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Resumen Introducción: La hospitalización de pacientes durante la pandemia de COVID-19 se incrementó de manera importante, y evidenció las carencias de los sistemas de salud, que no respondieron de forma adecuada y eficiente. Objetivo: Determinar la evolución de pacientes hospitalizados durante la pandemia de COVID-19 en Perú. Métodos: Investigación descriptiva, transversal, retrospectiva. Efectuada con una data de 115 306 pacientes, a quienes se valoró su última evolución, el ingreso a Unidad de Cuidados Intensivos, si recibieron oxígeno o ventilación, fallecidos por COVID-19 y vacunación contra esta enfermedad, según los datos de la plataforma nacional de datos abiertos del Ministerio de Salud del Perú. Para analizar los datos se usaron frecuencias absolutas y relativas y para la asociación comparativa de variables, el chi cuadrado de homogeneidad con una significancia estadística de p < 0,01. Resultados: De los pacientes que ingresaron a Unidad de Cuidados Intensivos, que recibieron oxígeno y ventilación, el 51,1 %, 59,1 % y 44,9 %, respectivamente, fueron dados de alta. Del 28,3 % de pacientes que fallecieron, el 90,2 % fue por COVID-19. La mayor proporción fueron adultos (51,1 %) y adultos mayores (31,2 %), de los cuales el 36,3 % y 62,4 % fallecieron por COVID-19. De los fallecidos por COVID-19, el 96,9 % no tenía ninguna dosis de vacuna contra la enfermedad. Conclusión: Más de la mitad de los pacientes que ingresaron a Unidad de Cuidados Intensivos y recibieron oxígeno fueron dados de alta, la mayoría de los fallecidos por COVID-19 fueron adultos, adultos mayores y no vacunados. Las diferencias entre todos los pares de variables comparadas fueron altamente significativas (p < 0,001). Abstract Introduction: The hospitalization of patients during the COVID-19 pandemic increased significantly, and evidenced the shortcomings of the health systems, which did not respond adequately and efficiently. Objective: To determine the evolution of hospitalized patients during the COVID-19 pandemic in Peru. Methods: Descriptive, cross sectional, retrospective research. Done with a data of 115,306 patients, who were assessed their latest evolution, admission to the Intensive Care Unit, if they received oxygen or ventilation, died from COVID-19 and vaccination against this disease, according to data from the national data platform open from the Ministry of Health of Peru. To analyze the data, absolute and relative frequencies were used and for the comparative association of variables, the chi-square of homogeneity with a statistical significance of p

Resumen Objetivo: Describir los años potenciales de vida perdidos (APVP) y la distribución espacial de la mortalidad por incidente vial en peatones de Medellín durante el período 2015-2020. Métodos: Se realizó estudio descriptivo con fuente de información secundaria, se analizaron la totalidad de registros de peatones muertos en incidente vial. El cálculo de los APVP fue realizado por grupos quinquenales y eligiendo como edad límite la esperanza de vida al nacer de Colombia, estimada por el DANE para el período 2015-2020. Para conocer la distribución geográfica de las muertes se creó mapa de puntos y densidad de Kernel con clasificación estándar-cuantil. El análisis de proximidad se realizó por el método búfer de anillos múltiples, con distancias de 100, 200 y 300 metros. Resultados: En Medellín, durante los años 2015-2020, se registraron 696 muertes de peatones, 514(73,9%) hombres y 182 (26,1%) mujeres. Las comunas de mayor mortalidad fueron Candelaria con 217(31,2%) muertes y Castilla con 61(8,8%). Las lesiones más frecuentes fueron politraumatismos 401 (57,6%) y lesiones en cabeza 231 (33,2%). En total los peatones de la ciudad perdieron 14.553 APVP por incidente vial. Del total de incidentes fatales en peatones, 400 (57,5%) ocurrieron en un radio de distancia de 300 metros de un puente peatonal. Conclusión: Peatones hombres presentaron las tasas de APVP más altas del período, y son quienes más mueren en la vía. Lesiones en cabeza y cráneo son las más fatales, especialmente si son adultos mayores quienes las sufren. La pérdida de fuerza laboral y económica es alta para la ciudad, pero la social y familiar es incalculable. Abstract Objective: To describe the Years of Potential Life Lost (YPLL), and the spatial distributions of mortality caused by road accidents in Medellin pedestrians between the periods of 2015-2020. Methods: A descriptive study with a secondary source of information was carried out, and all the records of pedestrians killed in road accidents were analyzed. The calculation of the YPLL was carried out by five-year age groups and the Life Expectancy at Birth of Colombia as the age limit estimated by DANE for the period 2015-2020 was chosen. To know the geographical distribution of the deaths, point maps, and kernel density estimation with a standard quantile classification were created. The proximity analysis was performed by the multiple ring buffer method, with distances of 100, 200 and 300 meters. Results: During the years 2015-2020, 696 pedestrian deaths were registered in Medellin, from which 514 (73.9%) were men and 182 (26.1%) were women. The neighborhoods with the highest mortality were Candelaria with a percentage of 31.2% (217 deaths), and Castilla with a percentage of 8.8% (61 deaths). The most frequent injuries were polytrauma with a total of 401 cases (57.6%), and head injuries in 231 cases (33.2%). In total, the city's pedestrians lost 14,553 YPLL due to road accidents. From the total number of fatal pedestrian accidents, 400 (57.5%) of them occurred within a 300-meter radius of a pedestrian bridge. Conclusion: Male pedestrians had the highest YPLL rates of the period, and they are the ones who die the most on the road. Head and skull injuries are the most fatal, especially if they are suffered by older adults. The loss of labor and economic power is high for the city, but the social and family loss is incalculable.

Fundamentos: El impacto económico que causan las enfermedades va mucho más allá del gasto sanitario, transmitiéndose a la sociedad a través de diferentes dimensiones. El principal objetivo de este estudio fue estimar la evolución de las pérdidas de productividad laboral causadas por muertes prematuras en España durante el periodo 2005-2009. Métodos: Se emplearon varias fuentes estadísticas (Registro de defunciones según la causa de muerte, Encuesta de Población Activa y Encuesta de Estructura Salarial) para desarrollar un modelo de simulación basado en el enfoque de capital humano que permitió estimar las pérdidas laborales ocasionadas por muertes prematuras para el periodo analizado. Adicionalmente, se llevaron a cabo dos escenarios alternativos en los que se analizó la influencia de la evolución epidemiológica en los resultados obtenidos. Resultados: El modelo de simulación mostró una caída de las pérdidas laborales asociadas a muertes prematuras que fue desde 8.935 millones de euros en 2005 a 8.073 millones de euros en 2009. El análisis de las causas reducidas de muerte señaló que nueve causas de enfermedad (accidentes de tráfico, tumor maligno de tráquea, suicidios, infarto agudo de miocardio, SIDA, cirrosis, tumor de mama, enfermedades cerebrovasculares y cáncer de colon) supusieron el 35,6% del total de Años Potenciales de Vida Laboral Perdidos y 36,6% del total de pérdida estimada. Las pérdidas estimadas representaron el 0,98%, 0,85% y 0,77% del Producto Interior Bruto de 2005, 2007 y 2009, respectivamente. Conclusiones: Las pérdidas laborales ocasionadas por muertes prematuras en España disminuyeron sustancialmente en el periodo analizado. Esta reducción se debió fundamentalmente a la favorable evolución epidemiológica de la mortalidad prematura. Background: The economic impact caused by diseases goes far beyond health care costs and, therefore it is transferred to the society through different dimensions. The aim of this study was to estimate the productivity losses due to premature deaths caused by diseases occurred in Spain during the period 2005-2009. Methods: We used data from several sources (Death Registry, Labour Force Survey and Wage Structure Survey) to develop a simulation model based on the human-capital approach that allowed us to estimate the labour productivity losses caused by premature deaths in the period analysed. Additionally, we also carried out two alternative scenarios in which we analysed how epidemiologic data influenced our results. Results: Our model showed the estimated loss of productivity due to premature death fell from 8,935 billion euros in 2005 to 8,073 billion euros in 2009. Nine diseases (traffic accidents, malignant tumour of the trachea, suicides, acute myocardial infarction, AIDS, cirrhosis, breast tumour, cerebrovascular disease and colon cancer) accounted for 35.6% of the total Years of Potential Productive Life Lost and 36.5% of the estimated productivity losses. The estimated losses represented 0.98%, 0.85% and 0.77% of Gross Domestic Product in 2005, 2007 and 2009, respectively. Conclusions: The labour productivity losses caused by premature deaths decreased substantially in the period analysed. This reduction was mainly due to the epidemiological evolution of premature mortality.

Repensar estratégias efetivas para o controle e prevenção das doenças crônicas não transmissíveis (DCNT) tem sido um desafio para os sistemas de saúde. Segundo a OMS, as DCNT respondem por 73% dos óbitos no mundo, com destaque para doenças cardiovasculares (31,3%). No Brasil, as doenças cardiovasculares (DCV) constituem a primeira causa de morte em todas as regiões brasileiras. O presente estudo teve como campo de pesquisa o município de Praia Grande-SP, com objetivo de avaliar o desempenho da rede de atenção à saúde ao paciente portador de DCV. A pesquisa foi realizada em duas fases. A primeira, de caráter quantitativo, buscou identificar a evolução das taxas de mortalidade por doenças do aparelho circulatório (doenças isquêmicas do coração, doenças cerebrovasculares e doenças hipertensivas) no período entre 1996 e 2012, antes e após a criação do Serviço de Verificação de Óbitos regional no município de Praia Grande. A segunda parte do estudo, de caráter qualitativo, buscou conhecer, por meio de coleta de informações orais, o circuito do atendimento em rede à pessoa que procura os serviços de saúde do município de Praia Grande na perspectiva do usuário com doença cardiovascular, desde o diagnóstico até a ocorrência do óbito, com o objetivo de reconstruir as formas de acesso aos serviços de saúde e continuidade do cuidado. Com essa finalidade realizamos uma seleção aleatória de 17 óbitos por DCV de residentes na Praia Grande ocorridos no período de janeiro a maio de 2013. Os prontuários foram localizados nas Unidades de Saúde da Família e usados para coleta de dados, realizada por meio de questionário semiestruturado. Os familiares e profissionais dos serviços de saúde acessados para o atendimento do evento que levou ao óbito foram entrevistados para recompor a rede de assistência Resultados: Verificamos uma forte correlação positiva entre aumento da mortalidade proporcional por doenças cardiovasculares e número de óbitos investigados por necropsia no Serviço de Verificação de Óbito sugerindo que a investigação da causa de morte e o preenchimento correto da declaração de óbito pode ter sido um fator importante na modificação do perfil de mortalidade do município de Praia Grande no período 2006-2012. A observação do comportamento em espelho das tendências das mortalidades proporcionais por causas mal definidas e doenças cardiovasculares permite supor que o aumento de participação das últimas no obituário se deu à custa do declínio das primeiras. No ano de 2013, este estudo indicou que apenas o aumento quantitativo de equipes da Estratégia de Saúde da Família não se mostrou suficiente para o enfrentamento da DCV de forma efetiva e contínua, embora a rede de atenção básica do município de Praia Grande contasse com uma cobertura de mais de 56 % da população local com a Estratégia de Saúde da Família. Os nós dificultadores identificados neste circuito de serviços de saúde no município de Praia Grande são constituídos pelo desafio de trabalhar em rede, com comunicação entre os pares e transpondo barreiras locais, além do protagonismo fundamental do agente comunitário de saúde na questão do conhecimento, do monitoramento e da vigilância da população moradora em seu território, seja ela usuária do SUS ou da rede de saúde suplementar. À época da pesquisa, as unidades da atenção básica não pareciam ser uma porta aberta quando da agudização da sua condição crônica de saúde, o que leva o usuário a procurar primeiramente por serviços de urgência e emergência, continuando o fluxo para os serviços de internação, cujos procedimentos de alta complexidade também são dificultadores para uma boa evolução antes da ocorrência do óbito por DCV. Rethinking effective strategies for prevention and control of chronic non-communicable diseases (NCD) has been a challenge for health care systems. According to the WHO, NCDs account for 73% of deaths worldwide, especially cardiovascular diseases (31.3%). In Brazil, cardiovascular diseases (CVD) are the leading cause of death in all Brazilian regions. This study’s research field was the municipality of Praia Grande -São Paulo, and its goal was to evaluate the performance of the health care network for the patient with CVD. The survey was conducted in two phases. The first, of quantitative character, sought to identify the evolution of mortality rates from cardiovascular diseases (ischemic heart disease, cerebrovascular disease and hypertensive disease) in the period between 1996 and 2012, before and after the creation of Regional Coroner's Service in Praia Grande’s municipality. The second part of the study, qualitative, sought to know, through collecting oral information, the path along the service network of the person seeking health services on the Praia Grande’s municipality in the perspective of the patient with cardiovascular disease until death occurred, in order to reconstruct the forms of access to health services and the continuity of care. The authors conducted a random selection of 17 CVD deaths of residents in Praia Grande that occurred in the period from January to May 2013. The records were located on the Family Health Units and used for data collection, carried out through semi-structured questionnaire. Family members and health services’ professionals that had been accessed during the event that led to the death were interviewed to recompose the service network. Results: We found a strong positive correlation between increased proportional cardiovascular mortality and number of deaths investigated by necropsy in the Coroner's Service suggesting that the investigation of the cause of death and the correct completion of death certificates may have been an important factor in mortality profile modification of Praia Grande municipality in the period 2006-2012. The behavioral observation using mirror of the trends of proportional mortality from ill-defined causes and cardiovascular disease suggests that the increase in participation in recent obituary occurred at the expense of the decline of the first. In the year 2013, this study indicated that the quantitative increase of teams of the Family Health Strategy alone was not enough to manage effectively and continuously the CVDs, although the primary care network of Praia Grande municipality had more than 56% of the local population covered with the Family Health Strategy. The knots within the health care circuit in the city of Praia Grande are the challenge to network, to communicate between peers, to transpose local walls and the fundamental role of the Community Health Agent in the matter of knowledge, monitoring and surveillance of the population living in his territory, whether SUS user or of the private healthcare services. At the time of the survey, the primary care units did not seem to be an open door at the moment that their chronic health condition worsens. This lead the user to look first for urgency and emergency services, continuing the flow for inpatient services, whose highly complex procedures are also hindering for a good outcome instead the occurrence of death from CVD. BV UNIFESP: Teses e dissertações

Fundamentos: El impacto económico que causan las enfermedades va mucho más allá del gasto sanitario, transmitiéndose a la sociedad a través de diferentes dimensiones. El principal objetivo de este estudio fue estimar la evolución de las pérdidas de productividad laboral causadas por muertes prematuras en España durante el periodo 2005-2009. Métodos: Se emplearon varias fuentes estadísticas (Registro de defunciones según la causa de muerte, Encuesta de Población Activa y Encuesta de Estructura Salarial) para desarrollar un modelo de simulación basado en el enfoque de capital humano que permitió estimar las pérdidas laborales ocasionadas por muertes prematuras para el periodo analizado. Adicionalmente, se llevaron a cabo dos escenarios alternativos en los que se analizó la influencia de la evolución epidemiológica en los resultados obtenidos. Resultados: El modelo de simulación mostró una caída de las pérdidas laborales asociadas a muertes prematuras que fue desde 8.935 millones de euros en 2005 a 8.073 millones de euros en 2009. El análisis de las causas reducidas de muerte señaló que nueve causas de enfermedad (accidentes de tráfico, tumor maligno de tráquea, suicidios, infarto agudo de miocardio, SIDA, cirrosis, tumor de mama, enfermedades cerebrovasculares y cáncer de colon) supusieron el 35,6% del total de Años Potenciales de Vida Laboral Perdidos y 36,6% del total de pérdida estimada. Las pérdidas estimadas representaron el 0,98%, 0,85% y 0,77% del Producto Interior Bruto de 2005, 2007 y 2009, respectivamente. Conclusiones: Las pérdidas laborales ocasionadas por muertes prematuras en España disminuyeron sustancialmente en el periodo analizado. Esta reducción se debió fundamentalmente a la favorable evolución epidemiológica de la mortalidad prematura. Background: The economic impact caused by diseases goes far beyond health care costs and, therefore it is transferred to the society through different dimensions. The aim of this study was to estimate the productivity losses due to premature deaths caused by diseases occurred in Spain during the period 2005-2009. Methods: We used data from several sources (Death Registry, Labour Force Survey and Wage Structure Survey) to develop a simulation model based on the human-capital approach that allowed us to estimate the labour productivity losses caused by premature deaths in the period analysed. Additionally, we also carried out two alternative scenarios in which we analysed how epidemiologic data influenced our results. Results: Our model showed the estimated loss of productivity due to premature death fell from 8,935 billion euros in 2005 to 8,073 billion euros in 2009. Nine diseases (traffic accidents, malignant tumour of the trachea, suicides, acute myocardial infarction, AIDS, cirrhosis, breast tumour, cerebrovascular disease and colon cancer) accounted for 35.6% of the total Years of Potential Productive Life Lost and 36.5% of the estimated productivity losses. The estimated losses represented 0.98%, 0.85% and 0.77% of Gross Domestic Product in 2005, 2007 and 2009, respectively. Conclusions: The labour productivity losses caused by premature deaths decreased substantially in the period analysed. This reduction was mainly due to the epidemiological evolution of premature mortality.