Registry of adverse events related to health care that results in deaths in Brazil, 2014-2016. / Notificações de eventos adversos relacionados com a assistência à saúde que levaram a óbitos no Brasil, 2014-2016.

OBJECTIVE: to describe the adverse events related to health care resulting in death. METHODS: a descriptive study of reports recorded in the Brazilian Health Surveillance Notification System (Notivisa) in Brazil from Jun 2014 to Jun 2016; notifications recorded as 'other' in the 'incident type' were recoded. RESULTS: 417 cases were recorded, mostly in adults and the elderly (85%), with no sex differences; the states of São Paulo (N=92), Paraná (N=75) and Minas Gerais (N=66) were the main reporter; hospitals contributed to 97% of the records, principally in the intensive care and hospitalization sectors; the investigation by the notifying unit occurred in 5% of cases; in the recode of the type of incident, 52 records were recovered; the most common type of incident was 'failures during health care' (50%). CONCLUSION: notifications resulting in death occurred mainly in hospitals; were identified failure to register and need to investigate the large proportion of deaths.

Notificações de eventos adversos relacionados com a assistência à saúde que levaram a óbitos no Brasil, 2014-2016 / Registros de eventos adversos relacionados con la asistencia de salud que resultaron en muertes en Brasil, 2014-2016 / Registry of adverse events related to health care that results in deaths in Brazil, 2014-2016

Objetivo: descrever os eventos adversos relacionados com a assistência à saúde resultantes em óbito. Métodos: estudo descritivo das notificações registradas no Sistema de Notificações para a Vigilância Sanitária (Notivisa) no Brasil, de junho/2014 a junho/2016; notificações registradas como 'outros' em 'tipo de incidente' foram reclassificadas. Resultados: foram registrados 417 óbitos, a maioria em adultos e idosos (85%), sem diferenças entre sexos; os estados de São Paulo (N=92), Paraná (N=75) e Minas Gerais (N=66) foram os maiores notificadores; os hospitais contribuíram com 97% dos registros, com concentração nos setores 'terapia intensiva' e 'internação'; houve investigação pela unidade notificadora em 5% das notificações; na reclassificação do tipo de incidente, recuperaram-se 52 registros; o tipo de incidente mais comum foi 'falhas durante a assistência à saúde' (50%). Conclusão: notificações resultantes em óbito ocorreram principalmente em hospitais; foram identificadas falhas no registro e necessidade de investigação de grande proporção dos óbitos.

Objetivo: describir los eventos adversos relacionados con la asistencia sanitaria que resultaran en muerte. Métodos: estudio descriptivo de las notificaciones registradas en el Sistema de Notificaciones para la Vigilancia Sanitaria (Notivisa) en Brasil entre junio/2014-junio/2016; las notificaciones registradas como 'otros' en la variable 'tipo de incidente' fueron reclasificadas. Resultados: se registraron 417 casos, la mayoría en adultos y ancianos (85%), sin predominio de sexo; los estados de São Paulo (N=92), Paraná (N=75) y Minas Gerais (N=66) fueron los mayores notificantes; los hospitales contribuyeron con el 97% de los registros; la investigación por la unidad notificante se produjo en el 5% de los casos; en la reclasificación, se recuperaron 52 registros; el tipo de incidente más común fue 'fallas durante la asistencia sanitaria' (50%). Conclusión: las notificaciones de eventos resultantes de la muerte son principalmente de hospitales; se identificaron fallas en el registro y necesidad de más investigación de las muertes.

Objective: to describe the adverse events related to health care resulting in death. Methods: a descriptive study of reports recorded in the Brazilian Health Surveillance Notification System (Notivisa) in Brazil from Jun 2014 to Jun 2016; notifications recorded as 'other' in the 'incident type' were recoded. Results: 417 cases were recorded, mostly in adults and the elderly (85%), with no sex differences; the states of São Paulo (N=92), Paraná (N=75) and Minas Gerais (N=66) were the main reporter; hospitals contributed to 97% of the records, principally in the intensive care and hospitalization sectors; the investigation by the notifying unit occurred in 5% of cases; in the recode of the type of incident, 52 records were recovered; the most common type of incident was 'failures during health care' (50%). Conclusion: notifications resulting in death occurred mainly in hospitals; were identified failure to register and need to investigate the large proportion of deaths.

Ten years of a hantavirus disease emergency in the Federal District, Brazil.

INTRODUCTION: Hantavirus diseases are emerging human diseases caused by Hantavirus spp. of the Bunnyaviridae family. Hantavirus pulmonary syndrome (HPS) has been detected in the Federal District (DF) of Brazil since 2004. Among the 27 Brazilian Federal Units, DF has the highest fatality rate. More than 10 years have already passed since then, with confirmation of cases caused by the Araraquara and Paranoa species. The reservoir is Necromys lasiurus. METHODS: Local surveillance data of the confirmed cases were analyzed, including age, sex, month and year of occurrence, clinical symptoms, syndromes and outcomes, and probable transmission place (PTP). The cases were mainly confirmed by IgM detection with a capture enzyme immunoassay. The cases were classified as autochthonous if PTPs were in the DF area. RESULTS: From 2004 to 2013, in the DF, 126 cases of hantavirus were confirmed, and the cumulative incidence was 5.0 per 100,000 inhabitants. The occurrence of cases was predominantly from April to August. At least 75% of the cases were autochthonous. Acute respiratory failure was reported in 47.5% of cases, and the fatality rate was 40%. CONCLUSIONS: In the DF, the cumulative incidence of HPS was one of the highest worldwide. A seasonal pattern of hantavirus disease in the dry season is clear. There was a high frequency of severe clinical signals and symptoms as well as a high fatality rate. For the near future, visitors and inhabitants of DF rural areas, particularly male adults, should receive continuous education about hantavirus transmission and prevention.

Ten years of a hantavirus disease emergency in the Federal District, Brazil

Abstract: INTRODUCTION: Hantavirus diseases are emerging human diseases caused by Hantavirus spp. of the Bunnyaviridae family. Hantavirus pulmonary syndrome (HPS) has been detected in the Federal District (DF) of Brazil since 2004. Among the 27 Brazilian Federal Units, DF has the highest fatality rate. More than 10 years have already passed since then, with confirmation of cases caused by the Araraquara and Paranoa species. The reservoir is Necromys lasiurus. METHODS: Local surveillance data of the confirmed cases were analyzed, including age, sex, month and year of occurrence, clinical symptoms, syndromes and outcomes, and probable transmission place (PTP). The cases were mainly confirmed by IgM detection with a capture enzyme immunoassay. The cases were classified as autochthonous if PTPs were in the DF area. RESULTS: From 2004 to 2013, in the DF, 126 cases of hantavirus were confirmed, and the cumulative incidence was 5.0 per 100,000 inhabitants. The occurrence of cases was predominantly from April to August. At least 75% of the cases were autochthonous. Acute respiratory failure was reported in 47.5% of cases, and the fatality rate was 40%. CONCLUSIONS: In the DF, the cumulative incidence of HPS was one of the highest worldwide. A seasonal pattern of hantavirus disease in the dry season is clear. There was a high frequency of severe clinical signals and symptoms as well as a high fatality rate. For the near future, visitors and inhabitants of DF rural areas, particularly male adults, should receive continuous education about hantavirus transmission and prevention.

Perfil da mortalidade por intoxicação com medicamentos no Brasil, 1996-2005: retrato de uma década / Profile of mortality by intoxication with medication in Brazil, 1996-2005: portrait of a decade

A ocorrência de óbitos por intoxicação com medicamentos tem sido considerada um dos agravos de saúde pública. O estudo descreve o perfil epidemiológico da mortalidade por intoxicação com medicamentos na população do Brasil entre 1996 e 2005. Realizou-se um estudo descritivo com dados do Sistema de Informações sobre Mortalidade do Ministério da Saúde. Selecionaram-se os óbitos segundo a Classificação Internacional de Doenças (CID-10). Foram identificados 4.403 óbitos ocorridos em homens (53,9 por cento), solteiros (53,7 por cento) e faixa etária de 20-39 anos (44,0 por cento). A maioria dos óbitos foi por autointoxicação intencional por anticonvulsivantes, sedativos, antiparkinsonianos e psicotrópicos. A taxa padronizada de mortalidade foi maior na região Centro-Oeste e os Anos Potenciais de Vida Perdidos aumentou durante o período estudado em 15,50 por cento. O estudo apresentou as características e variações na mortalidade por intoxicação com medicamentos no Brasil que pode ser um reflexo do padrão de consumo dos medicamentos no país atrelado à necessidade de aprimoramento das políticas de vigilância sanitária.

The occurrence of deaths caused by intoxication with medication have been considered a worsening public health problem. The study describes the epidemiological profile of medication-related intoxication in the general Brazilian population from 1996 to 2005. A descriptive study was conducted with mortality data obtained from the Mortality Information System of the Brazilian Ministry of Health. Deaths were selected according to the codes of the International Classification of Diseases (ICD-10). A total of 4,403 deaths were found inn males (53.9 percent), bachelors (53.7 percent) and the 20 to 39 year-old age bracket (44 percent). The majority of deaths were caused by intentional self-intoxication using anticonvulsants, sedatives, antiparkinsonians and psychotropics. The standardized mortality rate was higher in the Midwest region and Potential Life-Years Lost increased by 15.5 percent. The study showed the characteristics and variations in mortality by intoxication with medication in Brazil, which can be a reflex of the medication consumption patterns of the country, indicating the need for enhancement of sanitary vigilance policies.

Prevalence and antimicrobial resistance of Salmonella in chicken carcasses at retail in 15 Brazilian cities / Prevalencia y resistencia a los antimicrobianos de Salmonella en polloscongelados de venta al por menor en 15 ciudades del Brasil

Objetivo. Describir la prevalencia y la resistencia a los antibióticos de Salmonella spp. en canales de pollo congeladas de venta al por menor en 15 ciudades del Brasil. Métodos. Entre septiembre del 2004 y julio del 2006 se llevó a cabo un estudio descriptivo de los datos del Programa Nacional Brasileño de Vigilancia de la Prevalenciade la Resistencia Bacteriana en el Pollo (PREBAF). Durante el programa serecolectaron canales de pollo en 15 capitales estatales del Brasil, en las cinco regiones geográficas del país. Para aislar Salmonella spp. e identificar los serotipos, se usaron las técnicas convencionales. Para evaluar la resistencia frente a 18 antibióticos, se usó el método de la concentración inhibitoria mínima. Resultados. En las 2 679 canales de pollo examinadas, la prevalencia de Salmonella spp. fue de 2,7% (amplitud, 0,0%–8,9%). El 50,6% de las muestras positivas provinieron del estado de São Paulo. Se identificaron 18 serotipos. Los más frecuentes fueron Salmonella Enteritidis (48,8%), Salmonella Infantis (7,6%), Salmonella Typhimurium (7,2%) y Salmonella Heidelberg (6,4%). Las 250 cepas evaluadas fueron resistentes auno o más antibióticos, y 133 (53,2%) fueron multirresistentes (≥ 3 clases de antibióticos). Salmonella Heidelberg fue resistente a la ceftriaxona (75,0%) y al ceftiofur (43,8%). Conclusiones. La prevalencia de Salmonella spp. en este estudio fue relativamente baja. Sin embargo, hubo una proporción elevada de cepas multirresistentes, inclusivea las cefalosporinas de tercera generación usadas para tratar la salmonelosis invasora. Los resultados confirman la relevancia del programa PREBAF, el cual se recomienda mejorar, por ejemplo, mediante un análisis oportuno de los datos. También es necesario revisar los límites permitidos de Salmonella spp. en el pollo que se vende al por menor en el Brasil.

Objective. To describe the prevalence and antimicrobial resistance of Salmonella spp. in frozen chicken carcasses at retail from 15 Brazilian cities. Methods. A descriptive study of data from the Brazilian National Program for Monitoring the Prevalence of Bacterial Resistance in Chicken (PREBAF) was conducted from September 2004 to July 2006. The program collected chicken carcasses in 15 state capitals of Brazil inthe five geographic regions of the country. Standardized methodologies were used to isolate Salmonella spp. and identify serotypes. The minimal inhibitory concentration method wasused to test resistance to 18 antimicrobials. Results. In 2 679 carcasses examined, the prevalence of Salmonella spp. was 2.7% (range0.0%–8.9%). São Paulo State produced 50.6% of positive samples. Eighteen serotypes were identified. The most frequently occurring were Salmonella Enteritidis (48.8%), Salmonella Infantis (7.6%), Salmonella Typhimurium (7.2%), and Salmonella Heidelberg (6.4%). All 250 strains tested were resistant to one or more antibiotics, and 133 (53.2%) were multidrug resistant (≥ 3 classes). S. Heidelberg was resistant to ceftriaxone (75.0%) and to ceftiofur (43.8%).Conclusions. The prevalence of Salmonella spp. found in this study was relatively low. However, there were a high proportion of multidrug-resistant strains, including thirdgenerationcephalosporins used to treat invasive salmonellosis. The results confirm the relevance of the PREBAF program. It is recommended that PREBAF be improved, including a timely data analysis. A review of permitted limits for Salmonella spp. in retail chicken in Brazil is also needed.

Percepções sobre qualidade de serviços que atendem à saúde da mulher / Perceptions on the quality of services relating to women's healthcare

O objetivo deste trabalho é identificar as características relacionadas à qualidade em serviços que atendem à saúde da mulher na perspectiva de profissionais de vigilância sanitária (Visa) e de coordenadores de saúde da mulher (CSM) de municípios. Trata-se de um estudo de abordagem qualitativa, efetuado por meio de entrevistas semiestruturadas. Foram selecionadas três capitais brasileiras e entrevistados três sujeitos de cada capital - um responsável e um técnico da área de Visa em serviços de saúde e um CSM. A análise das entrevistas foi realizada pela técnica de análise de conteúdo, organizando as respostas em categorias temáticas baseadas no modelo de avaliação dos serviços de saúde de Donabedian: estrutura, processos e resultados. Os técnicos de Visa relataram com maior frequência aspectos relacionados à estrutura dos serviços de saúde, como equipamentos e recursos humanos qualificados. Os responsáveis pela Visa citaram aspectos relacionados à estrutura e aos processos como priorização no atendimento. Os CSM abordaram as três categorias, com destaque para os processos. As entrevistas apontam para um possível prejuízo na avaliação por resultados. O estudo reforça a necessidade de atuação conjunta entre os setores de vigilância e assistência, a fim de promover a qualidade nos serviços.

The scope of this work is to identify the characteristics relating to the quality of women's healthcare services from the perspective of the sanitary vigilance professionals (Visa) and women's healthcare coordinators (CSM) in the municipalities. It is a study with a qualitative approach that was carried out using semi-structured interviews. Three Brazilian state capitals were selected and three individuals in each capital were interviewed, namely a Visa healthcare service chief, as well as a technician, and a CSM coordinator. The content analysis technique was adopted to organize the data and the answers were grouped into the healthcare service evaluation topics based on Donabedian's model, i.e. structure, processes, and outcomes. Visa workers reported aspects related to the structure of health services, such as equipment and qualified human resources more frequently. The Visa chief mentioned aspects related to structure and processes, such as prioritization in attendance. The CWH coordinator examined all three categories, especially processes. Analysis of interviews points to a potential distortion in evaluation by results. The study highlights the need for joint action between the surveillance and assistance sectors to improve the quality of services.

Prevalence and antimicrobial resistance of Salmonella in chicken carcasses at retail in 15 Brazilian cities.

OBJECTIVE: To describe the prevalence and antimicrobial resistance of Salmonella spp. in frozen chicken carcasses at retail from 15 Brazilian cities. METHODS: A descriptive study of data from the Brazilian National Program for Monitoring the Prevalence of Bacterial Resistance in Chicken (PREBAF) was conducted from September 2004 to July 2006. The program collected chicken carcasses in 15 state capitals of Brazil in the five geographic regions of the country. Standardized methodologies were used to isolate Salmonella-spp. and identify serotypes. The minimal inhibitory concentration method was used to test resistance to 18 antimicrobials. RESULTS: In 2 679 carcasses examined, the prevalence of Salmonella spp. was 2.7% (range 0.0%-8.9%). São Paulo State produced 50.6% of positive samples. Eighteen serotypes were identified. The most frequently occurring were Salmonella Enteritidis (48.8%), Salmonella Infantis (7.6%), Salmonella Typhimurium (7.2%), and Salmonella Heidelberg (6.4%). All 250 strains tested were resistant to one or more antibiotics, and 133 (53.2%) were multidrug resistant (≥ 3 classes). S. Heidelberg was resistant to ceftriaxone (75.0%) and to ceftiofur(43.8%). CONCLUSIONS: The prevalence of Salmonella spp. found in this study was relatively low. However, there were a high proportion of multidrug-resistant strains, including third-generation cephalosporins used to treat invasive salmonellosis. The results confirm the relevance of the PREBAF program. It is recommended that PREBAF be improved, including a timely data analysis. A review of permitted limits for Salmonella spp. in retail chicken in Brazil is also needed.

Avaliação do sistema nacional de hemovigilância dos anos 2002 a 2005. / Brazilian National Hematologic Vigilance System Assessment from 2002 to 2005.

Hemovigilância é um sistema de avaliação e alerta, com o objetivo de coletar e avaliar informações sobre eventos adversos pós-transfusionais. No Brasil, a hemovigilância iniciou-se em 2002, sob responsabilidade da Agência Nacional de Vigilância Sanitária, tendo hospitais sentinelascomo unidades notificadoras. Este trabalho apresenta uma avaliação do Sistema Nacional de Hemovigilância do Brasil (SNH), de 2002 a 2005, utilizando o Guia para Avaliação de Sistemas de Vigilância em Saúde Pública do CDC-Atlanta. Foram avaliados os atributos simplicidade,aceitabilidade, qualidade dos dados, oportunidade e representatividade. Foram notificados 3.237 eventos adversos pós-transfusionais; 73% confirmados. O SNH mostrou-se complexo, em especial pela quantidade excessiva de campos na ficha de notificação. Apresentoubaixa aceitabilidade com 30% dos hospitais sentinelas notificando. A representatividade foi classificada como regular, pois esse atributo não foi satisfatório nas regiões centro-oeste, norte e nordeste. Por outro lado, a qualidade dos dados e a oportunidade foram consideradas boas.Recomenda-se a reformulação da ficha de notificação, com redução no número de campos e melhor organização e a ampliação do número de unidades notificadoras. A Anvisa adotou as recomendações para o novo Sistema Nacional de Vigilância de Eventos Adversos e QueixasTécnicas de Produtos sob Vigilância Sanitária.

Hematologic vigilance is a system of evaluation and alert that aims to collect and analyze information regarding post-transfusion adverse events. Brazilian Hematologic Vigilance System (BHS) was established in 2002, under responsibility of Agência Nacional de Vigilância Sanitária(Anvisa ? national sanitary vigilance agency). Sentinel hospitals were targeted as notification units. This article presents an evaluation of BHS attributes, from 2002 to 2005, based on Guidelines for Evaluating Public Health Surveillance Systems, from CDC-Atlanta. We evaluatedsimplicity, acceptability, data quality, opportunity and representative ness. A total of 3237 reports of adverse events were notified; 73% confirmed events. BHS is complex, mainly regarding the notification form, composed by an excessive number of s to be filled. The acceptabilitywas low, and only 30% of the sentinel hospitals notified frequently. The representative ness was average, because of its unsatisfactory evaluation on central-west, north and northeast Brazilian geographic regions. Data quality and opportunity were considered good. Recommendations as changes in report form and to increase the number of notifies were suggested to improve simplicity, acceptability and representative ness. Some of the recommendations were effectively put in practice by Anvisa.

Investigation of two outbreaks of suspected oral transmission of acute Chagas disease in the Amazon region, Para State, Brazil, in 2007.

Acute Chagas disease (ACD) is caused by Trypanosoma cruzi. ACD outbreaks due to probable oral transmission occur regularly in small family gatherings that are exposed to contaminated foods. We studied two cohorts of residents on islands in the Breves and Bagre municipalities, in July and August 2007, to identify risk factors of transmission and to recommend preventative measures. Of the 25 cases identified in both cohorts, 13 (52%) were men, and the most frequent symptoms were fever (96%),asthenia (80%), myalgia (76%), abdominal pain (64%), retro-orbital pain, headaches and asthma (52%). We recommend detailed investigation of future outbreaks and other studies to better understand and control oral transmission of T. cruzi.