Resumo O artigo apresenta uma análise do desempenho da APS no estado de São Paulo na última década, em contexto de crise econômica e retração dos investimentos em saúde. Utilizaram-se indicadores de desempenho, determinantes em saúde e sistema de saúde, em série temporal (2010 a 2019), a partir de matriz conceitual adaptada. Foram calculadas variações percentuais anuais (VPA) de cada indicador em modelo log-linear. Os indicadores de desempenho apresentaram, no geral, evolução favorável; no entanto, ocorreu piora em indicadores relacionados à qualidade do cuidado (sífilis congênita, partos cesáreos e rastreamento de câncer de colo uterino). Verificou-se, ainda, um potencial aumento das demandas ao SUS (envelhecimento da população e redução da cobertura da saúde suplementar) e aumento das despesas em saúde em contexto de redução do PIB per capita.

Abstract This article presents the results of an analysis of the performance of primary health care in São Paulo state over the last decade against a backdrop of financial crisis and health funding cuts. We conducted a time series analysis (2010-2019) of performance indicators across the following dimensions based on an adapted conceptual framework: health service performance, health system, and determinants of health. Annual percentage change was calculated for each indicator using a log-linear model. Performance across the indicators was generally positive; however, there was a decline in performance across indicators of quality of care (congenital syphilis, cesarean section rate and cervical cancer screening). The findings also show a potential rise in demand for public services (due to population aging and a reduction in the percentage of the population with private health insurance) and increase in health expenditure against a backdrop of falling GDP per capita.

Abstract This article presents the results of an analysis of the performance of primary health care in São Paulo state over the last decade against a backdrop of financial crisis and health funding cuts. We conducted a time series analysis (2010-2019) of performance indicators across the following dimensions based on an adapted conceptual framework: health service performance, health system, and determinants of health. Annual percentage change was calculated for each indicator using a log-linear model. Performance across the indicators was generally positive; however, there was a decline in performance across indicators of quality of care (congenital syphilis, cesarean section rate and cervical cancer screening). The findings also show a potential rise in demand for public services (due to population aging and a reduction in the percentage of the population with private health insurance) and increase in health expenditure against a backdrop of falling GDP per capita. cuts 20102019 2010 2019 (2010-2019 framework system loglinear log linear model positive however congenital syphilis screening. screening . screening) due insurance capita 2010201 201 (2010-201 201020 20 (2010-20 20102 2 (2010-2 (2010- (2010 (201 (20 (2 (

Resumo O artigo apresenta uma análise do desempenho da APS no estado de São Paulo na última década, em contexto de crise econômica e retração dos investimentos em saúde. Utilizaram-se indicadores de desempenho, determinantes em saúde e sistema de saúde, em série temporal (2010 a 2019), a partir de matriz conceitual adaptada. Foram calculadas variações percentuais anuais (VPA) de cada indicador em modelo log-linear. Os indicadores de desempenho apresentaram, no geral, evolução favorável; no entanto, ocorreu piora em indicadores relacionados à qualidade do cuidado (sífilis congênita, partos cesáreos e rastreamento de câncer de colo uterino). Verificou-se, ainda, um potencial aumento das demandas ao SUS (envelhecimento da população e redução da cobertura da saúde suplementar) e aumento das despesas em saúde em contexto de redução do PIB per capita. década Utilizaramse Utilizaram se 2010 (201 2019, 2019 , 2019) adaptada VPA (VPA loglinear. loglinear log linear. linear log-linear apresentaram geral favorável entanto sífilis congênita uterino. uterino . uterino) Verificouse, Verificouse Verificou se, Verificou-se ainda envelhecimento suplementar capita 201 (20 20 (2 2 (

ABSTRACT BACKGROUND: Few food frequency questionnaires (FFQ) have been validated for pregnant women, particularly those in small- and medium-sized cities in different regions of Brazil. OBJECTIVES: To validate and calibrate a semiquantitative FFQ for pregnant women. DESIGN AND SETTING: The study was validated with a sample of 50 pregnant women (≥ 18 years) enrolled in Brazilian prenatal services. METHODS: An FFQ and a 24-hour recall were used to evaluate dietary intake. Dietary variables were tested for normality and log-converted when asymmetrical. Pearson's Correlation Coefficient was used to validate the questionnaire. Linear regression was applied to extract calibration factors. All variables underlying the consumption analysis were adjusted for energy. RESULTS: The mean age of the pregnant women was 26 years ± 6.2 years; 58% were in their first trimester, and 30% were identified as overweight/obese. The Pearson correlation analysis results indicated that the FFQ overestimated energy and nutrient intake, whose coefficients ranged from −0.15 (monounsaturated fat) to 0.50 (carbohydrate). Adjusting for energy reduced the mean values of intake coefficients, which now ranged from −0.33 (sodium) to 0.96 (folate). The calibration analysis results indicated variation in the coefficients from −0.23 (sodium) to 1.00 (folate). Calibration produced satisfactory coefficients for the FFQ compared with the reference standard for energy, macronutrients, monounsaturated fat, cholesterol, vitamins B12/C, folate, sodium, iron, and calcium. CONCLUSIONS: After validating and calibrating tests, we observed that the FFQ was adequately accurate for assessing the food consumption of the pregnant women in this study. BACKGROUND (FFQ small mediumsized medium sized Brazil OBJECTIVES SETTING 5 ≥ ( 1 services METHODS 24hour hour 24 logconverted log converted asymmetrical Pearsons s questionnaire factors RESULTS 2 62 6 6. 58 trimester 30 overweightobese overweight obese overweight/obese 015 0 15 −0.1 fat 050 0.5 carbohydrate. carbohydrate . (carbohydrate) 033 33 −0.3 sodium (sodium 096 96 0.9 folate. folate (folate) 023 23 −0.2 100 00 1.0 macronutrients cholesterol B12C BC B12 C B B12/C iron calcium CONCLUSIONS tests 3 01 −0. 05 0. (carbohydrate 03 09 9 (folate 02 10 1. B1 −0 −

ABSTRACT Objective: We aimed to analyze the association of diabetes and subclinical hypothyroidism with subclinical atherosclerosis measured by coronary artery calcium (CAC) in the baseline of the ELSA-Brasil study. Materials and methods: CAC was measured using a 64-detector computed tomographic scanner. The association of CAC > 0 was presented as an odds ratio (OR) and 95% confidence intervals (95%CI) in logistic models and as β (95%CI) in linear models after multivariable adjustment for confounders. Results: We analyzed 3,809 participants (mean-age (SD) 50.5 (8.8); 51.7% women). In the main analysis, we did not find an association of diabetes and subclinical hypothyroidism with CAC. However, in stratified analysis according to age strata, we found no significative interaction terms, an important heterogeneity between the groups, with the younger age strata showing an association of the group with both diseases and CAC > 0 (OR 7.16; 95%CI, 1.14; 44.89) with a wide but significative 95%CI, suggesting that the smaller number of participants in the younger group may influence the results. Our findings also showed an association of CAC > 0 and log (CAC+1) with diabetes in logistic (OR, 1.31; 95%CI, 1.05-1.63) and linear models (β, 0.24, 0.16, 0.40), respectively. Diabetes was independently associated with CAC > 0 in linear models. Discussion: In conclusion, our results showed a great heterogeneity in stratified analysis based on age in the younger age strata. Although we found no significant interaction factors, the smaller sample size for the analysis may influence the negative findings. Objective (CAC ELSABrasil ELSA Brasil study methods 64detector detector 64 scanner OR 95 95%CI 95CI CI (95%CI confounders Results 3809 3 809 3,80 meanage mean SD (SD 505 50 5 50. 8.8 88 8 (8.8) 517 51 7 51.7 women. women . women) However terms groups 7.16 716 16 1.14 114 1 14 44.89 4489 44 89 CAC+1 CAC1 (CAC+1 OR, 1.31 131 31 1.051.63 105163 1.05 1.63 05 63 1.05-1.63 β, (β 024 24 0.24 016 0.16 0.40, 040 0.40 , 40 0.40) respectively Discussion conclusion factors 6 9 380 80 3,8 8. (8.8 51. 7.1 71 1.1 11 44.8 448 4 CAC+ (CAC+ 1.3 13 051 1.051.6 10516 105 1.0 163 1.6 1.05-1.6 02 2 0.2 01 0.1 04 0.4 38 3, (8. 7. 1. 44. 1.051. 1051 10 1.05-1. 0. (8 1.051 1.05-1 ( 1.05-

ABSTRACT Objective: To estimate trends in mortality rate and average age of death, and identify sociodemographic factors associated with early death in patients with sickle cell disease (SCD). Methods: An ecological and cross-sectional study was conducted using data from the Mortality Information System. All deaths of patients residing in the state of São Paulo from 1996 to 2015 with at least one International Disease Code for SCD in any field of the death certificate were included. Simple linear regression was used to estimate trends. The Log-rank test and multiple Cox regression were used to identify factors associated with early death. Results: The age-standardized mortality rate per million inhabitants increased by 0.080 per year (R2=0.761; p<0.001). When the events were stratified by age at death, the increase was 0.108 per year for those occurring at age 20 years or older, (R2=0.789; p<0.001) and 0.023 per year for those occurring before age 20 years old (R2=0.188; p=0.056). The average age at death increased by 0.617 years (7.4 months) per year (R2=0.835; p<0.001). Sociodemographic factors associated with early death identified were male gender (hazard ratio — HR=1.30), white race (HR=1.16), death occurring in the hospital (HR=1.29), and living in the Greater São Paulo (HR=1.13). Conclusions: The mortality rate and the average age of death in patients with SCD have increased over the last two decades. Sociodemographic factors such as gender, race, place of occurrence, and residence were found to be associated with early death. Objective SCD. . (SCD) Methods crosssectional cross sectional System 199 201 included Logrank Log rank Results agestandardized standardized 0080 0 080 0.08 R2=0.761 R20761 R R2 761 (R2=0.761 p<0.001. p0001 p p<0.001 001 0108 108 0.10 2 older R2=0.789 R20789 789 (R2=0.789 0023 023 0.02 R2=0.188 R20188 188 (R2=0.188 p=0.056. p0056 p=0.056 056 p=0.056) 0617 617 0.61 7.4 74 7 4 (7. months R2=0.835 R20835 835 (R2=0.835 hazard HR=1.30, HR130 HR HR=1.30 , 1 30 HR=1.30) HR=1.16, HR116 HR=1.16 16 (HR=1.16) HR=1.29, HR129 HR=1.29 29 (HR=1.29) HR=1.13. HR113 HR=1.13 13 (HR=1.13) Conclusions decades occurrence (SCD 19 008 08 0.0 R2=0.76 R2076 76 (R2=0.76 p000 p<0.00 00 010 10 0.1 R2=0.78 R2078 78 (R2=0.78 002 02 R2=0.18 R2018 18 (R2=0.18 p005 p=0.05 05 061 61 0.6 7. (7 R2=0.83 R2083 83 (R2=0.83 HR13 HR=1.3 3 HR11 HR=1.1 (HR=1.16 HR12 HR=1.2 (HR=1.29 (HR=1.13 0. R2=0.7 R207 (R2=0.7 p00 p<0.0 01 R2=0.1 R201 (R2=0.1 p=0.0 06 6 ( R2=0.8 R208 8 (R2=0.8 HR1 HR=1. (HR=1.1 (HR=1.2 R2=0. R20 (R2=0. p0 p<0. p=0. HR=1 (HR=1. R2=0 (R2=0 p<0 p=0 HR= (HR=1 R2= (R2= p< p= (HR= (R2 (HR (R

RESUMO Objetivo: Estimar as tendências da taxa de mortalidade e da idade média de morte e identificar os fatores sociodemográficos associados ao óbito precoce em pacientes com doença falciforme (DF). Métodos: Estudo ecológico e transversal realizado com dados do Sistema de Informações sobre Mortalidade. Foram incluídos todos os eventos de óbitos de pacientes residentes no estado de São Paulo de 1996 a 2015, que continham pelo menos um Código Internacional de Doenças para DF, em qualquer campo do atestado de óbito. As tendências foram estimadas por meio da regressão linear simples. Para a identificação dos fatores associados ao óbito precoce, foram realizadas análises de sobrevida, por meio da regressão de Cox simples e múltipla. Resultados: A taxa de mortalidade, padronizada pela idade, por milhão de habitantes, aumentou 0,080 ao ano (R²=0,761; p<0,001). Quando os eventos foram estratificados por idade do óbito, naqueles que ocorreram com 20 anos ou mais, o aumento foi de 0,108 ao ano (R²=0,789; p<0,001) e, nos que ocorreram antes de 20 anos, foi de 0,023 ao ano (R²=0,188; p=0,056). A idade média ao morrer aumentou 0,617 ano por ano (R²=0,835; p<0,001). Os fatores associados ao óbito precoce identificados no modelo múltiplo foram: sexo masculino (hazard ratio — HR=1,30), raça branca (HR=1,16), morte dentro do hospital (HR=1,29) e moradia na Grande São Paulo (HR=1,13). Conclusões: Houve aumento da taxa de mortalidade e da idade média de óbito com DF nas duas últimas décadas estudadas. Os fatores sociodemográficos sexo, raça, local de ocorrência e município de residência estiveram associados com a faixa etária do óbito. Objetivo DF. . (DF) Métodos Mortalidade 199 2015 sobrevida múltipla Resultados habitantes 0080 0 080 0,08 R²=0,761 R²0761 R R² 761 (R²=0,761 p<0,001. p0001 p p<0,001 001 2 mais 0108 108 0,10 R²=0,789 R²0789 789 (R²=0,789 0023 023 0,02 R²=0,188 R²0188 188 (R²=0,188 p=0,056. p0056 p=0,056 056 p=0,056) 0617 617 0,61 R²=0,835 R²0835 835 (R²=0,835 hazard HR=1,30, HR130 HR HR=1,30 , 1 30 HR=1,30) HR=1,16, HR116 HR=1,16 16 (HR=1,16) HR=1,29 HR129 29 (HR=1,29 HR=1,13. HR113 HR=1,13 13 (HR=1,13) Conclusões estudadas (DF 19 201 008 08 0,0 R²=0,76 R²076 76 (R²=0,76 p000 p<0,00 00 010 10 0,1 R²=0,78 R²078 78 (R²=0,78 002 02 R²=0,18 R²018 18 (R²=0,18 p005 p=0,05 05 061 61 0,6 R²=0,83 R²083 83 (R²=0,83 HR13 HR=1,3 3 HR11 HR=1,1 (HR=1,16 HR=1,2 HR12 (HR=1,2 (HR=1,13 0, R²=0,7 R²07 7 (R²=0,7 p00 p<0,0 01 R²=0,1 R²01 (R²=0,1 p=0,0 06 6 R²=0,8 R²08 8 (R²=0,8 HR1 HR=1, (HR=1,1 (HR=1, R²=0, R²0 (R²=0, p0 p<0, p=0, HR=1 (HR=1 R²=0 (R²=0 p<0 p=0 HR= (HR= R²= (R²= p< p= (HR (R² (R

ABSTRACT Objective: To evaluate the association between neck circumference (NC) measured during pregnancy and markers of glucose metabolism measured 2-6 months postpartum in women with overweight/obesity with and without gestational diabetes (GDM). Subjects and methods: This prospective study enrolled 100 pregnant women (including 50 with GDM) with pregestational body mass index (BMI) ≥ 25 kg and < 40 kg/m². The cohort was stratified according to NC tertiles during pregnancy. Glucose metabolism was assessed in the postpartum period. The association between NC during pregnancy and markers of glucose metabolism postpartum was tested using linear regression analysis. Results: Participants with NC in the third tertile, compared with those with NC in the second and first tertiles, had higher levels of glycated hemoglobin (HbA1c; 5.6 ± 0.4% versus 5.4 ± 0.3% versus 5.3 ± 0.2%, respectively, p = 0.006), fasting insulin (13.2 ± 6.6 µIU/mL versus 11.1 ± 5.8 µIU/mL versus 9.5 ± 4.9 µIU/mL, respectively, p = 0.035), homeostasis model for insulin resistance (HOMA-IR; 3.1 ± 1.7 versus 2.5 ± 1.3 versus 2.1 ± 1.2, respectively, p = 0.035) and triglyceride-glucose index (TyG; 4.6 ± 0.2 versus 4.5 ± 0.2 versus 4.5 ± 0.3, respectively, p = 0.010). In crude linear regression analysis, NC measured during pregnancy was significantly associated with levels of fasting plasma glucose, 2-hour glucose, HbA1c, log HOMA-IR, and TyG index. The association remained after adjustment for age, family history of diabetes, and number of pregnancies. When adjusted for pregestational BMI and gestational weight gain, NC remained independently associated with fasting plasma glucose and HbA1c levels. Conclusion: The NC measured during pregnancy was positively associated with worse glucose metabolic profile in the postpartum among women with obesity/overweight with and without GDM. The NC measurement may be a feasible tool for early identification of women at a higher risk of developing type 2 diabetes mellitus. Objective (NC 26 6 2- overweightobesity overweight obesity GDM . (GDM) methods 10 including 5 (BMI 4 kgm² kgm m² m kg/m² period analysis Results tertile HbAc HbA c (HbA1c 56 5. 04 0 0.4 54 03 3 0.3 53 02 0.2% respectively 0.006, 0006 0.006 , 006 0.006) 13.2 132 13 (13. 66 6. µIUmL µIU mL 111 11 1 11. 58 8 95 9 9. 49 4. 0.035, 0035 0.035 035 HOMAIR HOMA IR (HOMA-IR 31 3. 17 7 1. 2. 21 12 1.2 triglycerideglucose triglyceride (TyG 46 0. 45 0.010. 0010 0.010 010 0.010) 2hour hour HOMAIR, IR, HOMA-IR age pregnancies gain Conclusion obesityoverweight mellitus (GDM kg/m 000 0.00 00 13. (13 003 0.03 001 0.01 01 0.0 (1 (

Abstract In this paper, a methodology is proposed to evaluate the optimal design of truss structures considering progressive collapse. This methodology combines Total-Lagrangian formulation for material and geometrical nonlinear analysis, using nodal positions and log-strain measure; the Systematic Reliability-based Approach to Progressive Collapse method; and risk-optimization formulation. Two benchmark examples are analyzed and discussed. The results demonstrate the accuracy, robustness, and efficiency of the proposed methodology in evaluation the optimal design of truss structures subjected to progressive collapse. It is shown that material behavior (elastic, elastoplastic, and hyperelastic) and rate of loading (step and linear load) can lead to different optimal design configurations. In the redundant hyperstatic truss example, the coefficient of vulnerability identifies the most critical bar for each truss configuration. The most vulnerable bars in the reference design become less vulnerable in the optimal design, leading to load redistribution, or alternate load paths, which reduce the probability of occurrence of progressive collapse. paper collapse TotalLagrangian Total Lagrangian analysis logstrain log strain measure Reliabilitybased Reliability based method riskoptimization risk optimization discussed accuracy robustness elastic, elastic (elastic elastoplastic hyperelastic step configurations example configuration redistribution paths

Abstract The impact of forestry practices was evaluated on Eucalyptus’s growth variables and mortality dynamics. An experiment was conducted in Uruguay over sixteen years, sixteen spacing and thinning treatments were compared depending on the genetic material and productive objective. Tree height and diameter at breast height were assessed annually. All variables were analyzed using linear mixed models. Kaplan-Meier survival analysis and the Log Rank test were used to compare tree survival. 460 trees ha-1 from seed material resulted in the highest individual basal area (0.023 m2), while treatments with 2000 trees ha-1, without thinning, generated a greater yield per hectare (1014 m3 ha-1). Variations in mortality were detected in higher-density treatments (above 800 trees ha-1). This study underscores the critical importance of managing spacing, genetic material, and thinning practices to optimize Eucalyptus growth. Eucalyptuss s dynamics years objective annually models KaplanMeier Kaplan Meier 46 ha1 ha 1 ha- 0.023 0023 0 023 (0.02 m2, m2 m , m2) 200 ha1, 1, 1014 (101 ha1. . ha-1) higherdensity higher density above 80 4 0.02 002 02 (0.0 20 101 (10 8 0.0 00 (0. 2 10 (1 0. (0 (

Resumo Este estudo visou avaliar a capacidade de reparação de tecidos de quatro cimentos endodônticos biocerâmicos através da quantificação de fibras colágenas de tipo I e III. Foram testados os seguintes cimentos: EndoSequence BC Sealer (Brasseler, Brasseler, Savannah, EUA), Bio C Sealer (Angelus, Londrina, Brasil), Bioroot RCS (Septodont, Santa Catarina, Brasil), e Sealer Plus BC (MKLife, Porto Alegre, Brasil). Foram implantados tubos de polietileno de 1,5 mm de diâmetro e 1 cm de comprimento contendo os cimentos endodônticos no tecido subcutâneo de cinco ratos (Rattus norvegicus albinus, linhagem Wistar). Após 14 dias, os animais foram eutanasiados e as fibras colágenas foram quantificadas a partir de cortes histológicos do tecido. Diante de uma distribuição não-normal dos dados, uma regressão gama com função de ligação log, implementada por meio do módulo de modelos lineares generalizados, foi empregada para testar se havia diferença significativa entre os cimentos. A comparação dois a dois foi realizada utilizando Least significant difference. Houve diferença significativa entre os cimentos para os colágenos tipo I (p=0,001), tipo III (p=0,023) e colágeno total (p=0,002). No geral, o cimento Bioroot foi estatisticamente superior aos demais cimentos, com exceção na análise do colágeno tipo III na qual não houve diferença entre o cimento Bioroot e o cimento Bio C Sealer e o grupo controle (p>0,05). O cimento endodôntico biocerâmico Bioroot RCS foi capaz de estimular uma maior produção de colágeno. Brasseler (Brasseler Savannah EUA, EUA , EUA) Angelus, Angelus (Angelus Londrina Brasil, Brasil Brasil) Septodont, Septodont (Septodont Catarina MKLife, MKLife (MKLife Alegre Brasil. . 15 5 1, Rattus albinus Wistar. Wistar Wistar) dias nãonormal normal dados log generalizados difference p=0,001, p0001 p p=0,001 0 001 (p=0,001) p=0,023 p0023 023 (p=0,023 p=0,002. p0002 p=0,002 002 (p=0,002) geral p>0,05. p005 p>0,05 05 (p>0,05) p000 p=0,00 00 (p=0,001 p=0,02 p002 02 (p=0,02 (p=0,002 p00 p>0,0 (p>0,05 p=0,0 (p=0,00 (p=0,0 p0 p>0, (p>0,0 p=0, (p=0, p>0 (p>0, p=0 (p=0 p> (p>0 p= (p= (p> (p

Abstract This study aimed to evaluate the tissue repair capacity of four bioceramic endodontic sealers by quantifying type I and III collagen fibers. The following sealers were tested: EndoSequence BC Sealer (Brasseler, Brasseler, Savannah, USA), Bio C Sealer (Angelus, Londrina, Brazil), Bioroot RCS (Septodont, Santa Catarina, Brazil), and Sealer Plus BC (MKLife, Porto Alegre, Brazil). Polyethylene tubes 1.5 mm in diameter and 1 cm in length containing the endodontic sealers were implanted in the subcutaneous tissue of five rats (Rattus norvegicus albinus, Wistar lineage). After 14 days, the animals were euthanized, and collagen fibers were quantified from the histological tissue sections. Given a non-normal distribution of the data, a gamma regression with log link function was employed and implemented through the generalized linear models module, was used to test whether there was a significant difference between the sealers. The pairwise comparison was performed using Least significant difference. There were significant differences between the sealers for type I (p=0.001), type III (p=0.023), and total collagen (p=0.002). Overall, Bioroot sealer was statistically superior to the other sealers, except in the analysis of type III collagen, in which there was no difference between the Bioroot sealer and Bio C Sealer sealer and the control group (p>0.05). Bioroot RCS bioceramic endodontic sealer stimulates a greater production of collagen. tested Brasseler (Brasseler Savannah USA, USA , USA) Angelus, Angelus (Angelus Londrina Brazil, Brazil Brazil) Septodont, Septodont (Septodont Catarina MKLife, MKLife (MKLife Alegre Brazil. . 15 5 1. Rattus albinus lineage. lineage lineage) days euthanized sections nonnormal non normal data module p=0.001, p0001 p p=0.001 0 001 (p=0.001) p=0.023, p0023 p=0.023 023 (p=0.023) p=0.002. p0002 p=0.002 002 (p=0.002) Overall p>0.05. p005 p>0.05 05 (p>0.05) p000 p=0.00 00 (p=0.001 p002 p=0.02 02 (p=0.023 (p=0.002 p00 p>0.0 (p>0.05 p=0.0 (p=0.00 (p=0.02 p0 p>0. (p>0.0 p=0. (p=0.0 p>0 (p>0. p=0 (p=0. p> (p>0 p= (p=0 (p> (p= (p

Resumen Los casos de VIH no diagnosticados contribuyen al incremento de nuevas infecciones, estimar esta cifra es importante para evaluar estrategias en los programas de control de VIH. El objetivo de este estudio fue estimar el número de casos de VIH no diagnosticados en la Región Cajamarca, Perú entre el 2015 y 2021. Los casos de VIH se obtuvieron de tres fuentes de información: La Estrategia Sanitaria Regional de Prevención y Control de VIH (ESPC-VIH); el aplicativo de notificación epidemiológica de VIH (Noti-VIH) y el sistema de información de laboratorio (Netlab). Se vincularon las tres bases de datos; un análisis de captura recaptura mediante un modelo log-linear, proporcionó estimaciones del número de casos de VIH no diagnosticados, tomando en cuenta las interacciones y el criterio de información de Akaike. Después de la vinculación se obtuvo 991 casos de VIH registrados. Se estimaron 1388 casos (IC 95%: 1265,6-1542,8) de personas viviendo con VIH, de los cuales 393 (28,4%) no fueron diagnosticados. El subregistro de cada fuente fue 51,9% en la ESPC-VIH, 63,6% en Netlab y 88% en Noti-VIH. Se concluyó que un número elevado de casos de VIH no fueron diagnosticados, siendo necesario replantear estrategias para incrementar la detección sistemática de casos de VIH. infecciones Cajamarca 201 2021 ESPCVIH ESPC (ESPC-VIH) NotiVIH Noti (Noti-VIH Netlab. . (Netlab) datos loglinear, loglinear log linear, linear log-linear Akaike 99 registrados 138 IC 95% 95 1265,61542,8 1265615428 1265,6 1542,8 1265 6 1542 8 1265,6-1542,8 39 28,4% 284 28 4 (28,4% 519 51 9 51,9 ESPCVIH, ESPC-VIH 636 63 63,6 88 NotiVIH. Noti-VIH 20 202 (ESPC-VIH (Netlab 13 61542 1265,61542, 126561542 12656 1265, 15428 1542, 126 154 1265,6-1542, 3 28,4 2 (28,4 5 51, 63, 1 6154 1265,61542 12656154 12 15 1265,6-1542 28, (28, 615 1265,6154 1265615 1265,6-154 (28 61 1265,615 126561 1265,6-15 (2 1265,61 1265,6-1 ( 1265,6-

Abstract Undiagnosed HIV cases contribute to the increase in new infections, therefore estimating this figure is important in order to assess strategies in HIV control programs. The objective of this study was to estimate the number of undiagnosed HIV cases in the Cajamarca region in Peru between 2015 and 2021. HIV cases were obtained from three sources of information: The Regional Health Strategy for HIV Prevention and Control (ESPC-HIV); the HIV epidemiological notification application (Noti-HIV), and the laboratory information system (Netlab). The three databases were linked; a capture-recapture analysis using a log-linear model provided estimates of the number of undiagnosed HIV cases, taking into account interactions and the Akaike information criterion. After linkage, 991 registered HIV cases were obtained. An estimated 1388 cases (95%CI: 1265.6-1542.8) of people living with HIV were estimated, of which 393 (28.4%) were not diagnosed. The underreporting of each source was: 51.9% in the ESPC-HIV; 63.6% in Netlab; and 88% in Noti-HIV. The conclusion drawn was that a high number of HIV cases went undiagnosed, and strategies need to be reconsidered to increase the systematic detection of HIV cases. infections programs 201 2021 ESPCHIV ESPC (ESPC-HIV) NotiHIV, NotiHIV Noti , (Noti-HIV) Netlab. Netlab . (Netlab) linked capturerecapture capture recapture loglinear log linear criterion linkage 99 138 95%CI 95CI CI 95 (95%CI 1265.61542.8 1265615428 1265.6 1542.8 1265 6 1542 8 1265.6-1542.8 39 28.4% 284 28 4 (28.4% diagnosed 519 51 9 51.9 ESPC-HIV 636 63 63.6 88 NotiHIV. HIV. Noti-HIV 20 202 (ESPC-HIV (Noti-HIV (Netlab 13 61542 1265.61542. 126561542 12656 1265. 15428 1542. 126 154 1265.6-1542. 3 28.4 2 (28.4 5 51. 63. 1 6154 1265.61542 12656154 12 15 1265.6-1542 28. (28. 615 1265.6154 1265615 1265.6-154 (28 61 1265.615 126561 1265.6-15 (2 1265.61 1265.6-1 ( 1265.6-

Resumo Objetivos: analisar a tendência de indicadores de morbimortalidade por doenças diarreicas agudas em menores de cinco anos no Piauí. Métodos: estudo ecológico com dados do Departamento de Informática do Sistema Único de Saúde. Calculou-se os indicadores taxa de internação e coeficiente de mortalidade pela doença entre 2000 e 2019. Realizou-se análise descritiva dos indicadores no período estudado e pelas macrorregiões do estado. Para análise da tendência, foi utilizado o modelo de regressão linear simples com log-transformação. As tendências foram classificadas como crescentes, decrescentes e estáveis, com nível de significância de 5%. Resultados: a média das taxas de internação foi maior na macrorregião semiárido (36,6/1000 menores de cinco anos) e menor em Teresina (14,9/1000 menores de cinco anos). A média dos coeficientes de mortalidade foi maior na macrorregião litoral (0,98/1000 nascidos vivos) e menor em Teresina (0,47/1000 nascidos vivos). Os indicadores mostraram tendência de redução em todos os locais analisados (p<0,05). Notou-se um ponto de inflexão a partir de 2009, com redução significativa das taxas de internação nas macrorregiões cerrados e semiárido. Conclusão: os indicadores de morbimortalidade por doenças diarreicas agudas em menores de cinco anos mostraram tendência de redução no Piauí entre 2000 e 2019, com diferenças das tendências entre as macrorregiões avaliadas. Objetivos Métodos Saúde Calculouse Calculou se 200 2019 Realizouse Realizou estado logtransformação. logtransformação log transformação. transformação log-transformação crescentes estáveis 5 5% Resultados 36,6/1000 3661000 36 6 1000 (36,6/100 14,9/1000 1491000 14 9 (14,9/100 anos. . 0,98/1000 0981000 0 98 (0,98/100 vivos 0,47/1000 0471000 47 (0,47/100 vivos. p<0,05. p005 p p<0,05 05 (p<0,05) Notouse Notou 2009 Conclusão avaliadas 20 201 36,6/100 366100 3 100 (36,6/10 14,9/100 149100 1 (14,9/10 0,98/100 098100 (0,98/10 0,47/100 047100 4 (0,47/10 p00 p<0,0 (p<0,05 2 36,6/10 36610 10 (36,6/1 14,9/10 14910 (14,9/1 0,98/10 09810 (0,98/1 0,47/10 04710 (0,47/1 p0 p<0, (p<0,0 36,6/1 3661 (36,6/ 14,9/1 1491 (14,9/ 0,98/1 0981 (0,98/ 0,47/1 0471 (0,47/ p<0 (p<0, 36,6/ 366 (36,6 14,9/ 149 (14,9 0,98/ 098 (0,98 0,47/ 047 (0,47 p< (p<0 36,6 (36, 14,9 (14, 0,98 09 (0,9 0,47 04 (0,4 (p< 36, (36 14, (14 0,9 (0, 0,4 (p (3 (1 0, (0 (

Abstract Objectives: to analyze the trend of morbidity and mortality indicators due to acute diarrheal diseases in children under five years old in Piauí. Methods: ecological study with data from the Information Technology Department at the Public Health System. The indicators of hospitalization rate and coefficient of mortality from the disease between 2000 and 2019 were calculated. A descriptive analysis of the indicators was carried out in the studied period and by the macro-regions in the State. For trend analysis, the simple linear regression model with log-transformation was used. Trends were classified as increasing, decreasing and stable, with a significance level of 5%. Results: the average on hospitalization rate was higher in the semi-arid macro-region (36.6/1000 children under five years old) and lower in Teresina (14.9/1000 children under five years old). The mean mortality coefficients were higher in the coastal macro-region (0.98/1000 live births) and lower in Teresina (0.47/1000 live births). The indicators showed a downward trend in all analyzed locations (p<0.05). A turning point was noted from 2009, with a significant reduction in hospitalization rates in the savanna and semi-arid macro-regions. Conclusion: indicators of morbidity and mortality due to acute diarrheal diseases in children under five years old showed a downward trend in Piauí between 2000 and 2019, with differences in trends between the evaluated macro-regions. Objectives Methods System 200 201 calculated macroregions macro regions State logtransformation log transformation used increasing stable 5 5% Results semiarid semi arid macroregion region 36.6/1000 3661000 36 6 1000 (36.6/100 14.9/1000 1491000 14 9 (14.9/100 old. . 0.98/1000 0981000 0 98 (0.98/100 births 0.47/1000 0471000 47 (0.47/100 births. p<0.05. p005 p p<0.05 05 (p<0.05) 2009 macroregions. regions. Conclusion 20 36.6/100 366100 3 100 (36.6/10 14.9/100 149100 1 (14.9/10 0.98/100 098100 (0.98/10 0.47/100 047100 4 (0.47/10 p00 p<0.0 (p<0.05 2 36.6/10 36610 10 (36.6/1 14.9/10 14910 (14.9/1 0.98/10 09810 (0.98/1 0.47/10 04710 (0.47/1 p0 p<0. (p<0.0 36.6/1 3661 (36.6/ 14.9/1 1491 (14.9/ 0.98/1 0981 (0.98/ 0.47/1 0471 (0.47/ p<0 (p<0. 36.6/ 366 (36.6 14.9/ 149 (14.9 0.98/ 098 (0.98 0.47/ 047 (0.47 p< (p<0 36.6 (36. 14.9 (14. 0.98 09 (0.9 0.47 04 (0.4 (p< 36. (36 14. (14 0.9 (0. 0.4 (p (3 (1 0. (0 (

Abstract Introduction: Plasmatic fibrinogen is known as a main risk factor to cardiometabolic diseases through mechanisms such as thrombin formation, platelet aggregation and inflammation, part of the endothelial dysfunction leading to Acute Coronary Syndrome. Elevated fibrinogen levels may be present in subjects with obesity; however, there is no enough information on whether this is also the same among metabolically obese normal-weight subjects (MONW). Objective: To determine the association between being MONW and fibrinogen levels in a sample of Peruvian inhabitants. Methodology: Cross-sectional analytical study. Secondary data analysis of the PERU MIGRANT study (2007, 989 participants). For the diagnosis of MONW, it was considered if it presented two or more characteristics such as: waist circumference (anthropometric evaluation), triglycerides, fasting glucose, systolic blood pressure or diastolic blood pressure, HDL-cholesterol, insulin resistance through HOMA-IR, C-reactive protein. Elevated fibrinogen ≥450 mg/dL was considered. For regression analysis we used generalized linear model with link log and family Poisson with robust variance. We present crude prevalence ratio and adjusted by mentioned variables, as association parameter. We considered confidence interval 95%. Results: Of the 393 selected participants, 46.3% were women, the median of age was 47(37-56), only 13.5% had elevated fibrinogen levels. The prevalence of the MONW subject was 32.67%. In the correlation analysis, there was only a statistically significant relationship between fibrinogen and plasma CRP (rho= 0.54; p<0.001). In multiple regression, association was found between being MONW and high plasma fibrinogen levels (PR=1.93, 95%CI: 1.44-2.57; p<0.001). Conclusions: There is an association between high levels of plasmatic fibrinogen and MONW. These results can serve as a first step for future prospective research, either to be a risk factor or as an additional marker of consideration for monitoring and diagnosis in normal-weight people.

Resumen Introducción: El fibrinógeno plasmático es reconocido como un factor de riesgo importante para eventos cardiometabólicos a través de mecanismos como la formación de trombina, agregación plaquetaria e inflamación, todos partes de la disfunción endotelial conducentes al Síndrome Coronario Agudo. Elevados niveles pueden estar presentes en sujetos con obesidad, sin embargo, no hay información suficiente sobre si esto también es igual en los sujetos delgados metabólicamente obesos (DMO). Objetivo: Determinar la asociación entre el DMO y niveles de fibrinógeno en una muestra de pobladores peruanos. Metodología: Estudio transversal analítico. Análisis de datos secundarios del estudio PERU MIGRANT (2007, 989 participantes). Para el diagnóstico de DMO se consideró si presentaba dos o más características de siete criterios metabólicos: circunferencia de la cintura (mediante evaluación antropométrica), triglicéridos, glucosa en ayunas, presión arterial sistólica y diastólica, colesterol-HDL, HOMA-IR, proteína C reactiva (PCR). Se consideró fibrinógeno (elevado ≥450 mg/dL). Para el análisis de regresión, se realizó un modelo lineal generalizado con enlace log y familia Poisson con varianza robusta. De esa forma, se obtuvo como medida de asociación las razones de prevalencia crudas (RPc) y ajustadas (RPa) por las covariables mencionadas, se consideró intervalos de confianza al 95% (IC95%). Resultados: De los 393 participantes seleccionados, el 46,3% fueron mujeres, la mediana de edad fue 47(37-56), 13,5% presentó niveles de fibrinógeno elevado. La prevalencia de DMO fue 32,67%. Solo hubo una relación estadísticamente significativa entre fibrinógeno y el PCR-plasmático (rho=0,54; p<0,001). La regresión múltiple, encontró asociación entre el DMO y el nivel altos fibrinógeno plasmático (RP=1,93 IC95%: 1,44-2,57; p<0,001). Conclusiones: Existe asociación entre los niveles altos de fibrinógeno plasmático y el DMO. Estos resultados pueden servir para futuras investigaciones prospectivas, ya sea para considerarlo un factor de riesgo o como un marcador adicional para el seguimiento y diagnóstico en personas delgadas.

Abstract Introduction: Plasmatic fibrinogen is known as a main risk factor to cardiometabolic diseases through mechanisms such as thrombin formation, platelet aggregation and inflammation, part of the endothelial dysfunction leading to Acute Coronary Syndrome. Elevated fibrinogen levels may be present in subjects with obesity; however, there is no enough information on whether this is also the same among metabolically obese normal-weight subjects (MONW). Objective: To determine the association between being MONW and fibrinogen levels in a sample of Peruvian inhabitants. Methodology: Cross-sectional analytical study. Secondary data analysis of the PERU MIGRANT study (2007, 989 participants). For the diagnosis of MONW, it was considered if it presented two or more characteristics such as: waist circumference (anthropometric evaluation), triglycerides, fasting glucose, systolic blood pressure or diastolic blood pressure, HDL-cholesterol, insulin resistance through HOMA-IR, C-reactive protein. Elevated fibrinogen ≥450 mg/dL was considered. For regression analysis we used generalized linear model with link log and family Poisson with robust variance. We present crude prevalence ratio and adjusted by mentioned variables, as association parameter. We considered confidence interval 95%. Results: Of the 393 selected participants, 46.3% were women, the median of age was 47(37-56), only 13.5% had elevated fibrinogen levels. The prevalence of the MONW subject was 32.67%. In the correlation analysis, there was only a statistically significant relationship between fibrinogen and plasma CRP (rho= 0.54; p<0.001). In multiple regression, association was found between being MONW and high plasma fibrinogen levels (PR=1.93, 95%CI: 1.44-2.57; p<0.001). Conclusions: There is an association between high levels of plasmatic fibrinogen and MONW. These results can serve as a first step for future prospective research, either to be a risk factor or as an additional marker of consideration for monitoring and diagnosis in normal-weight people.

Resumen Introducción: El fibrinógeno plasmático es reconocido como un factor de riesgo importante para eventos cardiometabólicos a través de mecanismos como la formación de trombina, agregación plaquetaria e inflamación, todos partes de la disfunción endotelial conducentes al Síndrome Coronario Agudo. Elevados niveles pueden estar presentes en sujetos con obesidad, sin embargo, no hay información suficiente sobre si esto también es igual en los sujetos delgados metabólicamente obesos (DMO). Objetivo: Determinar la asociación entre el DMO y niveles de fibrinógeno en una muestra de pobladores peruanos. Metodología: Estudio transversal analítico. Análisis de datos secundarios del estudio PERU MIGRANT (2007, 989 participantes). Para el diagnóstico de DMO se consideró si presentaba dos o más características de siete criterios metabólicos: circunferencia de la cintura (mediante evaluación antropométrica), triglicéridos, glucosa en ayunas, presión arterial sistólica y diastólica, colesterol-HDL, HOMA-IR, proteína C reactiva (PCR). Se consideró fibrinógeno (elevado ≥450 mg/dL). Para el análisis de regresión, se realizó un modelo lineal generalizado con enlace log y familia Poisson con varianza robusta. De esa forma, se obtuvo como medida de asociación las razones de prevalencia crudas (RPc) y ajustadas (RPa) por las covariables mencionadas, se consideró intervalos de confianza al 95% (IC95%). Resultados: De los 393 participantes seleccionados, el 46,3% fueron mujeres, la mediana de edad fue 47(37-56), 13,5% presentó niveles de fibrinógeno elevado. La prevalencia de DMO fue 32,67%. Solo hubo una relación estadísticamente significativa entre fibrinógeno y el PCR-plasmático (rho=0,54; p<0,001). La regresión múltiple, encontró asociación entre el DMO y el nivel altos fibrinógeno plasmático (RP=1,93 IC95%: 1,44-2,57; p<0,001). Conclusiones: Existe asociación entre los niveles altos de fibrinógeno plasmático y el DMO. Estos resultados pueden servir para futuras investigaciones prospectivas, ya sea para considerarlo un factor de riesgo o como un marcador adicional para el seguimiento y diagnóstico en personas delgadas.

Abstract The state of Uttarakhand in India lies in a highly seismically active zone, therefore earthquake resistant design criteria have been followed for major construction practice in this region. One of the major inputs for earthquake-resistant design is average shear wave velocity (V S ) at 30 m depth. In the present work, at twenty-six different sites, the Horizontal to vertical spectral ratio (HVSR) technique and multichannel analysis of surface wave (MASW) is used for joint analysis to obtain a one-dimensional velocity model that supports both the HV spectrum and dispersion curve obtained from HVSR and MASW methods, respectively. Shear wave profiles obtained at various sites are compared with the bore log data obtained from drilling and it clearly shows that the (V S ) for the same formation have a strong dependence on the depth at which it occurred. Data from twenty-four shear wave profiles have been used to prepare a linear regression relation of (V S ) for different lithological formations with respect to their depth of occurrence. Root mean square error obtained from the developed relationship for various lithologies clearly shows that the results are fairly well within the range of acceptance. The developed relations have been further validated by calculating Vs profile from bore log data obtained at two new location sites that are not included in the data set used for the preparation of regression relations. A comparison of two velocity sections clearly shows that the velocity profile computed from regression relation matches closely with that obtained from the seismic survey and thereby establishing the efficacy of developed regression relationship for its practical implementation. This developed relation allows soil type classification for zoning purposes.

Resumen El estado de Uttarakhand en la India se encuentra en una zona de alta actividad sísmica, por lo que se han seguido criterios de diseño resistentes a los terremotos para las principales prácticas de construcción en esta región. Una de las principales entradas para el diseño resistente a los terremotos es la velocidad media de la onda de corte (V S ) a 30 m de profundidad. En el presente trabajo, en veintiséis sitios diferentes, la técnica de la relación espectral horizontal a vertical (HVSR) y el análisis multicanal de onda de superficie (MASW) se utiliza para el análisis conjunto para obtener un modelo de velocidad unidimensional que soporta tanto la curva de espectro de HV como la curva de dispersión obtenida de los métodos HVSR y MASW, respectivamente. Los perfiles de onda de corte obtenidos en varios sitios se comparan con los datos de registro de perforación obtenidos de la perforación y muestra claramente que los Vs para la misma formación tienen una fuerte dependencia de la profundidad en la que ocurrió. Se han utilizado datos de veinticuatro perfiles de onda de corte para preparar una relación de regresión lineal de Vs para diferentes formaciones litológicas con respecto a su profundidad de ocurrencia. El error cuadrático medio obtenido a partir de la relación desarrollada para varias litologías muestra claramente que los resultados están bastante bien dentro del rango de aceptación. Las relaciones desarrolladas han sido validadas adicionalmente por el cálculo de perfil Vs de los datos de registro de perforación obtenidos en dos nuevos sitios de ubicación que no están incluidos en el conjunto de datos utilizado para la preparación de relaciones de regresión. Una comparación de dos secciones de velocidad muestra claramente que el perfil de velocidad calculado a partir de la relación de regresión coincide estrechamente con el obtenido de la encuesta sísmica y por lo tanto se establece la eficacia de la relación de regresión desarrollada para su implementación práctica. Esta relación desarrollada permite la clasificación del tipo de suelo para fines de zonificación.

Resumen Objetivo. El objetivo de este estudio fue identificar la tendencia de los diferentes tipos de defectos congénitos en la tasa de mortalidad infantil y neonatal en Costa Rica durante el período 2010-2018 con respecto al primer período 2000-2009. Métodos. Se realizó un análisis de estadísticas vitales. La fuente de información fue el Instituto Nacional de Estadísticas y Censos de Costa Rica, mediante su sistema de acceso público y consulta en línea, se consultó la base de defunciones por causa y la base de nacimientos para el período 2000-2018. Las causas de defunción por defectos congénitos se agruparon por sistemas, además se seleccionaron los defectos de mayor mortalidad en el periodo de estudio para su análisis específico. Para describir el comportamiento de la mortalidad infantil por defectos congénitos de 2010-2018 con respecto al decenio anterior, se calcularon tasas de mortalidad infantil y neonatal para los períodos 2000- 2009 y 2010-2018 con su respectivo intervalo de confianza (IC95%). Se construyó un modelo de regresión Poisson Log lineal para cada grupo de defectos congénitos y para los defectos específicos seleccionados, tomando como factor de ajuste los subperíodos comparados. Se estimaron razones de prevalencias y se compararon mediante chi cuadrado de Wald usando como base el período 2000-2009. Resultados. En las últimas dos décadas, los defectos congénitos causaron 29% a 38% de la mortalidad infantil general. La tasa de mortalidad infantil por defectos congénitos durante 2000-2009 fue 3,19 (IC95%: 3,1-3,3) y descendió significativamente a 2,97 (IC95%: 2,8-3,1) en el período 2010-2018. Esta disminución se dio a expensas de la afectación de los sistemas circulatorio y digestivo.Al analizar la mortalidad infantil por defectos congénitos específicos, se demostró una disminución significativa únicamente en espina bífida y algunos defectos cardiacos: transposición de grandes arterias, defecto septal ventricular, coartación aorta y otras anomalías cardiacas no especificadas. La tasa de mortalidad neonatal por defectos congénitos no varió significativamente entre los períodos comparados, en 2000-2009 fue 2,13 (IC95%: 2,0-2,2) y 2,17 (IC95%: 2,1-2,3) en 2010-2018. El único grupo de defectos congénitos que presentó una disminución significativa en la tasa de mortalidad neonatal en la última década fue el sistema circulatorio. Conclusiones. En la última década se presentó una disminución significativa de la tasa de mortalidad infantil por defectos congénitos. Este descenso obedeció principalmente a una disminución significativa en las tasas de mortalidad infantil y neonatal por defectos cardiacos.

Abstract Objective. This study aims to identify the trend of the different types of congenital defects in the infant and neonatal mortality rate in Costa Rica during the period 2010- 2018, and to compare it with the period 2000-2009. Methods. A vital statistics analysis was performed. The source of information was the Costa Rican National Institute of Statistics and Censuses, through its public domain system and online consultation, the base of deaths by cause and the base of births for the period 2000-2018 were consulted. The causes of death due to congenital defects were grouped by system, in addition, the defects with the highest mortality in the study period were selected for their specific analysis. To describe the behavior of infant mortality due to congenital defects in 2010-2018 with respect to the previous decade, infant and neonatal mortality rates were calculated for the periods 2000-2009 and 2010- 2018 with their respective confidence interval (95% CI). A linear Poisson Log regression model was constructed for each group of congenital defects and for the specific defects selected, taking the sub periods compared as an adjustment factor. Prevalence ratios were estimated and compared using Wald’s chi square based on the period 2000-2009. Results. In the last two decades, birth defects caused 29% to 38% of overall infant mortality. The infant mortality rate due to congenital defects during 2000-2009 was 3.19 (95% CI: 3.06-3.32) and presented a significant decrease to 2.97 (95% CI: 2.84-3.11) in the 2010-2018 period. This decrease occurred at the expense of the affection of circulatory and digestive systems. When analyzing infant mortality due to specific congenital defects, a significant decrease was shown only in spina bifida and some cardiac defects: transposition of the great arteries, ventricular septal defect, aortic coarctation and other unspecified cardiac anomalies. The neonatal mortality rate due to congenital defects did not vary significantly between the periods compared, in 2000-2009 it was 2.13 (95% CI: 2.03-2.24) and 2.17 (95% CI: 2.06-2, 29) in 2010-2018. The only group of congenital defects that presented a significant decrease in the neonatal mortality rate in the last decade was the circulatory system. Conclusions. In the last decade there was a significant decrease in the infant mortality rate due to congenital defects. This decrease was mainly due to a significant decrease in infant and neonatal mortality rates from heart defects.