Maria Luiza C de Lima

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.

Análise espacial dos determinantes socioeconômicos dos homicídios no Estado de Pernambuco

OBJECTIVE To investigate the association between homicide rates and socio-economic variables taking into account the spatial site of the indicators. METHODS An ecological study was conducted. The dependent variable was the rate of homicides among the male population aged 15 to 49 years, residing in the districts of the State of Pernambuco from 1995 to 1998. The independent variables were an index of the living conditions, per capita family income, Theil inequality index, Gini index, average income of the head of the family, poverty index, rate of illiteracy, and demographic density. The following techniques were used in the analysis: a spatial autocorrelation test determined by the Moran index, multiple linear regression, a spatial regression model (CAR) and a generalized additive model for the detection of spatial trend (LOESS). RESULTS The illiteracy and the poverty index explained 24.6% of the total variability of the homicide rates and there was an inverse relationship. Morans I statistics indicated spatial autocorrelation between municipalities. The multiple linear regression model best fitted for the purposes of this study was the Conditional Auto Regressive (CAR) model. The latter confirmed the association between the poverty index, illiteracy and homicide rates. CONCLUSIONS The inverse association observed between socio-economic indicators and homicides may be expressing a process that propitiates improvement in living conditions and that is linked predominantly to conditions that generate violence, such as drug traffic.OBJETIVO: Investigar a associacao entre variaveis socioeconomicas e taxas de homicidio, considerando a localizacao espacial dos indicadores. METODOS: Utilizou-se o metodo de estudo ecologico. A variavel dependente foi taxa de homicidio da populacao masculina de 15 a 49 anos, residente nos municipios do Estado de Pernambuco, em 1995 a 1998. As variaveis independentes referem-se a: indice de condicoes de vida, renda familiar per capita, desigualdade de Theil, indice de Gini, renda media do chefe de familia, indice de pobreza, taxa de analfabetismo, densidade demografica.Utilizou-se teste de correlacao espacial determinado pelo Indice de Moran, regressao multipla, Conditional Auto Regressive (CAR) e a funcao Loess, como modelo de deteccao de tendencia especial. RESULTADOS: Os indicadores taxa de analfabetismo e indice de pobreza explicaram 24,6% da variabilidade total das taxas de homicidio, cuja associacao foi inversa. O indice de Moran revelou autocorrelacao espacial entre os municipios. O modelo de regressao espacial que melhor se adequou ao estudo foi o CAR, que confirmou a associacao entre indice de pobreza, analfabetismo e homicidio. CONCLUSOES: A relacao inversa observada entre os indicadores socioeconomicos e homicidios pode expressar determinado processo que propicia melhoria das condicoes de vida, e esta atrelado predominantemente a condicoes geradoras de violencia, como a do trafico de drogas.

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.

Cárie Dentária em Pré-Escolares: um Estudo em Áreas Cobertas pela Estratégia Saúde da Família do Recife, PE, Brasil

Dantas Cabral de MELO, Márcia Maria; Vieira de SOUZA, Wayner; Carvalho de LIMA, Maria Luiza; Bosco Lindoso COUTO, Geraldo; Malheiros CHAVES, Thaís Cárie Dentária em Pré-Escolares: um Estudo em Áreas Cobertas pela Estratégia Saúde da Família do Recife, PE, Brasil Pesquisa Brasileira em Odontopediatria e Clínica Integrada, vol. 10, núm. 3, septiembre-diciembre, 2010, pp. 337-343 Universidade Federal da Paraíba Paraíba, Brasil

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.

Indicadores epidemiológicos de morbimortalidade por acidentes e violências

SOUZA, E. R., and LIMA, M. L. C. Indicadores epidemiológicos de morbimortalidade por acidentes e violências. In: NJAINE, K., ASSIS, S. G., and CONSTANTINO, P. Impactos da Violência na Saúde [online]. Rio de Janeiro: Editora FIOCRUZ, 2007, pp. 105-124. ISBN: 978-85-7541-588-7. Available from: doi: 10.7476/9788575415887.007. Also available in ePUB from: http://books.scielo.org/id/7yzrw/epub/njaine-9788575415887.epub.