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Introduction: The conflict in Ukraine, ongoing since 2014 and escalating with the Russian invasion in 2022, has unveiled profound challenges in prehospital care essential for the survival and recovery of warfighters and civilians alike, necessitating a detailed examination of the current medical response mechanisms and their effectiveness., Materials and Methods: This study provides an overview of these challenges and examines how these critical vulnerabilities have impacted the delivery of medical care in war-torn regions. It also explores the role of NATO and its member states in addressing these challenges, focusing on the efforts to standardize prehospital care, enhance training, and foster interoperability among medical services. Furthermore, it explores the role of global heath engagement through NGOs in addressing these prehospital care gaps within the Ukrainian conflict zone, drawing from direct observations, expert testimonials, and secondary data., Results: Findings reveal significant enhancements in prehospital care through improved training, interoperability, and logistics management, despite ongoing challenges in medical infrastructure and extended evacuation times, which continue to impact the quality of care., Conclusions: The study underscores the critical role of international collaboration and standardized protocols in bolstering prehospital medical responses in conflict settings, highlighting the need for continuous adaptation and support to mitigate the complexities of modern warfare. The insights gained from the Ukraine conflict offer valuable lessons for future military and humanitarian medical responses in similar conflict settings., (© The Association of Military Surgeons of the United States 2024. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site–for further information please contact journals.permissions@oup.com.)

Type 2 diabetes mellitus currently ranks high among indicators used in Global Burden of Disease Studies. The current study estimated the burden of disease attributable to type 2 diabetes mellitus and its chronic complications in Brazil, 2008. We calculated disability-adjusted life years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) stratified by gender, age bracket, and major geographic region. Type 2 diabetes mellitus accounted for 5% of the burden of disease in Brazil, ranking 3rd in women and 6th in men in the composition of DALYs. The largest share of DALYs was concentrated in the 30-59-year age bracket and consisted mainly of YLDs. The highest YLL and YLD rates were in the Northeast and South of Brazil, respectively. Chronic complications represented 80% of YLDs from type 2 diabetes mellitus. Type 2 diabetes mellitus ranked as a leading health problem in Brazil in 2008, accounting for relevant shares of mortality and morbidity.

Background and Purpose: Symptomatic carotid artery disease is associated with significant morbidity and mortality. The pathophysiologic mechanisms of cerebral ischemia among patients with carotid occlusion remain underexplored., Methods: We conducted a prospective observational cohort study of patients hospitalized within 7 days of ischemic stroke or transient ischemic attack because of ≥50% carotid artery stenosis or occlusion. Transcranial Doppler emboli detection was performed in the middle cerebral artery ipsilateral to the symptomatic carotid. We describe the prevalence of microembolic signals (MES), characterize infarct topography, and report clinical outcomes at 90 days., Results: Forty-seven patients, 19 with carotid occlusion and 28 with carotid stenosis, had complete transcranial Doppler recordings and were included in the final analysis. MES were present in 38%. There was no difference in MES between those with carotid occlusion (7/19, 37%) compared with stenosis (11/28, 39%; P=0.87). In patients with radiographic evidence of infarction (n=39), 38% had a watershed pattern of infarction, 41% had a nonwatershed pattern, and 21% had a combination. MES were present in 40% of patients with a watershed pattern of infarction. Recurrent cerebral ischemia occurred in 9 patients (19%; 6 with transient ischemic attack, 3 with ischemic stroke). There was no difference in the rate of recurrence in those with compared to those without MES., Conclusions: Cerebral embolization plays an important role in the pathophysiology of ischemia in both carotid occlusion and stenosis, even among patients with watershed infarcts. The role of aggressive antithrombotic and antiplatelet therapy for symptomatic carotid occlusions may warrant further investigation given our findings., (© 2017 American Heart Association, Inc.)

This study analyzes the number of medical appointments and referrals performed in primary health care in Brazil focusing on the Mais Médicos Program (More Doctors Program). It is a cross-sectional study on the work of physicians included, or not, to the Mais Médicos Program in 2014. Based on validation protocols, a unified database was created from two health information system databases - SIAB and ESUS. Absolute indicators were defined: the total of medical appointments per month; medical referrals and community health education activities. In addition, other indicators were considered, such as weekly rates and productivity of appointments, in line with the profile of Brazilian municipalities. The mean of all appointments was 285 per month corresponding to an average of 14.4 appointments/day. In the poorest municipalities, the figures for the Mais Médicos Program physicians were higher than national rates. The educational activities provided by primary care teams that included a Mais Médicos Program professional were higher in Brazilian capital cities. The Mais Médicos Program achieved one of its main goals, which was to increase health access for vulnerable populations and to contribute towards the consolidation of primary health care in Brazil.

Objective: to describe the proportion of duplicate records held on the Brazilian Notifiable Diseases Information System, 2008-2009., Methods: identification of duplicate records of dengue, leprosy, visceral leishmaniasis and cutaneous leishmaniasis, meningitis and tuberculosis was conducted using Reclink III(r); the proportion of duplicate records was calculated by geographical region, state and municipal population size categories., Results: visceral leishmaniasis (VL) and meningitis had higher proportions of duplicate notification (5.3% and 3.6%, respectively) whilst leprosy had the lowest (0.7%); the states with highest repetitions were Rio Grande do Norte (VL 6.8% and leprosy 5.1%), Rio de Janeiro (tuberculosis 2.5% and meningitis 4.9%) and Goiás (dengue 2.0% and meningitis 7.2%)., Conclusion: the Northeast region had the highest proportion of duplicate records for four of the six diseases analyzed; with the exception of dengue, percentage repetition was lower in municipalities with larger population size.

The objective of this study was to compare estimates of external causes based on the Global Burden of Disease in Brazil Study for the years 1998 and 2008. Methods included estimation of DALYs (disability-adjusted life years) and YLL (years of life lost), based on the methodology proposed in the Global Burden of Disease Study. Calculation of YLD (years lived with disability) required applying the same methodology in both years, with the 2008 methodology as the standard. Although external causes accounted for some 10% of total DALYs in both years, their internal distribution showed marked differences between regions of Brazil, with a decrease in the Southeast and increase in the North and Northeast. There was an increase in intentional causes, and YLLs accounted for the largest share of DALYs. The results can support new policies and/or improve existing ones to address external causes.

The current study estimated DALY (disability-adjusted life years), an indicator of burden of disease, for Brazil in 2008. The North and Northeast regions showed higher burden of disease. Chronic noncommunicable diseases predominated in all regions of the country, especially cardiovascular diseases, mental disorders (particularly depression), diabetes, and chronic obstructive pulmonary disease. The study also showed a high burden of homicides and traffic accidents. Brazil's epidemiological profile appears even more complex when one considers the non-negligible burden of communicable diseases, maternal and perinatal conditions, and nutritional deficiencies. The analyses allowed a more detailed understanding of the Brazilian's population's health status, underscoring the need for crosscutting actions beyond specific health sector policies and greater attention to the quality of information on morbidity and mortality.

Alcohol use/dependence are an important risk factor for cirrhosis of the liver. The article aims to describe and conduct a comparative analysis of Disability Adjusted Life Years (DALY), Years of Life Lost (YLL) and Years Lived with Disability (YLD) of alcohol use disorders and non-viral cirrhosis in Brazil in 2008. DALY was calculated as the sum of YLL and YLD. For YLL estimates, the mean number of deaths from 2007- 2009 in the country was considered. After revision of epidemiological data, prevalence of each disease was modelled with the DisMod tool, which generated incidence data for YLD estimates. Alcohol and non-viral cirrhosis were responsible for 3% and 1% of total DALYs, respectively. In both diseases, men contributed to a greater proportion of DALYs. Among the first ten causes of DALYs, alcohol use disorders occupied the second, third and sixth positions at the ages of 15-29, 30-44 and 45- 59, respectively. Non-viral cirrhosis was the eighth cause of DALY in the 30-44 age group in men; the fifth, in the 45-59 group and the eighth, in the 60-69 group. Age distribution suggests that interventions directed against alcohol use/dependence would have effects on the burden of alcoholic cirrhosis in the country.

OBJECTIVE To estimate the burden of type 2 diabetes mellitus and its percentage attributable to overweight and obesity in Brazil. METHODS The burden of diabetes mellitus was described in terms of disability-adjusted life years, which is the sum of two components: years of life lost and years lived with disability. To calculate the fraction of diabetes mellitus attributable to overweight, obesity, and excess weight, we used the prevalence of these risk factors according to sex and age groups (> 20 years) obtained from the 2008 Pesquisa Dimensões Sociais das Desigualdades (Social Dimensions of Inequality Survey) and the relative risks derived from the international literature. RESULTS Diabetes mellitus accounted for 5.4% of Brazilian disability-adjusted life years in 2008, with the largest fraction attributed to the morbidity component (years lived with disability). Women exhibited higher values for disability-adjusted life years. In Brazil, 49.2%, 58.3%, and 70.6% of diabetes mellitus in women was attributable to overweight, obesity, and excess weight, respectively. Among men, these percentages were 40.5%, 45.4%, and 60.3%, respectively. Differences were observed with respect to Brazilian regions and age groups. CONCLUSIONS A large fraction of diabetes mellitus was attributable to preventable individual risk factors and, in about six years, the contribution of these factors significant increased, particularly among men. Policies aimed at promoting healthy lifestyle habits, such as a balanced diet and physical activity, can have a significant impact on reducing the burden of diabetes mellitus in Brazil.

The aim of this study was to estimate the global burden of disease from external causes in 2008 in Brazil, based on DALYs (disability-adjusted life years). YLLs (years of life lost) were estimated according to the method proposed by Murray & Lopez (1996). Meanwhile, the method for estimating YLDs (years lived with disability) included methodological adjustments taking the Brazilian reality into account. The study showed a total of 195 DALYs per 100 thousand inhabitants, of which 19 DALYs were related to external causes. Among YLLs, 48% were from unintentional causes and 52% from intentional causes. Among YLDs, unintentional causes predominated, with 95%. The share of YLLs in DALYs was 90%. The cause with the highest proportion of YLLs was "homicide and violence" (43%), followed by "road traffic accidents" (31%). Falls accounted for the highest share of YLDs (36%). The sex ratio (male-to-female) was 4.8 for DALYs, and the predominant age bracket was 15-29 years. Since external causes are avoidable, the study provides potentially useful information for policymakers in public security and health.

The World Health Organization (WHO) defines essential medicines as those that meet the population's priority healthcare needs. Their selection aims to reflect collective needs, thus recommending the use of studies on global burden of disease. An exploratory study was performed to link the medicines from the RENAME lists to Global Burden of Disease in Brazil (1998 and 2008) and the scientific evidence. The study thus sought to verify whether the RENAME (2002 to 2012) met WHO guidelines for drug selection. Although RENAME 2010 and 2012 both adhere to Global Burden of Disease in Brazil 2008, the 2012 version includes a longer list of medicines and appears to be pressured by the growing market for new technologies. Thus, RENAME is no longer a list of essential medicines, but has become a list of financing for pharmaceutical care.

Oral disease is a major public health problem due to its prevalence in practically all age groups. This is a study of the overall burden of dental caries, edentulism and periodontal disease. The Disability-Adjusted Life Year (DALY) indicator was used as it simultaneously measures the impact of mortality and of health problems that affect the quality of life. The overall burden of oral diseases was analyzed in absolute terms and in rates per 1000 inhabitants. The number of Years Lived with Disability (YLD) due to dental caries was 4,489. An estimated 33,888 YLD were lost due to edentulism, with a rate of 1.8/1000 (2.2/1000 among women). An estimated 3217 YLD were lost due to periodontal disease, with a rate of 0.2/1000 for both sexes. Edentulism was the condition that contributed most to the overall burden of oral diseases and is more frequent among women. Higher rates of edentulism and periodontal disease were found in persons aged 45-69 years, while dental caries was more frequent from 15-49 years. The overall burden of oral disease studies represent an important aspect of health diagnosis, integrating both fatal and non-fatal outcomes. Furthermore, these studies provide highly relevant information for preventive and therapeutic policy making.

Summary: Despite the popularity of chronic obstructive pulmonary disease (COPD) guidelines, studies have reported important deficits among primary care physicians (PCPs) with respect to diagnosis and treatment of COPD; as a consequence, COPD remains underrecognized and undertreated., Methods: This was a multicenter pilot study to assess prescribing practices for COPD by PCPs according to COPD guidelines. This was a 2-phase study: In phase 1, PCPs from 27 Mexican cities, referred patients for evaluation, including spirometry and in phase 2, PCPs from 10 of those same cities were asked to answer a questionnaire on COPD practice guidelines., Results: A total of 2293 subjects were included in phase 1; 472 (20.6%) had a FEV1/FVC <70%. Only 39% of patients with 30% ≤ FEV1 < 50% and 22% with FEV1 <30% were receiving combination therapy (long-acting bronchodilator + inhaled steroid). In phase 2, we recruited 999 PCPs; 72.5% of them said that they had read a COPD guideline and 59.4% answered that they used one in their practice. When asked which guideline(s) they used, we had 86 different responses with GOLD (Global Initiative for Chronic Obstructive Lung Disease; 34.1%) being the most common, followed by GINA (Global Initiative for Asthma; 12.8%). When asked why they did not used a guideline, we got 33 different answers; "never read them" was the most frequent answer (41.8%) followed by "lack of access to them" (18.2%) and "not enough time to read them" (6.0%)., Conclusion: Despite the existence and availability of evidence-based guidelines, only a minority of primary health care COPD patients in Mexico are receiving state-of-the-art treatment at the primary care level.

Background and Purpose: The ABCD(2) score is increasingly used for risk stratification of transient ischemic attack patients. We sought to determine the reliability and convergent validity of retrospective ABCD(2) score estimation from medical records., Methods: We compared ABCD(2) scores that were prospectively determined by a vascular neurology attending to scores determined retrospectively from medical record review. Emergency department records and neurology consult notes for patients with acute transient ischemic attack were abstracted with explicit ABCD(2) scoring redacted. Scores were estimated by 2 independent raters using these records. Estimated ABCD(2) component scores, total scores, and risk category were compared both between retrospective raters and with prospectively obtained scores. Reliability was assessed using unweighted κ statistics., Results: Interrater reliability was substantial with 72% exact agreement in total score between retrospective raters (κ=0.64) and nearly perfect with 82% agreement for ABCD(2) category (κ=0.71). Interrater agreement was best for age and diabetes mellitus and poorest for clinical features and duration. Agreement between the retrospective raters and prospectively obtained score was >90% for age, blood pressure, and diabetes mellitus, but only ≈70% for clinical features and duration. Retrospectively, estimated total ABCD(2) score exactly matched the prospective score in 58% of patients for rater 1 and 44% of patients for rater 2. Retrospectively, estimated ABCD(2) category matched the prospectively scored category in 67% of patients for rater 1 and 71% of patients for rater 2., Conclusions: The ABCD(2) score can be abstracted from medical records with substantial interrater reliability but limited convergent validity. This may lead to misclassification of risk category in more than one third of patients.

Introduction: Studies on the relationship of chronic obstructive pulmonary disease (COPD) prevalence and altitude have reported contrasting results. The aim of this COPD case-finding study was to include a larger number of geographical sites to determine if there is an association between altitude and COPD prevalence., Patients and Methods: Individuals aged 40 or older with known COPD risk factors, whether symptomatic or not, were referred by primary-care physicians. After obtaining written informed consent, they were invited to answer a questionnaire and undergo pre- and post-bronchodilator spirometry., Results: Subjects were recruited in 27 Mexican cities, within an altitude range from 1 to 2,680 m above sea level. We found a weak (-0.31; P<.0001) although significant negative correlation between altitude and COPD prevalence. The COPD rate for cities located ≤1,000 m was 32.7% vs 16.4% for cities located >1,000 m (P<.0001); the rate for cities located at ≤2,000 m was 22.7% vs 15.6% for those >2,000 m; in the multiple logistic regression analysis, older age, male sex, tobacco habit, pack-years of smoking, years of exposure to biomass smoke and city altitude over sea level were significantly associated with COPD prevalence., Conclusions: Our data shows a significant inverse correlation between prevalence/severity of COPD and altitude., (Copyright © 2011 SEPAR. Published by Elsevier Espana. All rights reserved.)

We describe the outcome of treatment of multidrug-resistant tuberculosis (MDR-TB) in Baja California, Mexico, by a United States-Mexico consortium. From June 2006 to December 2010, 42 patients started treatment. Strains were resistant to 4.15 ± 1.3 drugs; all patients achieved culture conversion on treatment after an average of 3.4 ± 1.6 months. A total of 19 patients (47.5%) were discharged as cured, 3 died (7.5%) and 1 defaulted (2.5%). MDR-TB cases can be cured under a well-organized out-patient program; in this consortium, the US partner introduced program elements that were gradually integrated into the Mexican state TB program.

In Brazil, quality monitoring of data from the various health information systems does not follow a regular evaluation plan. This paper reviews quality evaluation initiatives related to the Brazilian information systems, identifying the selected quality dimensions and the method employed. The SciELO and LILACS databases were searched, as were the bibliographical references from articles identified in the search. 375 articles were initially identified, leaving a final total of 78 after exclusions. The four most frequent dimensions in articles totaled approximately 90% of the analyses. The studies prioritized certain quality dimensions: reliability, validity, coverage, and completeness. Half of the studies were limited to data from Rio de Janeiro and São Paulo. The limited number of studies on some systems and their unequal distribution between regions of the country hinder a comprehensive quality assessment of Brazil's health information systems. The importance of accurate information highlights the need to implement a data management policy for health information systems in Brazil.

Type II diabetes mellitus accounts for 90% of all cases of diabetes, and its inclusion in health evaluation has shown that its complications have a considerable impact on the population's quality of life. The current article presents the results of the Global Burden of Disease Study in Brazil for the year 1998, with an emphasis on diabetes mellitus and its complications. The indicator used was disability-adjusted life years (DALY), using a discount rate of 3%. In Brazil, ischemic heart disease, stroke, and diabetes accounted for 14.7% of total lost DALYs. Brazil showed a higher proportion of years lived with disability (YLDs) among total DALYs for diabetes as compared to other countries. Retinopathy and neuropathy were the complications that contributed most to YLDs. According to forecasts, diabetes mellitus will have an increasing impact on years of life lost due to premature death and disability in the world, shifting from the 11th to 7th cause of death by 2030. It is thus urgent to implement effective measures for prevention, early diagnosis, counseling, and adequate follow-up of patients with diabetes mellitus.

This study attempted to determine the safety of percutaneous release of trigger fingers, with particular attention given to border digits and the thumb. We performed percutaneous release of the A1 pulley in six fresh frozen cadaveric hands utilizing established surface landmarks. After freezing all specimens, we performed cross-sections at the A1 pulley, avoiding dissection of soft tissues, which could alter the natural position of the digital nerves. There was no difference in the distance from the needle tract to the neurovascular bundle when comparing between digits, and the closest distance was 2.7 mm. There was no significant difference between the needle tract and the radial and ulnar digital nerves. Based on our findings, percutaneous trigger finger release can safely be performed on all digits, including the thumb, small fingers, and index fingers.

Immobilization protocols for nondisplaced scaphoid fractures have included the elbow, wrist, and thumb. This study attempts to demonstrate whether or not immobilization of the thumb makes a difference in preventing motion at the scaphoid fracture site. Using six fresh frozen forearm specimens, a transverse waist scaphoid fracture was created through a dorsal approach. Metallic markers were imbedded on either side of the fracture. Sutures were secured to the flexor pollicus longus (FPL) and extensor pollicus longus (EPL). Each specimen was loaded in extension and flexion by attaching 50-g weights to the EPL and FPL, first with no casting, then with a short arm cast, and finally a short arm thumb spica cast. Angulation and displacement at the fracture site were measured in the coronal, sagittal, and axial planes utilizing image reconstructions from computed tomography. One-way ANOVA with repeated measures and Tukey-Kramer multiple comparison test post hoc analysis were used for statistical evaluation. There was no significant difference in fracture angulation or rotation between spica and short arm casts. There was a significant difference in angulation and rotation in all three planes when comparing between casting and no casting, p < 0.05. In our cadaveric model, wrist immobilization is crucial for nondisplaced scaphoid waist fractures, and short arm casting was just as effective as thumb spica casting in preventing fracture displacement.

This study analyzes the characteristics of 14,419 chronic renal failure patients treated with hemodialysis and time to first kidney transplantation in the State of Rio de Janeiro, Brazil, from 1998 to 2002. Survival analysis methods were used, such as the Kaplan-Meier non-parametric method and the semi-parametric method with the Cox proportional hazards model. Besides the survival model for transplantation, time to death was analyzed to compare the two models' estimates. During the period studied, only 6.3% of patients received transplants, 32.4% were referred for transplantation, and 6.3% were included on the waiting list. Odds of transplantation were greater for those who had been referred, those on the waiting list, and younger patients. Diabetes mellitus reduced the probability of conducting transplantation by 35%. All the estimates showed directions opposite to those obtained for the mortality survival model.

Created in 1999, the Information System on Government Health Budgets (SIOPS) provides information on health revenues and expenditures at the three government levels: Municipal, State, and Federal. The lack of other databases with nationwide coverage and detailed information on municipal expenditures makes SIOPS the main source of data for such studies or estimates. The current study aims to compare the revenues declared in SIOPS by the municipalities and the National Health Fund records in order to assess the reliability of the two databases and identify which variables are most discordant. It also compares the data on Municipal expenditures with those from National Treasury records. The Intra-Class Correlation Coefficient (CCIC) was used for this analysis, complemented by a scatterplot of the mean values for the two databases and their differences. The 2002 data showed better quality. The recognition that SIOPS provides reliable data should stimulate new studies including financial aspects in the analysis of population health.

The access to obstetric care in the city of Rio de Janeiro, Brazil, was evaluated in this study. The aim of this article was to determine the social, demographic and obstetric factors associated with the antenatal search for health services, in a sample of 6,652 postpartum women. It was observed that 1/3 of patients have to search for services in more than one hospital, not uncommonly in 3 or more. It is important to consider that only 1/5 of these patients are transferred by ambulance. The factors associated with this peregrination were: place of residence, birth weight, age, skin color, marital status and residence in places where garbage is not picked up. There was no association with schooling; Kotelchuck modified index, obstetric risk, water source and residence in slums.

Light or electromagnetic radiation has been reported to enhance wound healing. The use of selected spectra, including infrared and microwave, has been described; however, no studies to date have examined the potential benefit of combining these spectra. In this study, a device that emits electromagnetic radiation across both the infrared and microwave ranges was used. To test the effects of this unique electromagnetic radiation spectrum on wound healing, two clinically relevant wound-healing models (i.e., tensile strength of simple incisions and survival of McFarlane flaps) were selected. After the creation of a simple full-thickness incision (n = 35 rats) or a caudally based McFarlane flap (n = 33 rats), animals were randomly assigned to one of three treatment groups: untreated control, infrared, or combined electromagnetic radiation. Treatment was administered for 30 minutes, twice daily for 18 days in animals with simple incisions, and 15 days in animals with McFarlane flaps. The wound area or flap was harvested and analyzed, blinded to the treatment regimens. A p value of less than 0.05 obtained by analysis of variance was considered to be statistically significant. Animals receiving combined electromagnetic radiation demonstrated increased tensile strength (2.62 N/mm2) compared with animals receiving infrared radiation (2.36 N/mm2) or untreated controls (1.73 N/mm2, p < 0.001). Animals with McFarlane flaps receiving combined electromagnetic radiation had increased flap survival (78.0 percent) compared with animals receiving infrared radiation (69.7 percent) and untreated controls (63.1 percent, p < 0.01). Thus, combined electromagnetic radiation provided a distinct advantage in wound healing that might augment current treatment regimens.

Objective: To analyze variations in early neonatal mortality, stillbirth rates, and a set of indicators collected from obstetric hospitals affiliated to the Brazilian National Unified Health System (SUS) for their monitoring through the Hospital Data System (SIH/SUS) and Live Births Data System (SINASC)., Methods: One-hundred and thirty five hospitals in the state of Rio de Janeiro were assessed in 1997. Factor analysis was conducted using principal components. Score distribution for the first two components were established, which allowed to classify hospitals according to maternal risk profile and care outcomes., Results: Hospitals affiliated to SUS were responsible for 77.8% of all deliveries in the state of Rio de Janeiro and 23% of them performed fewer than 100 deliveries a year. Among hospitals of extreme high maternal risk and low performance, there were several units considered as referral centers for high-risk pregnancy. It was also observed that 5% of hospital units with low complexity infrastructures showed a profile of high maternal risk and questionable care outcomes., Conclusions: The Hospital Information Data System affiliated to the National Unified Health System has proven to be an important information source for monitoring hospital stillbirth and early neonatal mortality rates as well as for planning surveillance actions for health services providing obstetric and/or neonatal care.

The main objective of this article is to estimate stillbirth and neonatal mortality rates in Brazilian States based upon the country's Hospital Information System. Analysis of 1995 data reveals contrasting rates between the various regions of the country. In order to elucidate the States' different rates, we focused on the association between indicators of coverage, utilization, and access to the Unified Health System (SUS). The results for the neonatal period mostly showed higher early neonatal mortality rates when compared to late neonatal mortality rates, higher neonatal mortality rates in the States comprising the South and Southeast regions, less variable rates between those States, and extremely low rates in some States of the North, Central-West, and Northeast regions. The limited supply of SUS services and low access to same are relevant constraints on health care for the population in the North and Northeast. Aspects related to quality of childbirth and neonatal care are also reflected in the rates studied. The findings suggest that spatial and temporal monitoring of these rates could provide analytical support for organizing the Maternal and Child Health Program.

Objective: Studies on the evolution of infant mortality rate are very relevant. Nevertheless, lack of vital statistics in Brazil limits the temporal and spatial analysis of this indicator. This study aims to investigate the possible use of the Brazilian Hospital Information System as an alternative information source for stillbirth and neonatal mortality rates by age group., Methods: A new method to estimate the stillbirth and neonatal mortality rates is proposed. It was applied in a set of selected Brazilian states in the year of 1995. For comparative purposes, the Brazilian Death Information System was assessed to estimate the mortality rates under study, after adjusting the registered number of live births by using a demographic tool., Results: By assessing the Hospital Information System a larger number of fetal and early neonatal deaths were observed when compared to data given by the death information system of the Northeastern states. Besides, in the Southern and Southeastern states, where death records are more thorough, the mortality rates calculated using both information sources were very similar., Conclusions: The results suggest that the proposed methodology could greatly contribute to the analysis of the spatial-time evolution of stillbirth and neonatal death rates in recent years in Brazil, as data on death registration in the majority of the Brazilian states are less thorough than those from the hospital information system.

The authorization form for hospital admittance (AIH), an observation unit under the Hospital Information System of the Unified Health System (SIH/SUS), may represent a short-term hospital admittance or a longer hospital stay. This study presents an algorithm for composing admittance data based on the AIH forms, allowing for a proper assessment of hospital mortality, costs under the Unified Health System (SUS), and longer hospital stays, typical of chronic, terminal, and psychiatric patients.

This study reports mortality from neonatal tetanus in Brazil (1979-1987), based on an analysis of death certificates. The distribution of causes of death in time and space was used as an indicator of proportional neonatal mortality from tetanus. Underreporting remains a serious problem, particularly in northern and northeastern Brazil. In most municipalities, only one death was notified during the period under consideration, thus highlighting the importance of considering the theoretical approach of "sentinel events" in the control of this disease. A proportional decrease in mortality from neonatal tetanus was observed in the states of Rondônia, Pará, Sergipe, São Paulo, Paraná, and Rio Grande do Sul. It was not possible to detect an association between immunization coverage with two doses of tetanus toxoid and neonatal tetanus mortality. The reduction in the number of deliveries taking place in the home during the period studied appears to have played an important role in the reduction of neonatal deaths attributable to this cause.