Groups Of Causes Research Articles

ANALYSIS OF STATISTICS OF ACCIDENTS AND FAILURES OF THE MASTAKH - BERGE - YAKUTSK MAIN GAS PIPELINE

The problem of analyzing the causes of accidents and failure occurrences, risk assessment and prediction of critical changes of the complex technical systems state is among the most relevant areas of fundamental and applied research, serious attention is paid to this problem. Operation of oil and gas pipelines laid in the cryolithozone conditions is carried out in extremely contrasting conditions and natural environments with the active occurrence of complex climatic and geological processes interacting with the pipeline. A number of works are devoted to data analysis and classification of the causes of accidents and failure occurrences during operation of the gas pipeline «Srednevilyuyskoye Gas Condensate Field (SVGKM) - Mastakh - Berge - Yakutsk». The paper provides a statistical analysis of the causes leading to accidents and failures on the linear part of the main gas pipeline. Data on accidents and failure occurrences of the Mastakh - Berge - Yakutsk gas pipeline are collected, analyzed and entered into the geographic information database. This paper presents a statistical analysis of the causes of accidents and failure occurrences on the linear part of the main gas pipeline. The results of studies of emergency situations show that the combined effect of several factors leads to the destruction of the pipe. For each group of causes, the contribution to the total number of accidents (share of all cases), the distribution of damage for each emergency from this group of causes was calculated. Using the Pareto diagram, a set of reasons that lead to the greatest losses of gas is determined. The dependence of the accident rate on the development of hazardous geological processes in the area and the service life of gas pipelines was considered. The study of statistical data in this work allowed to outline the contribution of various factors to the accident rate of pipelines. Emergency situations caused by the loss of stability in geocryological changes of soils constitute a sufficient percentage of the total number of accidents, which leads to the feasibility of the organization of geotechnical monitoring of the natural and technical system, which allows to detect the initial stages of activation of dangerous geological processes and predict the occurrence of accidents. To solve the problems of monitoring and ensuring the safe operation of main gas pipeline, it is necessary to create a geoinformation database of the distribution of natural and man-made sources of danger. As the initial information for the formation of the database, the materials of remote sensing of the earth, data of ground survey and special works, statistical and natural resource information are used. This kind of data is necessary when ranking sections of the main gas pipeline according to the degree of danger and carrying out preventive measures, such as drainage, installation of thermal stabilizers and other protection measures.

Italian Atlas of mortality inequalities by education level.

To evaluate the geographical and socioeconomic differences in mortality and in life expectancy in Italy; to evaluate the proportion of mortality in the population attributable to a medium-low education level through the use of maps and indicators. Longitudinal design of the population enrolled in the 2011 Italian Census, following the population over time and registering any exit due to death or emigration. The study used the database of the Italian National Institute of Statistics (Istat) developed by linking the 2011 Census with the Italian National Register of Causes of Death (2012-2014) for 35 groups of causes of death. Age, sex, residence, and education level information were collected from the Census. Life expectancy at birth was calculated by sex, Italian region, and education level. For the population aged 30-89 years, the following items were developed by sex: 1. provincial maps showing, for each cause of death, the distribution in quintiles of smoothed standardized mortality ratio (SMR), adjusted for age and education level and estimated with Bayesian models for small areas (spatial conditional autoregressive model); 2. regional maps of population attributable fraction (PAF) for low and medium education levels, calculated starting from age-standardized mortality ratios; 3. tables illustrating for each region standardized mortality rates and standardized years of life lost rate by age (standardized YLL rate), and mortality rate ratios standardized by age (MMRs). Males with a lower education level throughout Italy show a life expectancy at birth that is 3 years less than those with higher education; residents in Southern Italy lose an additional year in life expectancy, regardless of education level. Social inequalities in mortality are present in all regions, but are more marked in the poorer regions of Southern Italy. Geographical differences, taking into account the different population distributions in terms of age and education level, produce mortality differences for all causes: from -15% to +30% in women and from -13% to +26% in men, compared to the national average. Among the main groups of causes, the geographical differences are greater for cardiovascular diseases, respiratory diseases, and accidents, and lower for many tumour sites. A clear mortality gradient with an excess in Southern Italy can be seen for cardiovascular diseases: there are some areas where mortality for people with higher education level is higher than that for residents in Northern Italy with low education level. The gradient for "All tumours", instead, is from South to North, as it is for most single tumour sites. Population attributable fraction for low education level in Italy, taking into account the population distribution by age, is 13.4% in women and 18.3% in men. The study highlighted important geographical differences in mortality, regardless of age and socioeconomic level, with a more significant impact in the poorer Southern regions, revealing a never-before-seen health advantage in the regions along the Adriatic coast. A lower education level explains a considerable proportion of mortality risk, although with differing effects by geographical area and cause of death. There are still mortality inequalities in Italy, therefore, representing a possible missed gain in health in our Country; these inequalities suggest a reassessment of priorities and definition of health targets. Forty years after the Italian National Health Service was instituted, the goal of health equity has not yet been fully achieved.

Hospitalizations due to primary care sensitive conditions: an ecological study.

ABSTRACTOBJECTIVETo evaluate the trend of hospitalizations due to primary care sensitive conditions and its relationship with the Family Health Strategy coverage.METHODSEcological study of time series using the records from the Hospital Information System, from 2005 to 2015, with data for the state of Goiás, Brazil. Trend analyses were performed by the generalized linear regression method of Prais-Winsten with robust variance, which allowed to verify if the trend of hospitalizations due to primary care sensitive conditions was stationary (p > 0.05), declining (p < 0.05 and negative regression coefficient), or ascending (p < 0.05 and positive regression coefficient) in each region of Goiás and for each diagnosis group, stratified by sex. Pearson correlation was used to verify the degree of association between the Family Health Strategy coverage and the rate of hospitalizations due to primary care sensitive conditions.RESULTSHospitalizations due to primary care sensitive conditions accounted for 1,092,070 (30.0%) of hospitalizations in Goiás. The average hospitalizations rate due to primary care sensitive conditions was statically less than the rate for other conditions in the analyzed period (167.6% against 386.2%; t = −13.18; p < 0.001). There has been a downward trend in hospitalizations trend due to primary care sensitive conditions in Goiás and in most health regions. The trends varied between sexes in the groups of causes. We observed a negative correlation between the Family Health Strategy coverage and the hospitalizations trend due to primary care sensitive conditions in the state and also in most health regions.CONCLUSIONSHospitalizations due to primary care sensitive conditions had a significant reduction trend over the analyzed period. Despite this progressive decrease, this rate remains high and the reduction trend was not linear for all causes. These results allow for directing public policies, while drawing a general overview of hospitalizations due to primary care sensitive conditions by sex and region in the state.

Causes of Accident at Construction Sites in Bangladesh

Abstract Bangladeshi construction industry suffers more safety issues than other developing countries in the world. Among many of these, accidents at the construction site go far beyond and shape a horrific figure of death every year. The aims of this study are to identify and prioritize the causes of accidents. This study also analyses and discusses causes of accident at the construction site in Bangladesh. A widespread literature review and open discussion took place to identify the causes and design the questionnaire. The questionnaire-based survey was used to elicit the attitude of four stakeholders such as workers, owners, consultants and contractors towards the causes of accident. Mean and relative importance index (RII) were used to determine the rank of causes, and Statistical Package for the Social Sciences (SPSS) 23 was used to perform the data validation test. This study identifies 77 causes under 14 major groups and ranked them based on the mean and RII. The top five major groups of causes are management-, consultant-, technology-, labour- and contractor-related causes. The top five causes are unawareness of safety-related issue, lack of personal protective equipment, lack of safety eliminating/avoiding design, unfit equipment, lack of knowledge and training on equipment. This study will help the project participants and authorities to know and understand the various characteristics and linkage of causes of construction accidents to improve the construction safety management. It contributes to the body of knowledge, as it reveals for the first time the causes of accidents in the Bangladeshi construction industry.

Life-threatening conditions at birth: an analysis of causes of death and survival estimate for under-five children in live birth cohorts.

Despite the reduction in under-five mortality, the causes are still mostly avoidable, and survival may be compromised by life-threatening conditions at birth. The study estimated the burden of life-threatening conditions at birth, neonatal near miss, and mortality, with an emphasis on avoidable causes, as well as under-five survival in live birth cohorts. This was a retrospective cohort study of live birth in the city of Rio de Janeiro, Brazil (2012-2016). The databases from the Brazilian Information System on Live Births and the Brazilian Mortality Information System were linked. Pragmatic criteria were used to define life-threatening conditions and near miss. Deaths were classified according to the Brazilian list of causes of avoidable deaths. Morbidity and mortality and survival indicators were estimated (Kaplan-Meier). Of the 425,505 live birth , 2.2% presented life-threatening conditions at birth. The under-five, infant and neonatal mortality rates were 0.01, 0.06, and 14.97 per 1,000 person-days, respectively. Avoidable, unclearly avoidable, and ill-defined causes accounted respectively for 61%, 35%, and 4% of the deaths. The risk of death from avoidable causes attributable to life-threatening conditions at birth was 97.6%. Survival was lower in newborns with life-threatening conditions compared to those without life-threatening conditions. The pragmatic criteria for life-threatening conditions determined the profile of proportional mortality by causes of death according to the three groups of causes in the Brazilian list of causes of avoidable deaths. Life-threatening conditions at birth increases the risk of morbidity and mortality in under-five children and raises the discussion on vulnerability and the need for care for these children and social support for their families.

НАРКОТИЗМ КАК СОЦИАЛЬНОЕ ЯВЛЕНИЕ, РАЗРУШАЮЩЕЕ ЧЕЛОВЕКА И ОБЩЕСТВО

We consider such social phenomenon as narcotism. This concept goes back to the past. However, in modern conditions there is an activation of the process destroying society and the state. In itself, the concept of narcotism is very extensive and complex, due to its specificity and the set of circumstances that characterize this concept. We consider features of drug addiction, the reasons of emergence and development of this phenomenon are revealed. There are two groups of causes of narcotism: social and physiological. The first group is the most numerous, and the second group without interrelation with social conditions some scientists don't recognize. Narcotism is a very destructive phenomenon that destroys the human body and its social personality, causes dependence. We consider the mechanism of reliance on drugs in two aspects: human adaptation to drugs, physical and mental dependence. Physical and psychological dependence is the most dangerous for a person who has used drugs for the first time. In the future, they form harmful to humans, the habit of consumption of “poison”. We reveal and consider the aspects of society destruction under the influence of this phenomenon. Narcotism has a destructive impact on society, as it contributes to the development of diseases and crime.

Comparison of death rates due to three groups of causes in the Russian Federation during the 2014-2016 economic crisis

Comparison of death rates due to three groups of causes in the Russian Federation during the 2014-2016 economic crisis

Смертность на территории Тамбовской области по статистическим данным судебно-медицинской службы за 2016-2018 гг.

In the article we analyzed the indicators of violent (from external causes) and non-violent death in the Tambov region and their dynamics on the basis of the data of the forensic medical service of the region for the period from 2016 to 2018. At the same time, we noted trends in mortality from cardiovascular diseases and mechanical trauma, against the background of the decrease in the overall mortality rate from external causes. We determined the dynamics of death rates in its individual groups by cause. The aim of the study is to carry out a comparative analysis of the main indicators of the structure and dynamics of adult death in the Tambov region. The material of the study was the results of forensic expert studies of corpses produced in 2016-2018 in the departments of forensic medical examination of TRSBHI «BFM» (according to the annual report). Methods. We carried out the analysis of the incidence of various types of violent and non-violent death among adults. We performed comparative quantitative analysis and chart construction in the Microsoft Excel spreadsheet environment of the Microsoft Office 2010 application package. We also carried out the analysis of the structure of mortality according to the classes of causes. Results. Analysis of indicators of mortality structure due to causes of death for 2016-2018 allowed to identify some patterns in its changes and to establish regional peculiarities of its structure and dynamics in the Tambov region, which allows to determine priority directions for reduction of these indicators in certain important groups of causes of death in the general structure of mortality in the region.

Pre-service teachers’ perceptions of factors contributing to school failure and their relationship to prior personal experience of school success

Factors that pre-service class and subject teachers perceive as significant in explaining the occurrence of school failure were examined using mixed methods strategy. The qualitative phase of the study (N = 74) revealed that pre-service teachers recognize a wide range of causes for school failure (16 distinctive categories). The relative significance of the causes was established in the subsequent quantitative phase. The Scale of school failure causes was constructed, applied to 408 pre-service teachers and subjected to exploratory factor analysis, which pointed to the three latent groups of causes explaining 43% of variance. The lack of ability and motivation in students (1st factor) and the lack of educational support (2nd factor) were perceived as highly contributing to school failure, while moderate importance was attributed to the causes related to family and social context (3rd factor). Compared to pre-service subject teachers, pre-service class teachers were more willing to recognize the teachers? responsibility for the occurrence of school failure. Pre-service teachers? perceptions of different factors were related to prior experiences of school success.

Global, regional, and national age-sex-specific mortality for 282 causes of death in 195 countries and territories, 1980–2017: a systematic analysis for the Global Burden of Disease Study 2017

SummaryBackgroundGlobal development goals increasingly rely on country-specific estimates for benchmarking a nation's progress. To meet this need, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2016 estimated global, regional, national, and, for selected locations, subnational cause-specific mortality beginning in the year 1980. Here we report an update to that study, making use of newly available data and improved methods. GBD 2017 provides a comprehensive assessment of cause-specific mortality for 282 causes in 195 countries and territories from 1980 to 2017.MethodsThe causes of death database is composed of vital registration (VR), verbal autopsy (VA), registry, survey, police, and surveillance data. GBD 2017 added ten VA studies, 127 country-years of VR data, 502 cancer-registry country-years, and an additional surveillance country-year. Expansions of the GBD cause of death hierarchy resulted in 18 additional causes estimated for GBD 2017. Newly available data led to subnational estimates for five additional countries—Ethiopia, Iran, New Zealand, Norway, and Russia. Deaths assigned International Classification of Diseases (ICD) codes for non-specific, implausible, or intermediate causes of death were reassigned to underlying causes by redistribution algorithms that were incorporated into uncertainty estimation. We used statistical modelling tools developed for GBD, including the Cause of Death Ensemble model (CODEm), to generate cause fractions and cause-specific death rates for each location, year, age, and sex. Instead of using UN estimates as in previous versions, GBD 2017 independently estimated population size and fertility rate for all locations. Years of life lost (YLLs) were then calculated as the sum of each death multiplied by the standard life expectancy at each age. All rates reported here are age-standardised.FindingsAt the broadest grouping of causes of death (Level 1), non-communicable diseases (NCDs) comprised the greatest fraction of deaths, contributing to 73·4% (95% uncertainty interval [UI] 72·5–74·1) of total deaths in 2017, while communicable, maternal, neonatal, and nutritional (CMNN) causes accounted for 18·6% (17·9–19·6), and injuries 8·0% (7·7–8·2). Total numbers of deaths from NCD causes increased from 2007 to 2017 by 22·7% (21·5–23·9), representing an additional 7·61 million (7·20–8·01) deaths estimated in 2017 versus 2007. The death rate from NCDs decreased globally by 7·9% (7·0–8·8). The number of deaths for CMNN causes decreased by 22·2% (20·0–24·0) and the death rate by 31·8% (30·1–33·3). Total deaths from injuries increased by 2·3% (0·5–4·0) between 2007 and 2017, and the death rate from injuries decreased by 13·7% (12·2–15·1) to 57·9 deaths (55·9–59·2) per 100 000 in 2017. Deaths from substance use disorders also increased, rising from 284 000 deaths (268 000–289 000) globally in 2007 to 352 000 (334 000–363 000) in 2017. Between 2007 and 2017, total deaths from conflict and terrorism increased by 118·0% (88·8–148·6). A greater reduction in total deaths and death rates was observed for some CMNN causes among children younger than 5 years than for older adults, such as a 36·4% (32·2–40·6) reduction in deaths from lower respiratory infections for children younger than 5 years compared with a 33·6% (31·2–36·1) increase in adults older than 70 years. Globally, the number of deaths was greater for men than for women at most ages in 2017, except at ages older than 85 years. Trends in global YLLs reflect an epidemiological transition, with decreases in total YLLs from enteric infections, respiratory infections and tuberculosis, and maternal and neonatal disorders between 1990 and 2017; these were generally greater in magnitude at the lowest levels of the Socio-demographic Index (SDI). At the same time, there were large increases in YLLs from neoplasms and cardiovascular diseases. YLL rates decreased across the five leading Level 2 causes in all SDI quintiles. The leading causes of YLLs in 1990—neonatal disorders, lower respiratory infections, and diarrhoeal diseases—were ranked second, fourth, and fifth, in 2017. Meanwhile, estimated YLLs increased for ischaemic heart disease (ranked first in 2017) and stroke (ranked third), even though YLL rates decreased. Population growth contributed to increased total deaths across the 20 leading Level 2 causes of mortality between 2007 and 2017. Decreases in the cause-specific mortality rate reduced the effect of population growth for all but three causes: substance use disorders, neurological disorders, and skin and subcutaneous diseases.InterpretationImprovements in global health have been unevenly distributed among populations. Deaths due to injuries, substance use disorders, armed conflict and terrorism, neoplasms, and cardiovascular disease are expanding threats to global health. For causes of death such as lower respiratory and enteric infections, more rapid progress occurred for children than for the oldest adults, and there is continuing disparity in mortality rates by sex across age groups. Reductions in the death rate of some common diseases are themselves slowing or have ceased, primarily for NCDs, and the death rate for selected causes has increased in the past decade.FundingBill & Melinda Gates Foundation.

A preliminary investigation of information system using Ishikawa diagram and sectoral statistics

A preliminary investigation is a problem-solving procedure. The Ishikawa diagram illustrates the cause of the problem in a particular group of causes. Several studies have used Ishikawa diagrams in problem-solving procedures where the branches of the causes include some components of the information system. The purpose of this study is to conduct a preliminary investigation of information systems using Ishikawa diagram and sectoral statistics. This study uses the System Development Life Cycle method which is limited to preliminary investigation phase. This study has mapped all the components of the information system in the Ishikawa diagram as the branches of causes which grouped into 4M. Sectoral statistics determine the percentage of problems for each cause and category. Preliminary investigation produces several alternative solutions for clients/owners of sectoral statistics regarding categories and causes that have a percentage within the specified range. The percentages make determining the critical causes more measurable.

THE ANALYSIS OF THE POPULATION MORTALITY OF THE YAMAL-NENETS AUTONOMOUS DISTRICT FOR THE PERIOD OF 1993-2016

Aim. This study was designed for the determination of the priority directions of the reduction of the population mortality of the Yamalo-Nenets autonomous district and the estimation of the place of death from certain major groups of death causes in total mortality in the Yamal-Nenets autonomous district for the period of 1993−2016.Materials and methods. There was performed the analysis of the dynamics of death rates and the number of deaths depending on the sex, age group, locality and causes of death.Results. The change in the sex and age structure of the population due to the natural aging and migration movements (the decrease in the proportion of the population younger than 20 years by 8.38% and the increase of the proportion of the population older than 60 years by 4.62% of the total population) had a major influence on the dynamics of the change in death rates of the population. The most significant causes of death in 2016 were: in men − cardiovascular diseases, external causes of death, neoplasms; in women − cardiovascular diseases, neoplasms, external causes of death. The primary directions of reducing the mortality of the population of the YNAO can be determined by the most significant groups of causes of death: cardiovascular diseases of the population; diseases of the digestive system; neoplasms of the digestive, respiratory and genital organs; infant mortality due to infections (with the exception of respiratory infections) and circulatory problems; deaths due to alcohol-related causes.Conclusion. The obtained results can form the basis for management measures to reduce mortality in the Yamalo-Nenets Autonomous District.

Optimization of CT protocols using cause-and-effect analysis of outliers

The aim of this study was to implement an outlier marking and analysis methodology to optimize CT examination protocols.CT Head examination data, including dose metrics along with technical parameters, were stored in an automatic dose registry system. Reference dose metrics distribution was obtained throughout a 1-year period. Outlier thresholds were calculated taking into account the specific shape of the distribution, by using a robust measure of the skewness; the medcouple parameter. Subsequently, outliers from a 4-month period were marked and Cause-and-Effect analysis was carried out by a multidisciplinary dose committee.Reference Dose metrics distributions were obtained from 3690 CT Head examinations. Both CTDIvol and DLP showed a certain degree of skewness, with a medcouple value of 0.05 and 0.11, respectively. All of the upper-outliers fell within 3 identifiable groups of causes, ordered by relative importance: i) inadequate protocol selection, ii) arms or objects in the field-of-view, and iii) abnormal scanning region diameter. Regarding the lower-outliers, 90% were attributable to the inclusion of additional series in the original head protocol and the remaining 10% to unknown causes. Also, a general Cause-and-Effect diagram for outliers was elaborated.While the Dose Reference Level method applies to the general performance of a CT protocol and allows comparison with other centers, the outlier method represents a step further in the optimization process. The proposed method focuses on detecting incorrect utilization of the CT, which mainly arises from inadequate knowledge of CT technology.

Trend forecasting of main groups of causes-of-death in Iran using the Lee-Carter model.

Background: Authoritative information and description of the causes of mortality trends is one of the most basic principles of evaluation of the health sector in all countries. Therefore, this study aims to predict the trend in main groups of causes of death in the Islamic Republic of Iran. Methods: The study population comprised all deaths recorded in the system of registration and classification of causes of death of Ministry of Health and Medical Education during the years 2006 to 2015. The information was collected via death certificate, burial permit, and information forms. In order to forecast the trends of causes-of-death, Lee Carter model was employed in a demographic package 18.1 of R software version 3.3.1. Results: Based on the results, the crude death rate in the total population has reduced from 435.86 in 2006 to 405.01 per 100000 population in 2035. It is anticipated that endocrine, nutritional and metabolic diseases with the rate of 197.71 per 100000 population will be responsible for the highest causes of death in the year 2035 and from 2021 onwards, the mental and behavioral disorders will be responsible for the lowest rate of mortality. Conclusion: Non-communicable diseases have a major role in the deaths of Iranian population; therefore, to reduce the impact of non-communicable diseases on individuals and society, a holistic approach is needed which requires all sectors to cooperate.

Urological Diseases: Ruqya and Negative Ions Treatment

Urological diseases have two groups of causes: Decreased Oxygen Utilization and Jinn. Decreased Oxygen Utilization is caused by Positive Ions from man-made activities. Positive ions induce acidity and inflammation in our body, which are at the base of almost all diseases; the best treatment against Positive Ions is the use of Negative Ions, while Medicine is powerless in many cases. What is amazing, that the Negative Ions help also to diagnose the presence of the Jinn as a cause of the disease and remove the Evil of Satan as Allah “sent down upon you from the sky, rain by which to purify you and remove from you the evil (suggestions) of Satan and to make steadfast your hearts and plant firmly thereby your feet.†(Quran, Al Anfal 8:11). During the rain and thunderstorm there is a massive discharge of Negative Ions. Jinn contain more Positive Ions. The cure is only by Allah and when Ruqya is associated with Negative Ions the cure is quicker.

Facial nerve palsy in children: A retrospective study of 124 cases.

To report the causes and clinical evaluation of children with facial nerve palsy (FNP) admitted to an affiliated university hospital during a 5-year period (2011-2015). A total of 124 children were retrospectively categorised into two groups: idiopathic Bell's palsy (109 patients) and the second group into other FNP aetiologies (15 patients). All children received a standardised work-up and follow-up. Therapy consisted of steroid administration associated with antiviral treatment when a viral infection was suspected. All children of the first group had a full recovery under oral steroids within 2 months of treatment. From the second group, seven children (46%) had a viral infection based on serological findings, two of them were positive for neurotropic herpes viruses, and one had Ramsay Hunt syndrome; six children with infectious FNP had recurrent FNP on the ipsilateral or contralateral side. Five patients had FNP as a complication of acute otitis media; three of them (60%) had partial or full recovery postoperatively. One child developed FNP following temporal bone trauma that had an uneventful recovery with conservative treatment. One child suffered from Melkersson-Rosenthal syndrome, and another child presented with FNP associated with unilateral hemiparesis following an ischaemic cerebral infarct. Facial palsy in children is a manifestation of a heterogeneous group of causes. The most common aetiology of FNP in children in our study was idiopathic (Bell's palsy), followed by infective causes, such as acute otitis media and neurotropic herpes viruses. Therefore, treatment should be adapted to each patient depending on the underlying disease and severity of FNP.

Preventable deaths within Brazil's Public Health System in a population from 5 to 69 years old, 2000 - 2013.

To analyze the mortality trend in the Brazilian population aged between 5 and 69 years old, using the "Brazilian List of Causes of Preventable Deaths". This is an ecological study that uses a time-series analysis of the standardized mortality rate for preventable and unpreventable causes in the period from 2000 to 2013, with corrections for ill-defined causes and the under-reporting of informed deaths. There was a decline in the mortality rate in the Brazilian population aged 5 to 69 due to preventable causes (1.6% per year) and unpreventable causes (1.4% per year), in addition to a decrease among all of the groups of causes of preventable deaths in the period from 2000 - 2013. The study draws attention to the increase in deaths from specific causes such as pneumonia (1.9% per year) and transportation accidents (0.6% per year), as well the stability in the number of deaths from aggression and intentional self-harm. Deaths from noncommunicable diseases fell by 2.2% per year and were highest in the age group of 60 - 69 years old in 2013 (209.9/100,000 inhabitants for ischemic heart disease deaths, 157.2/100,000 inhabitants for cerebrovascular diseases and 116.8/100,000 inhabitants for diabetes). The rates of preventable deaths are still high, especially for noncommunicable diseases and external causes. These causes of death are sensitive to health promotion interventions and, therefore, this study reinforces the need to remain focused on these causes of illness and death, as well as their risk factors.

Improving reliability in forensic engineering: the Delft approach

Based on established theories from literature and best practices of forensic investigations in aerospace engineering, civil engineering and biomechanical engineering, the Delft University of Technology has developed a Delft approach for forensic investigations. This integrated approach consists of three elements. First, because a product has a life cycle with various phases, it is of importance to consider these phases when a failure is investigated. Second, it is acknowledged that failure is a multifaceted phenomenon. Therefore, the ‘Tree House of Failures’ was developed, a taxonomy or categorisation of failure causes, which addresses main groups of causes of failure related to product, instruction and execution. Third, use of a standard investigative approach with the steps ‘orientation’, ‘data collection’, ‘hypotheses generation’, ‘hypotheses testing’, ‘recommendations’ and ‘findings reporting’ is advised. In the Delft approach, the ‘ring of trustworthiness’ is used to underline the mind-set that a forensic engineering investigator should have to assure the investigation’s reliability and validity. The ring of trustworthiness states that an investigation should be objective, repeatable, verifiable, complete and correct. This paper presents the Delft approach for forensic investigations and explains how to use it to prevent several common pitfalls and biases that occur in various stages of a forensic engineering investigation. This approach aims to increase the reliability of forensic engineering investigations worldwide.

Preventable deaths by actions of the Public Health System in Brazilian population (2000–2013)

Introduction The causes of preventable or reducible deaths are defined as those that can be totally or partially prevented by effective actions of the health services. Studies have indicated a significant reduction in deaths due to preventable causes in Brazil and have reinforced the importance of advancing in analyzes of the differentials of mortality rates due to preventable causes according to age groups, regions and municipalities. Objectives To analyze the mortality trend in the Brazilian population from 5 to 69 years, in Brazil and regions, using the “Brazilian List of Causes of Preventable Deaths”. Methods This is an ecological study of time series of the standardized mortality rate for preventable and non-preventable causes in the period between 2000 and 2013, with corrections for ill-defined causes and under-reporting of deaths. Results There was a decline in the mortality rate in the Brazilian population aged 5–69 due to preventable causes (1.6% per year) and non-preventable (1.4% per year). We also found a decrease in all groups of causes of preventable deaths in 2000–2013 period. The study draws attention to the increase in deaths from specific causes, such as pneumonia (1.9% per year) and transport accidents (0.6% per year), and to the stability in deaths due to aggressions and intentional self-harm. Deaths due to non-communicable diseases fell by 2.2% per year and was highest in the age group 60–69 in 2013. Conclusion Rates of preventable deaths are still high, especially for non-communicable diseases and external causes. These causes of death are sensitive to health promotion interventions and, therefore, this study reinforces the need to focus on these causes of illness and death and their risk factors.

Tips for taking the medical history in patients with syncope

Transient loss of consciousness represents one of the most frequent reasons for patients to present in the emergency room. Already at the very beginning, the diagnostic work-up is faced with fundamental questions: (1)Was it really aloss of consciousness? (2)Which department (neurology, cardiology, or others) should check the patient? (3)Is an in-hospital diagnostic work-up required? These questions can be answered from ameticulous patient history which needs to be adjusted to the individual case but also has to systematically go through alist of questions. Patient history has to clarify whether syncope was present. Nonsyncopal events such as falls, transient global amnesia, epilepsy, psychogenic pseudosyncope, transient ischemic attack and drop attacks should be distinguished. In asecond step, the four groups of causes of syncope can be assessed. Neurocardiogenic reflex syncope usually occurs with typical prodromes in typical situations in (younger) patients without heart disease. Orthostasis always occurs in upright position, typically associated with standing up and in patients treated with antihypertensive drugs. Arrhythmogenic syncope frequently shows an abrupt onset without prodromes, associated with injury and with palpitations or fast heart beat before the attack, in older patients frequently associated with known heart disease, in young patients without heart disease frequently with afamily history positive for arrhythmias or sudden cardiac death. Apositive history of structural cardiovascular disease should be considered as acause of syncope, particularly if it occurs during exercise or in supine position, or is associated with chest pain or dyspnea. This review summarizes the most important questions that can elucidate the cause of syncope.