The information system of REIN / Le système d'information de REIN

On the occasion of the 20th anniversary of the REIN (French Renal Epidemiology and Information Network), a summary work on the contributions of the national French ESKD register was carried out. On the issue of its information system, the following key messages were retained. The REIN information system accompanies the register throughout the life cycle of the data. Two collection tools, one for dialysis, the other for transplantation are accessible via a secure WEB site. Several data quality control tools have been added. Finally, several reporting tools, including a geographic information system completes REIN's information system.

À l'occasion des 20 ans du REIN (Réseau Épidémiologie et Information en Néphrologie), un travail de synthèse sur les apports du registre a été mené. Sur la question de son système d'information, les messages clés suivants ont été retenus. Le système d'information de REIN accompagne le registre sur tout le cycle de vie de la donnée. Deux outils de recueil, l'un pour la dialyse, l'autre pour la greffe sont accessible via un site WEB sécurisé. Plusieurs outils de contrôle de la qualité des données y ont été ajoutés. Et enfin, plusieurs outils de retours d'information, dont un système d'information géographique, complètent le système d'information de REIN.

Which data in the French registry for advanced chronic kidney disease for public health and patient care?

Chronic kidney disease is a chronic non-transmittable disease of increasing incidence. The advanced stages are complicated by high morbidity and mortality, and individual management is complex due to the various treatments required at stage 5 including renal replacement. For the healthcare system, this disease also requires complex care organization. National registers of patients on renal replacement therapy have been developed to improve patient management and care arrangements. The purpose of our review was to report on the history of the French registry, its organization, the information collected and its evolution in response to the stage 5 problem. We successively detail the information system with its inclusion criteria, architecture and tools developed, its security rules, mode and type of information collected, its quality controls and, finally, the glossary of data available within the registry.

[Abuse of caesarean delivery in Brazil: geographic dimensions of a medical aberration]. / L'abus du recours à la césarienne au Brésil: dimensions géographiques d'une aberration médicale.

"Brazil is the world champion of caesareans." This prowess points out a serious public health problem. While the increase in the percentage of caesareans among all deliveries is an international phenomenon, it is highest by far in Brazil, where caesareans account for nearly 40% of births, that is, three times the maximum recommended by WHO. This abusive practice appears pandemic and has spread in recent years throughout the entire country, although at divergent rates. It weighs heavily on Brazil's national health insurance fund. After a critical examination of the information sources related to births, we analyze successively the principal factors likely to explain this abuse: level of development, emergence of family planning and the association of caesarean delivery with tubal ligation for sterilization purposes, and tension within the healthcare system, especially the role of private physicians in urban areas. By studying these aspects of the problem in their geographic dimensions, we find important regional differences that must be considered in defining policies to limit this excess.