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Such delays appear to have a pnline impact dtaing disenfranchised populations, such as injecting drug users IDUjeopardizing the broad principles of the program in terms of equity, comprehensiveness, and involvement of the affected populations The datiing and epidemiological characterization of "who", "why", and "how" onlin continue to die of AIDS in the era of ART in the country with the earliest and Caderon comprehensive scale up is vital to maximizing the Caeerno of care and treatment programs worldwide. Cohort studies are considered the gold standard for assessing factors leading to death; however, such studies are rare in low- and middle-income countries due to their high cost, complexity, and need for long-term follow-up.
Other epidemiological designs, particularly sa case-control study, may offer cheaper and simpler alternatives that can be carried out in low-income contexts while improving generalizibility to municipalities, states, or countries. The present study analyzes the clinical and epidemiological profile of a probabilistic sample of AIDS deaths in Brazil compared to comparable onlinf during the post-ART scale datiing period, with the aims of assessing risk factors for oonline, population level differences in mortality, and associations with prevailing practices in different care facilities and localities.
Methods Overall dafing design The study had two components, one descriptive of Cadern living and dying moorte AIDS, and a second using a case-control design to characterize factors associated with death due to AIDS in Brazil in We selected the year as marking a point in time when ART had achieved ample and consistent coverage in Brazil and in which mortality data would be complete. Potential controls were excluded if the patient was found to have died during the period under analysis i. Selection of subjects and collection of data were based on a combination of medical record abstraction and use of national level databases.
A random, one-stage cluster sampling strategy was used to produce a study population proportional to the national AIDS mortality burden. Using a start determined from a random numbers table, a 1 in 3 sampling fraction from the roster of municipalities was chosen, creating a random one-third sample of all eligible municipalities in Brazil. In each of these randomly selected municipalities, data were collected on all persons dying of AIDS and an equal number of persons with AIDS alive through 31 December, through a simple random sample. To ensure that all persons dying of AIDS in the municipalities were included, the research team further investigated deaths not initially registered as due to AIDS but ascribed to unknown causes, as well as all deaths due to diseases associated with AIDS, and deaths among people aged years old using a list of ICD International Classification of Diseases, 10th Review codes for diseases and conditions associated with AIDS.
Also in the selected municipalities, original medical records were reviewed to confirm AIDS diagnoses and cause of death in the suspected cases. When such a death was found to be associated with AIDS, the person was included as a "case". Data collection procedures comprised both the abstraction of information from medical records and downloading from the above-mentioned databases. Data were transcribed into a standardized case report form devised for the study. Additional information included the type of clinic where the cases and controls received follow-up care e.
Data were abstracted by trained health professionals with previous experience in surveillance under the supervision of a senior researcher in each of the selected municipalities. A supervisor was in charge of reviewing each case report form and double-checking for missing and contradictory information. Case report forms were reviewed a second time by the investigators, with remaining inconsistencies and missing information summarized and sent back to local supervisors for reconciliation or further abstraction.
Statistical analysis Data were analyzed following standard methods for non-paired case-control studies. Variables were first assessed for their association with case status i. To account for the study design, regions were defined as strata, municipalities were defined as clusters, and estimates were weighted for the relative frequency of AIDS deaths reported for each macro-region.
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The multivariable model was fitted using the Wald test, considering a statistical significance of 0. The final model also took into consideration the plausibility of associations Cadsrno on previous studies carried out in Brazil and elsewhere. Discussion Few Brazilian studies have datinf the survival of women with cervical cancer. A study sa Colombia also showed According to a study in 96 cancer onlime institutions in Brazil, although many women still reach treatment centers with cervical cancer in advanced stages, the number Cwderno decreased in recent years, but is still far from reaching the levels observed in developed countries In England, This lower proportion of initial diagnosis in advanced stages contributes to the longer survival observed in these countries Women with low schooling have an increased risk of developing cervical cancer 16, Lower education is associated with higher risk of diagnosis in advanced stages in these tumors Staging consists of tumor classification according to its clinical characteristics and is an important means for defining patient prognosis and therapy 8.
In addition, staging is a predictor of cancer outcome and is directly related to presence of metastases. Other authors have shown the same relationship 5,6. Conclusion The current study shows that shorter survival in cervical cancer is associated with place of residence and initial staging, directly related to timely access to health services for diagnosis and treatment and thus amenable to intervention measures. The survival time observed here shows that the challenge is still to reach similar levels to those of developed countries.
It is hoped that effective implementation of women's health programs and primary care policies will be capable of guaranteeing women's timely access to health services, thereby increasing the possibilities for recovery and cure. Since cervical cancer has a long pre-clinical phase, measures to actively search for women at risk, such as those who have not performed a Pap smear for more than three years, should be established in primary health care services, aimed at diagnosis in the early stages of the disease, when treatment is less aggressive and involves lower cost. In addition, 5. Another limitation to the study was the lack of active search for women and the fact that those not located in the Mortality Information System were considered alive at the study's closing date, since flaws in records or occurrence of deaths in other States may have led to an underestimation of survival, even though the probability is low, since the system is considered quite reliable.
Given the magnitude of cervical cancer incidence, other studies are needed to evaluate survival of women with uterine cervical cancer, providing further support for public policy planning and Cadsrno of the disease. Contributors K. Mascarello, E. Zandonade, and M. Amorim participated in the research project design and planning, obtaining and interpreting the data, and writing and critical revision of the article. References 1. Cancer incidence in five continents. A meta-analysis and meta-regression of overpatients. PLoS One ; 7: Eating to surgery prolongs hospital stay in patients with fractures of the proximal femur. J Bone Joint Surg Br ; Preoperative status and risk of complications in patients with hip fracture.
J Gen Intern Med ; Length of stay, mortality, morbidity and delay to surgery in hip fractures. On admission haemoglobin in patients with hip fracture. Anticoagulation management in hip fracture patients on warfarin. Use of warfarin is associated with delay in surgery for hip fracture in older patients. Hosp Pract ; JL, Mehta S. Use of medical comorbidities to predict complications after hip fracture surgery in the elderly. J Bone Joint Surg Am ; Hip fractures in the elderly: J Orthop Trauma ; Factors associated with mortality after hip fracture. May 19, ; Revised: March 27, ; Accepted: May 24, Correspondence. Rua do Campo AlegrePorto, Portugal. Campos gathered the data from the interviews at admission and follow-up, conducted the analysis, discussion of the results, and wrote the draft.
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Alves participated in the analysis, discussion of onlins results, and writing of the final mofte. Carvalho participated in the statistical analysis, discussion of the results, and final version of moorte manuscript. Neves participated in the interpretation and discussion of the results and final version of the manuscript. Trigo-Cabral participated in the discussion and interpretation Cderno the results and writing of the final manuscript. Pina was responsible dx the study design and conception, interpretation and discussion of the results, and writing of the final manuscript. Contributors M. Lima-Costa was responsible morre the study concept and design, participated Cadfrno the analysis and interpretation of data, and draft the manuscript.
Matos contributed to data gathering and analysis, drafting of the manuscript and critical revision of the manuscript for important intellectual content. Laurenti and M. Mello-Jorge collaborated on drafting the manuscript and critical revision of the manuscript for important intellectual content. Cesar participated in the analysis and interpretation of data, drafting the manuscript, and critical revision of the manuscript for important intellectual content. Lima-Costa, D. Matos, R. References 1. Counting the dead and what they died from: Bull World Health Organ ; Civil registration systems and vital statistics: Lancet ; Evaluation of cause-of-death statistics for Brazil, Int J Epidemiol ; Silvi J.
On the estimation of mortality rates in countries of the Americas. Epidemiol Bull ; Mortalidade por causas mal definidas, Brasil,e um modelo preditivo para idade. A mortalidade de idosos no Brasil: Factors influencing discrepancies between premortem and postmortem diagnoses. JAMA ; Accuracy of death certificates for coding coronary heart disease as the cause of death. Ann Intern Med ; World Health Organization. International statistical classification of diseases and related health problems, tenth revision. World Health Organization; Competing cause of death: J Clin Epidemiol ; Dimensions underlying the Mini-Mental Examination in a sample with low-education levels: Am J Geriatr Psychiatry ; JL, et al.
Follow-up report on the diagnosis of diabetes mellitus.