Patrícia Carla dos Santos

Mortalidade por homicídios no Brasil na década de 90: o papel das armas de fogo

OBJECTIVE: To describe the growth of homicide death in Brazil and to investigate the contribution of firearms to homicide death growth in the 90s. METHODS: An ecological descriptive time series was carried out for the period 1991 to 2000. External cause mortality data were obtained according to place of residence for the overall population and by gender from the Ministry of Health Mortality Information System. Homicides were classified as firearm, non-firearm and unknown (weapon) deaths. Proportional mortality and mortality rates (by 100,000) were calculated. RESULTS: Homicides accounted for 33% of all external cause deaths in the 90s. Firearms were used in more than 50% of deaths in 1991 and in almost 70% in 2000. This growth was seen for both genders and in all state capitals. Homicide mortality rate grew 27.5% in the whole country, and firearm homicide mortality rate grew 72.5%. During the same period there was a drop in deaths classified as unknown weapon homicide, which could partially explain the growth seen in firearm homicide rates. CONCLUSIONS: Data suggest the magnitude of firearm contribution for the growing tendency of homicide deaths in Brazil in the 90s. Data quality regarding intentionality and type of weapon used has hindered data analysis.OBJECTIVE To describe the growth of homicide death in Brazil and to investigate the contribution of firearms to homicide death growth in the 90s. METHODS An ecological descriptive time series was carried out for the period 1991 to 2000. External cause mortality data were obtained according to place of residence for the overall population and by gender from the Ministry of Health Mortality Information System. Homicides were classified as firearm, non-firearm and unknown (weapon) deaths. Proportional mortality and mortality rates (by 100,000) were calculated. RESULTS Homicides accounted for 33% of all external cause deaths in the 90s. Firearms were used in more than 50% of deaths in 1991 and in almost 70% in 2000. This growth was seen for both genders and in all state capitals. Homicide mortality rate grew 27.5% in the whole country, and firearm homicide mortality rate grew 72.5%. During the same period there was a drop in deaths classified as unknown weapon homicide, which could partially explain the growth seen in firearm homicide rates. CONCLUSIONS Data suggest the magnitude of firearm contribution for the growing tendency of homicide deaths in Brazil in the 90s. Data quality regarding intentionality and type of weapon used has hindered data analysis.

Homicídios, desenvolvimento socioeconômico e violência policial no Município de São Paulo, Brasil

OBJECTIVE To analyze the association between police violence and homicide mortality rates taking into consideration the effect of contextual variables. METHODS This was an environmental, cross-sectional study that included the 96 census districts in the City of São Paulo. The association between the variables was analyzed using Spearmans rank correlation and simple and multiple regression analysis. RESULTS Univariate analysis revealed a strong and significant association between homicide mortality coefficients and all the indicators of socioeconomic development and police violence. After controlling for potential confounding factors, the association between police violence and homicide mortality coefficients remained strong and significant. This significance was lost only after control for the size of the resident population. CONCLUSION The results indicate that police action that violates basic human rights is not the right answer to urban violence. The combination of homicides from interpersonal violence and deaths from police violence results in negative socialization and promotes further violence.OBJETIVO: Analisar a associacao entre violencia policial e coeficientes de mortalidade por homicidio, considerando o efeito de variaveis contextuais. METODOS: Estudo ecologico de corte transversal considerando os 96 distritos censitarios do Municipio de Sao Paulo. A associacao entre as variaveis foi determinada atraves de correlacao de Spearman e de analise de regressao linear simples e multipla. RESULTADOS: Nas analises univariadas, encontramos associacao forte e significativa entre os coeficientes de mortalidade por homicidio e todos os indicadores de desenvolvimento socioeconomico e violencia policial. Apos controle dos potenciais confundidores, a associacao entre a violencia policial e os coeficientes de mortalidade por homicidio manteve-se forte e significativa. Apenas com o controle para o tamanho da populacao residente a associacao perdeu a significância estatistica. CONCLUSAO: Os resultados indicam que uma acao policial centrada na violacao de direitos humanos basicos nao parece ser a resposta correta para o enfrentamento da violencia urbana. A combinacao de homicidios que resultam de violencia interpessoal com mortes por violencia policial representa uma situacao de socializacao negativa, favorecendo ainda mais violencia.

Qualidade das informações registradas nas declarações de óbito fetal em São Paulo, SP

OBJETIVO: Avaliar a qualidade da informacao registrada nas declaracoes de obito fetal. METODOS: Estudo documental com 710 obitos fetais em hospitais de Sao Paulo, SP, no primeiro semestre de 2008, registrados na base unificada de obitos da Fundacao Sistema Estadual de Analise de Dados e da Secretaria de Estado da Saude de Sao Paulo. Foi analisada a completitude das variaveis das declaracoes de obito fetal emitidas por hospitais e Servico de Verificacao de Obitos. Os registros das declaracoes de obito de uma amostra de 212 obitos fetais de hospitais do Sistema Unico de Saude foram comparados com os dados dos prontuarios e do registro do Servico de Verificacao de Obitos. RESULTADOS: Dentre as declaracoes de obito, 75% foram emitidas pelo Servico de Verificacao de Obitos, mais frequente nos hospitais do Sistema Unico de Saude (78%). A completitude das variaveis das declaracoes de obito emitidas pelos hospitais foi mais elevada e foi maior nos hospitais nao pertencentes ao Sistema Unico de Saude. Houve maior completitude, concordância e sensibilidade nas declaracoes de obito emitidas pelos hospitais. Houve baixa concordância e elevada especificidade para as variaveis relativas as caracteristicas maternas. Maior registro das variaveis sexo, peso ao nascer e duracao da gestacao foi observada nas declaracoes emitidas no Servico de Verificacao de Obitos. A autopsia nao resultou em aprimoramento da indicacao das causas de morte: a morte fetal nao especificada representou 65,7% e a hipoxia intrauterina, 24,3%, enquanto nas declaracoes emitidas pelos hospitais foi de 18,1% e 41,7%, respectivamente. CONCLUSOES: E necessario aprimorar a completitude e a indicacao das causas de morte dos obitos fetais. A elevada proporcao de autopsias nao melhorou a qualidade da informacao e a indicacao das causas de morte. A qualidade das informacoes geradas de autopsias depende do acesso as informacoes hospitalares.OBJECTIVE To evaluate the quality of information registered on fetal death certificates. METHODS Records were reviewed from 710 fetal deaths registered in the consolidated database of deaths from the State System for Data Analysis and the São Paulo State Secretary of Health, for deaths in São Paulo municipality (Southeastern Brazil) during the first semester of 2008. Completeness was analyzed for variables on fetal death certificates issued by hospitals and autopsy service. The death certificates from a sub-sample of 212 fetal deaths in hospitals of the National Unified Health System (public) were compared to medical records and to the records from Coroners Office. RESULTS Among death certificates, 75% were issues by Coroners Office, with a greater frequency in public hospitals (78%). Completeness of variables on death certificates issued by hospitals was higher among non-public hospitals. There was greater completeness, agreement and sensitivity in death certificates issued by hospitals. There was low agreement and high specificity for variables related to maternal characteristics. Increased reporting of gender, birth weight and gestational age was observed in certificates issued by Coroners Office. Autopsies did not result in improved ascertainment of cause of death, with 65.7% identified as unspecified fetal death as 24.3% as intrauterine hypoxia, while death certificates by hospitals reported 18.1% as unspecified and 41.7% as intrauterine hypoxia. CONCLUSIONS Completeness and the ascertainment of cause of fetal death need to be improved. The high proportion of autopsies did not improve information and ascertainment of cause of death. The quality of information generated by autopsies depends on access to hospital records.

Análise espacial dos aglomerados de nascimentos ocorridos em hospitais SUS e não SUS do município de São Paulo, Brasil

The scope of this study is to evaluate the spatial distribution of live births (LB) in the Municipality of São Paulo (MSP), verify if there is spatial dependence, identify possible differences in birth profiles and evaluate the distances between homes and delivery hospitals. LB occurring in high complexity hospitals were studied, namely 4 from the Unified Health System (SUS) and 4 from the private network in MSP in 2008. 46,190 LB were geocoded: 48.8% from SUS hospitals and 51.2% from private hospitals, accounting for 27.9% of total live births in MSP. LB in SUS hospitals formed two clusters, with a high proportion of households with incomes of 1/2 to 2MW and a marked number of shantytowns and high birth rates. LB in private hospitals formed a cluster in the central region of MSP, where there is a high proportion of households with > 10 MW income and a low birth rate. Differences in maternal, pregnancy and childbirth characteristics were statistically significant in SUS and non-SUS hospitals, as well as the frequency of multiple births. There was no difference in the prevalence of low birth weight and pre-term births. The results showed differences in the LB cluster profile reflecting the current inequalities in living conditions.O objetivo deste estudo e avaliar a distribuicao espacial de nascidos vivos (NV) do municipio de Sao Paulo (MSP), verificar se ha dependencia espacial, identificar possiveis diferencas no perfil dos nascimentos e avaliar as distâncias percorridas entre os domicilios e os hospitais do parto. Foram estudados os NV ocorridos em hospitais de alta complexidade, quatro SUS e quatro da rede nao SUS no MSP em 2008. Foram georreferenciados 46.190 NV: 48,8% em hospitais SUS e 51,2% nao SUS, estes representaram 27,9% do total de NV do MSP. Os NV de hospitais SUS formaram dois aglomerados com elevada proporcao de domicilios com renda de 1/2 a 2SM, concentracao de favelas e altas taxas de natalidade. Os NV de hospitais nao SUS formaram um aglomerado na regiao central do MSP, onde ha elevada proporcao de domicilios com renda > 10 SM e baixa natalidade. Foram encontradas diferencas estaticamente significantes das caracteristicas maternas, da gestacao e do parto entre os NV de hospitais SUS e nao SUS e da frequencia de gemelaridade. Nao houve diferenca na prevalencia de baixo peso e pre-termo. Os resultados mostraram existir diferenciais no perfil dos aglomerados de NV, que refletem as desigualdades das condicoes de vida do MSP.The scope of this study is to evaluate the spatial distribution of live births (LB) in the Municipality of Sao Paulo (MSP), verify if there is spatial dependence, identify possible differences in birth profiles and evaluate the distances between homes and delivery hospitals. LB occurring in high complexity hospitals were studied, namely 4 from the Unified Health System (SUS) and 4 from the private network in MSP in 2008. 46,190 LB were geocoded: 48.8% from SUS hospitals and 51.2% from private hospitals, accounting for 27.9% of total live births in MSP. LB in SUS hospitals formed two clusters, with a high proportion of households with incomes of 1/2 to 2MW and a marked number of shantytowns and high birth rates. LB in private hospitals formed a cluster in the central region of MSP, where there is a high proportion of households with > 10 MW income and a low birth rate. Differences in maternal, pregnancy and childbirth characteristics were statistically significant in SUS and non-SUS hospitals, as well as the frequency of multiple births. There was no difference in the prevalence of low birth weight and pre-term births. The results showed differences in the LB cluster profile reflecting the current inequalities in living conditions.

Quality of information registered on fetal deaths certificates in São Paulo, Southeastern Brazil

OBJETIVO: Avaliar a qualidade da informacao registrada nas declaracoes de obito fetal. METODOS: Estudo documental com 710 obitos fetais em hospitais de Sao Paulo, SP, no primeiro semestre de 2008, registrados na base unificada de obitos da Fundacao Sistema Estadual de Analise de Dados e da Secretaria de Estado da Saude de Sao Paulo. Foi analisada a completitude das variaveis das declaracoes de obito fetal emitidas por hospitais e Servico de Verificacao de Obitos. Os registros das declaracoes de obito de uma amostra de 212 obitos fetais de hospitais do Sistema Unico de Saude foram comparados com os dados dos prontuarios e do registro do Servico de Verificacao de Obitos. RESULTADOS: Dentre as declaracoes de obito, 75% foram emitidas pelo Servico de Verificacao de Obitos, mais frequente nos hospitais do Sistema Unico de Saude (78%). A completitude das variaveis das declaracoes de obito emitidas pelos hospitais foi mais elevada e foi maior nos hospitais nao pertencentes ao Sistema Unico de Saude. Houve maior completitude, concordância e sensibilidade nas declaracoes de obito emitidas pelos hospitais. Houve baixa concordância e elevada especificidade para as variaveis relativas as caracteristicas maternas. Maior registro das variaveis sexo, peso ao nascer e duracao da gestacao foi observada nas declaracoes emitidas no Servico de Verificacao de Obitos. A autopsia nao resultou em aprimoramento da indicacao das causas de morte: a morte fetal nao especificada representou 65,7% e a hipoxia intrauterina, 24,3%, enquanto nas declaracoes emitidas pelos hospitais foi de 18,1% e 41,7%, respectivamente. CONCLUSOES: E necessario aprimorar a completitude e a indicacao das causas de morte dos obitos fetais. A elevada proporcao de autopsias nao melhorou a qualidade da informacao e a indicacao das causas de morte. A qualidade das informacoes geradas de autopsias depende do acesso as informacoes hospitalares.OBJECTIVE To evaluate the quality of information registered on fetal death certificates. METHODS Records were reviewed from 710 fetal deaths registered in the consolidated database of deaths from the State System for Data Analysis and the São Paulo State Secretary of Health, for deaths in São Paulo municipality (Southeastern Brazil) during the first semester of 2008. Completeness was analyzed for variables on fetal death certificates issued by hospitals and autopsy service. The death certificates from a sub-sample of 212 fetal deaths in hospitals of the National Unified Health System (public) were compared to medical records and to the records from Coroners Office. RESULTS Among death certificates, 75% were issues by Coroners Office, with a greater frequency in public hospitals (78%). Completeness of variables on death certificates issued by hospitals was higher among non-public hospitals. There was greater completeness, agreement and sensitivity in death certificates issued by hospitals. There was low agreement and high specificity for variables related to maternal characteristics. Increased reporting of gender, birth weight and gestational age was observed in certificates issued by Coroners Office. Autopsies did not result in improved ascertainment of cause of death, with 65.7% identified as unspecified fetal death as 24.3% as intrauterine hypoxia, while death certificates by hospitals reported 18.1% as unspecified and 41.7% as intrauterine hypoxia. CONCLUSIONS Completeness and the ascertainment of cause of fetal death need to be improved. The high proportion of autopsies did not improve information and ascertainment of cause of death. The quality of information generated by autopsies depends on access to hospital records.

Spatial analysis of live birth clusters in Unified Health System (SUS) and private hospitals in the municipality of São Paulo, Brazil

The scope of this study is to evaluate the spatial distribution of live births (LB) in the Municipality of São Paulo (MSP), verify if there is spatial dependence, identify possible differences in birth profiles and evaluate the distances between homes and delivery hospitals. LB occurring in high complexity hospitals were studied, namely 4 from the Unified Health System (SUS) and 4 from the private network in MSP in 2008. 46,190 LB were geocoded: 48.8% from SUS hospitals and 51.2% from private hospitals, accounting for 27.9% of total live births in MSP. LB in SUS hospitals formed two clusters, with a high proportion of households with incomes of 1/2 to 2MW and a marked number of shantytowns and high birth rates. LB in private hospitals formed a cluster in the central region of MSP, where there is a high proportion of households with > 10 MW income and a low birth rate. Differences in maternal, pregnancy and childbirth characteristics were statistically significant in SUS and non-SUS hospitals, as well as the frequency of multiple births. There was no difference in the prevalence of low birth weight and pre-term births. The results showed differences in the LB cluster profile reflecting the current inequalities in living conditions.O objetivo deste estudo e avaliar a distribuicao espacial de nascidos vivos (NV) do municipio de Sao Paulo (MSP), verificar se ha dependencia espacial, identificar possiveis diferencas no perfil dos nascimentos e avaliar as distâncias percorridas entre os domicilios e os hospitais do parto. Foram estudados os NV ocorridos em hospitais de alta complexidade, quatro SUS e quatro da rede nao SUS no MSP em 2008. Foram georreferenciados 46.190 NV: 48,8% em hospitais SUS e 51,2% nao SUS, estes representaram 27,9% do total de NV do MSP. Os NV de hospitais SUS formaram dois aglomerados com elevada proporcao de domicilios com renda de 1/2 a 2SM, concentracao de favelas e altas taxas de natalidade. Os NV de hospitais nao SUS formaram um aglomerado na regiao central do MSP, onde ha elevada proporcao de domicilios com renda > 10 SM e baixa natalidade. Foram encontradas diferencas estaticamente significantes das caracteristicas maternas, da gestacao e do parto entre os NV de hospitais SUS e nao SUS e da frequencia de gemelaridade. Nao houve diferenca na prevalencia de baixo peso e pre-termo. Os resultados mostraram existir diferenciais no perfil dos aglomerados de NV, que refletem as desigualdades das condicoes de vida do MSP.The scope of this study is to evaluate the spatial distribution of live births (LB) in the Municipality of Sao Paulo (MSP), verify if there is spatial dependence, identify possible differences in birth profiles and evaluate the distances between homes and delivery hospitals. LB occurring in high complexity hospitals were studied, namely 4 from the Unified Health System (SUS) and 4 from the private network in MSP in 2008. 46,190 LB were geocoded: 48.8% from SUS hospitals and 51.2% from private hospitals, accounting for 27.9% of total live births in MSP. LB in SUS hospitals formed two clusters, with a high proportion of households with incomes of 1/2 to 2MW and a marked number of shantytowns and high birth rates. LB in private hospitals formed a cluster in the central region of MSP, where there is a high proportion of households with > 10 MW income and a low birth rate. Differences in maternal, pregnancy and childbirth characteristics were statistically significant in SUS and non-SUS hospitals, as well as the frequency of multiple births. There was no difference in the prevalence of low birth weight and pre-term births. The results showed differences in the LB cluster profile reflecting the current inequalities in living conditions.

Calidad de las informaciones registradas en las declaraciones de óbito fetal en Sao Paulo, Sureste de Brasil

OBJETIVO: Avaliar a qualidade da informacao registrada nas declaracoes de obito fetal. METODOS: Estudo documental com 710 obitos fetais em hospitais de Sao Paulo, SP, no primeiro semestre de 2008, registrados na base unificada de obitos da Fundacao Sistema Estadual de Analise de Dados e da Secretaria de Estado da Saude de Sao Paulo. Foi analisada a completitude das variaveis das declaracoes de obito fetal emitidas por hospitais e Servico de Verificacao de Obitos. Os registros das declaracoes de obito de uma amostra de 212 obitos fetais de hospitais do Sistema Unico de Saude foram comparados com os dados dos prontuarios e do registro do Servico de Verificacao de Obitos. RESULTADOS: Dentre as declaracoes de obito, 75% foram emitidas pelo Servico de Verificacao de Obitos, mais frequente nos hospitais do Sistema Unico de Saude (78%). A completitude das variaveis das declaracoes de obito emitidas pelos hospitais foi mais elevada e foi maior nos hospitais nao pertencentes ao Sistema Unico de Saude. Houve maior completitude, concordância e sensibilidade nas declaracoes de obito emitidas pelos hospitais. Houve baixa concordância e elevada especificidade para as variaveis relativas as caracteristicas maternas. Maior registro das variaveis sexo, peso ao nascer e duracao da gestacao foi observada nas declaracoes emitidas no Servico de Verificacao de Obitos. A autopsia nao resultou em aprimoramento da indicacao das causas de morte: a morte fetal nao especificada representou 65,7% e a hipoxia intrauterina, 24,3%, enquanto nas declaracoes emitidas pelos hospitais foi de 18,1% e 41,7%, respectivamente. CONCLUSOES: E necessario aprimorar a completitude e a indicacao das causas de morte dos obitos fetais. A elevada proporcao de autopsias nao melhorou a qualidade da informacao e a indicacao das causas de morte. A qualidade das informacoes geradas de autopsias depende do acesso as informacoes hospitalares.OBJECTIVE To evaluate the quality of information registered on fetal death certificates. METHODS Records were reviewed from 710 fetal deaths registered in the consolidated database of deaths from the State System for Data Analysis and the São Paulo State Secretary of Health, for deaths in São Paulo municipality (Southeastern Brazil) during the first semester of 2008. Completeness was analyzed for variables on fetal death certificates issued by hospitals and autopsy service. The death certificates from a sub-sample of 212 fetal deaths in hospitals of the National Unified Health System (public) were compared to medical records and to the records from Coroners Office. RESULTS Among death certificates, 75% were issues by Coroners Office, with a greater frequency in public hospitals (78%). Completeness of variables on death certificates issued by hospitals was higher among non-public hospitals. There was greater completeness, agreement and sensitivity in death certificates issued by hospitals. There was low agreement and high specificity for variables related to maternal characteristics. Increased reporting of gender, birth weight and gestational age was observed in certificates issued by Coroners Office. Autopsies did not result in improved ascertainment of cause of death, with 65.7% identified as unspecified fetal death as 24.3% as intrauterine hypoxia, while death certificates by hospitals reported 18.1% as unspecified and 41.7% as intrauterine hypoxia. CONCLUSIONS Completeness and the ascertainment of cause of fetal death need to be improved. The high proportion of autopsies did not improve information and ascertainment of cause of death. The quality of information generated by autopsies depends on access to hospital records.