975 to about 20,000 at the beginning of the 21st century, whereby tumors have become the fastest growing cause of death. Least changes in absolute number of deaths in the last half century were marked among violent deaths. Observed by gender, men are in average three times more numerous among violent deaths than women. In the middle of the 20th century in Serbia, one third of the deaths caused by violence were younger than 25 and as many as one half were younger than 35 years old. Only one tenth (11%) of total number of violent deaths were from the age group of 65 or older. At the end of the first decade of the 21st century (2009), the share of population younger than 25 in the total number of violent deaths was decreased four times (and amounted to 8%). At the same time, the rate of those older than 65 or more quadrupled (amounted to 39%).

BRAIN CANCER AMONG AGRICULTURAL WORKERS FROM RIO DE JANEIRO, BRAZIL: A DEATH CERTIFICATE-BASED CASE-CONTROL STUDY

Background: Several studies indicate that agricultural workers are at greater risk to develop some specific types of cancer, such as brain cancer. The underline hypothesis for such increased risk is the intense exposure to pesticides experienced by these workers. Objectives: To estimate the magnitude of the association between brain cancer mortality and agricultural activities, as well as ethnicity, education, and place of residence. Methods: In this death certificate-based case-control study, cases were defined as any resident of Rio de Janeiro State, 18 years or older, male, whose basic cause of death was registered as brain cancer. For each case, 2 controls were randomly chosen among any male individual, 18 years or older, whose basic cause of death was registered as any disease different from neoplasms and diseases of the Nervous System. Results: Agricultural workers were at higher risk to die by brain cancer, when compared to non-agricultural workers (OR: 1.41; CI95%: 1.09-1.85). Adjustment by age, ethnicity, and residence, increased the magnitude of this risk (OR: 1.83; CI95%: 1.26-2.65). In addition, the brain cancer mortality risk was higher among those individuals of higher education, white, and residents of Nova Friburgo region. Conclusions: In agreement with international evidences, the present study suggests an association between brain cancer mortality and agricultural activity in the State of Rio de Janeiro, Brazil. Our results reinforce the hypothesis that environmental exposures experienced by this group of workers may play a role in the development of type of cancer.

Molecular detection of Treponema pallidum sp. pallidum in blood samples of VDRL-seroreactive women with lethal pregnancy outcomes: a retrospective observational study in northern Brazil

Although control measures of maternal and congenital syphilis are available in Brazil, difficulties exist within the healthcare network in providing a laboratory diagnosis of the infection during the prenatal period. The objective of this study was to confirm the presence of Treponema pallidum by PCR in women with positive VDRL serology and lethal pregnancy outcomes, i.e., abortion, stillbirth and neonatal death. A retrospective study was conducted on VDRLseroreactive women with lethal pregnancy outcomes admitted to the Fundação Santa Casa de Misericórdia do Pará (FSCM-PA) between January and July 2004. Serum samples and DNA from whole blood were obtained at the time of screening by the VDRL test. These samples were analyzed by IgG ELISA, IgM FTA-Abs and simple PCR (polA). During the study period, 0.7% (36/4,912) of women with lethal pregnancy outcomes presented a positive VDRL test. The polAgene was amplified in 72.7% (24/33) of these women, with 55.6% (20/36) and 94.4% (34/36) presenting IgM and IgG antibodies against T. pallidum, respectively. Comparison of these results showed a significant difference, with agreement between the PCR and IgM FTA-Abs results, suggesting that maternal syphilis was an active infection. No basic cause of death of the conceptus was reported in 97.2% (35/36) of cases. Among women who were submitted to the VDRL test during the prenatal period, only four of the nine seroreactive patients underwent treatment. The high frequency of syphilis in the group studied indicates the fragility of the service of infection diagnosis, treatment and monitoring, compromising epidemiological control.

Esophageal cancer among Brazilian agricultural workers: Case–control study based on death certificates

Several studies suggest that agricultural workers are at higher risk to develop and die by certain types of cancer. Esophageal cancer is not commonly listed among these types. However, some recent studies indicated that if there is an association between agricultural working and esophageal cancer, it s more likely to be observed among workers highly exposed to pesticides. In the present study, the magnitude of the association between agricultural working and esophageal cancer mortality was evaluated in a high pesticide use area in Brazil, through a death certificate-based case-control study. Cases were individuals from both genders, 30-59 years old, for whom basic cause of death was ascertained as cancer of the esophagus. For each case, one control was randomly selected from all possible controls for which the basic cause of death was ascertained as different from neoplasm and diseases of the digestive system. In addition, controls matched their cases by sex, age, year of death, and state of residence. Crude and adjusted odds ratios were then calculated to estimate the magnitude of the risk. Results showed that, in general, agricultural workers were at significantly higher risk to die by esophageal cancer, when compared to non-agricultural workers. Stratified analysis also revealed that the magnitude of such risk was slightly higher among illiterate agricultural workers, and simultaneous adjustment for several covariates showed that the risk was quantitatively higher among younger southern agricultural workers. These results suggest the esophageal cancer may be included among those types of cancer etiologically associated to agricultural working.

Mortality trends from diabetes mellitus in the seven socioeconomic regions of Mexico, 2000-2007

To determine trends in mortality from diabetes mellitus nationwide according to federative entity, socioeconomic region, and sex and to establish the association between education level, federation entity of residence, and socioeconomic region and mortality from diabetes in Mexico during the years 2000-2007. Records of mortality associated with diabetes for 2000-2007 were obtained from the National Information System of the Secretariat of Health. This information is generated by the National Institute of Statistics, Geography and Informatics through death certificates. Codes of International Classification of Diseases, 10th Revision, that correspond to the basic cause of death from diabetes mellitus were identified. Rates of mortality by federative entity and socioeconomic region were calculated, along with the strength of association (obtained by Poisson regression) between federative entity of residence, socioeconomic region, and education level and mortality from diabetes. The seven socioeconomic regions elaborated by the National Institute of Statistics, Geography and Informatics include the 32 federative entities according to indicators related to well-being such as education, occupation, health, housing, and employment. Individuals who did not complete elementary school had a higher risk of dying from diabetes (relative risk [RR] 2.104, 95% confidence interval [CI] 2.089-2.119). The federative entity and socioeconomic region with the strongest association with mortality from diabetes were Mexico City (RR 2.5, CI 2.33-2.68 for 2000; RR 2.06, CI 1.95-2.18 for 2007) and region 7 (RR 2.47, CI 2.36-2.57 for 2000; RR 2.05, CI 1.98-2.13 for 2007). Mortality rates increased from 77.9 to 89.2 per 100,000 inhabitants in the period 2000-2007. Women had higher mortality than men. Individuals who did not complete elementary school had a higher risk of dying from diabetes (RR 2.104, CI 2.089-2.119). Mexico City as federative entity and socioeconomic region 7 presented the strongest association with mortality from diabetes.

IMPACT OF THE HYPERTENSION ON GENERAL MORTALITY IN VENEZUELA: PP.28.119

Objective: To determine the impact of the Hypertension (H) on general mortality in Venezuela during the period: 2003–2007. Methods: The data was obtained of the Health Ministry, surged of the individual death certificates, selecting the codes associated with H mortality (F01, I10-I13.9, I15.0-I15.9, I66.9, I67.2, I67.4, I70.1, O10-O16, P00.0, P29.2). Also, we obtained the mortality by heart diseases (HD) (codes: I05-I09, I11-I13, I121, I151). It was used the 10th Review of International Classification of Diseases Codes. The mortality rates were calculated using the population of Venezuela estimated for the National Statistical Institute. The HD and H mortality rates were calculated for each studied year and were expressed as the mean of the period. The impact of the H mortality on the HD mortality and general mortality was estimated using the proportionate rates. Results: The general mean H mortality rates was 32.15 per 100 000 population, 31.91 per 100 000 population in males and 32.93 per 100 000 population in females. The age-adjusted H mortality rates for each studied year were: for males 673.66, 612.76, 694.10, 609.3 and 448.89 per 100 000 population, respectively; and for females, 842.82, 927.25, 836.29, 794.79 and 1090.61 per 100 000 population, respectively. The mean proportionate rate of the H mortality (I11-I13) on HD mortality was 24.92%and H was 7.05% on the general mortality. Conclusions: In Venezuela, the H is responsible for the 7.05% of the general mortality. The H (I11-I13) explains the 24.92% of the HD mortality. The females show a higher tendency to dye for H. Non-sistematic observations permits to think in the presence of underestimate values for the H, besides the procedures used for the selection and codification of the basic cause of death, and the following selection rules and their sequences, lead to the exclusion of pathologies with H ethiology, being probable that the true impact of H on general mortality be higher than the national mortality data permits to know.

Diseño y análisis comparativo de un inventario de indicadores de mortalidad evitable adaptado a las condiciones sanitarias de Colombia

To develop a list of indicators of avoidable mortality (LIAM) in order to analyze failed efforts to control the mortality risks prevalent in Colombia, and to compare its results to those of two widely-used approaches. The official mortality records of Colombia for 1985-2001 were reviewed; the basic causes of death were classified according to the ICD-9. Indicators of avoidable mortality (AM) were selected using an algorithm that combined the lists of Holland and Taucher, the definition of Rutstein and colleagues, and the principle of Uemura. The proportions of avoidable deaths that resulted from applying the LIAM and the two AM lists were compared to a database containing Colombia's official death records from 1993-1996. Of the 680 617 deaths registered during the study period, 18.2% were classified as avoidable according to Holland's list, and 51.3%, by Taucher's list. According to the LIAM, avoidable mortality rose to 76.7%. This pattern remained relatively stable in 1993-1996. The differences observed between the proportions of avoidable deaths according to the LIAM and that of the two other lists were related to the local epidemiological profile and the conceptual approach of each list. The differences between the LIAM and the AM lists of Taucher and of Holland attest to the consequences of using one or another classification in the Colombian context. The LIAM can be a valuable resource for undergirding and evaluating health policies, but must be adjusted to the specific situation in which it is applied.

Comparação entre dois métodos para investigação da mortalidade materna em município do Sudeste brasileiro

to compare maternal death data from the National Death Information System (DIS), with a death survey of 10 to 49 year-old women at reproductive age (RAMOS), in order to identify sub-notification and to search for causes of maternal death (MD) from 1999 to 2006. population based temporal series taken from death certificate (DC) information from Fundação Sistema Estadual de Análise de Dados (SEADE) database, with the death causes codified by the International Classification of Diseases (ICD), tenth revision, and the number of born alive babies (BA). Death was categorized into declared, presumptive MD and non-maternal. The identification of cases was done from a list with both the birth and death dates in the municipal morgues, and further information was obtained in the epidemiological sector of the Municipal Committee of Surveillance of Maternal Death (MCSMD). Information on MD was raised in the DIS. Sub-notification rates in cases of declared and non-declared MD were identified, maternal official death rates (MDR) and the adjusted factor for the period were calculated and corrected, and MD cases were reviewed and classified. twelve MD were identified, six of them declared and six non-declared. Sub-notification rate was 50%, giving an adjusting factor equal to 2. The official MDR was 14.7 and the corrected one was 29.4 deaths by 100,000 born alive. In most of the cases, the basic causes of death were mistaken. Direct obstetric causes were more prevalent, among them eclampsia and HELLP syndrome, followed by infections. political and administrative measures are needed for the effective action of MD survey committees. The prevalence of direct obstetric causes indicates failures in maternal and perinatal care.

Neoplasia and paracoccidioidomycosis

Published studies on the association between cancer and paracoccidioidomycosis consist either isolated cases or clinical data based on hospital cohorts of paracoccidioidomycosis. The frequency of neoplasia in series of > or = 80 patients with paracoccidioidomycosis ranges from 0.16 to 14.1%, mean of 3.96%. There are only two retrospective controlled studies, one of them showing greater incidence of carcinoma in biopsy and necropsy samples of paracoccidioidomycosis (12 cases in 147 patients with the mycosis: 8.2%) than in the necropsies of the control group (320 cases in 7,302 necropsies: 4.9%). In the other, 22,409 autopsies were reviewed and 4,372 cases of cancer were found; of the 85 patients with paracoccidioidomycosis, 12 were diagnosed with cancer. No differences were observed in the frequency of malignancies between the group of patients with paracoccidioidomycosis (14.1%) and the control group (19.5%). Considering all the reported cases, carcinoma was more frequent than hematological malignancies, and was more often found at the same site or in a neighboring site affected by the mycosis, usually occurring after the diagnosis of the mycosis. Commonly, the basic cause of death was related to secondary infections or neoplasia. Lymphoma was associated with poorly organized rich in fungi granuloma. The clinical course and mortality were related to the cancer evolution or secondary infections and was worse in lymphoid series, metastatic carcinoma or in patients under cytotoxic chemotherapy. Additionally, as in several cases the clinical and histopathological data may mimick neoplasia, the correct diagnosis of both diseases is essential to guarantee an early and safe intervention.

Dom João VI's death: convulsions and coma

Dom João VI's death occurred in adverse political conditions that led to the regicide hypothesis. The main aim of this paper is to mention life style and conditions of the death of the king by means of narrative review based on primary and secondary sources. Dom João VI died in the way of convulsions and gastrointestinal symptoms. This could be the result of the pathological chain of genetic determination, accentuated by the inappropriate life style, obesity and sedentary habits, and/or poisoning. The finding of arsenic in high doses in his viscera favors the last hypothesis as the basic cause of death, but one can not discard the atherosclerosis predisposing risk factors for a final stroke.

Anos potenciais de vida perdidos por mulheres em idade fértil na cidade do Recife, Pernambuco, vítimas de morte por homicídio nos anos de 2001 e 2002

OBJETIVOS: determinar a freqüência dos óbitos de mulheres em idade fértil segundo os quatro principais grupos de causas básicas de óbito, calcular os Anos Potenciais de Vida Perdidos (APVP) para homicídio, comparando-o com as outras causas de morte mais freqüentes e os coeficientes de APVP destas quatro causas de óbito. MÉTODOS: estudo descritivo, tipo corte transversal, incluindo as declarações de óbito de mulheres com idade entre 10 e 49 anos, na cidade de Recife, Pernambuco, nos anos de 2001 a 2002. A causa básica de óbito foi classificada de acordo com a CID-10, os APVP foram analisados segundo critérios do Ministério da Saúde e de Romeder e McWhinnie, utilizando-se o Epi-Info 2000. RESULTADOS: o grupo das neoplasias foi a causa de óbito mais freqüente (25,7%), seguida das doenças do aparelho circulatório (21,2%), causas externas (17,6) e doença infecciosa e parasitária (9,6%). Os homicídios foram responsáveis por 49% (4380) do total de anos potenciais de vida perdidos, com um coeficiente de APVP de 8,82. O coeficiente de APVP para câncer de mama correspondeu a 4,14 e 3,77 para o infarto agudo do miocárdio. CONCLUSÕES: o risco das mulheres perderem anos potenciais de vida por homicídio foi 2,1 vezes maior do que por câncer de mama e 2,3 do que por infarto agudo do miocárdio.

Time series of tuberculosis mortality in Brazil (1980-2001)

This descriptive study aimed to describe Tuberculosis-related mortality in Brazil between 1980 and 2001, through time series analysis of data from the DATASUS related to cases in which Tuberculosis was the basic cause of death. The mortality rates were calculated per 100,000 inhabitants according to gender and age. We found a decrease in Tuberculosis mortality of approximately 42% for men and 54% for women across the period analyzed. The International Classification of Diseases was used: ICD-9, for the period of 1980 to 1995; ICD-10 for 1996 to 2001. Deaths are related to late diagnosis, which is a problem of organization of the primary health care, as neither prevention actions nor case detections by active search for respiratory symptoms were incorporated into the health professionals' practice which contributes to higher death rates in more vulnerable groups.

Mortalidad por cáncer en los mineros del mercurio

Objectives To analyze cancer mortality in a cohort of mercury miners. Methods Cancer mortality in 3,998 workers exposed to mercury in Minas de Almadén y Arrayanes S.A. was studied. The follow-up period was from 1895 to 1994. Vital status and the basic cause of death, in the case of fatalities, were determined. Standardized mortality ratios (SMR) by age, sex and calendar period were calculated. Expected deaths were obtained from age, sex and calendar period specific rates for the Spanish population. Results The vital status of 92% of the workers could be assessed. At the end of the follow-up period, 1,786 workers were alive in 1994 (49%), 1,535 were dead (42%) and the status of 327 could not be determined (8%). Cancer mortality was significantly lower than expected, with an SMR of 0.72 (95% confidence interval, 0.63-0.82), mainly due to lower than expected mortality from colon and bladder cancer. Deaths from liver cancer were slightly higher than expected (20 deaths vs. 17 expected). Deaths from lung and central nervous system cancers were as expected, while mortality from kidney cancer was lower than expected. A positive trend in mortality from all types of cancer was observed, associated with exposure duration. Conclusions This study provides additional evidence of the absence of an increased risk of cancer in workers exposed to inorganic mercury.

Mortalidad por enfermedades cardiovasculares en los mineros de mercurio

To study the mortality from cardiovascular diseases after long-term exposure to inorganic mercury. 3,998 workers exposed to mercury in Minas de Almadén y Arrayanes S.A. were studied. The follow-up period was a century, since 1895 to 1994. The study was completed assessing the vital status and the basic cause of death, in case of fatalities. Standardized mortality ratios (SMR) by age, sex and calendar period were calculated. Expected deaths were obtained from age, sex and calendar period specific from rates for the Spanish and regional populations. A significant increase in mortality due to circulatory diseases was found (SMR 1.11, 95% confidence interval [CI], 1.02-1.20), especially for hypertension (SMR 2.78, 95% CI, 1.89-3.95), cerebrovascular diseases (SMR 1.17, 95% CI, 1.01-1.35), and other diseases of the heart (SMR 1.51, 95% CI, 1.29-1.76). Ischemic heart disease showed a significant decrease in these workers, with an SMR 0.69, and a CI between 0.57 and 0.84. Cerebrovascular diseases showed a trend over the time since first exposure, duration of exposure and with the accumulated expected exposure, while none of the exposure variables was linearly associated with mortality due to ischemic heart diseases. There was also a trend over the time since first exposure for mortality due to hypertension and other heart diseases. This study suggests an association between long-term exposure to inorganic mercury in workers of mercury mines and an increased risk of circulatory mortality, especially mortality due to hypertension and cerebrovascular diseases.

Demographic dynamics of the Suyá, a Jê people of the Xingu Indigenous Park, Central Brazil, 1970-2004

This paper analyses the demographic dynamics of the Suyá, a Jê people, inhabitants of the Xingu Indigenous Park, Mato Grosso State, Brazil, during the years 1970-2004. Data was gathered from medical records of the São Paulo Federal University Health Program at the Xingu Indigenous Park. The demographic characteristics addressed include composition by age and sex, crude birth rates, general mortality rates, mortality rates by age and sex, proportional mortality by sex, age, and basic causes of death. The results show a population recovery process, with growth rates of 3% per year between 1970 and 2004. In addition to moderate birth rates and declining mortality rates, migration has also played an important role in the demographic dynamics. Mortality indicators show a decline in general and infant mortality rates, higher death rates among women, higher proportions of deaths among individuals < 1 and 50+ years of age, and major causes of death to be infectious diseases and cancer.

Mortality within 1 year after hip fracture surgical repair in the elderly according to postoperative period: a probabilistic record linkage study in Brazil

The purpose of this study was to assess, by applying probabilistic record linkage (PRL) methodology, the excess mortality and underlying causes of death in a cohort of elderly patients who underwent hip fracture surgical repair during 1995 in Rio de Janeiro, Brazil. We searched the Brazilian Hospital Admission Information System (HAIS) for the city of Rio de Janeiro, identifying all cases of elderly patients who had hip fracture surgery between January 1 and December 31, 1995, and by means of the PRL methodology and RecLink software, crosslinked those data with the Brazilian Mortality Information System (MIS) for the same region for a follow-up period of 1 year. We calculated age- and gender-adjusted standardized mortality ratios (SMR) for three periods of time-1-30 days, 31-90 days, and 91-365 days after hospital admission-and analyzed the basic cause of death as reported in the death certificates and noted the death occurred at the index admission or after hospital discharge. We found an overall 21.5% (95% CI 18.2-24.9) mortality rate in 1 year and a statistically significant SMR of 1,080 (95% CI 794-1450) and 512.8 (95% CI 366.4-698.3) for the first two periods, 1-30 days and 31-90 days after hospital admission, respectively. For the last period the SMR displayed a statistically nonsignificant trend of 137 (95% CI 99-183). Even in the first 15 days after the index hospital admission, most deaths (55.1%) occurred after hospital discharge, reinforcing the importance of linking hospital mortality databases with general population mortality information systems. The leading three basic causes of death, as reported in death certificates, were cardiovascular events, falls, and infections. This study represents an example of the application of PRL methodology to produce relevant data on hip fracture, a subject of rising epidemiological importance in developing countries.

Mortalidad por enfermedades genitourinarias en los mineros de mercurio

ObjectivesTo study the mortality due to genitourinary diseases in mercury miners. Population and methods3.998 workers exposed to mercury in Minas de Almadén y Arrayanes S.A. were studied. The follow-up period was a century, since 1,895 to 1,994. It was completed assessing the vital status and the basic cause of death, in case of fatalities. Standardized Mortality Ratios by age, sex and calendar period were calculated. Expected deaths were obtained from age, sex and calendar period specific rates for the Spanish and Castilla-La Mancha populations. ResultsA significant increase in mortality due to genitourinary diseases was found (CIE-9 codes 580 to 629), being significant with respect to the total population for nephritis, nephrotic syndrome and nephrosis, with SMR of 1.69 an 95% CI 1.18 to 2.34. Mortality excesses due to nephritis, nephrotic syndrome and nephrosis were higher in the metallurgy workers than in miners. A Poisson multivariate regression detected a positive trend in the mortality due to nephritis and nephrosis associated to the exposure length, with the risk increasing fivefold after 30 years of exposure to mercury. ConclusionsThis paper shows an excess in the mortality due to genitourinary diseases, specially in nephritis, nephrotic syndrome and nephrosis, whose estimation and significance increases when compared to the population of Castilla-La Mancha.

Ocupação e mortalidade na Marinha do Brasil

To describe the distribution of mortality due to digestive tract, genitourinary and nervous system diseases according to occupation among Brazilian Navy servicemen. This was an exploratory study of proportional mortality among male servicemen in the Brazilian Navy who died between 1991 and 1995. The study population comprises the entire contingent of servicemen during this same time period. Data were obtained from death certificates submitted in order to obtain dependents' pensions, and from the corresponding occupational histories of these individuals. Basic causes of death were coded in accordance with the International Classification of Diseases (9th Revision). Servicemen presented increased proportional mortality for liver diseases related to alcohol consumption (age-adjusted proportional mortality ratio, PMRadj=2.03; 95% confidence interval, CI: 1.26-3.00), pancreatitis (PMRadj=2.03; 95% CI: 1.06-3.38), digestive hemorrhage (PMRadj=1.61; 95% CI: 1.10-2.23), chronic kidney diseases (PMRadj=2.82; 95% CI: 1.98-3.84), Parkinson's disease (PMRadj=3.00; 95% CI: 1.27-5.72) and degenerative brain diseases (PMRadj=2.88; 95% CI: 1.14-5.70), in relation to the reference population. A statistically non-significant association was observed between radar operators (PMR=6.50; 95% CI: 1.43-29.56) and nervous system diseases was observed. The results indicate the existence of possible occupational risk factors in the working environment of the Brazilian Navy, and the need for studies using quantitative measurement of such exposure.

Estudo comparativo dos diagnósticos macro e microscópicos de autópsias: análise de dificuldades e possíveis causas de erro

INTRODUCAO: O diagnostico do atestado de obito e muito utilizado em estatisticas de saude publica, entretanto o seu preenchimento se baseia apenas no diagnostico macroscopico da autopsia. Quando comparamos a macroscopia com o laudo definitivo da autopsia (microscopia), percebemos que a micro e decisiva, muitas vezes modificando o laudo do atestado. OBJETIVOS: Avaliar prospectivamente as diferencas entre os diagnosticos macro e microscopico de causa de obito e as limitacoes do atestado como ferramenta epidemiologica. METODOLOGIA: Estudamos 100 autopsias realizadas pelo Departamento de Patologia da Faculdade de Medicina de Sao Jose do Rio Preto (FAMERP) entre julho de 2000 e maio de 2001, sendo 65 homens e 35 mulheres com idade media de 44,17 anos. As causas basicas e imediatas do obito eram obtidas do atestado e comparadas ao diagnostico do laudo definitivo de cada autopsia. RESULTADOS: Das cem autopsias, 16 tiveram o diagnostico de causa imediata discordante e 22, discordância na causa basica. As divergencias foram principalmente em pulmoes, rins , figado e coracao. CONCLUSOES: O atestado de obito, embora muito utilizado, apresenta limitacoes como ferramenta epidemiologica, e o estudo microscopico e decisivo, principalmente quando envolve os orgaos referidos, nos quais a macroscopia apresenta uma limitacao diagnostica.