Maria Dilma de A Barros

Mortalidade por causas externas em crianças e adolescentes: tendências de 1979 a 1995

OBJECTIVE To analyze the magnitude and trends of mortality due to external causes in specific age groups, from 0 to 19 years old in a population living in the city of Recife, Brazil, from 1979 to 1995. METHODS Data from the Mortality Data System of the Ministry of Health and Health Department of Pernambuco State was used. The studied population, aged 0 to 19 years old, represented 41.8% of total city population in 1991. A time series exploratory ecological model was created to analyze trends in mortality coefficients due to external causes. Using simple linear regression these coefficients were assessed in specific age groups categorized by gender. RESULTS AND CONCLUSIONS In the time series, mortality coefficients due to external causes showed an increasing trend, in particular due to homicides among adolescents, where the coefficient increased on average 3.05 per year, yielding a relative increase of 601, 3% over the study period. In 1995, more than 90% of these homicides were perpetrated with fire weapons. These data reinforce the seriousness of this problem and the need to deal with it, taking into account the difficulties in determining the causes of violence.

Idosos do Município do Recife, Estado de Pernambuco, Brasil: uma análise da morbimortalidade hospitalar

Summary This article analyses the current morbidity and mortality situation (2005) of the elderly (60-year-old or more) in the Municipality of Recife, State of Pernambuco, Brazil. Data were obtained from the Hospitals Information System, of the Brazilian Health System (SIH/SUS). Elderly people, who represent 9.4% of the general population, were responsible for 19.2% of the hospitals admissions (AIH type I). The six main causes of the admission of the elderly were circulatory system diseases, followed by digestive system and respiratory system diseases, neoplasias and external causes, which together represented 68.1% of hospital morbidity causes. It was verified that the coefficient of hospital mortality of the elderly population was 3.3 times more than that of adults. Among women, the difference was even higher (five times). It was observed that the main causes for the morbidity among the elderly are passive to reduction through wide political promotion, prevention as well as opportune and adequate treatment of these illnesses.

Causa básica da morte por causas externas: validação dos dados oficiais em Recife, Pernambuco, Brasil

OBJECTIVE To validate the underlying cause of death recorded on the death certificates for individuals under 20 years of age who died from external causes in 1995 in Recife, Pernambuco, Brazil. METHODS We divided the study into two stages, coding and validation. In both stages we compared the official data concerning causes of death to the data we obtained during our study. We grouped the death certificates into 5 broad categories according to the cause of death; we later subdivided them into 14 categories. We also individually compared the death certificates applying the four-digit system of the International Classification of Diseases, Ninth Revision (ICD-9). We assessed the agreement between the official data and our data in terms of sensitivity and the kappa coefficient. We took as the standard the categorization of the cause of death that we had made during our investigation. RESULTS In the coding stage, considering all the external causes of death, the overall agreement between the official data and our study data was 94% for the 5 categories, 92% for the 14 categories, and 81% for the four-digit ICD-9 system. In the validation stage the overall agreement was 94% for the 5 categories, 91% for the 14 categories, and 73% for the four-digit ICD-9 system. CONCLUSIONS Our results suggest that for the death certificates to be reliable, the Institute of Legal Medicine must fill them out following recommended standards. In addition, hospitals and police departments must use greater care in completing the transfer slips that accompany the bodies that are sent to the Institute. More accurate data need to be generated and disseminated for a society to better understand its patterns of violence.

Sub-registro da violência doméstica em adolescentes: a (in)visibilidade na demanda ambulatorial de um serviço de saúde no Recife-PE, Brasil

OBJECTIVE: to estimate the under-reporting of domestic violence at a health service for adolescents (aged 10 - 19 years) in Recife, Brazil, comparing prevalences based on medical records and active investigation of cases in the past year and characterizing the victims and risk factors associated with life events. METHODS: a cross-sectional study was carried out with 333 adolescents attended between February and May 2004, using semi-structured questionnaires covering variables relating to the location and type of abuse, age, sex, occupation, level of education, religion, drug-use, marital status, household income, and family type. Pearsons chi-square test and logistic regression were used to assess the degree of association, using the Epi-info 6.04 and SPSS software packages. RESULTS: of the adolescents interviewed, 41.4% reported abuse although only 1.8% had this registered in medical records. Physical and psychological abuse were reported by 66.7% for each, and sexual violence by 17.7%. A third of the adolescents reported repeated abuse since childhood (20%). Fathers and step-fathers were the main perpetrators of abuse against both sexes, followed by intimate partners. Factors associate with abuse were: unemployment, low level of education and druguse (p<0.05). CONCLUSION: although the prevalence of abuse in the adolescents interviewed was high, it is poorly registered in medical records, suggesting that it is substantially under-reported. The factors identified as being associ ated with abuse reflect generally unsatisfactory living conditions.

Validity of death certificate variables in cases of death from external causes, Brazil

OBJECTIVE To validate variables other than the basic cause of death on death certificates from external causes of residents younger than 20 years old living in Recife, Brazil, in 1995. METHODS A survey of death records of the Institute of Forensic in Recife was carried out in order to validate death certificate variables included in official mortality registries. Agreement analysis was performed using Kappa indexes and sensitivity. As a result of the methodology used, the study data was considered to be more consistent and therefore regarded as standard. RESULTS Those variables forensic specialists indicated as their direct responsibility showed an excellent (gender, age, and category of violence) and good (type of accident) agreement. However, there were significant discrepancies in those variables seen as either of indirect or no forensic responsibility, such as locality and area where death took place, medical care provided and accident location. CONCLUSIONS Data reveal a dissociation between the reasons for including some variables in death certificates and the obtaining strategy and their social purpose.

Análise da mortalidade por homicídios no Recife-PE: tendências no período entre 1997 e 2006

Summary Objective: this study analyzed the magnitude and trend of homicide mortality in Recife, State of Pernambuco, Brazil, from 1997 to 2006. Methodology: data from the Mortality Information System of Recife’s Health Secretariat were used; a time series exploratory ecological model was created to analyze trends in mortality ratios; those coefficients were assessed according to gender and age, using the exponential model. Results: during that period, there were 9,850 homicides of Recife residents; approximately 67% of those killed were in the age group of 15 to 29 years; there was a difference in risk of mortality by gender and age group – young men were associated with increased risk of homicide, compared to women – the overall mortality rate went down about 7%, but that decline showed statistical significance only in men with 30 years or more. Conclusion: specific actions should be taken to benefit mainly adolescents and young adults, since there has been a high rate of homicide among that portion of the population living in the city.