Database of the alumni performance of the Ophthalmology Stricto sensu Postgraduate Program at Escola Paulista de Medicina, UNIFESP

Abstract Purpose To develop a database with social, demographic and professional information of all graduates of the two post-graduate programs in Ophthalmology of EPM-UNIFESP, including their opinions on quality, application, and contribution of the courses received in their professional careers. Methods The survey was conducted in the digital and physical archives of the University and by telephone contact. When the graduates' e-mails were all collected, the electronic questionnaire was applied. The responses were compiled. Descriptive analysis of the results obtained in this cross-sectional study was performed, and analyzed by the authors and by statistical professionals, through Excel graphs. Results The database suggests that most graduates were born and work in the state of São Paulo. A significant fraction of 66.77% is dedicated to academic work, but only 36.2% hold management positions. Most of them receive amounts of one to 56 minimum wages monthly. The main motivation was to improve their professional careers. Conclusion For post-graduate programs, a database with information of its graduates can elucidate whether the goals were achieved based on the proposed teaching, as well as can generate reflections to improve the quality, the courses expectations and the vision that students have of the University.

Suspected adverse drug reactions reported for Brazilian children: cross-sectional study / Suspeitas de reações adversas a medicamento relatadas em crianças brasileiras: estudo transversal

ABSTRACT Objective: To assess spontaneous reports of suspected adverse drug reactions in children aged 0-12 years from the Brazilian Health Regulatory Agency between 2008 and 2013. Methods: A cross-sectional study on suspected adverse drug reactions reports related to medicines and health products in children was carried out for a six-year period (2008-2013). Year of report, origin of report by Brazilian state, gender, age, suspected drug, adverse reaction description and seriousness were included in the analysis. The data obtained was compared to the number of pediatric beds in health services and to global data from the VigiBase (World Health Organization). Results: A total of 3330 adverse drug reactions were reported in children in Brazil in the investigated period (54% were in boys). About 28% of suspected adverse drug reactions reports involved 0 to 1-year-old children. Almost 40% of reports came from the Southeast region. Approximately 60% were classified as serious events. There was death in 75 cases. Nearly 30% of deaths involved off-label use; 3875 medicines (465 active substances) were considered suspected drugs. Anti-infective (vancomycin, ceftriaxone, oxacillin, and amphotericin), nervous system (metamizole) and alimentary tract and metabolism medicines were more frequent in reports. Conclusions: The distribution of suspected adverse drug reactions reports by sex and age group corresponded to the profile of children hospitalized in Brazil. Data about seriousness and medicines reported may be useful to encourage regulatory actions and improve the safe use of medicines in children.

RESUMO Objetivo: Analisar relatos espontâneos de suspeitas de Reação Adversa a Medicamento (RAM) em crianças de 0 a 12 anos notificadas pela Agência Nacional de Vigilância Sanitária entre 2008 e 2013. Métodos: Um estudo transversal a partir de notificações de suspeitas de RAM relacionadas a medicamentos e produtos para a saúde em crianças foi realizado por um período de seis anos (2008-2013). O ano da notificação, a origem do relato por estado brasileiro, sexo, idade, o medicamento suspeito, a descrição da reação adversa e a gravidade foram incluídos na análise, bem como o número de leitos nos serviços de saúde e dados global da VigiBase. Resultados: Um total de 3330 reações adversas foram relatadas em crianças no Brasil no período investigado (54% em meninos). Cerca de 28% dos relatos de suspeitas de RAM envolveram crianças de 0 a 1 ano de idade. Quase 40% dos relatos vieram da região Sudeste. Aproximadamente 60% foram classificados como eventos graves. Houve ocorrência de morte em 75 casos. Quase 30% das mortes envolveram o uso off-label dos medicamentos. Um total de 3875 medicamentos (465 substâncias ativas) foram considerados fármacos suspeitos. Medicamentos anti-infecciosos (vancomicina, ceftriaxona, oxacilina e anfotericina), com ação no sistema nervoso (dipirona) e no trato digestivo foram os mais frequentemente notificados. Conclusões: As notificações de suspeitas de RAM por sexo e faixa etária corresponderam ao perfil de crianças hospitalizadas no Brasil. Os dados sobre gravidade e medicamentos relatados podem ser úteis para encorajar ações reguladoras e melhorar o uso seguro de medicamentos em crianças.

Design of a geospatial model applied to Health management / La producción de un modelo geoespacial aplicado a la gestión de la salud / Concepção de um modelo geoespacial aplicado na gestão à saúde

ABSTRACT Objective: To identify geographically the beneficiaries categorized as prone to Type 2 Diabetes Mellitus, using the recognition of patterns in a database of a health plan operator, through data mining. Method: The following steps were developed: the initial step, the information survey. Development, construction of the process of extraction, transformation, and loading of the database. Deployment, presentation of the geographical information through a georeferencing tool. Results: As a result, the mapping of Paraná according to its health care network and the concentration of Type 2 Diabetes Mellitus is presented, enabling the identification of cause-and-effect relationships. Conclusion: It is concluded that the analysis of georeferenced information, linked to health information obtained through the data mining technique, can be an excellent tool for the health management of a health plan operator, contributing to the decision-making process in Health.

RESUMEN Objetivo: Identificar geográficamente a los beneficiarios categorizados como propensos a la enfermedad Diabetes mellitus tipo 2, utilizándose el reconocimiento de patrones en una base de datos de cierta compañía de seguro médico por medio de la minería de datos. Método: Se desarrollaron las siguientes etapas: fase inicial, levantamiento de información. Desarrollo, construcción del proceso de extracción, transformación y carga en la base de datos. Implantación, presentación de la información geográfica mediante la herramienta de georreferenciación. Resultados: Se presenta el mapeo de Paraná (Brasil) con relación a su red asistencial y la concentración de Diabetes mellitus tipo 2, proporcionando la identificación de las relaciones de causa-efecto. Conclusión: Se concluyó que el análisis de las informaciones georreferenciadas, vinculadas a las informaciones de salud obtenidas por la técnica de minería de datos, puede ser una excelente herramienta en la gestión de salud de cierta compañía de seguro médico, lo que contribuye al apoyo a la toma de decisiones en salud.

RESUMO Objetivo: Identificar geograficamente os beneficiários categorizados como propensos à doença Diabetes Mellitus Tipo 2, utilizando o reconhecimento de padrões em uma base de dados de uma operadora de plano de saúde, por meio da mineração de dados. Método: Desenvolveram-se as seguintes etapas: fase inicial, levantamento de informações. Desenvolvimento, construção do processo de extração, transformação e carga do banco de dados. Implantação, apresentação das informações geográficas por meio da ferramenta de georreferenciamento. Resultados: Como resultados, apresenta-se o mapeamento do Paraná em relação a sua rede assistencial e a concentração de Diabetes Mellitus Tipo 2, oportunizando a identificação de relações de causa-efeito. Conclusão: Conclui-se que a análise de informações georreferenciadas, vinculadas às informações de saúde obtidas por meio da técnica de mineração de dados, pode ser um excelente instrumento para a gestão da saúde de uma operadora de plano de saúde, contribuindo para o apoio à tomada de decisões em saúde.

Registro de dados sobre acidentes de trabalho fatais em sistemas de informação no Brasil / The recording of fatal work-related injuries in information systems in Brazil

Resumo O objetivo deste estudo é identificar sistemas de informação que dispõem de dados sobre acidentes de trabalho fatais (ATF) no Brasil, descrever suas características, fluxos e barreiras para a qualidade da informação. Empregando-se o método da pesquisa documental, foram encontrados: o Sistema de Informações sobre Mortalidade (SIM), o Sistema de Informações Hospitalares do SUS (SIH/SUS), o Sistema de Informação de Agravos de Notificação (Sinan) e o Sistema do Programa Vigilância de Violência e Acidentes (VIVA) do Ministério da Saúde; o Sistema de Informação de Comunicação de Acidentes do Trabalho (Siscat) da Previdência Social; e do Ministério do Trabalho e Emprego, a Relação Anual de Informações Sociais (RAIS). A falta de variáveis chave comuns limita a construção de uma base de dados única com todos os casos de ATF registrados. Dentre os vários filtros e barreiras identificados destaca-se o não reconhecimento da relação do acidente com o trabalho pelos profissionais registrantes.

Abstract This study aims to identify information systems having fatal work-related (ATF) data in Brazil, describing their characteristics, flows and barriers to information quality. Using a documental research approach, we found: the Mortality Information System (SIM), the Hospital Admission Register from the Unified Health System (SIH-SUS), the Notifiable Diseases Information System (SINAN) and the Violence and Injuries Surveillance Program (VIVA) from the Health Ministry; the Work-related Injuries Reporting System (SISCAT) of the Ministry of Social Insurance; and the Annual Report of Social Information (RAIS), Ministry of Labour and Employment. A lack of key common variables limits the construction of a single database composed by all ATF recorded cases. From several barriers identified, the most relevant for data quality was the lack of work-relatedness recognition and recording, a task performed by the health team.

Cadastro Nacional de Estabelecimentos de Saúde: evidências sobre a confiabilidade dos dados / National Registry of Health Facilities: data reliability evidence

Resumo O presente trabalho comparou a confiabilidade de um grupo de dados registrados junto às bases secundárias do Cadastro Nacional dos Estabelecimentos de Saúde. Para cumprir este objetivo, o trabalho foi realizado em 'survey' com 2.777 hospitais. Os hospitais visitados forneceram dados sobre equipamentos, localização geográfica, status de funcionamento e número de leitos. Quanto à concordância entre os hospitais visitados e o cadastro nacional, pode-se destacar que o status de funcionamento estava atualizado em 89% dos casos, o número de leitos em 44%, 82% mantinham o quantitativo de equipamentos correto e 63% apresentaram coordenadas geográficas precisas. Esses achados apontam para uma boa confiabilidade dos dados do Cadastro Nacional dos Estabelecimentos de Saúde, quanto às categorias comparadas, excetuando-se os dados referentes ao número de leitos cadastrados e quanto a existência de alguns equipamentos. Como desdobramento deste trabalho pesa a necessidade de discutir estratégias e incentivos para melhorar a confiabilidade dos dados que ainda apresentam inconsistências, de forma a ampliar a qualidade dos instrumentos utilizados para a formulação de políticas públicas.

Abstract This study compared the reliability of a data group registered in the secondary databases of the National Registry of Health Facilities. A survey was conducted in 2,777 with hospitals to achieve this objective. Visited hospitals provided information on equipment, geographic location, operating status and number of beds. Regarding matching data between visited hospitals and the National Registry, it can be noted that the operating status was updated in 89% of cases, the number of beds in 44%, 82% had the correct amount of equipment and 63% had accurate geographic coordinates. These findings point to a good reliability of information from the National Registry of Health Facilities, regarding the compared categories, excepting for data on the number of registered beds and for some equipment. As a further development of this work, we stress the need to discuss strategies and incentives to improve the reliability of data that still have inconsistencies, in order to improve the instruments used to formulate public policies.

Análise da preferência digital de idade no sistema de farmacovigilância do Brasil, 2008-2013 / Analysis of the digital preference for age in the pharmacovigilance system in Brazil, 2008-2013

Resumo Analisar a preferência digital na variável "idade" da base de dados de casos de eventos adversos a medicamentos notificados entre 2008 e 2013 no sistema de farmacovigilância do Brasil. A base de dados foi analisada em três etapas: 1) exploração inicial; 2) padronização de variáveis; e 3) manejo dos registros repetidos. A preferência digital da variável "idade", segundo sexo e regiões agrupadas do país, foi determinada usando os métodos de Whipple e Myers e medida, também, pelo teste de aderência baseado na estatística χ2 ao nível de 5% de significância.Predominou a população feminina (60,3%), perfazendo uma razão feminino/masculino de 1,5:1 e com maioria feminina em oito das 12 faixas etárias estudadas.Ao longo do período analisado não foi observado qualquer preferência de dígito terminal na variável "idade". As idades registradas nas notificações parecem não demonstrar imprecisão e, por conseguinte, esta informação pode ser interpretada como de qualidade não duvidosa. Tais resultados apontam para um bom desempenho na coleta de dados e informações relacionados à variável "idade" do sistema de farmacovigilância do Brasil.

Abstract The scope of this article is to analyze the digital preference for the "age" variable in the database of cases of adverse drug events reported between 2008 and 2013 in the pharmacovigilance system in Brazil. The database was analyzed in three stages: 1) Initial exploration; 2) standardization of variables; and 3) duplicate records management. The digital preference for the "age" variable according to sex and grouped regions of the country, was determined using the Whipple and Myers methods and also measured by the adhesion test based on statistical χ2 at 5% significance level. The female population was predominant (60.3%), with a female/male ratio of 1.5:1 and a female majority in 8 of the 12 age groups. Throughout the period under analysis, no preference for a terminal digit was observed in the "age" variable. The ages that were registered in the database appear not to reveal any imprecision and, therefore, this information cannot be interpreted as unreliable. These results point to a good performance in collecting data and information related to the "age" variable of the Brazil's pharmacovigilance system.

Avaliação da incompletude da variável escolaridade materna nos registros das Declarações de Nascidos Vivos nas capitais brasileiras - 1996 a 2013 / Assessment of the incompleteness of the maternal schooling variable in Live Birth Certificate databases in Brazilian state capitals, 1996-2013 / Evaluación de la incompletitud de la variable escolaridad materna en los registros de las Declaraciones de Nacidos Vivos en capitales brasileñas, de 1996 a 2013

O presente artigo avaliou a qualidade de preenchimento da variável escolaridade da mãe nas capitais brasileiras e sua distribuição regional, por intermédio do Sistema de Informações sobre Nascidos Vivos (SINASC), processado pela Declaração de Nascido Vivo (DNV). Foi realizado um estudo descritivo de uma série temporal no período de 1996 a 2013, com um total de 12.062.064 nascimentos, dos quais 11.442.494 (94,86%) possuíam informação válida para a variável escolaridade da mãe. Os resultados foram calculados por número de incompletude da variável para cada 1.000 nascidos vivos e foi avaliada a tendência por meio do software Jointpoint (versão 4.3.1). A análise regional demonstrou que a Região Sul apresentou uma tendência de redução da incompletude da escolaridade materna, mantida no período do estudo, em todas as suas capitais. Igualmente, de forma geral, a maior parte das outras capitais do país também evidenciou uma melhora na completude da variável. Entretanto, verificaram-se diferentes tendências, com algumas capitais, inclusive, apresentando uma maior incompletude ao final do período, quando comparado ao seu início. O SINASC demonstrou ser um instrumento valioso nas informações sobre as mães e seus recém-nascidos juntamente com as condições de parto e nascimento no país. Particularmente, a escolaridade materna, considerada um fator importante sobre os desfechos obstétricos e neonatais, é uma variável que permite a elaboração e avaliação das políticas e ações na área da saúde materno-infantil. Assim, alcançar a sua máxima completude requer um esforço conjunto, dos profissionais e gestores, garantindo a credibilidade dessas informações.

The article assessed the quality of completion of the maternal school variable in Brazilian state capitals and its regional distribution, based on the Brazilian Information System on Live Births (SINASC) with processed data from live birth certificates. A descriptive study was conducted in the time series from 1996 to 2013, with a total de 12,062,064 births, of which 11,442,494 (94.86%) had valid information on the maternal schooling variable. The results were calculated as the number of incomplete results in the variable per 1,000 live births, and the trend was assessed with the Joinpoint software, version 4.3.1. According to regional analysis, the South of Brazil showed a downward trend in incompleteness of maternal schooling throughout the study in all the state capitals of that region. Most of the country's other state capitals also showed improvement in the variable's completeness. However, there were different trends in some state capitals, even with greater incompleteness at the end of the period when compared to the beginning. SINASC proved to be a valuable source of data on mothers and their newborns, besides information on conditions in labor, delivery, and birth in the country. Maternal schooling, considered an important factor for obstetric and neonatal outcomes, is particularly useful for elaborating and evaluating policies and measures in maternal and child health. Thus, to achieve maximum completeness in data on this variable requires joint effort by health professionals and administrators, thereby guaranteeing the data's trustworthiness.

El presente artículo evaluó la calidad en la cumplimentación de la variable escolaridad de la madre en las capitales brasileñas y su distribución regional, mediante el Sistema de Información sobre Nacidos Vivos (SINASC), registrado vía la Declaración de Nacido Vivo (DNV). Se realizó un estudio descriptivo de una serie temporal, durante el período de 1996 a 2013, con un total de 12.062.064 nacimientos, de los cuales 11.442.494 (94,86%) contaban con información válida de la variable escolaridad de la madre. Los resultados se calcularon por número de registros con carácter incompleto de la variable por cada 1.000 nacidos vivos y se evaluó la tendencia mediante el programa Jointpoint (versión 4.3.1). El análisis regional demostró que la región sur presentó una tendencia en la reducción de la incompletitud de la escolaridad materna, sostenida durante el período del estudio, en todas sus capitales. Igualmente, de manera general, la mayor parte de las otras capitales del país también evidenció una mejora en la completitud de la variable. No obstante, se verificaron diferentes tendencias con algunas capitales, inclusive, algunas presentando una mayor incompletitud al final del período, cuando se compara con el principio del mismo. El SINASC demostró ser un instrumento valioso para la información sobre las madres y sus recién nacidos, junto a las condiciones de parto y nacimiento en el país. Particularmente, la escolaridad materna, considerada un factor importante sobre los desenlaces obstétricos y neonatales, es una variable que permite la elaboración y evaluación de las políticas y acciones en el área de la salud materno-infantil. De esta forma, alcanzar su máxima completitud requiere un esfuerzo conjunto, de profesionales y gestores, garantizando la credibilidad de esta información.

The brazilian registry of adult patient undergoing cardiovascular surgery, the bypass project: results of the first 1,722 patients

Abstract Objective: To report the early results of the BYPASS project - the Brazilian registrY of adult Patient undergoing cArdiovaScular Surgery - a national, observational, prospective, and longitudinal follow-up registry, aiming to chart a profile of patients undergoing cardiovascular surgery in Brazil, assessing the data harvested from the initial 1,722 patients. Methods: Data collection involved institutions throughout the whole country, comprising 17 centers in 4 regions: Southeast (8), Northeast (5), South (3), and Center-West (1). The study population consists of patients over 18 years of age, and the types of operations recorded were: coronary artery bypass graft (CABG), mitral valve, aortic valve (either conventional or transcatheter), surgical correction of atrial fibrillation, cardiac transplantation, mechanical circulatory support and congenital heart diseases in adults. Results: 83.1% of patients came from the public health system (SUS), 9.6% from the supplemental (private insurance) healthcare systems; and 7.3% from private (out-of -pocket) clinic. Male patients comprised 66%, 30% were diabetics, 46% had dyslipidemia, 28% previously sustained a myocardial infarction, and 9.4% underwent prior cardiovascular surgery. Patients underwent coronary artery bypass surgery were 54.1% and 31.5% to valve surgery, either isolated or combined. The overall postoperative mortality up to the 7th postoperative day was 4%; for CABG was 2.6%, and for valve operations, 4.4%. Conclusion: This first report outlines the consecution of the Brazilian surgical cardiac database, intended to serve primarily as a tool for providing information for clinical improvement and patient safety and constitute a basis for production of research protocols.

Espectrometría de masas MALDI-TOF: evaluación de la etapa preanalítica para la identificación de hongos miceliales / MALDI-TOF mass spectrometry: Evaluation of the preanalytical phase for identification of molds

Se evaluaron 3 metodologías de extracción de proteínas para la identificación de hongos miceliales por MALDI-TOF MS en 44 aislados: la extracción con agua-ácido fórmico (E. agua), la extracción con zirconio-etanol-acetonitrilo-ácido fórmico (E. zirconio) y la recomendada por el proveedor del equipo (E. tubo). Se compararon 2 bases de datos: Bruker (BK) y BK + National Institutes of Health. Los resultados obtenidos utilizando dichas bases fueron los siguientes (en el orden citado): identificación correcta (IC) a nivel de género, 10 y 16 con E. agua; 27 y 32 con E. zirconio y 18 y 23 con E. tubo; IC a nivel de especie, 5 y 7 con E. agua; 17 y 20 con E. zirconio y 11 y 14 con E. tubo; identificaciones no confiables, 18 y 12 con E. agua y 9 y 4, tanto con E. zirconio como con E. tubo; ausencia de pico, 16 con E. agua, 8 con E. zirconio y 17 con E. tubo. La extracción con zirconio mostró el mejor rendimiento (p < 0,05).

In order to optimize the identification of molds with MALDI-TOF MS, three protein extraction-methodologies were evaluated against 44 isolates: water extraction (WE), zirconium extraction (ZE) and the provider's recommended method (PRM). Two data bases were compared, Bruker (BK) and Bruker + National Institutes of Health. Considering both databases, results were respectively as follows: correct identification (CI) at gender level, 10 and 16 by WE; 27 and 32 by ZE and 18 and 23 by PRM; CI at species level, 5 and 7 by WE; 17 and 20 by ZE and 11 and 14 by PRM; non-reliable identification, 18 and 12 by WE; 9 and 4 by ZE and by PRM. No peaks were observed in 16 by WE, 8 by ZE and 17 by PRM. ZE showed the best perfomance (p < 0.05).

Clinical and epidemiological profile of leprosy patients attended at Ceará, 2007-2011

Abstract: Background: Leprosy is an infectious chronic condition associated with potentially serious physical, social and psychological impacts. Objectives: To characterize the clinical and epidemiological profile of leprosy patients treated from 2007 to 2011 in the University Hospital of Ceará, Northeastern Brazil. Methods: This is a retrospective and descriptive study. The study population consisted of residents in the state of Ceará treated in a dermatology clinic between 2007-2011. Clinical and epidemiological data analyzed were obtained from medical records and from the database of national Information System for Notifiable Diseases. Results: 475 cases were analyzed, mostly women (51.8%), aged 45-59 years (35.0%) - mean of 45.2 years at diagnosis - with 6.3% of children under 15 , with low education (73.7%), white color (68.8%), residency in the city of Fortaleza (82.3%), and no defined work occupation (59.6%). At diagnosis, most patients were multibacillary (MB) (65.5%), had borderline clinical form (48.0%), and 22.7% had physical disability (8.0% with grade 2), predominantly in MB cases (p <0.001). We observe worsening of disability in 5.1% of cases post-MDT. The proportion of cases with reactional episodes was 42.7%, mainly during MDT (51.2%). Conclusion: This is the first study conducted in this hospital context, revealing late diagnosis, high burden of disease, hidden endemicity, and high social vulnerability in the state of Ceará. This study reinforces the need to strengthen health care network for timely diagnosis and treatment, aiming at longitudinality of assistance.

Hospitalizations and deaths due to pertussis in children from 1996 to 2013☆ / Internações e óbitos por coqueluche em crianças no período entre 1996 e 2013

ABSTRACT OBJECTIVES: To assess temporal trends of hospitalizations and deaths from pertussis in Brazilian children in the period of 1996-2013. METHODS: This was a descriptive ecological study of temporal trends, based on the DATASUS database. The number of hospitalizations and deaths from pertussis in children up to 19 years of age from January 1996 to December 2013 was obtained. Descriptive statistics were applied for data analysis. RESULTS: During the study period, a total of 19,047 hospital admissions from pertussis were recorded, of which 88.2% occurred in infants younger than 1 year. In the period 1996-2010, the mean annual number of admissions was 755, ranging from a maximum of 1179 in 2004 to a minimum of 400 in 2010. There was an increase of admissions in the last three consecutive years (2011, 2012, and 2013) with 1177, 2954 and 3589 hospitalizations, respectively. There were 498 deaths from pertussis throughout the study period, of which 96.8% occurred in children younger than one year. There was an increase in the number of deaths from pertussis in children in the years 2011, 2012, and 2013, with 40, 93, and 87 recorded deaths, respectively. The increase in hospitalizations and deaths from pertussis in children occurred in all regions of the country, with the highest increase observed in the Southeast, North and Northeast regions. CONCLUSIONS: There was a substantial increase in hospitalizations and deaths from pertussis in children for three consecutive years (2011, 2012, and 2013) in all Brazilian regions. The most affected age group was that of children younger than one year.

RESUMO OBJETIVOS: Avaliar a tendência temporal de internações e óbitos por coqueluche em crianças brasileiras de 1996 a 2013. MÉTODOS: Trata-se de um estudo ecológico descritivo de tendência temporal, baseado no banco de dados Datasus. Foram extraídos os números de internações e de óbitos por coqueluche em crianças até 19 anos de janeiro de 1996 a dezembro de 2013. A estatística descritiva foi aplicada para análise de dados. RESULTADOS: No período estudado foram registradas 19.047 internações por coqueluche, das quais 88,2% foram de lactentes menores de um ano. De 1996 a 2010, o número médio anual de internações foi de 755 e oscilou entre o máximo de 1.179 em 2004 e o mínimo de 400 em 2010. Houve um acréscimo de internações nos últimos três anos consecutivos (2011, 2012 e 2013), com 1.177, 2.954 e 3.589 registros, respectivamente. Ocorreram 498 óbitos por coqueluche em todo o período estudado, dos quais 96,8% eram menores de um ano. Houve acréscimo no número de óbitos por coqueluche em crianças em 2011, 2012 e 2013, com 40, 93 e 87 registrados, respectivamente. O aumento de internações e óbitos por coqueluche em crianças ocorreu em todas as regiões do país e houve maior acréscimo nas regiões Sudeste e Norte-Nordeste. CONCLUSÕES: Houve um aumento substancial de internações e de óbitos por coqueluche em crianças por três anos consecutivos (2011, 2012 e 2013) em todas as regiões brasileiras. A faixa etária mais atingida foi a de menores de um ano.

Usage evaluation of the Physiotherapy Evidence Database (PEDro) among Brazilian physical therapists

BACKGROUND: It is unclear whether the Physiotherapy Evidence Database (PEDro) is widely and equally used by physical therapists in Brazil. As PEDro is considered a key resource to support evidence-based physical therapy, analyses of PEDro usage could reflect the extent of dissemination of evidence-based practice.OBJECTIVE: To describe the usage of PEDro among the five regions of the World Confederation for Physical Therapy (WCPT) and, in more detail, in the South American region and Brazil over a 5-year period.METHOD: PEDro home-page sessions and the number of searches performed were logged for a 5-year period (2010-2014). Absolute usage and relative usage were calculated for each region of the WCPT, each country in the South American region of WCPT, and each Regional Council (CREFITO) in Brazil.RESULTS: Europe had the highest absolute and relative usage among the five regions of the WCPT (971 searches per million-population per year), with the South American region ranked 4th in absolute terms and 3rd in relative terms (486). Within the South American region, Brazil accounted for nearly 60% of searches (755). Analysis at a national level revealed that usage per physical therapist in Brazil is very low across all CREFITOs. The highest usage occurred in CREFITO 6 with 1.3 searches per physical therapist per year.CONCLUSIONS: PEDro is not widely and equally used throughout Brazil. Strategies to promote PEDro and to make PEDro more accessible to physical therapists speaking Portuguese are needed.

Métodos para avaliar a completitude dos dados dos sistemas de informação em saúde do Brasil: uma revisão sistemática / Methods for assessing the completeness of data in health information systems in Brazil: a systematic review

Este estudo teve como objetivo revisar a literatura acerca dos métodos aplicados para avaliar a completitude dos dados dos sistemas de informação em saúde. Foram pesquisadas as bases de dados Medline, SciELO e Lilacs usando os descritores "qualidade", "qualidade dos dados", "qualidade da informação" e "sistemas de informação". Incluíram-se artigos, dissertações e teses que avaliaram o preenchimento das variáveis. Nos 19 estudos revisados os sistemas de racionalidade epidemiológica, foram os mais avaliados (90,5%). Estudos sobre completitude ainda são escassos (média de um/ano). Os métodos variam desde a sua análise isolada à avaliação de mais de uma dimensão de qualidade. O termo completitude é o mais utilizado para caracterizar o preenchimento das variáveis. O escore de Romero e Cunha é o mais frequente. As fontes e o meio de acesso aos dados mais comuns foram os bancos de dados dos SIS e o sítio do Datasus. Predominaram estudos com dados da região Sudeste e Brasil. Os indicadores que mensuram a completitude variam de uma simples frequência relativa a índices e indicadores-síntese. A heterogeneidade de métodos carece de padronização e divulgação de informações que permitam comparações entre os estudos.

The scope of this study was to review the literature on the methods used to assess the completeness of the data in health information systems. Searches were conducted in the Medline, SciELO and Lilacs databases using the key words "quality," "data quality," "quality of information" and "information systems." It included articles, dissertations and theses that assessed the fulfillment of variables. In the 19 studies reviewed, the epidemiological rationality systems were the most evaluated (90.5%). Studies on completeness are still scarce (one per year on average). Methods vary from isolated analysis to the evaluation of more than one dimension of quality. The term completeness is the word most used to characterize the fulfillment of variables. The Romero and Cunha score is the most frequent. The SIS databases and Datasus site were the sources and means of access to the most common data. Studies with data from the Southeast of Brazil were predominant. The indicators that measure the completeness vary from simple relative frequency to indices and synthesis-indicators. The heterogeneity of methods lacks standardization and dissemination of information to enable comparisons between the studies.

The outcome of tuberculosis treatment in subjects with chronic kidney disease in Brazil: a multinomial analysis / Desfecho do tratamento da tuberculose em indivíduos com doença renal crônica no Brasil: uma análise multinomial

OBJECTIVE: To analyze the association between clinical/epidemiological characteristics and outcomes of tuberculosis treatment in patients with concomitant tuberculosis and chronic kidney disease (CKD) in Brazil. METHODS: We used the Brazilian Ministry of Health National Case Registry Database to identify patients with tuberculosis and CKD, treated between 2007 and 2011. The tuberculosis treatment outcomes were compared with epidemiological and clinical characteristics of the subjects using a hierarchical multinomial logistic regression model, in which cure was the reference outcome. RESULTS: The prevalence of CKD among patients with tuberculosis was 0.4% (95% CI: 0.37-0.42%). The sample comprised 1,077 subjects. The outcomes were cure, in 58%; treatment abandonment, in 7%; death from tuberculosis, in 13%; and death from other causes, in 22%. The characteristics that differentiated the ORs for treatment abandonment or death were age; alcoholism; AIDS; previous noncompliance with treatment; transfer to another facility; suspected tuberculosis on chest X-ray; positive results in the first smear microscopy; and indications for/use of directly observed treatment, short-course strategy. CONCLUSIONS: Our data indicate the importance of sociodemographic characteristics for the diagnosis of tuberculosis in patients with CKD and underscore the need for tuberculosis control strategies targeting patients with chronic noncommunicable diseases, such as CKD. .

OBJETIVO: Analisar a associação de características clínicas e epidemiológicas de indivíduos com tuberculose e doença renal crônica (DRC) com os desfechos do tratamento da tuberculose no Brasil. MÉTODOS: Entre 2007 e 2011, foram selecionados indivíduos com DRC e tuberculose utilizando o Sistema de Informação de Agravos de Notificação do Ministério da Saúde do Brasil. Foram comparados os desfechos do tratamento da tuberculose com características clínicas e epidemiológicas dos pacientes por um modelo hierárquico de regressão logística multinomial, no qual cura foi o desfecho de referência. RESULTADOS: A prevalência de DRC entre os casos de tuberculose foi de 0,4% (IC95%: 0,37-0,42%). A amostra incluiu 1.077 indivíduos, cujos desfechos do tratamento da tuberculose foram os seguintes: cura, em 58%; abandono do tratamento, em 7%; óbito por tuberculose, em 13%; e óbito por outras causas, em 22%. As características que diferenciam as OR de abandono do tratamento e de óbito foram idade; alcoolismo; AIDS; abandono prévio; transferência para outra unidade de tratamento; suspeita de tuberculose em radiografia de tórax; baciloscopia inicial positiva; e indicação ou realização de tratamento diretamente observado. CONCLUSÕES: Os dados apontam para a importância das características sociodemográficas na determinação da tuberculose em indivíduos com DRC e reforçam a necessidade de estratégias de controle da tuberculose direcionadas a pacientes com doenças crônicas não transmissíveis, como a DRC. .

Feasibility of road traffic injury surveillance integrating police and health insurance data sets in the Dominican Republic / Factibilidad de la vigilancia de las lesiones por accidentes de tránsito mediante la integración de los conjuntos de datos de la policía y del seguro nacional de salud en la República Dominicana

OBJECTIVE: To assess the feasibility of semiautomated linking of road traffic injury (RTI) cases in different data sets in low- and middle-income countries. METHODS: The study population consisted of RTI cases in the Dominican Republic in 2010 and were identified in police and health insurance data sets. After duplicates were removed and fatality reporting was corrected by using forensic data, police and health insurance RTI records were linked if they had the same province, collision date, and gender of RTI cases and similar age within five years. A multinomial logistic regression model assessed the likelihood of being in only one of the data sets. RESULTS: One of five records was a duplicate, including 21.1% of 6 396 police and 16.2% of 6 178 insurance records. Health insurance data recorded 43 of 417 deaths as only injured. Capture - recapture estimated that both data sets recorded one of five RTI cases. Characteristics associated with increased likelihood (P < 0.05) of being only in the police data set were female gender [adjusted odds ratio (OR) = 2.5], age ≥ 16 years (OR = 1.7), collision in the regions of Cibao Northeast (OR = 4.1) and Valdesia (OR = 6.4), day of occurrence from Tuesday to Saturday (ORs from 1.5 to 2.9), month of occurrence from October to December (ORs from 1.6 to 4.5), and occupant of four-wheeled vehicles (OR = 5.4) or trucks (OR = 5.3). CONCLUSIONS: Consistent semiautomated linking procedures were feasible to ascertain the RTI burden in the Dominican Republic and could be improved by standardized coding of police and health insurance RTI reporting.

OBJETIVO: Evaluar la factibilidad de la vinculación semiautomática de los registros de casos de lesiones por accidentes de tránsito (LAT) de diferentes conjuntos de datos en países de ingresos bajos y medianos. MÉTODOS: La población de estudio la constituían los casos de LAT ocurridos en la República Dominicana en el 2010 y registrados en los conjuntos de datos de la policía y del seguro nacional de salud. Después de eliminar los casos duplicados y corregir la notificación de defunciones a partir de los datos forenses, se vincularon los registros de LAT de la policía y el seguro de enfermedad si los casos correspondían a la misma provincia, fecha de colisión y sexo, y la edad era similar con una diferencia no superior a cinco años. Se evaluó la probabilidad de aparecer únicamente en uno de los conjuntos de datos mediante un modelo de regresión logística polinómica. RESULTADOS: Uno de cada cinco registros estaba duplicado (21,1% de los 6 396 registros de la policía y 16,2% de los 6 178 registros del seguro). En el conjunto de datos del seguro nacional de salud se registraron 43 de las 417 defunciones como únicamente lesionados. Mediante el método de captura-recaptura se calculó que en ambos conjuntos de datos se registraban uno de cada cinco casos de LAT. Las características asociadas con una mayor probabilidad (P < 0,05) de aparecer únicamente en el conjunto de datos de la policía fueron el sexo femenino (razón de posibilidades ajustada [OR] = 2,5), la edad ≥ 16 años (OR = 1,7), la colisión en las regiones del nordeste de Cibao (OR = 4,1) y Valdesia (OR = 6,4), el día del accidente de martes a sábado (OR de 1,5 a 2,9), el mes del accidente de octubre a diciembre (OR de 1,6 a 4,5) y los ocupantes de vehículos de cuatro ruedas (OR = 5,4) o camiones (OR = 5,3). CONCLUSIONES: Los procedimientos sistemáticos de vinculación semiautomatizada se mostraron factibles para evaluar la carga de LAT en la República Dominicana, y se podrían mejorar mediante la codificación estandarizada de las notificaciones de LAT de la policía y del seguro nacional de salud.

Avaliação do tempo de permanência hospitalar em cirurgia de revascularização miocárdica segundo a fonte pagadora / Evaluation of the length of hospital stay in cases of coronary artery bypass graft by payer

OBJETIVO: O indicador de tempo de permanência hospitalar (TPH) permite avaliar a eficiência de uma determinada unidade hospitalar e serve como base para mensurar o número de leitos necessários para o atendimento da população de uma área específica. MÉTODOS: Levantamento retrospectivo de um banco de dados de 3010 pacientes submetidos à cirurgia de revascularização do miocárdio (CRM) de julho de 2009 a julho de 2010. RESULTADOS: Dos 2840 pacientes com critérios de inclusão, 92,1% tinham como fonte pagadora o Sistema Único de Saúde (SUS) e 7,9% eram de convênios e particulares (Não SUS); 70,2% eram do sexo masculino, a média de idade foi de 61,9 anos e a média do escore de risco (EuroSCORE) foi de 2,9%. Os grupos SUS e Não SUS não diferiram no tempo de espera pré-cirurgia (2,59±3,10 dias vs. 3,02±3,70 dias para os grupos SUS e não SUS, respectivamente; p = 0,790), mas diferiram nos tempos de terapia intensiva (2,17±3,84 vs. 2,52±2,72 dias para os grupos SUS e não SUS, respectivamente; p < 0,001), de pós-operatório (8,34±10,32 vs. 9,19 + 6,97 dias para os grupos SUS e não SUS, respectivamente; p < 0,001) e de permanência hospitalar total (10,93±11,08 vs. 12,21±8,20 dias para os grupos SUS e não SUS, respectivamente; p < 0.001). O grupo Não SUS teve mais cirurgia não eletiva (p = 0,002) e mais cirurgia sem circulação extracorpórea (p = 0,012). Os grupos não diferiram em relação a procedimento valvar associado (p = 0,057) e a outros procedimentos não valvulares (p = 0,053), mas diferiram nos procedimentos não cardíacos associados (p = 0,017). As taxas de readmissão na UTI (p = 0,636) e de complicações pós-operatórias foram semelhantes entre os grupos (p = 0,055). CONCLUSÃO: Os pacientes do grupo Não SUS tiveram tempos de permanência hospitalar maiores que o grupo SUS.

OBJECTIVE: The length of hospital stay (LOS) allows for the evaluation of the efficiency of a given hospital facility, as well as providing a basis for measuring the number of hospital beds required to provide assistance to the population in a specific area. METHODS: A retrospective survey was conducted on a database of 3,010 patients submitted to coronary artery bypass graft (CABG) from July, 2009 to July, 2010. RESULTS: Among 2,840 patients that met the inclusion criteria, 92.1% had their surgery paid by the Brazilian Unified Health System (Sistema Único de Saúde - SUS) and 7.9% by health plans or themselves (non-SUS). 70.2% were male, the average age was 61.9 years old, and the average risk score (EuroScore) was 2.9%. The SUS and the non-SUS groups did not differ regarding the waiting time for surgery (WTS) (2.59± 3.10 vs. 3,02±3,70 days for SUS and non-SUS respectively; p = 0.790), but did differ with respect to the length of stay in intensive care unit (2.17±3.84 vs. 2.52±2.72 days for SUS and non-SUS respectively; p < 0.001), the postoperative period (8.34±10.32 vs. 9,19±6.97 days for SUS and non-SUS respectively; p < 0.001), and the total LOS (10.93±11.08 vs. 12.21±8.20 days for SUS and non-SUS respectively; p < 0.001). The non-SUS group had more events of non-elective surgery (p = 0.002) and surgery without cardiopulmonary bypass (p = 0.012). The groups did not differ regarding the associated valve procedure (p = 0.057) nor other non-valve procedures (p = 0.053), but they did differ with respect to associated non-cardiac procedures (p = 0.017). ICU readmission (p = 0.636) and postoperative complications rates were similar in both groups (p = 0.055). CONCLUSION: The Non-SUS group showed longer LOS compared to the SUS group.

Compliance to micronutrient supplementation in children 3 to 24 months of age from a semi-rural community in Mexico

OBJECTIVE: To identify associated factors to compliance for multiple micronutrient (MM) or iron and vitamin A (IVITA) supplementation, in children (3 to 24 months old). MATERIALS AND METHODS: A database (n=465 children) from a randomized, controlled, clinical trial, carried out in a semi-rural setting in Mexico, was analyzed. The compliance rate of MM and IVITA supplements was calculated. Adequate compliance rate (AC>80%), and its association with children and households characteristics, was determined. RESULTS: The compliance mean was high (MM:78.2%, IVITA:80.1%; p<0.05). The odds of AC were 59% greater in the children of IVITA than with MM group, although the estimate was only marginally significant (p=0.052). Maternal education (p<0.001), child birth weight (p=0.003), and children with cough (p<0.001) or fever (p=0.024) were significantly associated with AC and significantly marginal was maternal indigenous (p=0.071). CONCLUSION: The high AC was consistent with others efficacy studies. More research is needed to document physiological, cultural, social and operative factors affecting compliance with supplementation.

OBJETIVO: Identificar factores asociados con el cumplimiento del consumo de suplementos con micronutrimentos múltiples (MM) o con hierro y vitamina A (FEVITA) en niños (<24 meses de edad). MATERIAL Y MÉTODOS: Información de un ensayo clínico aleatorizado, doble ciego en una localidad semirrural en México. Se calculó el porcentaje de cumplimiento (n=465 niños), cumplimiento adecuado (CA: >80%) y su asociación con varias características. RESULTADOS: El cumplimiento fue alto (MM: 78.2%, FEVITA: 80.1%; p<0.05). Los momios de CA fueron 59% mayores en niños del grupo FEVITA que en MM (p=0.052). Escolaridad materna (p<0.001), peso al nacer del niño (p=0.003), porcentaje de tiempo con tos (p<0.001) y con fiebre (p=0.024) y marginalmente, la condición indígena materna (p=0.071) se asociaron con el CA. CONCLUSIONES: La alta tasa de cumplimiento fue consistente con otros estudios. Es necesaria mayor investigación sobre factores fisiológicos, culturales, sociales y operativos relacionados con el cumplimiento del consumo de suplementos.

Interdistrict variations in child health status and health services utilization: Lessons for health sector priority setting and planning from a cross-sectional survey in rural India.

Background. There are limited data on interdistrict variations in child health status and health services utilization within the states of India. We conducted this study to identify and understand district-wise variations in child morbidity, mortality, healthcare seeking, and the status of health facilities in India. Methods. A cross-sectional population-based cluster survey was conducted from April to July 2007 in 16 districts of eight states in India. Two districts with similar demographic profile and health criteria were selected from each study state. Results. A total of 216 794 households and 24 812 under-5 children were surveyed. There were wide interdistrict variations in the health status of children within the same state and between different states across India. Interdistrict difference of >5 points/1000 live-births was found for infant mortality rate and under-5 mortality rate in all eight study states, while in six out of eight states this difference was >10 points/1000 live-births. Four states had a difference of >10 points/1000 live-births between respective districts for neonatal mortality rate. The interdistrict differences were also noted in childhood morbidity and health-seeking behaviour. Analysis of proportion of health facilities conforming to Indian public health standards revealed that the difference was m10% for availability of vaccines in five states, emergency services in three, laboratory services and logistics in four each, and referral facility in three of the eight study states. Conclusion. This study underscores an important information gap in the country where planners seem to rely heavily on a few selected national-level databases that may not be adequate at the micro level. The current process of sporadic health surveys also appears inadequate and inappropriate. There is a need for district-specific data for planning, improving quality of service and generating demand for health service utilization to improve child survival in India. The findings of this study may prove useful for child health programme planning in India.

Disponibilidad de datos y perfil de morbilidad en Colombia / Data availability and morbidity profile in Colombia

OBJETIVO: Caracterizar la morbilidad de la población colombiana según causas diagnósticas, género, edad, región y régimen de cobertura en salud, evaluando al mismo tiempo la disponibilidad y la calidad de la información sobre enfermedades en el país. Estudio de tipo descriptivo, transversal, que analiza la morbilidad atendida en consulta externa, hospitalización y urgencias en Colombia durante el quinquenio 2004-2008. MÉTODOS: Se utilizaron los "Registros individuales de prestación de servicios" (RIPS) de Colombia, clasificándose los diagnósticos según los grupos de causas definidos por la Organización Mundial de la Salud. Cada grupo de causas para utilización de servicios se discriminó por región geográfica, género y régimen de afiliación al sistema de salud. RESULTADOS: Los diagnósticos de enfermedades transmisibles se encontraron más concentrados en los grupos de edad inferiores, mientras que las no transmisibles fueron más frecuentes en los grupos etarios superiores. Las externalidades (accidentes, lesiones autoinfligidas y violencia) fueron una causa importante de morbilidad y afectaron con más fuerza a la población de entre 5 y 44 años de edad. Las patologías transmisibles fueron más prevalentes en mujeres (39,98 por ciento) que en hombres (28 por ciento), en tanto que los hombres se vieron más afectados por las externalidades que las mujeres (18,5 y 7,3 por ciento, respectivamente). CONCLUSIONES: Si bien en Colombia han aumentado los diagnósticos de enfermedades no transmisibles, las infecciones siguen teniendo una presencia relevante en todos los grupos de edad y escenarios de prestación de servicios de salud. Tal situación exige revisar las políticas sanitarias para orientarlas no solo a mejorar la salud de la población sino también a reducir la brecha de servicios que existe entre las diferentes regiones del país. Por otro lado, aun cuando los RIPS constituyen una valiosa fuente de datos sanitarios, es preciso fortalecerlos...

OBJECTIVE: To characterize morbidity in the Colombian population by diagnosis, sex, age, region, and health coverage system, and evaluate the availability and quality of information on diseases in the country. A descriptive, cross-sectional study to analyze morbidity treated in outpatient visits, hospitalization, and emergencies in Colombia during the 2004-2008 five-year period. METHODS: Based on Colombia's personal health records (Registro Individual de Prestación de Servicios-RIPS), diagnoses were classified according to World Health Organization cause groups. Each cause group for services utilization was differentiated by geographical region, sex, and type of affiliation to the health system. RESULTS: Communicable disease diagnoses were more concentrated in younger age groups, while noncommunicable diseases were more frequent in older age groups. External causes (accidents, self-inflicted injuries, and violence) were a major cause of morbidity and more frequently affected the population aged 5-44 years. Communicable diseases were more prevalent in females (39.98 percent) than in males (28 percent), while males were more affected by external causes than females (18.5 percent and 7.3 percent, respectively). CONCLUSIONS: Although diagnoses of noncommunicable diseases have increased in Colombia, infections continue to have an important presence in all age groups and health services delivery settings. This situation requires a review of health policies, not only to orient them toward improving the health of the population, but also toward bridging the services gap that exists among the country's different regions. Furthermore, although RIPS are a valuable source of health data, they need to be strengthened with a view to achieving information coverage for all or at least the vast majority of Colombians.