Measuring misclassification of Covid-19 as garbage codes: Results of investigating 1,365 deaths and implications for vital statistics in Brazil.

The purpose of this article is to quantify the amount of misclassification of the Coronavirus Disease-2019 (COVID-19) mortality occurring in hospitals and other health facilities in selected cities in Brazil, discuss potential factors contributing to this misclassification, and consider the implications for vital statistics. Hospital deaths assigned to causes classified as garbage code (GC) COVID-related cases (severe acute respiratory syndrome, pneumonia unspecified, sepsis, respiratory failure and ill-defined causes) were selected in three Brazilian state capitals. Data from medical charts and forensic reports were extracted from standard forms and analyzed by study physicians who re-assigned the underlying cause based on standardized criteria. Descriptive statistical analysis was performed and the potential impact in vital statistics in the country was also evaluated. Among 1,365 investigated deaths due to GC-COVID-related causes, COVID-19 was detected in 17.3% in the age group 0-59 years and 25.5% deaths in 60 years and over. These GCs rose substantially in 2020 in the country and were responsible for 211,611 registered deaths. Applying observed proportions by age, location and specific GC-COVID-related cause to national data, there would be an increase of 37,163 cases in the total of COVID-19 deaths, higher in the elderly. In conclusion, important undercount of deaths from COVID-19 among GC-COVID-related causes was detected in three selected capitals of Brazil. After extrapolating the study results for national GC-COVID-related deaths we infer that the burden of COVID-19 disease in Brazil in official vital statistics was probably under estimated by at least 18% in the country in 2020.

Is the Use of Information and Communication Technology Associated With Aspects of Women's Primary Health Care in Brazil?

The use of information and communication technology (ICT) is on the increase in the health systems, representing a means of improving the quality of health care. This study analyzed the ICT incorporation in primary care in Brazil and identified the different aspects that may be associated with better quality in the care provided, in relation to certain aspects of women's care. We noted an unevenness regarding ICT incorporation in Brazil. However, the findings indicate an association between ICT and certain aspects of the quality provided in women's health care, which reinforces the need for further studies on this type of evaluation.

Trends in mortality due to diabetes in Brazil, 1996-2011.

BACKGROUND: Over recent decades, Brazilian mortality registration has undergone increasing improvement in terms of completeness and quality in cause of death reporting. These improvements, however, complicate the description of mortality trends over this period. We aim to characterize the trend in diabetes mortality in Brazil and its five regions in adults (30-69 years), from 1996 to 2011 after corrections for underreporting of deaths and redistribution of ill-defined causes and "garbage codes". METHODS: Starting with official data from the Brazilian Mortality Information System (SIM) for adults aged 30-69 in the period 1996 to 2011 for diabetes (ICD-10 codes E10-14), we redistributed garbage codes using methods based on the Global Burden of Disease Study (2010), redistributed ill-defined causes based on recent Brazilian investigations of similar cases and corrected for underreporting using official estimates of deaths. RESULTS: With these corrections, age-standardized mortality fell approximately 1.1 %/year for men and 2.2 %/year for women from 1996 to 2011. The rate of decline first accelerated and then decelerated, reaching stable rates in men and minimal declines in women from 2005 onward. Regional inequalities decreased during the period in both relative and absolute terms. CONCLUSION: Mortality due to diabetes declined in Brazil from 1996 to 2011, minimally in men and considerably in women. The lesser declines in recent years may reflect the increasing prevalence of diabetes, and suggest that current efforts to prevent diabetes and minimize the impact of its complications need to be reinforced to ensure that declines will continue.

Drug dispensing and information giving in Belo Horizonte, Brazil.

PURPOSE: The purpose of this paper is to examine drug dispensing and associated activity in Belo Horizonte, Brazil. The paper aims to describe factors associated with patient information giving and dispensing time. DESIGN/METHODOLOGY/APPROACH: A specific protocol for recording data gathered from observations included: number of dispensing sessions; medical specialties active at the time; medication number and type; dispensing outcome; if information giving was observed and dispensing time. Information giving and time were considered response variables. The chi-square test and odds-ratios were used to verify associations between response and explanatory variables. FINDINGS: In 43 percent (45) consultations, information giving accompanied dispensing and was associated with number of dispensing sessions and medical specialty offered on a particular day. Assistance time was associated with drug type and number, which increased as dispensing sessions decreased. RESEARCH LIMITATIONS/IMPLICATIONS: Seasonal variations in the demand for pharmacy assistance were not investigated and sample size precluded multivariate analyses. Consequently, new studies may deepen understanding about communication between physicians, pharmacy assistants and users. PRACTICAL IMPLICATIONS: Pharmacy staff could improve quality and efficiency if two aspects were taken into account: fluctuating workload, and external conditions within which tasks are undertaken. ORIGINALITY/VALUE: The paper identifies external conditions that interfere with drug dispensing.

[The relationship between deaths that are avoidable with adequate health care and the implementation of the Unified Health System in Brazil]. / Relação entre as causas de morte evitáveis por atenção à saúde e a implementação do Sistema Unico de Saúde no Brasil.

OBJECTIVE: To analyze the relationship between the occurrence of deaths that are avoidable with adequate health care and the reorganization of the Brazilian health care system between 1983 and 2002. METHOD: This ecological study analyzed avoidable mortality in 117 municipalities of Brazil. The causes of death avoidable with adequate health care were grouped into three: (1) ones avoidable through early diagnosis and treatment, (2) ones avoidable with improvements in the quality of treatment and medical care, and (3) ischemic heart disease. To evaluate the association between avoidable mortality and reorganization of the health care system, the period under study was divided into two subperiods: from 1983 through 1992 and from 1993 through 2002 (respectively, before and after approval of the operational guideline that served as the reference for the organization of the Unified Health System (Sistema Unico de Saúde)). A negative binomial regression model that controlled for sex, age, geographic region, and socioeconomic conditions was used for the analysis. RESULTS: During the period analyzed, 1 854 165 individuals between 0 and 74 years old died from avoidable causes in the municipalities studied. The multivariate analysis showed that, for all three groups of avoidable causes, the risk of avoidable mortality was higher in the 1983-1992 subperiod than in the 1993-2002 subperiod. For the entire 1983-2002 period, the risk was higher for males than for females, especially with respect to ischemic heart disease. Younger populations had lower risk. Higher socioeconomic level reduced the risk of death from avoidable causes, except for ischemic heart disease. CONCLUSIONS: Our results suggest that in Brazil the decrease in avoidable mortality from the 1983-1992 subperiod to the 1993-2002 subperiod was partially due to the changes in the availability of and access to health services brought about by the reorganization of the Brazilian health care system.