Groups Of Causes Research Articles

Gewonnene Lebensjahre

In Germany life expectancy is continuously increasing. Differently to the increases in the nineteenth century, which were mainly driven by decreasing mortality from infectious diseases, the recent rise in life expectancy is the result of a mortality decline in all major groups of causes of death. Contrary to mortality, the incidence and prevalence of a large number of diseases, in particular cancer and cardiovascular diseases (CVD), is rising. However, this increase is mainly the result of changes in the population's age structure, differences in lifestyle, improvements in diagnostic techniques, and increasing prevention. Age-standardized death rates and survival rates indicate significant improvements in most of the diseases over the last decades. Important exceptions are cancer of the lung and bronchia for females as well as mental diseases for both sexes. Therefore, these diseases will grow in importance for public health measures in the next decades. A major potential for a further increase in female life expectancy lies in the reduction of CVD mortality. In contrast, decreases in mortality due to various types of cancer, diseases of the respiratory system, and diseases of the digestive system in addition to CVD mortality may lead to a significant rise in male life expectancy. Although declining mortality is strongly linked to an increase in the prevalence of multi-morbidity and the number of years with disability, it is also paralleled by an increase in healthy life years.

Estratégia Saúde da Família e internações hospitalares em menores de 5 anos no Piauí, Brasil

Hospitalizations for some health conditions can be reduced by timely primary care with appropriate quality, especially in children. This study analyzed the trend in hospitalizations in children under five years of age in Piauí State, Brazil, from 2000 to 2010, according to groups of causes (ICD-10) and hospital admissions in 2010, based on the Brazilian List of Hospitalizations for Primary Care-Sensitive Conditions. The objectives were to identify changes in the hospital morbidity profile and to discuss their relationship to expansion of the Family Health Strategy (FHS) in the State. Piauí showed the highest proportional expansion of the FHS in Brazil, reaching an estimated coverage of 97.2% in 2010. From 2000 to 2010, there was a reduction in the hospitalization frequency and rates in children under five years, but the proportion of hospitalizations in the leading groups of causes persisted or increased during the decade. In 2010, 60% of hospitalizations in children under five years were for causes that are sensitive to primary care, especially infectious gastroenteritis, respiratory infections, and asthma.

An industrial application of DMECA approach to management process analysis

This paper presents an application of ‘dysfunction mode and effects critical analysis’ to determine and to analyse possible dysfunctions of a management process in a power plant. The management process of the plant consists of 9 sub-processes and 57 activities. The study identified 175 potential causes of dysfunctions and its subsequent effects. It also made a list of priority interventions for all these dysfunctions. The findings of the study advocate that the causes of dysfunctions are interrelated and few corrective actions can remove a group of causes. At last, it suggested some actions to improve the management process of the plant.

When health technologies do not reach their effectiveness potential: A health service research perspective

This paper tries to unravel the following question: why do we sometimes obtain results that are worse than expected despite having used technologies that are provenly efficacious or effective and having eliminated major groups of causes leading to poor performance? Inductive analysis and synthesis based on nine areas of health service research show that to effectively adopt some health technologies, it is not enough to simply choose an efficacious or effective change strategy. It sometimes becomes necessary to change the behavior of the health workers that will use it, and to modify certain environmental elements. Technology's effectiveness also depends on intervening simultaneously at various levels. Using a mix of evidence-based change (multifaceted) strategies is often mandatory. Improving health service calls for permanent, not sporadic, efforts; for ensuring universal access to information, and for adopting regulations to prevent poor or potentially harmful service delivery. A portion of the service improvements that have been attained have resulted from the use not of isolated change measures, but of combinations of the most effective measures as part of a single integrated intervention. To further reduce the gap between observed and expected effectiveness we should pilot behavior change strategies before adopting some health technologies, and to permanently install in our health system the multifactorial, integrated technology adoption mechanisms that we still lack. Failure to do this will mean being inefficient and pursuing short-term results at the expense of feasible and legitimate medium-term objectives.

우리나라 피할 수 있는 사망의 기대수명에 미치는 영향

To evaluate the impact of avoidable mortality on the changes in life expectancy at birth in Korea. Standard life table techniques and the Arriaga method were used to calculate and to decompose life expectancy changes by age, effects and groups of causes of avoidable mortality among two periods(1990-2000 and 2000-2009). A list of causes of avoidable mortality reached by consensus and previously published in Spain was used. Mortality in young adults produced a reduction in life expectancy at birth during the 1990-2000, but there was an important increase in life expectancy at birth during the 2000-2009; in both cases, this was the result of factors amenable to health policy interventions. The highest improvement in life expectancy at birth was due to non-avoidable causes, but avoidable mortality through health service interventions showed improvements in life expectancy at birth in those elderly people than 1 year and in those younger. Making a distinction between several groups of causes of avoidable mortality and using decomposition by causes, ages and effects allowed us to better explain the impact of avoidable mortality on the life expectancy at birth of the whole population and gave a new dimension to this indicator that could be very useful in public health.

SENTIERI – OCCUPATIONAL EXPOSURE CONTRIBUTION TO MORTALITY: THE CASE OF MASSA CARRARA POLLUTED SITE

Background and Aims: SENTIERI project is aimed to describing health status of resident populations in Italian polluted sites defined as “of national concern” (Ministerial Decree n. 486, 2001, and successive Decrees) using mortality data. Identified sources of contamination were categorized as chemical industry, petrochemical plants & refineries, harbour area, asbestos or other mineral fibers, steel plants, thermoelectric power plants, mines or quarries, landfills, incinerators. Sixty-three groups of causes of death (ICD IX) were selected. Methods: A descriptive analysis (1995-2002) of mortality for both gender was performed calculating Standardised Mortality Ratio (SMR), crude and adjusted for deprivation (90% Confidence Intervals). Regional population was used for comparison. SENTIERI adopted an a priori definition of contaminated site and an a priori evaluation of the epidemiological evidence of the association between environmental exposure/s and cause specific mortality. Epidemiologists in working group examined bibliographic information, assessing the presence of a causal association between environmental exposure/s and cause specific mortality following standardised criteria. Evidence was classified as: Sufficient or Limited to infer the presence of a causal association, Inadequate to infer the presence or absence of a causal association. To take account of occupational exposures, authoritative publications were considered. Results: As an example, the case of Massa Carrara will be presented, as it is among the most complex polluted sites in terms of environmental contamination (asbestos, production of chemical substances, harbour area, incinerator, petrochemical plant and/or refinery, steel industry). Increased risk of death from several causes were found: diseases of cardiovascular, respiratory and digestive systems, malignant neoplasms of liver, lung, pleura. Conclusions: The potential contribution of previous occupational exposures to overall mortality in the polluted sites should not be overlooked, and the a priori SENTIERI approach seems to be fruitful.

Mercury as a cause of fulminant hepatic failure in a child: Case report and literature review

Fulminant hepatic failure (FHF) in children is devastating unless urgent liver transplantation is undergone. Intoxication or drug-related FHF is a well-known group of causes leading to FHF. Mercury intoxication is described in the literature to cause hepatitis but not described to cause DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome and FHF in the same patient. We describe a child with mercury intoxication and FHF with clinical features fulfilling DRESS syndrome criteria. To our best knowledge, this is the first case report of fatal acute liver failure secondary to mercury intoxication in the English literature. Mercury intoxication should receive a worldwide attention to its consequences in order to minimize the morbidities and mortalities that arise from its intoxication.

SP3-39 Variations of avoidable mortality in Russia

Variation of avoidable mortality in Russia and its relation to socio-economic conditions was analysed using official mortality data. Avoidable mortality in 2009 was 538.6 on 100 000 population for men...

P1-153 Assessment of the leading causes of infant mortality in Brazil in 1998 and 2008

Brazil had an estimated infant mortality rate (IMR) of 30.4 per 1000 live births in 1998 which declined to 19.8 in 2008; in the latter 68% of all infant deaths...

P2-93 Mortality from chronic diseases in Brazil, 1980–2008

IntroductionThe profile of causes of death in Brazil has changed in recent decades. The objective is to describe the evolution of mortality from chronic diseases in Brazil, 1980–2008.MethodsCrude and age-...

Multicentre Mortality Study of Contaminated Sites of National Concern in Italy

S-29B6-3 Background/Aims: Soil contamination requiring clean-up occurs in approximately 250,000 sites in the European Environment Agency-EEA member countries; several thousand sites qualify for remediation in Italy, 57 of them are defined as “of national concern” for the entity of the documented contamination. SENTIERI project, funded by the Italian Ministry of Health, aims at describing sources of environmental pollution in Italian contaminated sites and health status of resident populations using mortality data. Methods: In all, 44 sites were selected for analyses (298 municipalities, 5.5 million inhabitants, about 10% of Italian population at 2001 census). These sites were classified based on the presence of environmental exposure/s as documented in the Ministerial Decrees, namely presence of chemical/petrochemical plants, refineries, asbestos/other mineral fibers, steel plants, thermoelectric-power factories, mines/quarries, landfills/incinerators. Standardized mortality ratios, crude, and adjusted for deprivation (taking into account unemployment, education, house ownership, and overcrowding) were computed for 54 groups of causes of death (reference: regional populations, 1995–2002). Besides analyses of the health status, biomonitoring programs are in progress to improve exposure assessment and surveillance. Results: As an example, Taranto area, affected by a large industrial facility, including one of the largest European steel factories, showed significantly increased mortality for all causes, all cancers (namely esophagus, liver, pancreas, larynx, lung, and pleura), circulatory and respiratory diseases, and liver cirrhosis. Where applicable, cancer registry data are used to evaluate departures of observed incidence rates from expectation; thus, improving accuracy of outcome indicators and avoiding bias from differential survival by geographic area. In Taranto, an exploratory study on the body burden of dioxins and metals in a sample of residents is also ongoing. Conclusion: SENTIERI is the first project describing the health impact of residence in polluted sites at national level, it aims at identifying priorities in planning environmental remediation. International cooperation is desirable both for improving methodological approaches and for evaluating replicability of findings.

The Impact of Immigrant Concentration in Spanish Schools: School, Class, and Composition Effects

The existence of a negative correlation between the concentration of immigrants in certain schools and the school attainment of its students is a well-documented empirical conclusion in the American and European sociology of education, yet sociologists of education are still debating why the migrant (and ethnic) composition of schools has such an impact on results above and beyond individual characteristics. Using a Spanish survey study (INECSE, Evaluacion de la Educacion Primaria 2003, Madrid, 2005), this article intends to confirm and measure the poorer results of students in schools where immigrants are more highly represented. It also seeks to identify potential explanations to account for variation in attainment due to the concentration of immigrant origin students in some schools. In the literature, the empirical analyses that seek to explain this empirical regularity are far less frequent, despite the fact that the list of its potential causes includes several mediating mechanisms. We deal with three main groups of causes that could be responsible for this regularity: (i) micro-interactions or peer group effects; (ii) compositional effects—the pupil population is not randomly distributed on the school map but according to important features that determine their future school attainment (such as socio-economic status); and (iii) school/classroom effects—given their contextual characteristics, the quantity and quality of their human and material resources, some schools offer a less stimulating learning environment.

Análise das córneas do Banco de Olhos da Santa Casa de São Paulo utilizadas em transplantes

To identify the donors' profile and evaluate the factors influencing the quality of the donated corneas in Santa Casa Eye Bank, from July, 2000 to January, 2004. Data from the charts of 151 patients submitted to penetrating keratoplasty, registered in Santa Casa Eye Bank, from July, 2000 to January 2004 resulted in 180 surgeries. Mean age of the donors was 57.57 +/- 19.74 years old (varied from 9 months to 97 years old) and 54.44% were male. The cause of death was predominantly cardiovascular (50.55%), followed by consumptive diseases (17.77%), trauma (14.44%) and others (17.22%). Considering the quality of the cornea, there was no statistically significant difference among the three main groups of cause of death (p=0.527) and time from death to corneal preservation (p=0.053). There was a statistically significant difference between quality of donated corneas above 61 years old and other ages (p=0.037). The most frequent cause of death was cardiovascular, followed by pulmonary diseases and trauma. We could also note that factors inherent to donor like age (>60 years old) predisposed to a worse anatomical quality of the cornea and factors like cause of death and time between death and preservation did not influence the quality of the cornea.

A evolução da mortalidade por causas mal definidas na população idosa em quatro capitais brasileiras, 1996-2007

The objective of this article is to study the evolution of mortality from ill-defined causes in the population over age 60 in the Brazilian cities of Belo Horizonte, Rio de Janeiro, Sao Paulo and Porto Alegre between 1996 and 2007. The evolution of the proportion of deaths due to ill-defined causes during this period was analyzed, as well as the distribution of these deaths by age group, according to the codes in Chapter XVIII of the International Disease Classification (IDC-10) and the position of this group of causes in the total number of deaths of elderly persons. The chance ratio (95%) for ill-defined causes and their occurrence in hospitals was also evaluated. The evolution of the proportion of deaths from ill-defined causes between 1996 and 2007 in the cities mentioned indicated that the highest proportion of deaths from ill-defined causes in the elderly was in Rio de Janeiro, where such deaths are in 4th place among all causes for this age group. In addition, the percentage of deaths from ill-defined causes that occurred in hospitals in Rio de Janeiro was almost twice as high as that in the other cities. As expected, the classification of cause of death as ill-defined was negatively associated with deaths that occurred in hospitals. The findings show good quality of information but indicate frequent problems in providing medical attention to the elderly population.

Características generales de los defectos congénitos, terminología y causas

The general term used to call any type of embryonic and human fetal development, independently of the time of development in which it is produced, is that of congenital defects (or abnormalities). However, not all the embryonic and fetal development alterations are formed at the same time. Thus, depending on the development period in which they are produced, they receive different names. Therefore, what is understood as “ congenital malformations” are physical alterations, that occur during the first 10 weeks beginning on the first day of the last menstruation (embryonic period). However, there are some physical alterations that may occur at any time during the next 30 weeks of the pregnancy (from 11 to 40) – that correspond to the fetal period – that are not truly malformations. In order to distinguish those that are malformation from those that are not, different terminology has been established. Thus, for those that occur after the 10th week, which are not malformations, their name is generally based on the pathogenic mechanisms. In this article, these aspects, as well as the presentation forms of the congenital defects in the newborn child and the large group of causes are explained and defined.

Diferenciais entre homens e mulheres na mortalidade evitável no Brasil (1983-2005)

The aim of the article was to analyze gender differences in mortality in 117 Brazilian municipalities from 1983 to 2005, based on three groups of causes of avoidable death: (1) avoidable through early diagnosis and treatment, (2) avoidable by improvements in quality of treatment and medical care, and (3) ischemic heart disease. The association between avoidable mortality and demographic and socioeconomic conditions and healthcare variables was analyzed through negative binomial regression. The multiple decrement technique was used to evaluate the impact of avoidable causes on life expectancy for men and women. Men showed a higher risk of death for all three groups of avoidable causes, after controlling for selected variables. Women would gain more than men, with an increase of up to five years in life expectancy, if avoidable causes were eliminated by diagnosis and early treatment. Further research is needed in gender-related factors, which may be related to differential mortality rates in men and women.

Social inequalities in causes of death amenable to health care in Norway

Objective: Investigate if there are educational inequalities in causes of death considered amenable to health care in Norway and compare this with non-amenable causes. Methods: The study used the concept of “amenable mortality”, which here includes 34 specific causes of death. A linked data file, with information from the Norwegian Causes of Death Registry and the Educational Registry was analyzed. The study population included the whole Norwegian population in two age groups of interest (25-49 and 50-74 years). Information on deaths was from the period 1990-2001. Education was recorded in 1990 and it was grouped in four categories as: basic, lower secondary, higher secondary and higher. In the study men and women were analysed seperately. The analysis was conducted for all amenable causes pooled with and without ischemic heart disease. A Cox proportional hazard regression model was fitted to estimate hazard rate ratios. Results: The study showed educational differences in mortality from causes of death considered amenable to health care, in both age groups and sexes. This was seen both when including and excluding ischemic heart disease. The effect sizes were comparable for amenable and non-amenable causes in both age groups and sexes. Conclusions: This study revealed systematic higher risk of death in lower educational groups in causes of death considered amenable to health care. This indicates potential weaknesses in equitable provision of health care for the Norwegian population. Additional research is needed to identify domains within the health care system of particular concern.

Heart Failure: the Commonest Reason for Hospitalization in Germany—Medical and Economic Perspectives: Primary Diseases Need to Be Considered

Neumann et al, worried by data from the Federal Statistical Office, report on diagnoses, mortality, and of which, they say, currently one of the most common and most cost-intensive of the chronic diseases. The authors reflect generally on the costs associated with in Germany in 2006 and thinking about trends. However, we wish to point out that is not a chronic disease but a clinical syndrome with characteristic symptoms that can have very diverse underlying disease causes. Heart failure should not be the general term used when writing about a chronic form of and if a concrete nosological classification of the presented heterogeneous statistical columns of figures is not possible. Acute and chronic left as well as acute and chronic right have different symptoms, although they all comprise classic symptoms. These indicate manifold changes and diseases of the right and left and the pericardium, which constitute the three groups of causes of failure: decompensated cardiac hypertrophy, myogenic and pericardial changes. If new concepts for prevention and treatment [of failure] will be needed in the near future (1) because the population is ageing, the manifold etiologies of will have to be borne in mind. Non-smoking prevents chronic obstructive pulmonary disease (COPD) with right due to decompensated cor pulmonale. Blood pressure control and physical exercise prevent myocardial infarction and infarction related scarring as a result of coronary disease (2, 3). Fighting chronic alcoholism prevents some of the cardiomyopathies. These and many other diseases result in heart failure, which is not obvious from the reported global statistic for this individual diagnosis (1). Considering the primary diseases for seems indicated when medical and economic aspects of the most common reason for hospitalization are being discussed.

Una revisión de los estudios en torno a enfermedades gastrointestinales. En busca de nuevas alternativas para el análisis de los procesos de salud-enfermedad

In this paper, we introduce a critical revision of different approaches to the study of gastrointestinal pathologies, focusing on intestinal parasitosis in particular. We studied the way in which they have been built and defined, the way in which this has affected their treatment and we explored the possibility of trying new alternatives for their treatment.Our interest in the topic arises from the results obtained in different stages of interdisciplinary investigation developed in two Guaraní communities Mbya in Misiones Province, Argentina. In this context, we observed that the occurrence of gastrointestinal diseases, parasitic in particular, does not respond to a limited group of causes but it presents multiple causes of a diverse nature. In this sense, we analyze the necessity of identifying and assessing sociocultural aspects which are not considered in the traditional epidemiological studies, in order to recognize the biocultural conditions under which theses infections may prosper.

The magnitude and selectivity of natural and multiple anthropogenic mortality causes in hunted brown bears

1. The population dynamic and evolutionary effects of harvesting are receiving growing attention among biologists. Cause-specific estimates of mortality are necessary to determine and compare the magnitude and selectivity of hunting and other types of mortalities. In addition to the logistic and financial constraints on longitudinal studies, they are complicated by the fact that nonhunting mortality in managed populations usually consists of a mix of natural and human-caused factors. 2. We used multistate capture-recapture (MCR) models to estimate cause-specific survival of brown bears (Ursus arctos) in two subpopulations in Sweden over a 23-year period. In our analysis, we distinguished between legal hunting and other sources of mortality, such as intraspecific predation, accidents, poaching, and damage control removals. We also tested whether a strong increase in harvest quotas after 1997 in one of the subpopulations affected vulnerability to legal hunting. 3. Although only a fraction of mortalities other than legal hunting could be considered natural, this group of causes showed a general pattern of demographic selectivity expected from natural mortality regimes in populations of long-lived species, namely greater vulnerability of young animals. On the other hand, demographic effects on hunting vulnerability were weak and inconsistent. Our findings support the assumption that hunting and other mortalities were additive. 4. As expected, an increase in hunting pressure coincided with a correspondingly large increase in vulnerability to hunting in the affected subpopulation. Because even unbiased harvest can lead to selective pressures on life-history traits, such as size at primiparity, increasing harvest quotas may not only affect population growth directly, but could also alter optimal life-history strategies in brown bears and other carnivores. 5. Legal hunting is the most conveniently assessed and the most easily managed cause of mortality in many wild populations of large mammals. Although legal hunting is the single-most important cause of mortality for brown bears in Sweden, the combined mortality from other causes is of considerable magnitude and additionally shows greater selectivity in terms of sex and age than legal hunting. Therefore, its role in population dynamics and evolution should not be underestimated.