[Reregistration of the population residing in Foz do Iguaçu, Brazil, in compliance with the Primary Health Care PolicyReinscripción de la población residente en Foz do Iguaçu, Brasil, en cumplimiento de la Política de atención primaria de salud]. / Recadastramento da população residente em Foz do Iguaçu, Brasil, em atendimento à Política de Atenção Primária à Saúde.

Objective: To present the experience and results of the reregistration of residents in Foz do Iguaçu, a border town located in the state of Paraná, Brazil, to meet the guidelines of the national Primary Health Care (PHC) Policy and its new financing model (Programa Previne Brasil). Method: A scanning strategy (convenience sample) was used for data collection, with 52 263 households visited and 22 710 interviews conducted from September to November 2019. The interviews were conducted face-to-face by 54 community health workers. Data were collected on the household (ownership status, urban or rural location, type of household, construction material, availability of electrical and sewage networks, water supply and waste disposal). Demographic and health information on the residents was also collected. Results: The reregistration process revealed that most residents were home owners and lived in well-constructed homes, located mostly in urban areas, served by electricity, with access to water supply and garbage collection. Of the reregistered population, 52.8% were women, 62.5% were aged between 15 and 59 years and 60.0% declared themselves white. Among respondents aged 15 or over, 90.0% had completed elementary school. The main occupation was "formal salaried job". Additionally, 18.6% of the interviewees declared themselves to be hypertensive and 7.0%, diabetic. Conclusions: The reregistration process uncovered relevant information to support both PHC planning as well as social assistance, work and housing initiatives; it was also fundamental to define health care strategies in this border town during the COVID-19 pandemic.

Objetivo: Presentar la experiencia y los resultados de la reinscripción de la población residente en Foz do Iguaçu, un municipio fronterizo ubicado en el estado de Paraná (Brasil), en cumplimiento de las directrices de la Política de atención primaria de salud y su nuevo modelo de financiamiento (Programa Previne Brasil). Métodos: Utilizando una estrategia de barrido (muestreo de conveniencia) para la recolección de datos, se visitaron 52 263 hogares y se realizaron 22 710 entrevistas entre septiembre y noviembre de 2019. Las entrevistas fueron presenciales y estuvieron a cargo de 54 trabajadores comunitarios de salud. Se recopilaron datos sobre el hogar (régimen de propiedad de la vivienda, ubicación en una zona urbana o rural, tipo de vivienda, material de construcción, disponibilidad de redes de energía eléctrica y alcantarillado, abastecimiento de agua y eliminación de desechos) e información sobre la composición demográfica y la salud de los residentes. Resultados: La reinscripción reveló que los residentes eran propietarios de sus viviendas y que estas se encontraban ubicadas en zonas urbanas, estaban bien construidas y tenían servicios de energía eléctrica, abastecimiento de agua y recolección de basura. El 52,8% de la población registrada correspondió a mujeres, el 62,5% tenía entre 15 y 59 años y el 60,0% declaró que era de raza blanca. El 90,0% de los entrevistados mayores de 15 años había terminado la escuela primaria. La ocupación principal era "persona asalariada con carnet de trabajo". Además, el 18,6% de los entrevistados indicó que tenía hipertensión y el 7,0%, diabetes. Conclusiones: La reinscripción aportó información relevante para apoyar la planificación de la atención primaria de salud , así como las iniciativas en materia de asistencia social, trabajo y vivienda; también fue fundamental para definir las estrategias de atención de salud en ese municipio fronterizo durante la pandemia de COVID-19.

The burden of AIDS: a time series analysis of thirty-five years of the epidemic in Brazil.

Although traditional epidemiological information, such as mortality rate and prevalence or incidence rates, is relevant to the understanding of AIDS epidemiology in Brazil, a more complete indicator would be recommended. The aim of this study was to estimate the burden of AIDS and its trends in Brazil from 1980 to 2015. An ecological study using secondary data on mortality, morbidity and demography was carried out. Data were collected from official health information sources. Disability-adjusted life years (DALY) index was estimated by year. Trend analysis of the rates were performed using a segmented linear regression method. There were 826,452 confirmed HIV/AIDS cases and 302,614 deaths from AIDS-related causes in the studied period. The greatest burden occurred between 1994 and 1996, with a significant increase in the burden of AIDS for both sexes. The burden of AIDS in Brazil remains high, with a tendency to increase significantly the DALY rates in the study period. However, trend reversals in the DALY rates and in the mortality component, with a consequent increase in the morbidity component, were identified from 1995 onwards.

Prevention of neural tube defects by the fortification of flour with folic acid: a population-based retrospective study in Brazil.

OBJECTIVE: To determine if the fortification of wheat and maize flours with iron and folic acid - which became mandatory in Brazil from June 2004 - is effective in the prevention of neural tube defects. METHODS: Using data from national information systems on births in central, south-eastern and southern Brazil, we determined the prevalence of neural tube defects among live births and stillbirths in a pre-fortification period - i.e. 2001-2004 - and in a post-fortification period - i.e. 2005-2014. We distinguished between anencephaly, encephalocele, meningocele, myelomeningocele and other forms of spina bifida. FINDINGS: There were 8554 neural tube defects for 17,925,729 live births notified between 2001 and 2014. For the same period, 2673 neural tube defects were reported for 194,858 stillbirths. The overall prevalence of neural tube defects fell from 0.79 per 1000 pre-fortification to 0.55 per 1000 post-fortification (prevalence ratio, PR: 1.43; 95% confidence interval, CI: 1.38-1.50). For stillbirths, prevalence fell from 17.74 per 1000 stillbirths pre-fortification to 11.70 per 1000 stillbirths post-fortification. The corresponding values among live births were 0.57 and 0.44, respectively. CONCLUSION: The introduction of the mandatory fortification of flour with iron and folic acid in Brazil was followed by a significant reduction in the prevalence of neural tube defects in our study area.

A priority health index identifies the top six priority risk and related factors for non-communicable diseases in Brazilian cities.

BACKGROUND: In Brazil, 72% of all deaths in 2007 were attributable to non-communicable diseases (NCD). We used a risk and related factor based index to prioritize NCD prevention programs in the combined 26 capital cities and the federal district (i.e., Brasilia) of Brazil. METHODS: We used 2006-2011 data (adults) from census and Brazil's surveillance of 12 NCD risk factors and 74 disease group mortality. The risk and related factors were: smoking, physical inactivity, overweight-obesity, low fruits and vegetables intake, binge drinking, insufficient Pap smear screening (women aged 25 to 59 years), insufficient mammography screening (women aged 50 to 69 years), insufficient blood pressure screening, insufficient blood glucose screening, diagnosis of hypercholesterolemia, diagnosis of hypertension and diagnosis of diabetes. We generated six indicators: intervention reduction of the risk factor prevalence, intervention cost per person, prevalence of risk factor, deaths attributable to risk factor, risk factor prevalence trend and ratio of risk factor prevalence between people with and without a high school education. We transformed risk and related factor indicators into priority scores to compute a priority health index (PHI). We implemented sensitivity analysis of PHI by computing it with slightly altered formulas and altering values of indicators under the assumption of bias in their estimation. We ranked risk factors based on PHI values. RESULTS: We found one intermediate (i.e., overweight-obesity) and six top risk and related factors priorities for NCD prevention in Brazil's large urban areas: diagnosed hypertension, physical inactivity, blood pressure screening, diagnosed hypercholesterolemia, smoking and binge drinking. CONCLUSION: Brazil has already prioritized the six top priorities (i.e., hypertension, physical inactivity, blood pressure screening, hypercholesterolemia, smoking and binge drinking) and one intermediate priority (i.e., overweight-obesity) for NCD prevention identified in this report. Because effective interventions to reduce disease burden associated with each of the six priority risk factors are available, strategies based on these interventions need to be sustained in order to reduce NCD burden in Brazil. PHI can be used to track NCD prevention and health promotion actions at the local and national level in Brazil and in countries with similar public health surveillance systems.

Decline in diarrhea mortality and admissions after routine childhood rotavirus immunization in Brazil: a time-series analysis.

BACKGROUND: In 2006, Brazil began routine immunization of infants <15 wk of age with a single-strain rotavirus vaccine. We evaluated whether the rotavirus vaccination program was associated with declines in childhood diarrhea deaths and hospital admissions by monitoring disease trends before and after vaccine introduction in all five regions of Brazil with varying disease burden and distinct socioeconomic and health indicators. METHODS AND FINDINGS: National data were analyzed with an interrupted time-series analysis that used diarrhea-related mortality or hospitalization rates as the main outcomes. Monthly mortality and admission rates estimated for the years after rotavirus vaccination (2007-2009) were compared with expected rates calculated from pre-vaccine years (2002-2005), adjusting for secular and seasonal trends. During the three years following rotavirus vaccination in Brazil, rates for diarrhea-related mortality and admissions among children <5 y of age were 22% (95% confidence interval 6%-44%) and 17% (95% confidence interval 5%-27%) lower than expected, respectively. A cumulative total of ~1,500 fewer diarrhea deaths and 130,000 fewer admissions were observed among children <5 y during the three years after rotavirus vaccination. The largest reductions in deaths (22%-28%) and admissions (21%-25%) were among children younger than 2 y, who had the highest rates of vaccination. In contrast, lower reductions in deaths (4%) and admissions (7%) were noted among children two years of age and older, who were not age-eligible for vaccination during the study period. CONCLUSIONS: After the introduction of rotavirus vaccination for infants, significant declines for three full years were observed in under-5-y diarrhea-related mortality and hospital admissions for diarrhea in Brazil. The largest reductions in diarrhea-related mortality and hospital admissions for diarrhea were among children younger than 2 y, who were eligible for vaccination as infants, which suggests that the reduced diarrhea burden in this age group was associated with introduction of the rotavirus vaccine. These real-world data are consistent with evidence obtained from clinical trials and strengthen the evidence base for the introduction of rotavirus vaccination as an effective measure for controlling severe and fatal childhood diarrhea.

Restructuring of emergency services to COVID-19 in Brazil: a space-time analysis from February to August 2020. / Reestruturação dos serviços de emergência à COVID-19 no Brasil: uma análise espaço-temporal, fevereiro a agosto de 2020.

OBJECTIVE: To explore the reorganization of the health system in response to the COVID-19 pandemic. METHODS: We conducted an ecological, descriptive-exploratory study with analysis of spatio-temporal clusters by epidemiological week in Brazilian municipalities. Secondary data sources were used, from the National Health Establishment Registry (April 2020) and on COVID-19 cases, February to August 2020. Intensive Care Units (ICU) availability was overlaid on incidence and mortality hot spots in order to assess expanded access in critical regions. RESULTS: Of the 5,570 municipalities analyzed, 54% were identified as incidence hot spots and 31% as mortality hot spots. Of the municipalities in incidence hot spots and with scarce access, 28% were covered by ICU expansion, while with regard to mortality 14% were covered. CONCLUSION: The opening of new beds was not able to provide broad coverage for critical regions and could be optimized with the use of spatial analysis techniques.

COVID-19 as the leading cause of hospital deaths in the Brazilian public health system in 2020.

OBJECTIVES: To describe the profile of hospital deaths in Brazil according to cause of admission during the pre-pandemic (2019) and pandemic periods (2020). METHODS: Descriptive study based on individual-level records of all hospital admissions with death outcomes reimbursed by the Brazilian National Health System in 2019 and 2020. RESULTS: The number of hospital deaths increased by 16.7% in 2020 compared with 2019 (522,686 vs 609,755). Coronavirus disease 2019 (COVID-19) was associated with 19.5% (118,879) of all hospital deaths in 2020, surpassing diseases of the circulatory system (15.4%, 93,735) and diseases of the respiratory system (14.9%, 91,035). CONCLUSIONS: COVID-19 was the main cause of death in public hospitals in Brazil in 2020.

Data for health: impact on improving the quality of cause-of-death information in Brazil. / Dados para a saúde: impacto na melhoria da qualidade da informação sobre causas de óbito no Brasil.

INTRODUCTION: Knowing the number of deaths and their causes is relevant information for public health managers. However, the cause of death is often classified with codes that are not useful for mortality analysis, called garbage codes (GC). OBJECTIVE: To describe and evaluate the impact of investigation of the underlying cause of poorly classified deaths on death certificates in 2017. METHODS: Based on a standardized protocol, GC deaths from 60 municipalities were investigated, mainly in hospital records and autopsy services. Managers at the state level of the Mortality Information System also developed procedures to improve the classification of causes of death, with the consequent adherence of other municipalities (n = 4022). This made it possible to compare the results of GC research between these two groups of municipalities. RESULTS: In the country, among the 108,826 GC investigated in 2017, 48% were reclassified to specific causes. In the 60 focus municipalities, 58% of the 35,366 investigated deaths from GC were reclassified. After the intervention, the proportion of deaths classified as GC decreased by 11% in the country and 17% in the municipalities. DISCUSSION: The research in hospital records enabled almost half of the deaths from GC investigated to be reclassified. This is the first study to investigate GC in hospital records of more than 100,000 deaths. The 60 cities targeted by the intervention had better results than the other cities. CONCLUSION: The intervention proved to be an appropriate initiative to improve the quality of information on cause of death and should be encouraged.

INTRODUÇÃO: Conhecer o número de óbitos e suas causas se constitui em informação de relevância para gestores de saúde pública. Entretanto, muitas vezes a causa do óbito é classificada com códigos pouco úteis para as análises de mortalidade, denominados códigos garbage (CG). OBJETIVO: Descrever e avaliar o impacto da investigação da causa básica de morte mal classificada no atestado de óbito em 2017. MÉTODOS: Com base em protocolo padronizado, foram pesquisadas mortes com CG de 60 municípios que foram foco da intervenção, principalmente em prontuários hospitalares e serviços de autopsia. No nível estadual de gestão do Sistema de Informação de Mortalidade também foram desenvolvidas ações para melhoria da classificação da causa do óbito, com consequente adesão da maioria dos demais municípios (n = 4.022), o que permitiu comparações com os resultados da investigação de CG nas 60 cidades. RESULTADOS: No país, de 108.826 CG investigadas em 2017, 48% foram reclassificadas para causas específicas. Já nos 60 municípios selecionados, 58% dos 35.366 óbitos por CG pesquisados foram reclassificados. A proporção de óbitos por CG declinou em 11% no país e 17% nos municípios em que houve intervenção. DISCUSSÃO: Este é o primeiro estudo que investigou CG em registros médicos de mais de 100 mil mortes. A pesquisa possibilitou reclassificar para causas básicas específicas cerca de metade dos óbitos por CG investigados. As 60 cidades que foram alvo da intervenção tiveram melhor resultado que as demais cidades. CONCLUSÃO: A intervenção mostrou ser uma iniciativa adequada para a melhoria da qualidade da informação sobre causa de morte e deve ser estimulada.

Mortality on the first day of life: trends, causes of death and avoidability in eight Brazilian Federative Units, between 2010 and 2015. / Mortalidade no primeiro dia de vida: tendências, causas de óbito e evitabilidade em oito Unidades da Federação brasileira, entre 2010 e 2015.

OBJECTIVE: to calculate mortality rates on the first day of life from 2010 to 2015 in eight Brazilian Federative Units providing better quality information, to assess associated factors and to classify deaths by underlying causes and avoidability. METHODS: this was a descriptive study; mortality rates were compared according to maternal and child characteristics; avoidability analysis used the 'Brazilian list of avoidable causes of death'. RESULTS: 21.6% (n=20,791) of all infant deaths occurred on the first day of life; the mortality rate reduced from 2.7 to 2.3 deaths/1,000 live births; rates were higher in live births with low birthweight and preterm births, and among babies born to mothers with no schooling; main causes of death were respiratory distress syndrome (8.9%) and extreme immaturity (5.2%); 66.3% of causes of death were avoidable. CONCLUSION: 2/3 of deaths on the first day of life could have been avoided with adequate care for women during pregnancy and delivery and adequate care for live births.

Epidemiology of Self-Reported Diabetes Mellitus in the State of Maranhão, Northeastern Brazil: Results of the National Health Survey, 2013.

Objective: To estimate the prevalence and risk factors for self-reported diabetes mellitus (DM) in adults from the State of Maranhão, Northeastern Brazil. Methods: A cross-sectional study was carried out with 1774 individuals aged ≥18 years participating in the National Health Survey of 2013 in Maranhão. The adults were selected by probabilistic sampling and interviewed face-to-face by in-home visits. The Poisson regression model was used to verify the factors associated with DM. Results: The prevalence of DM was 5.39% (95% confidence interval [95% CI]: 3.73⁻7.73). After adjustment of the regression model for age, gender, smoking, education, hypertension, and hypercholesterolemia, DM was statistically associated with age ≥60 years, female sex, low educational level, and self-report hypertension. Conclusion: The present study found the prevalence of self-reported DM similar to that estimated in the general population of Brazil. Public policies for prevention and control should intensify control, especially in the subgroups most vulnerable to DM.

[Prevalence and bacterial susceptibility of community acquired urinary tract infection in University Hospital of Brasília, 2001 to 2005]. / Prevalência e suscetibilidades bacterianas das infecções comunitárias do trato urinário, em Hospital Universitário de Brasília, no período de 2001 a 2005.

Urinary tract infection is among the most common infectious diseases in clinical medicine, and knowledge of its epidemiology and the sensitivity profile of the etiological agents is mandatory. The aim of this study was to identify the most frequent etiological agents and the profile of sensitivity to antimicrobial agents of the bacteria isolated from urine cultures from outpatients at the University Hospital of Brasília between 2001 and 2005. From analyses at the hospitals microbiology laboratory, there were 2,433 positive urine cultures. Escherichia coli was the most commonly isolated bacteria (62.4%), followed by Klebsiella pneumoniae (6.8%) and Proteus mirabilis (4.7%). Escherichia coli showed the highest sensitivity to amikacin (98.6%), gentamicin (96.2%), nitrofurantoin (96.3%) and the quinolones ciprofloxacin (90.9%) and norfloxacin (89.8%), with low sensitivity to sulfamethoxazole-trimethoprim (50.6%). The others bacteria presented similar sensitivity profiles. In conclusion, Escherichia coli was the most commonly isolated bacteria, and it was highly sensitive to aminoglycosides, nitrofurantoin and quinolones.

[Use of vital data to estimate mortality indicators in Brazil: from the active search for events to the development of methods]. / Utilização das informações vitais para a estimação de indicadores de mortalidade no Brasil: da busca ativa de eventos ao desenvolvimento de métodos.

The article addresses Brazil's historical development in the use of vital data, incorporating procedures for the evaluation of such data and research with active search of births and deaths, resulting in the proposal of methods for calculating birth and mortality indicators through the use of continuous records. In addition to research to capture vital events from the years 2000 and 2008, the article presents procedures for the correction of events reported to the information systems and the paradigm shift in the method for calculating mortality indicators, resulting from such initiatives. The study also features advances in the adequacy of information on deaths and live births in Brazil, changes in the estimates on infant mortality resulting from the proposed methods, and the challenge of estimating the indicator for subnational geographic areas with lower population contingents, mostly consisting of municipalities (counties) with low and irregular data coverage.

Recadastramento da população residente em Foz do Iguaçu, Brasil, em atendimento à Política de Atenção Primária à Saúde / Reregistration of the population residing in Foz do Iguaçu, Brazil, in compliance with the Primary Health Care Policy / Reinscripción de la población residente en Foz do Iguaçu, Brasil, en cumplimiento de la Política de atención primaria de salud

RESUMO Objetivo. Apresentar a experiência e os resultados do recadastramento da população residente em Foz do Iguaçu, um município de fronteira localizado no estado do Paraná, Brasil, para atender às diretrizes da Política de Atenção Primária à Saúde (APS) e ao seu novo modelo de financiamento pelo Programa Previne Brasil. Métodos. Utilizando uma estratégia de varredura (amostra de conveniência) para coleta de dados, foram visitados 52 263 domicílios e realizadas 22 710 entrevistas de setembro a novembro de 2019. As entrevistas foram realizadas pessoalmente por 54 agentes comunitários de saúde. Foram coletados dados sobre o domicílio (status de posse da moradia, localização urbana ou rural, tipo de domicílio, material da construção, disponibilidade de rede elétrica e de esgoto, abastecimento de água e destino do lixo) e informações demográficas e de saúde dos moradores. Resultados. O recadastramento revelou que os domicílios eram predominantemente casas próprias, em área urbana, bem edificados e servidos por energia elétrica, rede geral de água e coleta de lixo. Sobre a população recadastrada, 52,8% eram mulheres, 62,5% tinham idade de 15 a 59 anos e 60,0% se autodeclararam brancos. Entre os entrevistados com 15 anos ou mais, 90,0% tinham completado o ensino fundamental. A principal ocupação foi "assalariado com carteira de trabalho". Ainda, 18,6% dos entrevistados se autodeclararam hipertensos e 7,0%, diabéticos. Conclusões. O recadastramento trouxe informações relevantes para subsidiar o planejamento da APS, assim como iniciativas de assistência social, trabalho e habitação; também foi fundamental para definir estratégias de atenção à saúde nesse município de fronteira durante a pandemia de COVID-19.

ABSTRACT Objective. To present the experience and results of the reregistration of residents in Foz do Iguaçu, a border town located in the state of Paraná, Brazil, to meet the guidelines of the national Primary Health Care (PHC) Policy and its new financing model (Programa Previne Brasil). Method. A scanning strategy (convenience sample) was used for data collection, with 52 263 households visited and 22 710 interviews conducted from September to November 2019. The interviews were conducted face-to-face by 54 community health workers. Data were collected on the household (ownership status, urban or rural location, type of household, construction material, availability of electrical and sewage networks, water supply and waste disposal). Demographic and health information on the residents was also collected. Results. The reregistration process revealed that most residents were home owners and lived in well-constructed homes, located mostly in urban areas, served by electricity, with access to water supply and garbage collection. Of the reregistered population, 52.8% were women, 62.5% were aged between 15 and 59 years and 60.0% declared themselves white. Among respondents aged 15 or over, 90.0% had completed elementary school. The main occupation was "formal salaried job". Additionally, 18.6% of the interviewees declared themselves to be hypertensive and 7.0%, diabetic. Conclusions. The reregistration process uncovered relevant information to support both PHC planning as well as social assistance, work and housing initiatives; it was also fundamental to define health care strategies in this border town during the COVID-19 pandemic.

RESUMEN Objetivo. Presentar la experiencia y los resultados de la reinscripción de la población residente en Foz do Iguaçu, un municipio fronterizo ubicado en el estado de Paraná (Brasil), en cumplimiento de las directrices de la Política de atención primaria de salud y su nuevo modelo de financiamiento (Programa Previne Brasil). Métodos. Utilizando una estrategia de barrido (muestreo de conveniencia) para la recolección de datos, se visitaron 52 263 hogares y se realizaron 22 710 entrevistas entre septiembre y noviembre de 2019. Las entrevistas fueron presenciales y estuvieron a cargo de 54 trabajadores comunitarios de salud. Se recopilaron datos sobre el hogar (régimen de propiedad de la vivienda, ubicación en una zona urbana o rural, tipo de vivienda, material de construcción, disponibilidad de redes de energía eléctrica y alcantarillado, abastecimiento de agua y eliminación de desechos) e información sobre la composición demográfica y la salud de los residentes. Resultados. La reinscripción reveló que los residentes eran propietarios de sus viviendas y que estas se encontraban ubicadas en zonas urbanas, estaban bien construidas y tenían servicios de energía eléctrica, abastecimiento de agua y recolección de basura. El 52,8% de la población registrada correspondió a mujeres, el 62,5% tenía entre 15 y 59 años y el 60,0% declaró que era de raza blanca. El 90,0% de los entrevistados mayores de 15 años había terminado la escuela primaria. La ocupación principal era "persona asalariada con carnet de trabajo". Además, el 18,6% de los entrevistados indicó que tenía hipertensión y el 7,0%, diabetes. Conclusiones. La reinscripción aportó información relevante para apoyar la planificación de la atención primaria de salud , así como las iniciativas en materia de asistencia social, trabajo y vivienda; también fue fundamental para definir las estrategias de atención de salud en ese municipio fronterizo durante la pandemia de COVID-19.

Pulmonary thromboembolism in AIDS patient with chronic venous insufficiency, pulmonary tuberculosis and breast cancer: a case report and pathophysiology review.

Recent literature reports thrombotic episodes occurring in patients with HIV infection associated with other abnormalities including neoplasms and infections predisposing to a hypercoagulable state. We report a 47-year-old woman who developed pulmonary thromboembolism in association with HIV infection, pulmonary tuberculosis and breast cancer. She was treated with rifampin, isoniazid, pyrazinamide; heparin, phenprocoumon, zidovudine, lamivudine and efavirenz. Acid fast bacilli were visualized in a sputum smear and three months after, Mycobacterium tuberculosis was isolated from lymph node biopsy during a episode of immune reconstitution. The isolated mycobacteria showed sensitivity to all first-line drugs. HIV infection, breast cancer and pulmonary tuberculosis have several mechanisms that induce hypercoagulable state and can lead to thromboembolic complications. Pulmonary thromboembolism in this patient was a diagnostic challenge because of all the other severe diseases that she experienced at the same time.

Review of deaths correction methods and quality dimensions of the underlying cause for accidents and violence in Brazil. / Revisão dos métodos de correção de óbitos e dimensões de qualidade da causa básica por acidentes e violências no Brasil.

This review article aims to perform analysis and critical discussion about the literature on methods correcting mortality from accidents and violence reported to the Brazilian Mortality Information System. We consulted Medline and SciELO databases, as well as the Global Burden of Disease site, using time filter for the 1996-2015 interval. Of the 77 studies identified, we selected 29, and 14 met the corrections production criteria for cases of underreporting: underreporting of deaths in the Mortality Information System, deaths declared as ill-defined causes or deaths from external causes declared with nonspecific codes. We found that the underreporting of external causes was not significantly different from what occurs in total deaths and sometimes was higher in small and medium-sized municipalities. The reclassification of ill-defined causes of death corrected external causes to non-negligible values. The selected studies differ on proposals for correction of unspecified external causes. Evidence supports interventions to improve the quality of data, and the availability of correction procedure of external causes that bring together application conditions.

Method for estimating infant mortality and low birth weight indicators for Brazilian municipalities, 2012. / Método para estimação de indicadores de mortalidade infantil e baixo peso ao nascer para municípios do Brasil, 2012.

OBJECTIVE: to present a method for estimating low birth weight (LBW) prevalence and infant mortality rate (IMR) indicators for Brazilian municipalities, so as to incorporate considerations with regard to sampling fluctuation. METHODS: binomial and Poisson distributions were used to estimate 95% confidence intervals (95%CI); when the number of infant deaths was zero, the upper limit of the 95%CI was estimated by the cross-multiplication method; indicators were estimated for the year 2012 for demonstration purposes. RESULTS: a slight increase in LBW and a decrease in IMR were detected as municipality population size increased; LBW estimates were more accurate than those for IMR; single-year estimates showed large width 95%CI in small municipalities and low reliability. CONCLUSION: an electronic spreadsheet was developed which will allow service managers to estimate the precision of these indicators for their municipalities.

Reestruturação dos serviços de emergência à COVID-19 no Brasil: uma análise espaço-temporal, fevereiro a agosto de 2020 / Reestructuración de los servicios de emergencia a COVID-19 en Brasil: un análisis espacio-temporal de febrero a agosto de 2020 / Restructuring of emergency services to COVID-19 in Brazil: a space-time analysis from February to August 2020

Objetivo: Explorar a reorganização do sistema de saúde voltado para a pandemia de COVID-19. Métodos: Realizou-se estudo ecológico, descritivo-explicativo, com análise de aglomerados espaço-temporais por semana epidemiológica nos municípios brasileiros. Foram utilizadas fontes de dados secundárias, do Cadastro Nacional de Estabelecimentos de Saúde (abril de 2020) e de casos de COVID-19 (fevereiro a agosto de 2020). As áreas quentes de incidência e mortalidade foram sobrepostas com a disponibilidade de unidades de tratamento intensivo (UTIs), para se avaliar a ampliação do acesso em regiões críticas. Resultados: Dos 5.570 municípios analisados, 54% foram identificados como áreas quentes para incidência e 31% para mortalidade. Dos municípios em áreas quentes para incidência e com escassez de acesso, 28% foram contemplados pela ampliação de UTIs. Para mortalidade, esse valor foi de 14%. Conclusão: A abertura de novos leitos não conseguiu abranger amplamente as regiões críticas, entretanto poderia ser otimizada com o uso de técnicas de análise espacial.

Objetivo: Explorar la reorganización del sistema sanitario centrada en la pandemia de COVID-19. Métodos: Se realizó un estudio ecológico, descriptivo-exploratorio con análisis de clusters espacio-temporales, por semana epidemiológica en los municipios brasileños El análisis utilizó fuentes de datos secundarias, del Registro Nacional de Establecimientos de Salud y de los casos de COVID-19, para los meses de abril y agosto de 2020, respectivamente. Las áreas vulnerables a incidencia y mortalidad se superpusieron a la disponi-bilidad de UCIs para evaluar la expansión del acceso en las regiones críticas. Resultados: De los 5.570 municipios analizados, 54% fueron identificados como zonas vulnerables a incidencia y 31% a mortalidad. De los municipios en zonas calientes de incidencia y con escaso acceso, el 28% estaba contemplados por la ampliación de la UCI. En cuanto a la mortalidad, este valor fue del 14%. Conclusión: La apertura de nuevos lectores no consiguió ampliar las regiones críticas y podría ser optimizada con el uso de técnicas de análisis espacial.

Objective: To explore the reorganization of the health system in response to the COVID-19 pandemic. Methods: We conducted an ecological, descriptive-exploratory study with analysis of spatio-temporal clusters by epidemiological week in Brazilian municipalities. Secondary data sources were used, from the National Health Establishment Registry (April 2020) and on COVID-19 cases, February to August 2020. Intensive Care Units (ICU) availability was overlaid on incidence and mortality hot spots in order to assess expanded access in critical regions. Results: Of the 5,570 municipalities analyzed, 54% were identified as incidence hot spots and 31% as mortality hot spots. Of the municipalities in incidence hot spots and with scarce access, 28% were covered by ICU expansion, while with regard to mortality 14% were covered. Conclusion: The opening of new beds was not able to provide broad coverage for critical regions and could be optimized with the use of spatial analysis techniques.

Ill-defined causes of death in Brazil: a redistribution method based on the investigation of such causes.

OBJECTIVE To propose a method of redistributing ill-defined causes of death (IDCD) based on the investigation of such causes. METHODS In 2010, an evaluation of the results of investigating the causes of death classified as IDCD in accordance with chapter 18 of the International Classification of Diseases (ICD-10) by the Mortality Information System was performed. The redistribution coefficients were calculated according to the proportional distribution of ill-defined causes reclassified after investigation in any chapter of the ICD-10, except for chapter 18, and used to redistribute the ill-defined causes not investigated and remaining by sex and age. The IDCD redistribution coefficient was compared with two usual methods of redistribution: a) Total redistribution coefficient, based on the proportional distribution of all the defined causes originally notified and b) Non-external redistribution coefficient, similar to the previous, but excluding external causes. RESULTS Of the 97,314 deaths by ill-defined causes reported in 2010, 30.3% were investigated, and 65.5% of those were reclassified as defined causes after the investigation. Endocrine diseases, mental disorders, and maternal causes had a higher representation among the reclassified ill-defined causes, contrary to infectious diseases, neoplasms, and genitourinary diseases, with higher proportions among the defined causes reported. External causes represented 9.3% of the ill-defined causes reclassified. The correction of mortality rates by the total redistribution coefficient and non-external redistribution coefficient increased the magnitude of the rates by a relatively similar factor for most causes, contrary to the IDCD redistribution coefficient that corrected the different causes of death with differentiated weights. CONCLUSIONS The proportional distribution of causes among the ill-defined causes reclassified after investigation was not similar to the original distribution of defined causes. Therefore, the redistribution of the remaining ill-defined causes based on the investigation allows for more appropriate estimates of the mortality risk due to specific causes.

Mortalidade no primeiro dia de vida: tendências, causas de óbito e evitabilidade em oito Unidades da Federação brasileira, entre 2010 e 2015 / Mortalidad en el primer día de vida: tendencias, causas de muerte y evitabilidad en ocho Unidades de la Federación brasileña, entre 2010 y 2015 / Mortality on the first day of life: trends, causes of death and avoidability in eight Brazilian Federative Units, between 2010 and 2015

Objetivo: calcular taxas de mortalidade no primeiro dia de vida entre 2010 e 2015 em oito Unidades da Federação brasileira com melhor qualidade de informação, avaliar fatores associados e classificar os óbitos segundo causa básica e evitabilidade. Métodos: estudo descritivo; as taxas foram comparadas conforme características maternas e da criança; a análise de evitabilidade usou a 'Lista brasileira de causas de mortes evitáveis'. Resultados: 21,6% (n=20.791) dos óbitos infantis ocorreram no primeiro dia de vida; a taxa de mortalidade reduziu-se de 2,7 para 2,3 óbitos/1.000 nascidos vivos; observaram-se maiores taxas em NV com baixo peso, nascidos pré-termo e filhos de mães sem escolaridade; as principais causas dos óbitos foram síndrome da angústia respiratória (8,9%) e imaturidade extrema (5,2%); 66,3% das causas de óbito foram consideradas evitáveis. Conclusão: dois terços dos óbitos no primeiro dia de vida poderiam ser evitados por atenção adequada à mulher na gestação e no parto, e ao NV.

Objetivo: calcular la mortalidad en el primer día de vida entre 2010 y 2015 en ocho Unidades de la Federación brasileña con mejor calidad de información, analizar factores asociados y clasificar las causas básicas y la evitabilidad de los óbitos. Métodos: estudio descriptivo; las tasas de mortalidad fueron comparadas según las características maternas y del recién nacido (RN); el análisis de evitabilidad utilizó la 'Lista brasileña de causas de muertes evitables'. Resultados: un 21,6% (n=20.791) de los óbitos infantiles ocurrió en el primer día de vida; la tasa de mortalidad se redujo de 2,7 a 2,3 óbitos/1.000 nacidos vivos (NV); las tasas fueron mayores en NV de bajo peso, prematuros e hijos de madres sin escolaridad; las principales causas de óbito fueron síndrome de angustia respiratoria (8,9%) e inmadurez extrema (5,2%); un 66,3% de las causas de óbito fueron consideradas evitables. Conclusión: 2/3 de los óbitos en el primer día de vida podrían haber sido evitados con una atención adecuada a la mujer embarazada, al parto y al NV.

Objective: to calculate mortality rates on the first day of life from 2010 to 2015 in eight Brazilian Federative Units providing better quality information, to assess associated factors and to classify deaths by underlying causes and avoidability. Methods: this was a descriptive study; mortality rates were compared according to maternal and child characteristics; avoidability analysis used the 'Brazilian list of avoidable causes of death'. Results: 21.6% (n=20,791) of all infant deaths occurred on the first day of life; the mortality rate reduced from 2.7 to 2.3 deaths/1,000 live births; rates were higher in live births with low birthweight and preterm births, and among babies born to mothers with no schooling; main causes of death were respiratory distress syndrome (8.9%) and extreme immaturity (5.2%); 66.3% of causes of death were avoidable. Conclusion: 2/3 of deaths on the first day of life could have been avoided with adequate care for women during pregnancy and delivery and adequate care for live births.

Dados para a saúde: impacto na melhoria da qualidade da informação sobre causas de óbito no Brasil / Data for health: impact on improving the quality of cause-of-death information in Brazil

RESUMO Introdução: Conhecer o número de óbitos e suas causas se constitui em informação de relevância para gestores de saúde pública. Entretanto, muitas vezes a causa do óbito é classificada com códigos pouco úteis para as análises de mortalidade, denominados códigos garbage (CG). Objetivo: Descrever e avaliar o impacto da investigação da causa básica de morte mal classificada no atestado de óbito em 2017. Métodos: Com base em protocolo padronizado, foram pesquisadas mortes com CG de 60 municípios que foram foco da intervenção, principalmente em prontuários hospitalares e serviços de autopsia. No nível estadual de gestão do Sistema de Informação de Mortalidade também foram desenvolvidas ações para melhoria da classificação da causa do óbito, com consequente adesão da maioria dos demais municípios (n = 4.022), o que permitiu comparações com os resultados da investigação de CG nas 60 cidades. Resultados: No país, de 108.826 CG investigadas em 2017, 48% foram reclassificadas para causas específicas. Já nos 60 municípios selecionados, 58% dos 35.366 óbitos por CG pesquisados foram reclassificados. A proporção de óbitos por CG declinou em 11% no país e 17% nos municípios em que houve intervenção. Discussão: Este é o primeiro estudo que investigou CG em registros médicos de mais de 100 mil mortes. A pesquisa possibilitou reclassificar para causas básicas específicas cerca de metade dos óbitos por CG investigados. As 60 cidades que foram alvo da intervenção tiveram melhor resultado que as demais cidades. Conclusão: A intervenção mostrou ser uma iniciativa adequada para a melhoria da qualidade da informação sobre causa de morte e deve ser estimulada.

ABSTRACT Introduction: Knowing the number of deaths and their causes is relevant information for public health managers. However, the cause of death is often classified with codes that are not useful for mortality analysis, called garbage codes (GC). Objective: To describe and evaluate the impact of investigation of the underlying cause of poorly classified deaths on death certificates in 2017. Methods: Based on a standardized protocol, GC deaths from 60 municipalities were investigated, mainly in hospital records and autopsy services. Managers at the state level of the Mortality Information System also developed procedures to improve the classification of causes of death, with the consequent adherence of other municipalities (n = 4022). This made it possible to compare the results of GC research between these two groups of municipalities. Results: In the country, among the 108,826 GC investigated in 2017, 48% were reclassified to specific causes. In the 60 focus municipalities, 58% of the 35,366 investigated deaths from GC were reclassified. After the intervention, the proportion of deaths classified as GC decreased by 11% in the country and 17% in the municipalities. Discussion: The research in hospital records enabled almost half of the deaths from GC investigated to be reclassified. This is the first study to investigate GC in hospital records of more than 100,000 deaths. The 60 cities targeted by the intervention had better results than the other cities. Conclusion: The intervention proved to be an appropriate initiative to improve the quality of information on cause of death and should be encouraged.