Estimating completeness of national and subnational death reporting in Brazil: application of record linkage methods.

BACKGROUND: In Brazil, both the Civil Registry (CR) and Ministry of Health (MoH) Mortality Information System (SIM) are sources of routine mortality data, but neither is 100% complete. Deaths from these two sources can be linked to facilitate estimation of completeness of mortality reporting and measurement of adjusted mortality indicators using generalized linear modeling (GLM). METHODS: The 2015 and 2016 CR and SIM data were linked using deterministic methods. GLM with covariates of the deceased's sex, age, state of residence, cause of death and place of death, and municipality-level education decile and population density decile, was used to estimate total deaths and completeness nationally, subnationally and by population sub-group, and to identify the characteristics of unreported deaths. The empirical completeness method and Global Burden of Disease (GBD) 2017 estimates were comparators at the national and state level. RESULTS: Completeness was 98% for SIM and 95% for CR. The vast majority of deaths in Brazil were captured by either system and 94% were reported by both sources. For each source, completeness was lowest in the north. SIM completeness was consistently high across all sub-groups while CR completeness was lowest for deaths at younger ages, outside facilities, and in the lowest deciles of municipality education and population density. There was no clear municipality-level relationship in SIM and CR completeness, suggesting minimal dependence between sources. The empirical completeness method model 1 and GBD completeness estimates were each, on average, less than three percentage points different from GLM estimates at the state level. Life expectancy was lowest in the northeast and 7.5 years higher in females than males. CONCLUSIONS: GLM using socio-economic and demographic covariates is a valuable tool to accurately estimate completeness from linked data sources. Close scrutiny of the quality of variables used to link deaths, targeted identification of unreported deaths in poorer, northern states, and closer coordination of the two systems will help Brazil achieve 100% death reporting completeness. The results also confirm the validity of the empirical completeness method.

Impact evaluation of Zika epidemic on congenital anomalies registration in Brazil: An interrupted time series analysis.

This study aimed to assess the impact of the Zika epidemic on the registration of birth defects in Brazil. We used an interrupted time series analysis design to identify changes in the trends in the registration of congenital anomalies. We obtained monthly data from Brazilian Live Birth Information System and used two outcome definitions: 1) rate of congenital malformation of the brain and eye (likely to be affected by Zika and its complications) 2) rate of congenital malformation not related to the brain or eye unlikely to be causally affected by Zika. The period between maternal infection with Zika and diagnosis of congenital abnormality attributable to the infection is around six months. We therefore used September 2015 as the interruption point in the time series, six months following March 2015 when cases of Zika started to increase. For the purposes of this analysis, we considered the period from January 2010 to September 2015 to be "pre-Zika event," and the period from just after September 2015 to December 2017 to be "post-Zika event." We found that immediately after the interruption point, there was a great increase in the notification rate of congenital anomalies of 14.9/10,000 live births in the brain and eye group and of 5.2/10,000 live births in the group not related with brain or eye malformations. This increase in reporting was in all regions of the country (except in the South) and especially in the Northeast. In the period "post-Zika event", unlike the brain and eye group which showed a monthly decrease, the group without brain or eye malformations showed a slow but significant increase (relative to the pre-Zika trend) of 0.2/10,000 live births. These findings suggest an overall improvement in the registration of birth malformations, including malformations that were not attributed to Zika, during and after the Zika epidemic.

A multicentre study to predict neonatal survival according to lung-to-head ratio and liver herniation in fetuses with left congenital diaphragmatic hernia (CDH): Hidden mortality from the Latin American CDH Study Group Registry.

OBJECTIVE: To evaluate natural history of fetuses congenital diaphragmatic hernia (CDH) prenatally diagnosed in countries where termination of pregnancy is not legally allowed and to predict neonatal survival according to lung area and liver herniation. METHODS: Prospective study including antenatally diagnosed CDH cases managed expectantly during pregnancy in six tertiary Latin American centres. The contribution of the observed/expected lung-to-head ratio (O/E-LHR) and liver herniation in predicting neonatal survival was assessed. RESULTS: From the total population of 380 CDH cases, 144 isolated fetuses were selected showing an overall survival rate of 31.9% (46/144). Survivors showed significantly higher O/E-LHR (56.5% vs 34.9%; P < .001), lower proportion of liver herniation (34.8% vs 80.6%, P < .001), and higher gestational age at birth (37.8 vs 36.2 weeks, P < 0.01) than nonsurvivors. Fetuses with an O/E-LHR less than 35% showed a 3.4% of survival; those with an O/E-LHR between 35% and 45% showed 28% of survival with liver up and 50% with liver down; those with an O/E-LHR greater than 45% showed 50% of survival rate with liver up and 76.9% with liver down. CONCLUSIONS: Neonatal mortality in CDH is higher in Latin American countries. The category of lung hypoplasia should be classified according to the survival rates in our Latin American CDH registry.

Evaluation of the mortality registry in Ecuador (2001-2013) - social and geographical inequalities in completeness and quality.

BACKGROUND: Mortality registries are an essential data source for public health surveillance and for planning and evaluating public policy. Nevertheless, there are still large inequalities in the completeness and quality of mortality registries between and within countries. In Ecuador, there have been few nationwide evaluations of the mortality registry and no evaluations of inequalities between provinces. This kind of analysis is fundamental for strengthening the vital statistics system. METHODS: Ecological study assessing the completeness, quality and internal consistency of mortality data in the provinces of Ecuador, using 13 years of mortality data (2001-2013). Completeness was assessed using three types of death distribution methods (DDMs), quality by estimating the percentages of garbage codes and deaths with unspecified age or sex in the registered deaths, and internal consistency by estimating the percentage of deaths with reported causes of deaths considered impossible in some age-sex combinations. Finally, we propose a classification of the mortality registry in the studied areas based on completeness and quality. RESULTS: Completeness estimates (mean of the three methods used) in the provinces ranged from 21 to 87% in women and from 35 to 89% in men. The percentage of garbage codes in the provinces ranged from 21 to 56% in women and from 25 to 52% in men. Garbage coding was higher in women and in older age groups. The percentage of deaths with unspecified age or sex, and the percentage of deaths with reported causes of deaths considered impossible in some age-sex combinations was low in all the studied areas. The mortality registry could only be classified as acceptable in one area for men and one area for women. CONCLUSIONS: We found substantial inequalities by sex, geographical areas and age in the completeness and quality of the mortality registry of Ecuador. The findings of this study will be helpful to direct measures to improve Ecuador's vital statistics system and to generate strategies to reduce bias when using mortality data to analyse health inequalities in the country.

Design and Implementation of a Depression Registry for Primary Care.

Registries are fundamental to the success of population health initiatives to improve care and outcomes for patients, including those with depression. The purpose of this article is to describe the design and clinical implementation of a depression registry as part of a collaborative care for depression intervention at 2 large academic outpatient internal medicine practices. The primary objective of the registry was to identify and track patients with depression and monitor antidepressant therapy. Secondary objectives of the registry were to assist in addressing pay-for-performance and value-based reimbursement metrics for depression screening and remission. The registry design and variables for inclusion in the registry were defined with input from clinicians, institutional leadership, and data analysts. For implementation, specific clinical workflows were established and responsible team roles were designated.

Sudden Death in Young Brazilian Athletes: Isn't It Time We Created a Genuinely National Register?

Young competitive athletes (≤ 35 years old) with or without a previous diagnosis of cardiovascular disease may suddenly die in competitive activities, potentially leading to an impact in society through the media. Although the relative risk for sudden death (SD) in athletes is twice as high as for their counterparts, the absolute incidence is low. While there is consensus among medical societies worldwide that early detection of causal factors is highly desirable, there is debate among different screening schemes to that end. In Brazil, the recommendations of the Brazilian Society of Cardiology mirror the guidelines of the European Society of Cardiology (ESC), which indicate a clinical examination combined with a 12-lead resting electrocardiogram, regardless of the presence of risk factors. The possibility of genetic screening is also plausible, since most clinical entities that cause SD in young competitive athletes are related to genotype. Finally, considering the diversity of practiced sports, and the population miscegenation, we emphasize the need to a national registry of cases.

[Preliminary results of the strengthening of the national death registry information system]. / Resultados preliminares del fortalecimiento del sistema informático nacional de defunciones.

Peru has a low coverage of deaths with a cause of death (54%) and a poor-quality registration of causes of death, as about 30% of causes of death are classified as poorly-defined or not very useful for the formulation of public policies. In response to these problems, the Ministry of Health, together with other government agencies, with the support of the Bloomberg Philanthropies "Data for Health Initiative," is implementing the National Death Registry Information System (SINADEF). The objective of this article is to describe the process of strengthening the mortality information system in Peru, focused on the implementation of SINADEF. The activities that have been carried out are described in the following areas: a) Management of the mortality information system, b) Process standardization, c) Use of information and communication technology, d) Coverage of deaths with medical certificate, e) Improvement of the quality of information, f) Development of studies, and g) Monitoring of processes. Since the implementation of SINADEF in August 2016 until July 2018, 28,407 users of the SINADEF application have been created and a total of 122,411 deaths have been registered. The quality of data recording, including the cause of death, has been improved, while low coverage of deaths with a cause of death still persists.

El Perú tiene una baja cobertura de defunciones con causa de defunción (54 %) y una mala calidad del registro de las causas de defunción, mas de 45 % de las causas de muerte se clasifican como mal definidas o poco útiles para la formulación de políticas públicas. En respuesta a estos problemas, el Ministerio de Salud, junto a otras agencias gubernamentales, con el apoyo de la Iniciativa Bloomberg "Información para la Salud" está implementando el Sistema Informático Nacional de Defunciones (SINADEF). El objetivo de este artículo es describir el proceso de fortalecimiento del sistema de información de la mortalidad en Perú, centrado en la implementación del SINADEF. Se describe las actividades que se vienen realizando en los siguientes ejes: a) Gestión del sistema de información de la mortalidad, b) Estandarización de procesos, c) Uso de tecnología de información y comunicación, d) Cobertura de las defunciones con certificación médica, e) Mejora de la calidad de la información, f) Desarrollo de estudios y g) Monitoreo de los procesos. Desde el inicio de la implementación del SINADEF, en agosto de 2016 hasta julio de 2018, se han creado 28 407 usuarios del aplicativo del SINADEF y se han registrado un total de 122 411 defunciones. Se ha mejorado la calidad del registro de los datos, incluyendo la causa de defunción, pero aún persiste la baja cobertura de defunciones con causa de muerte.

[Simulation and comparison of techniques for the correction of incomplete data on age to calculate incidence rates]. / Simulação e comparação de técnicas de correção de dados incompletos de idade para o cálculo de taxas de incidência.

The objective was to compare two techniques to estimate age in databases with incomplete records and analyze their application to the calculation of cancer incidence. The study used the database of the Population-Based Cancer Registry from the city of São Paulo, Brazil, containing cases of urinary tract cancer diagnosed from 1997 to 2013. Two techniques were applied to estimate age: correction factor and multiple imputation. Using binomial distribution, six databases were simulated with different proportions of incomplete data on patient's age (from 5% to 50%). The ratio between the incidence rates was calculated, using the complete database as reference, whose standardized incidence was 11.83/100,000; the other incidence rates in the databases, with at least 5% incomplete data for age, were underestimated. By applying the correction factors, the corrected rates did not differ from the standardized rates, but this technique does not allow correcting specific rates. Multiple imputation was useful for correcting the standardized and specific rates in databases with up to 30% of incomplete data, but the specific rates for individuals under 50 years of age were underestimated. Databases with 5% incomplete data or more require correction. Although the implementation of multiple imputation is complex, it proved to be superior to the correction factor. However, it should be used sparingly, since age-specific rates may remain underestimated.

O objetivo foi comparar duas técnicas para estimar idade em bancos de dados com registros incompletos e analisar sua aplicação no cálculo da incidência de câncer. Utilizou-se a base de dados do Registro de Câncer de Base Populacional do Município de São Paulo, Brasil, contendo casos diagnosticados por câncer do trato urinário, entre 1997 e 2013. Foram aplicadas duas técnicas para estimativa de idade: fator de correção e imputação múltipla. Foram simuladas, usando a distribuição binomial, seis bases de dados com diferentes proporções de dados incompletos para idade de 5% até 50%. A razão entre as incidências foi calculada tendo, como referência, a base completa, cuja incidência padronizada foi de 11,83/100 mil; as demais incidências nas bases com 5% ou mais de dados incompletos para idade apresentaram-se subestimadas. Ao aplicar o fator de correção, as taxas corrigidas não apresentaram diferenças em comparação com as padronizadas, entretanto, essa técnica não permite corrigir taxas específicas. A imputação múltipla foi útil na correção das taxas padronizadas e específicas em bancos com até 30% de dados incompletos, entretanto, as taxas específicas para indivíduos com menos de 50 anos apresentaram-se subestimadas. Bases com 5% ou mais de dados incompletos necessitam de aplicação de correção. A imputação múltipla, apesar de complexa em sua execução, mostrou-se superior ao fator de correção. Todavia, deve ser utilizada com parcimônia, pois taxas específicas por idade podem manter-se subestimadas.

El objetivo fue comparar dos técnicas para estimar edad en bancos de datos con registros incompletos y analizar su aplicación en el cálculo de la incidencia de cáncer. Se utilizó la base de datos del Registro de Cáncer de Base Poblacional del municipio de São Paulo, Brasil, conteniendo casos diagnosticados de cáncer del tracto urinario, entre 1997 y 2013. Se aplicaron dos técnicas para la estimativa de edad: factor de corrección e imputación múltiple. Fueron simuladas, usando una distribución binomial, seis bases de datos con diferentes proporciones de datos incompletos para edad desde un 5% hasta el 50%. La razón entre las incidencias se calculó teniendo, como referencia, la base completa, cuya incidencia padronizada fue de 11,83/100.000; las demás incidencias en las bases con un 5% o más de datos incompletos en la edad se presentaron subestimadas. Al aplicar el factor de corrección, las tasas corregidas no presentaron diferencias, en comparación con las estandarizadas, sin embargo, esta técnica no permite corregir tasas específicas. La imputación múltiple fue útil en la corrección de las tasas estandarizadas y específicas en bancos con hasta un 30% de datos incompletos, no obstante, las tasas específicas para individuos con menos de 50 años se presentaron subestimadas. Bases con un 5% o más de datos incompletos necesitan una aplicación de corrección. La imputación múltiple, a pesar de ser compleja en su ejecución, se mostró superior al factor de corrección. Sin embargo, debe ser utilizada con prudencia, puesto que las tasas específicas por edad pueden seguir manteniéndose subestimadas.

Resultados preliminares del fortalecimiento del sistema informático nacional de defunciones / Preliminary results of the strengthening of the national death registry information system

El Perú tiene una baja cobertura de defunciones con causa de defunción (54 %) y una mala calidad del registro de las causas de defunción, mas de 45 % de las causas de muerte se clasifican como mal definidas o poco útiles para la formulación de políticas públicas. En respuesta a estos problemas, el Ministerio de Salud, junto a otras agencias gubernamentales, con el apoyo de la Iniciativa Bloomberg «Información para la Salud¼ está implementando el Sistema Informático Nacional de Defunciones (SINADEF). El objetivo de este artículo es describir el proceso de fortalecimiento del sistema de información de la mortalidad en Perú, centrado en la implementación del SINADEF. Se describe las actividades que se vienen realizando en los siguientes ejes: a) Gestión del sistema de información de la mortalidad, b) Estandarización de procesos, c) Uso de tecnología de información y comunicación, d) Cobertura de las defunciones con certificación médica, e) Mejora de la calidad de la información, f) Desarrollo de estudios y g) Monitoreo de los procesos. Desde el inicio de la implementación del SINADEF, en agosto de 2016 hasta julio de 2018, se han creado 28 407 usuarios del aplicativo del SINADEF y se han registrado un total de 122 411 defunciones. Se ha mejorado la calidad del registro de los datos, incluyendo la causa de defunción, pero aún persiste la baja cobertura de defunciones con causa de muerte.

Peru has a low coverage of deaths with a cause of death (54%) and a poor-quality registration of causes of death, as about 30% of causes of death are classified as poorly-defined or not very useful for the formulation of public policies. In response to these problems, the Ministry of Health, together with other government agencies, with the support of the Bloomberg Philanthropies «Data for Health Initiative,¼ is implementing the National Death Registry Information System (SINADEF). The objective of this article is to describe the process of strengthening the mortality information system in Peru, focused on the implementation of SINADEF. The activities that have been carried out are described in the following areas: a) Management of the mortality information system, b) Process standardization, c) Use of information and communication technology, d) Coverage of deaths with medical certificate, e) Improvement of the quality of information, f) Development of studies, and g) Monitoring of processes. Since the implementation of SINADEF in August 2016 until July 2018, 28,407 users of the SINADEF application have been created and a total of 122,411 deaths have been registered. The quality of data recording, including the cause of death, has been improved, while low coverage of deaths with a cause of death still persists.

Quality of death certification in Colombia.

OBJECTIVE: To evaluate the quality of the certification of general death and cancer in Colombia. METHODS: Validity indicators were described for each province and the cities of Bogotá, Cali, Manizales, Pasto and Bucaramanga. A factorial analysis of principal components was carried out in order to identify non-obvious relationships. RESULTS: Were analyzed 984,159 deaths, among them there were 164,542 deaths due to cancer. 93.7% of the general mortality was well certified. The predominant errors were signs, symptoms and ill-defined conditions. 92.8% of cancer mortality was well certified. The predominant errors were due to poorly defined cancer sites. CONCLUSIONS: Certification of quality indicators in Colombia has improved. Given the good performance of the quality indicators for certificating general death and cancer, it is considered that this is a valid input for the estimation of cancer incidences.

OBJETIVO: Evaluar la calidad de la certificación de la muerte general y por cáncer en Colombia. MÉTODOS: Se describieron indicadores de validez para cada departamento y las ciudades de Bogotá, Cali, Manizales, Pasto y Bucaramanga. Se realizó un análisis factorial de componentes principales con el fin de identificar relaciones no evidentes. RESULTADOS: Se analizaron 984,159 defunciones, dentro de las cuales había 164,542 muertes por cáncer. El 93.7% de la mortalidad general estaba bien certificada. Los errores predominantes fueron signos, síntomas y afecciones mal definidas. El 92.8% de la mortalidad por cáncer estaba bien certificada. Los errores predominantes fueron cánceres de sitio mal definido. CONCLUSIONES: Los indicadores de calidad de certificación en Colombia mejoraron. Ante el buen comportamiento de los indicadores de calidad de la certificación de la muerte general y por cáncer, se considera que ésta es un insumo válido para la estimación de incidencia de cáncer.

Measurement of the Inter-Rater Reliability Rate Is Mandatory for Improving the Quality of a Medical Database: Experience with the Paulista Lung Cancer Registry.

BACKGROUND: Database quality measurement should be considered a mandatory step to ensure an adequate level of confidence in data used for research and quality improvement. Several metrics have been described in the literature, but no standardized approach has been established. We aimed to describe a methodological approach applied to measure the quality and inter-rater reliability of a regional multicentric thoracic surgical database (Paulista Lung Cancer Registry). STUDY DESIGN: Data from the first 3 years of the Paulista Lung Cancer Registry underwent an audit process with 3 metrics: completeness, consistency, and inter-rater reliability. The first 2 methods were applied to the whole data set, and the last method was calculated using 100 cases randomized for direct auditing. Inter-rater reliability was evaluated using percentage of agreement between the data collector and auditor and through calculation of Cohen's κ and intraclass correlation. RESULTS: The overall completeness per section ranged from 0.88 to 1.00, and the overall consistency was 0.96. Inter-rater reliability showed many variables with high disagreement (>10%). For numerical variables, intraclass correlation was a better metric than inter-rater reliability. Cohen's κ showed that most variables had moderate to substantial agreement. CONCLUSIONS: The methodological approach applied to the Paulista Lung Cancer Registry showed that completeness and consistency metrics did not sufficiently reflect the real quality status of a database. The inter-rater reliability associated with κ and intraclass correlation was a better quality metric than completeness and consistency metrics because it could determine the reliability of specific variables used in research or benchmark reports. This report can be a paradigm for future studies of data quality measurement.

Quality of death certification in Colombia / Calidad de la certificación de la muerte en Colombia

Abstract Objective: To evaluate the quality of the certification of general death and cancer in Colombia. Methods: Validity indicators were described for each province and the cities of Bogotá, Cali, Manizales, Pasto and Bucaramanga. A factorial analysis of principal components was carried out in order to identify non-obvious relationships. Results: Were analyzed 984,159 deaths, among them there were 164,542 deaths due to cancer. 93.7% of the general mortality was well certified. The predominant errors were signs, symptoms and ill-defined conditions. 92.8% of cancer mortality was well certified. The predominant errors were due to poorly defined cancer sites. Conclusions: Certification of quality indicators in Colombia has improved. Given the good performance of the quality indicators for certificating general death and cancer, it is considered that this is a valid input for the estimation of cancer incidences.

Resumen Objetivo: Evaluar la calidad de la certificación de la muerte general y por cáncer en Colombia. Métodos: Se describieron indicadores de validez para cada departamento y las ciudades de Bogotá, Cali, Manizales, Pasto y Bucaramanga. Se realizó un análisis factorial de componentes principales con el fin de identificar relaciones no evidentes. Resultados: Se analizaron 984,159 defunciones, dentro de las cuales había 164,542 muertes por cáncer. El 93.7% de la mortalidad general estaba bien certificada. Los errores predominantes fueron signos, síntomas y afecciones mal definidas. El 92.8% de la mortalidad por cáncer estaba bien certificada. Los errores predominantes fueron cánceres de sitio mal definido. Conclusiones: Los indicadores de calidad de certificación en Colombia mejoraron. Ante el buen comportamiento de los indicadores de calidad de la certificación de la muerte general y por cáncer, se considera que ésta es un insumo válido para la estimación de incidencia de cáncer.

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.

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

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.

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.

Simulação e comparação de técnicas de correção de dados incompletos de idade para o cálculo de taxas de incidência / Simulation and comparison of techniques for the correction of incomplete data on age to calculate incidence rates / Simulación y comparación de técnicas de corrección de datos incompletos de edad para el cálculo de tasas de incidencia

O objetivo foi comparar duas técnicas para estimar idade em bancos de dados com registros incompletos e analisar sua aplicação no cálculo da incidência de câncer. Utilizou-se a base de dados do Registro de Câncer de Base Populacional do Município de São Paulo, Brasil, contendo casos diagnosticados por câncer do trato urinário, entre 1997 e 2013. Foram aplicadas duas técnicas para estimativa de idade: fator de correção e imputação múltipla. Foram simuladas, usando a distribuição binomial, seis bases de dados com diferentes proporções de dados incompletos para idade de 5% até 50%. A razão entre as incidências foi calculada tendo, como referência, a base completa, cuja incidência padronizada foi de 11,83/100 mil; as demais incidências nas bases com 5% ou mais de dados incompletos para idade apresentaram-se subestimadas. Ao aplicar o fator de correção, as taxas corrigidas não apresentaram diferenças em comparação com as padronizadas, entretanto, essa técnica não permite corrigir taxas específicas. A imputação múltipla foi útil na correção das taxas padronizadas e específicas em bancos com até 30% de dados incompletos, entretanto, as taxas específicas para indivíduos com menos de 50 anos apresentaram-se subestimadas. Bases com 5% ou mais de dados incompletos necessitam de aplicação de correção. A imputação múltipla, apesar de complexa em sua execução, mostrou-se superior ao fator de correção. Todavia, deve ser utilizada com parcimônia, pois taxas específicas por idade podem manter-se subestimadas.

The objective was to compare two techniques to estimate age in databases with incomplete records and analyze their application to the calculation of cancer incidence. The study used the database of the Population-Based Cancer Registry from the city of São Paulo, Brazil, containing cases of urinary tract cancer diagnosed from 1997 to 2013. Two techniques were applied to estimate age: correction factor and multiple imputation. Using binomial distribution, six databases were simulated with different proportions of incomplete data on patient's age (from 5% to 50%). The ratio between the incidence rates was calculated, using the complete database as reference, whose standardized incidence was 11.83/100,000; the other incidence rates in the databases, with at least 5% incomplete data for age, were underestimated. By applying the correction factors, the corrected rates did not differ from the standardized rates, but this technique does not allow correcting specific rates. Multiple imputation was useful for correcting the standardized and specific rates in databases with up to 30% of incomplete data, but the specific rates for individuals under 50 years of age were underestimated. Databases with 5% incomplete data or more require correction. Although the implementation of multiple imputation is complex, it proved to be superior to the correction factor. However, it should be used sparingly, since age-specific rates may remain underestimated.

El objetivo fue comparar dos técnicas para estimar edad en bancos de datos con registros incompletos y analizar su aplicación en el cálculo de la incidencia de cáncer. Se utilizó la base de datos del Registro de Cáncer de Base Poblacional del municipio de São Paulo, Brasil, conteniendo casos diagnosticados de cáncer del tracto urinario, entre 1997 y 2013. Se aplicaron dos técnicas para la estimativa de edad: factor de corrección e imputación múltiple. Fueron simuladas, usando una distribución binomial, seis bases de datos con diferentes proporciones de datos incompletos para edad desde un 5% hasta el 50%. La razón entre las incidencias se calculó teniendo, como referencia, la base completa, cuya incidencia padronizada fue de 11,83/100.000; las demás incidencias en las bases con un 5% o más de datos incompletos en la edad se presentaron subestimadas. Al aplicar el factor de corrección, las tasas corregidas no presentaron diferencias, en comparación con las estandarizadas, sin embargo, esta técnica no permite corregir tasas específicas. La imputación múltiple fue útil en la corrección de las tasas estandarizadas y específicas en bancos con hasta un 30% de datos incompletos, no obstante, las tasas específicas para individuos con menos de 50 años se presentaron subestimadas. Bases con un 5% o más de datos incompletos necesitan una aplicación de corrección. La imputación múltiple, a pesar de ser compleja en su ejecución, se mostró superior al factor de corrección. Sin embargo, debe ser utilizada con prudencia, puesto que las tasas específicas por edad pueden seguir manteniéndose subestimadas.

Adequacy of mortality data and correction of reported deaths from the Proactive Search of Deaths. / Adequação das informações de mortalidade e correção dos óbitos informados a partir da Pesquisa de Busca Ativa.

The aim of this paper is to propose indicators of adequacy and to estimate correction factors for deaths reported to SIM. In 2014, we carried out a Proactive Search to capture deaths that occurred in 2012 in a sample of municipalities in the regions North and Northeast, and the states of Minas Gerais, Mato Grosso and Goiás. To characterize the coverage of deaths information, we proposed indicators of adequacy by municipality. Correction factors were estimated for individuals one year of age or older and younger than 1 year old. Among the deaths of people aged one year or more, the coverage was above 90% in 12 states. As for infant deaths, the coverage was less than 80% in 7 states. The results of the regression models showed association between the correction factors estimated and the proposed indicators of adequacy. We found very poor death information in 227 municipalities, for which the reported number of infant deaths even after correction, could not reach the minimum expected. Although the progress made in information of vital data in Brazil is recognized, the results show that our greatest challenge is to reach rural and remote municipalities, which do not yet have adequate vital information.

Resumo O objetivo deste artigo é propor indicadores de adequação e estimar fatores de correção para os óbitos informados ao SIM. Em 2014, foi realizada uma Pesquisa de Busca Ativa para captar óbitos ocorridos no ano de 2012 em uma amostra de municípios das regiões Norte e Nordeste, e dos estados de Minas Gerais, Mato Grosso e Goiás. Para caracterizar a cobertura das informações de óbitos, foram propostos indicadores de adequação por município. Os fatores de correção foram estimados para indivíduos com um ano ou mais de idade e para crianças menores de 1 ano. Entre os óbitos de 1 ano ou mais, as coberturas são superiores a 90% em 12 estados. Já para óbitos infantis, a cobertura foi inferior a 80% em 7 estados. Os resultados dos modelos de regressão mostraram associação entre os fatores de correção estimados e os indicadores de adequação propostos. Verificou-se grande precariedade das informações em 227 municípios, para os quais o número informado de óbitos infantis, mesmo corrigido, não conseguiu atingir o mínimo esperado. Embora os avanços conseguidos na informação dos dados vitais no Brasil sejam reconhecidos, os resultados mostram que o nosso maior desafio está em alcançar municípios rurais e remotos, que ainda não dispõem de informações vitais adequadas.

Adequação das informações de mortalidade e correção dos óbitos informados a partir da Pesquisa de Busca Ativa / Adequacy of mortality data and correction of reported deaths from the Proactive Search of Deaths

Resumo O objetivo deste artigo é propor indicadores de adequação e estimar fatores de correção para os óbitos informados ao SIM. Em 2014, foi realizada uma Pesquisa de Busca Ativa para captar óbitos ocorridos no ano de 2012 em uma amostra de municípios das regiões Norte e Nordeste, e dos estados de Minas Gerais, Mato Grosso e Goiás. Para caracterizar a cobertura das informações de óbitos, foram propostos indicadores de adequação por município. Os fatores de correção foram estimados para indivíduos com um ano ou mais de idade e para crianças menores de 1 ano. Entre os óbitos de 1 ano ou mais, as coberturas são superiores a 90% em 12 estados. Já para óbitos infantis, a cobertura foi inferior a 80% em 7 estados. Os resultados dos modelos de regressão mostraram associação entre os fatores de correção estimados e os indicadores de adequação propostos. Verificou-se grande precariedade das informações em 227 municípios, para os quais o número informado de óbitos infantis, mesmo corrigido, não conseguiu atingir o mínimo esperado. Embora os avanços conseguidos na informação dos dados vitais no Brasil sejam reconhecidos, os resultados mostram que o nosso maior desafio está em alcançar municípios rurais e remotos, que ainda não dispõem de informações vitais adequadas.

Abstract The aim of this paper is to propose indicators of adequacy and to estimate correction factors for deaths reported to SIM. In 2014, we carried out a Proactive Search to capture deaths that occurred in 2012 in a sample of municipalities in the regions North and Northeast, and the states of Minas Gerais, Mato Grosso and Goiás. To characterize the coverage of deaths information, we proposed indicators of adequacy by municipality. Correction factors were estimated for individuals one year of age or older and younger than 1 year old. Among the deaths of people aged one year or more, the coverage was above 90% in 12 states. As for infant deaths, the coverage was less than 80% in 7 states. The results of the regression models showed association between the correction factors estimated and the proposed indicators of adequacy. We found very poor death information in 227 municipalities, for which the reported number of infant deaths even after correction, could not reach the minimum expected. Although the progress made in information of vital data in Brazil is recognized, the results show that our greatest challenge is to reach rural and remote municipalities, which do not yet have adequate vital information.

Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke: Primary Results of the STRATIS Registry.

BACKGROUND AND PURPOSE: Mechanical thrombectomy with stent retrievers has become standard of care for treatment of acute ischemic stroke patients because of large vessel occlusion. The STRATIS registry (Systematic Evaluation of Patients Treated With Neurothrombectomy Devices for Acute Ischemic Stroke) aimed to assess whether similar process timelines, technical, and functional outcomes could be achieved in a large real world cohort as in the randomized trials. METHODS: STRATIS was designed to prospectively enroll patients treated in the United States with a Solitaire Revascularization Device and Mindframe Capture Low Profile Revascularization Device within 8 hours from symptom onset. The STRATIS cohort was compared with the interventional cohort of a previously published SEER patient-level meta-analysis. RESULTS: A total of 984 patients treated at 55 sites were analyzed. The mean National Institutes of Health Stroke Scale score was 17.3. Intravenous tissue-type plasminogen activator was administered in 64.0%. The median time from onset to arrival in the enrolling hospital, door to puncture, and puncture to reperfusion were 138, 72, and 36 minutes, respectively. The Core lab-adjudicated modified Thrombolysis in Cerebral Infarction ≥2b was achieved in 87.9% of patients. At 90 days, 56.5% achieved a modified Rankin Scale score of 0 to 2, all-cause mortality was 14.4%, and 1.4% suffered a symptomatic intracranial hemorrhage. The median time from emergency medical services scene arrival to puncture was 152 minutes, and each hour delay in this interval was associated with a 5.5% absolute decline in the likelihood of achieving modified Rankin Scale score 0 to 2. CONCLUSIONS: This largest-to-date Solitaire registry documents that the results of the randomized trials can be reproduced in the community. The decrease of clinical benefit over time warrants optimization of the system of care. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02239640.

[Validity of information on birth weight for studies based on fetal programming]. / Validade da informação sobre o peso ao nascer para estudos fundamentados na programação fetal.

Birth weight is essential information in fetal programming studies and is generally obtained retrospectively. In Brazil's Information System on Live Births (SINASC), birth weight is valid information but is not always accessible. The study aimed to establish an algorithm for the selection of the most reliable data source for birth weight in the absence of information in the SINASC database. In a cross-sectional study of 6-14-year-old schoolchildren in Niterói, Rio de Janeiro State, Brazil, in 2010, birth weight was collected through a self-completed questionnaire, interview, medical records from the Family Physician Program, and the SINASC database. We calculated intra-class correlation coefficients (ICCs) and differences in mean birth weight. ICCs varied from 0.90 to 0.99. All the other sources showed higher mean birth weight than SINASC, allowing differences up to 100g. Birth weight is recorded at birth (SINASC) or close to it (Family Physician Program), and in the absence of these sources, birth weight as retrieved at 6-14 years of age is a reliable option. To complement information on birth weight in the absence of SINASC, we recommend the following order: Family Physician Program, interview, and questionnaire.

EpiFibro (Brazilian Fibromyalgia Registry): data on the ACR classification and diagnostic preliminary criteria fulfillment and the follow-up evaluation / EpiFibro (Registro Brasileiro de Fibromialgia): dados sobre a classificação do ACR e preenchimento dos critérios diagnósticos preliminares e avaliação de seguimento

Abstract Introduction: EpiFibro (Brazilian Epidemiological Study of Fibromyalgia) was created to study Fibromyalgia patients. Patients were included since 2011 according to the 1990 American College of Rheumatology Classification Criteria for Fibromyalgia (ACR1990). Objectives: To determine how many patients still fulfill the ACR1990 and the ACR2010 criteria in 2014; to determine the correlation between the impact of FM and to describe data on the follow-up evaluation. Methods: This is a cross sectional study in a multicenter cohort of patients. The data was collected between 2013 and 2015. Physician included patients that fulfilled the ACR1990 criteria on the date of entry. The follow-up data were considered only for patients with at least two evaluations. A minimally significant change was considered to be a 30% variation of parameters scores. Results: 810 patients’ data were analyzed. Patients presented a mean age of 51.8 ± 11.5 years old. There were 786 female. Most patients met both criteria. There was a greater fulfilling of the ACR2010. There was a moderate correlation between Polysymptomatic Distress Scale and Fibromyalgia Impact Questionnaire. Three hundred fourteen patients with more than one assessment were found, but 88 patients were excluded. Thus, 226 patients with one follow-up monitoring parameter were considered (Fibromyalgia Impact Questionnaire: 222; Polysymptomatic Distress Scale: 199; both: 195). The mean follow-up time was 9.1 ± 7.5 months (1–44). Most patients became stable. Conclusion: InEpiFibro, most patients fulfill simultaneously the ACR1990 and ACR2010. A larger number of patients fulfill the ACR2010 at the time of the evaluation. There was a moderate correlation between the Polysymptomatic Distress Scale and the Fibromyalgia Impact Questionnaire. Most patients remained stable over time.

Resumo Introdução: O EpiFibro (Estudo Epidemiológico Brasileiro de Fibromialgia) foi criado para estudar pacientes com fibromialgia. Foram incluídos pacientes desde 2011 de acordo com os critérios de classificação para a fibromialgia do American College of Rheumatology de 1990 (ACR1990). Objetivos: Determinar quantos pacientes ainda atendem aos critérios ACR1990 e ACR2010 em 2014; determinar a correlação entre o impacto da FM medido pelo Questionário de Impacto da Fibromialgia (FIQ) e pela Polysymptomatic Distress Scale (PDS) e descrever dados sobre a avaliação de seguimento. Métodos: Estudo transversal em uma coorte multicêntrica de pacientes. Os dados foram coletados entre 2013 e 2015. O médico incluiu pacientes que atenderam aos critérios ACR1990 no momento da entrada. Consideraram-se os dados de seguimento apenas dos pacientes com pelo menos duas avaliações. Uma variação de 30% nos escores dos parâmetros foi considerada uma alteração minimamente significativa. Resultados: Analisaram-se os dados de 810 pacientes. Os pacientes apresentaram média de 51,8 ± 11,5 anos. Havia 786 mulheres. A maior parte dos pacientes atendeu a ambos os critérios. Houve um maior atendimento aos critérios ACR2010. Houve uma correlação moderada entre a PDS e o FIQ. Encontraram-se 314 pacientes com mais de uma avaliação, mas 88 pacientes foram excluídos. Assim, foram considerados 226 pacientes com um parâmetro de monitoramento no seguimento. (FIQ: 222; PDS: 199; ambos: 195). O tempo médio de seguimento foi de 9,1 ± 7,5 meses (1 a 44). A maior parte dos pacientes tornou-se estável. Conclusão: No EpiFibro, a maior parte dos pacientes atendia simultaneamente ao ACR1990 e ao ACR2010. Uma maior quantidade de pacientes atendia ao ACR2010 no momento da avaliação. Houve uma correlação moderada. A maior parte dos pacientes manteve-se estável ao longo do tempo.