Deaths from homicides: a historical series

OBJECTIVE:

to describe mortality from homicides in Itabuna, in the State of Bahia.

METHOD:

study with hybrid, ecological and time-trend design. The mortality coefficients per 1,000 inhabitants, adjusted by the direct technique, proportional mortality by sex and age range, and Potential Years of Life Lost were all calculated.

RESULTS:

since 2005, the external causes have moved from third to second most-common cause of death, with homicides being responsible for the increase. In the 13 years analyzed, homicides have risen 203%, with 94% of these deaths occurring among the male population. Within this group, the growth occurred mainly in the age range from 15 to 29 years of age. It was ascertained that 83% of the deaths were caused by firearms; 57.2% occurred in public thoroughfares; and 98.4% in the urban zone. In 2012, the 173 homicides resulted in 7,837 potential years of life lost, with each death causing, on average, the loss of 45.3 years.

CONCLUSIONS:

mortality by homicide in a medium-sized city in Bahia reaches levels observed in the big cities of Brazil in the 1980s, evidencing that the phenomenon of criminality - formerly predominant only in the big urban centers - is advancing into the rural area of Brazil, causing changes in the map of violent homicide in Brazil.     

PHB6 Health Care Use in Women Age 45 and Older

Key components of preventive health care for middleaged and older women include evaluating the risk for osteoporosis and coronary artery disease, considering hormone replacement therapy (HRT), and cancer screening. HRT is effective for treating the symptoms of acute menopause, and it may prevent some chronic health problems associated with growing older. However, HRT may increase the risks for other diseases.
OBJECTIVE: The purpose of this study was to estimate the level of health care use and costs incurred by post-menopausal women for conditions that have been associated with HRT.
METHODS: National health care survey and discharge data were used to estimate health care use by women age 45 and older for cardiovascular disease, osteoporosis, breast cancer, uterine cancer, and deep-vein thrombosis/ pulmonary embolism. The databases used were the Healthcare Utilization Project-3, National Ambulatory Medical Care Survey, National Hospital Ambulatory Medical Care Survey, National Nursing Home Survey, and National Home and Hospice Care Survey. Clinical Classification for Health Policy Research codes were used to identify patients whose primary diagnosis or procedure corresponded with the above conditions. National weights were used to estimate resource use. Treatment costs were estimated using cost-to-charge ratios or Medicare Fee Schedule to calculate costs of individual procedures.
RESULTS: For each of the five conditions, resource use and costs are reported for hospitalization, outpatient, nursing home, and home health care services. Resource use and costs are also reported by age and race/ethnicity.
CONCLUSION: Results of the study may be used to estimate the burden of disease for conditions commonly affecting postmenopausal women and to provide data for cost-effectiveness models comparing newly developed drugs to existing HRTs.     

Renal allograft rejection: evaluation by Doppler US and MR imaging

A prospective study compared the efficacy of Doppler ultrasonography (US) and magnetic resonance (MR) imaging in evaluating 38 renal allografts, with specific attention to transplant rejection. Forty-three Doppler US and 42 MR examinations were performed and interpreted. Histologic correlation was obtained from 22 biopsy or nephrectomy specimens. Clinical correlation or a response to instituted therapy was used as confirmation in the remaining allografts. Accuracy in identifying cyclosporine toxicity or acute tubular necrosis could not be evaluated because there were few such cases, with concomitant rejection in most. The ability to predict and identify presence or absence of rejection was not affected by different serum creatinine values. Doppler US was significantly superior to MR imaging in identifying allograft rejection, demonstrating a higher sensitivity (95% vs. 70%), specificity (95% vs. 73%), and accuracy (95% vs. 71%). Because of its low cost and accessibility, Doppler US should become the primary modality for renal transplant screening.     

Influence of physiologic motion on the appearance of tissue in MR images

Studies were performed to determine the possible influence of physiologic motion on the parenchymal intensity of organs in magnetic resonance (MR) images. It is known that periodic motion associated with respiration and cardiac function causes characteristic artifacts in spin-warp images. The present study shows that bulk motion can also cause striking intensity changes at velocities equivalent to the craniocaudal respiratory excursion of organs in the upper abdomen. The magnitude of the effect depends on the velocity and direction of motion with respect to the three orthogonal axes of the imager and on the technical details of the imager and pulse sequence. Large systematic errors in calculated tissue relaxation times are possible due to this phenomenon. The findings have important implications for clinical imaging because motion can cause artifactual changes in the gray-scale relationships among tissues. Some pulse sequences are much less sensitive to these effects. These results provide guidance for selecting MR techniques that reduce the detrimental effect of respiratory and other physiologic motion on examinations of the upper abdomen and thorax.     

CO2 laser in brain stem gliomas

The author presents his experience with the use of carbon dioxide laser surgery on five patients with brain stem gliomas. Such problematically located tumors, when removed by this freehand, secure, and efficient technique, were completely evaporated with minimum trauma to neighboring tissue. This method represents new hope for these unfortunate patients. Additional time is needed before we can draw the conclusions regarding long-term results of the treatment described.