Revisão das dimensões de qualidade dos dados e métodos aplicados na avaliação dos sistemas de informação em saúde

Hospital case fatality and mortality related to Chagas disease in Brazil over two decades

OBJECTIVE

To analyse hospital case fatality and mortality related to Chagas disease (CD) in Brazil, 2000-2019.

METHOD

This is a mixed ecological study with spatial and temporal trends, based on national population data from the Brazilian Ministry of Health - hospital admissions (HA) and death certificates (DC). Records with CD as a primary or secondary cause of death in HA and/or as an underlying or associated cause of death in DC were evaluated. Temporal trends were analysed by Joinpoint regression and the spatial distribution of age- and gender-adjusted rates, spatial moving averages, and standardized morbidity ratios.

RESULTS

There were a total of 4,376 HA due to CD resulting in death in Brazil, with a hospital case fatality rate of 0.11/100,000 inhabitants. The Southeast region had the highest rate (63.9%, n = 2,796; 0.17/100,000 inhabitants). The general trend for this indicator in Brazil is upwards (average annual percentage change [AAPC] 7.5; 95% confidence interval [CI] 5.3 to 9.9), with increases in the North, Northeast and Southeast regions. During the same period 122,275 deaths from CD were registered in DC, with a mortality rate of 3.14/100,000 inhabitants. The highest risk of CD-related death was found among men (relative risk [RR] 1.27) and Afro-Brazilians (RR 1.63). There was a downward trend in CD mortality in the country (AAPC - 0.7%, 95%CI -0.9 to -0.5), with an increase in the Northeast region (AAPC 1.1%, 95%CI 0.6 to 1.6). Municipalities with a very high Brazilian Deprivation Index tended to show an increase in mortality (AAPC 2.1%, 95%CI 1.6 to 2.7), while the others showed a decrease.

CONCLUSION

Hospital case fatality and mortality due to CD are a relevant public health problem in Brazil. Differences related to gender, ethnicity, and social vulnerability reinforce the need for comprehensive care, and to ensure equity in access to health in the country. Municipalities, states, and regions with indicators that reveal higher morbidity and mortality need to be prioritized.

Frameworks, Dimensions, Definitions of Aspects, and Assessment Methods for the Appraisal of Quality of Health Data for Secondary Use: Comprehensive Overview of Reviews

BACKGROUND

Health care has not reached the full potential of the secondary use of health data because of-among other issues-concerns about the quality of the data being used. The shift toward digital health has led to an increase in the volume of health data. However, this increase in quantity has not been matched by a proportional improvement in the quality of health data.

OBJECTIVE

This review aims to offer a comprehensive overview of the existing frameworks for data quality dimensions and assessment methods for the secondary use of health data. In addition, it aims to consolidate the results into a unified framework.

METHODS

A review of reviews was conducted including reviews describing frameworks of data quality dimensions and their assessment methods, specifically from a secondary use perspective. Reviews were excluded if they were not related to the health care ecosystem, lacked relevant information related to our research objective, and were published in languages other than English.

RESULTS

A total of 22 reviews were included, comprising 22 frameworks, with 23 different terms for dimensions, and 62 definitions of dimensions. All dimensions were mapped toward the data quality framework of the European Institute for Innovation through Health Data. In total, 8 reviews mentioned 38 different assessment methods, pertaining to 31 definitions of the dimensions.

CONCLUSIONS

The findings in this review revealed a lack of consensus in the literature regarding the terminology, definitions, and assessment methods for data quality dimensions. This creates ambiguity and difficulties in developing specific assessment methods. This study goes a step further by assigning all observed definitions to a consolidated framework of 9 data quality dimensions.

Temporal Trends in the Completeness of Epidemiological Variables in a Hospital-Based Cancer Registry of a Pediatric Oncology Center in Brazil

This ecological time series study aimed to examine the temporal trends in the completeness of epidemiological variables from a hospital-based cancer registry (HbCR) of a reference center for pediatric oncology in Brazil from 2010 to 2016. Completeness categories were based on the percentage of missing data, with the categories excellent (<5%), good (5-10%), regular (11-20%), poor (21-50%), and very poor (>50%). Descriptive and bivariate analyses were performed using R.4.1.0; a Mann-Kendall trend test was performed to examine the temporal trends. Variables with the highest incompleteness included race/color (17.24% in 2016), level of education (51.40% in 2015), TNM (56.88% in 2012), disease status at the end of the first treatment (12.09% in 2013), cancer family history (79.12% in 2013), history of alcoholic consumption (39.25% in 2015), history of tobacco consumption (38.32% in 2015), and type of admission clinic (10.28% in 2015). Nevertheless, most variables achieved 100% completeness and were classified as excellent across the time series. A significant trend was observed for race/color, TNM, and history of tobacco consumption. While most variables maintained excellent completeness, the increasing incompleteness trend in race/color and decreasing trend in TNM underscore the importance of reliable and complete HbCRs for personalized cancer care, for planning public policies, and for conducting research on cancer control.

[Quality of anthropometric data of children under 5 years in the Brazilian National Food and Nutrition Surveillance System, 2008-2020]

The planning, monitoring, and evaluation of food and nutrition actions depend on reliable estimates based on adequate anthropometric data. The study aimed to analyze the quality of anthropometric data of children aged under 5 years in the Brazilian National Food and Nutrition Surveillance System (SISVAN) from 2008 to 2020. The sample comprised 23,453,620 children aged under 5 years. Initially, we evaluated the distribution of missing values and values outside the spectrum of the instrument, and calculated the digit preference index for weight and height. The nutritional indexes height for age (HAZ), weight for age (WAZ), and body mass index for age (BAZ) were calculated according to the World Health Organization 2006 child growth standards. Then, we identified the biologically implausible values (BIV) and calculated the standard deviation (SD) of the nutritional indexes. For each municipality, we calculated the mean and SD of HAZ and WAZ; and plotted the SD values as a function of the mean. In all Federative Units, the digit preference index reached a minimum value of 80 for height and 20 for weight. For the three nutritional indexes, there was a reduction in the frequency of BIV in the 2008-2020 period. Even after the exclusion of BIV, we identified high variability for the three nutritional indexes. The indicators evaluated showed low quality of measurement, especially in the North and Northeast regions. Our results indicate insufficient quality of anthropometric data in children aged under 5 years, and reinforce the need to invest in actions to improve the collection and recording of anthropometric information.

[Evaluation of the effectiveness of the intervention to improve the Brazilian Mortality Information System in Pernambuco, Brazil: a quasi-experimental study]

This study evaluated the influence of the variation in the implementation of the Brazilian Mortality Information System (SIM) on the results, before and after the intervention to improve the system in Pernambuco, Brazil. The SIM logical model and matrix of indicators and assessment were described, primary data were collected from the 184 municipalities and secondary data were collected from the system database. The degree of implementation (DI) was obtained from the indicators of structure and process, and then related to result indicators, based on the model. The intervention was directed at the shortcomings identified, and developed using strategic stages. The percentage of annual variation of the DI and the results before and after the intervention were calculated. The SIM was classified as partially implemented in the pre- (70.6%) and post-intervention (73.1%) evaluations, with increments in all components. The Health Regions followed the same classification of the state level, except for XII (80.3%), regarding implemented score after the intervention. The coverage of the system; deaths with a defined underlying cause; monthly transfer; and timely submission of data were above 90% in both evaluations. There was an improvement in the completeness of infant Death Certificates and in the timely recording of notifiable events. Strengthening the management and operationalization of the SIM with interventions applied to data registration can improve the system's results.

A completeness indicator of gestational and congenital syphilis information in Brazil

OBJECTIVE

To evaluate the quality of information on gestational syphilis (GS) and congenital syphilis (CS) on the Sistema de Informação de Agravos de Notificação (SINAN-Syphilis Brazil - Notifiable Diseases Information System) by compiling and validating completeness indicators between 2007 and 2018.

METHODS

Overall, care, and socioeconomic completeness scores were compiled based on selected variables, by using ad hoc weights assigned by experts. The completeness scores were analysed, considering the region and area of residence, the pregnant woman's race/colour, and the year of case notification. Pearson's correlation coefficients were used to validate the scores obtained by the weighted average method, compared with the values obtained by principal component analysis (PCA).

RESULTS

Most selected variables presented a good or excellent degree of completeness for GS and CS, except for clinical classification, pregnant woman's level of education, partner's treatment, and child's race/colour, which were classified as poor or very poor. The overall (89.93% versus 89.69%) and socioeconomic (88.71% versus 88.24%) completeness scores for GS and CS, respectively, were classified as regular, whereas the care score (GS-90.88%, and CS-90.72%) was good, despite improvements over time. Differences in the overall, care and socioeconomic completeness scores according to region, area of residence, and ethnic-racial groups were reported for syphilis notifications. The completeness scores estimated by the weighted average method and PCA showed a strong linear correlation (> 0.90).

CONCLUSION

The completeness of GS and CS notifications has been improving in recent years, highlighting the variables that form the care score, compared with the socioeconomic scores, despite differences between regions, area of residence, and ethnic-racial groups. The weighted average was a viable methodological alternative easily operationalised to estimate data completeness scores, allowing routine monitoring of the completeness of gestational and congenital syphilis records.

Incompleteness trends of epidemiological variables in a Brazilian high complexity cancer registry: An ecological time series study

Hospital Cancer Registries serve as a vital source of information for clinical and epidemiological research, allowing the evaluation of patient care outcomes through therapeutic protocol analysis and patient survival assessment. This study aims to assess the trend of incompleteness in the epidemiological variables within the Hospital Cancer Registry of a renowned oncology center in a Brazilian state. An ecological time-series study was conducted using secondary data from the Hospital Santa Rita de Cássia Cancer Registry in Espírito Santo between 2000 and 2016. Data completeness was categorized as follows: excellent (<5%), good (5%-10%), fair (10%-20%), poor (20%-50%), and very poor (>50%), based on the percentage of missing information. Descriptive and bivariate statistical analyses were performed using the free software RStudio (version 2022.07.2) and R (version 4.1.0). The Mann-Kendall test was used to assess temporal trends between the evaluated years, and the Friedman test was employed to evaluate quality scores across the years. Among the variables assessed, birthplace, race/color, education, occupation, origin, marital status, history of alcohol and tobacco consumption, previous diagnosis and treatment, the most important basis for tumor diagnosis, tumor-node-metastasis staging (TNM) staging, and clinical tumor staging by group (TNM) showed the highest levels of incompleteness. Conversely, other epidemiological variables demonstrated excellent completeness, reaching 100% throughout the study period. Significant trends were observed over the years for history of alcohol consumption (P < .001), history of tobacco consumption (P < .001), TNM staging (P = .016), clinical tumor staging by group (TNM) (P = .002), first treatment received at the hospital (P = .012), disease status at the end of the first treatment at the hospital (P < .001), and family history of cancer (P < .001), and tumor laterality (P = .032). While most epidemiological variables within the Hospital Santa Rita de Cássia Cancer Registry exhibited excellent completeness, some important variables, such as TNM staging and clinical staging, showed high levels of incompleteness. Ensuring high-quality data within Cancer Registries is crucial for a comprehensive understanding of the health-disease process.

[Evolution of the completeness and consistency of the gastroschisis registry in the Brazilian Live Birth Information System, from 2005 to 2020]

This study aimed to evaluate the evolution of the completeness and consistency of the gastroschisis registry in the Brazilian Live Birth Information System (SINASC). It is a time-series study on the completeness of the variable "occurrence of congenital anomaly" and the consistency of gastroschisis diagnosis in SINASC, in biennia from 2005 to 2020, for federative units, region, and Brazil. The consistency was estimated by the ratio between deaths from gastroschisis registered in the Brazilian Mortality Information System (SIM) and the total number of cases recorded in SINASC. Temporal trend was analyzed by joinpoint regression. In the period, 46,574,995 live births and 10,024 cases of gastroschisis were recorded. A total of 5,632 infant deaths due to gastroschisis were identified. The percentage of incompleteness decreased from 6.52% to 1.87%, with an annual percentage variation (APV) of -14.5%, and completeness reached excellence (≤ 5% of incompleteness), except in the Central-West Region. Case/death ratios above 1 were found in the North and Northeast regions and in some federative units in the Central-West, but there was a decrease, approaching the mortality found in studies in the South and Southeast regions. Its reduction was more pronounced until 2009-2010 (APV = -10.7%) and smaller later (APV = -4.4%). The quality of the gastroschisis registry reflects regional differences in the overall quality of SINASC, constituting as a marker for malformations that require complex neonatal care.

[Data processing of the Brazilian National System of Controlled Product Management for drug utilization research with antimicrobials]

The Brazilian National System of Controlled Product Management (SNGPC) stores data on the dispensing of manufactured and compounded drugs and pharmaceutical inputs, whether controlled and antimicrobial, based on the records of private pharmacies and drugstores. This study assessed the quality of SNGPC data from the dispensing records of manufactured antibiotics, aiming to propose their use in drug utilization researchs (DURs), with a descriptive and retrospective design, analyzing the raw dataset of the SNGPC from January 2014 to December 2020. A total of 475,805,207 drug-dispensing records were collected. On average, antibiotics corresponded to 54.5% of the total records. The quality dimension "unreported" was systematically identified in the variables "active ingredient", "sex", "age" and "ICD-10". The amount of vials/bottles and packages ranged from one to 536 units and the amount of pharmaceutical inputs dispensed, from one to 7,500 units. Results show that 25% of the records exceed an individual therapy and the SNGPC has no critical mechanism to avoid dispensations outside the therapeutic standard for the class. Despite vulnerabilities due to data quality, which can be overcome, the SNGPC allows for the construction of different analytical plans, involving time and other aggregations, in the analysis of community use of antimicrobials and controlled drugs, which makes it a powerful source of data for DUR.

Food intake markers in Sisvan: temporal trends in coverage and integration with e-SUS APS, Brazil 2015-2019

Abstract The aim of the present study was to estimate the population coverage of recording food intake markers in Brazil’s Food and Nutrition Surveillance System (Sisvan) and mean annual percent change (APC) in coverage according to the system used for data entry (e-SUS APS and Sisvan Web). We conducted an ecological time series study of the period 2015-2019. The data were stratified into region and age group. APC in coverage was calculated using Prais-Winsten regression and the correlation between APC and HDI, GDP per capita and primary healthcare coverage was assessed using Spearman’s correlation coefficient. Population coverage of recording food intake markers at national level was 0.92% in 2019. Mean APC in coverage throughout the period was 45.63%. The region and age group with the highest coverage rate were the Northeast (4.08%; APC=45.76%, p<0.01) and children aged 2-4 years (3.03%; APC=34.62%, p<0.01), respectively. There was an upward trend in data entry using e-SUS APS, to the detriment of Sisvan Web. There was a positive correlation between APC in coverage using e-SUS APS and HDI and GDP per capita in some age groups. Population coverage of recording Sisvan food intake markers remains low across the country. The e-SUS APS has the potential to be an important strategy for expanding food and nutrition surveillance.

Food intake markers in Sisvan: temporal trends in coverage and integration with e-SUS APS, Brazil 2015-2019

The aim of the present study was to estimate the population coverage of recording food intake markers in Brazil's Food and Nutrition Surveillance System (Sisvan) and mean annual percent change (APC) in coverage according to the system used for data entry (e-SUS APS and Sisvan Web). We conducted an ecological time series study of the period 2015-2019. The data were stratified into region and age group. APC in coverage was calculated using Prais-Winsten regression and the correlation between APC and HDI, GDP per capita and primary healthcare coverage was assessed using Spearman's correlation coefficient. Population coverage of recording food intake markers at national level was 0.92% in 2019. Mean APC in coverage throughout the period was 45.63%. The region and age group with the highest coverage rate were the Northeast (4.08%; APC=45.76%, p<0.01) and children aged 2-4 years (3.03%; APC=34.62%, p<0.01), respectively. There was an upward trend in data entry using e-SUS APS, to the detriment of Sisvan Web. There was a positive correlation between APC in coverage using e-SUS APS and HDI and GDP per capita in some age groups. Population coverage of recording Sisvan food intake markers remains low across the country. The e-SUS APS has the potential to be an important strategy for expanding food and nutrition surveillance.

A Terapêutica Cirúrgica e o Protocolo DH-II-90 no Tratamento da Doença de Hodgkin em Jovens e Adultos: um Estudo Ecológico

Introdução: A doença de Hodgkin (DH) e uma patologia que se inicia nos linfonodos, desenvolve-se nos tecidos neoplásicos e manifesta-se, majoritariamente, em jovens adultos. Objetivo: Correlacionar os resultados da terapêutica cirúrgica e do protocolo DH-II-90 em jovens adultos acometidos pela DH, e associa-los ao perfil epidemiológico, aos dados de mortalidade pela doença e a distribuição de recursos físicos no Brasil. Método: Estudo ecológico exploratório, com informações coletadas do Departamento de Informática do Sistema Único de Saúde (DATASUS), do Instituto Nacional de Câncer Jose Alencar Gomes da Silva (INCA), do Cadastro Nacional de Estabelecimentos de Saúde (CNES) e do Sistema de Informações Ambulatoriais do SUS (SIA/SUS), entre 2013 e 2021. O estudo, portanto, compara os resultados da terapêutica cirúrgica e do protocolo DH-II-90 associados a dados epidemiológicos, sendo o protocolo considerado o método mais eficiente, por apresentar melhores resultados quando comparado a métodos mais invasivos. Resultados: A Região Sudeste concentra maior número de leitos e procedimentos com números mais expressivos de pacientes diagnosticados de 0 a 29 anos. Em resumo, as taxas de mortalidade bruta por DH reduziram-se a partir de 1990, período no qual o protocolo DH-II-90 foi aplicado. Conclusão: O presente estudo fornece uma visão relevante sobre o perfil epidemiológico da DH e contribui para a comparação entre a terapêutica cirúrgica e o protocolo DH-II-90, sendo possível concluir que, apos a aplicação do protocolo, houve redução da taxa de mortalidade por DH no Brasil e no mundo.

Completeness, consistency and non-duplicity of records of child sexual abuse on the Notifiable Health Conditions Information System in the state of Santa Catarina, Brazil, 2009-2019

OBJECTIVE

To evaluate the completeness, consistency and duplicity of records of child sexual abuse on the Notifiable Health Conditions Information System (SINAN) in Santa Catarina, Brazil, between 2009 and 2019.

METHODS

This was a descriptive and analytical cross-sectional study aimed to assess the quality of SINAN data regarding completeness, consistency and non-duplicity.

RESULTS

3,489 cases of violence were reported, with a 662.5% increase in the number of notifications in the period studied, with the increase in the number of referral centers for the care of people in situations of sexual violence in the state, explaining 46.7% of the variation in the number of cases, between the years studied. Consistency was excellent in 90.0% of the records; and completeness ranged between excellent and good in 92.3% of them. There was an increased trend in completeness for 14 variables in the period. There were no duplicate records.

CONCLUSION

Data from the sexual violence against children surveillance system were considered adequate regarding the questions that were assessed in the study.

[Total expenditure of the municipalities on primary healthcare in Brazil: a method to adjust the declared expenditure from 2015 to 2020]

Recently, interest on the expenditure on primary healthcare (PHC) has grown due to a series of reforms to its organization and funding. Data on these and other expenses are declared via subfunctions by public health managers through the Brazilian Information System for the Public Budgets in Health (SIOPS). In the public budget, subfunctions detail in which expenditure area the government action was carried out. However, there are problems in the information via subfunctions, and the expenditures in main object areas - such as PHC - are commonly underestimated, if only the records of the specific subfunction are considered. Thus, this article proposes a method to adjust the total expenditure in primary care of each municipality, from 2015 to 2020, allowing for the production of adjusted databases to be used in PHC finance studies in Brazil. Therefore, an investigation based on budgetary-financial execution data in public health actions and services was conducted to produce a methodological framework, observing the following steps: (i) data identification; (ii) development; and (iii) validation of the methodological framework. The methodological framework was created and tested, confirming the validity of the proposed method for adjusting the expenditure declared for PHC in the period from 2015 to 2020. If the adjustment had not been made, the PHC expenditure would have been underestimated by BRL 11.4 billion, in 2015, and BRL 9.6 billion, in 2020, (at current prices), corresponding to a 19.8% and 12.6% underestimation, respectively.

Assessment of the completeness of filling the pregnant woman's card from the Ministry of Health: a national, cross-sectional study

This article aims to evaluate the completeness of the pregnant woman's card filling according to a model standardized by the Ministry of Health. Hospital based, nationwide, cross-sectional study conducted between 2011 and 2012, evaluated data from pregnant women's cards. Variables related to personal, obstetric history and current pregnancy data were used to assess completeness. We used the Kotelchuck index for quantitative evaluation. We analysed 6,577 cards, equivalent to 39% of the cards presented at the time of delivery. The mean completeness was overall "bad" in Brazil and macro-regions, except in the Southern region. Nationwide, the mean completion was "regular" for personal antecedents, "good" for obstetric history, and "bad" for fields related to the current pregnancy. Prenatal care was adequate for 58% of pregnant women. We observed a reduced use of the card recommended by the Ministry of Health and failures in the completeness of filling valuable information of the pregnant woman's card, related to the current pregnancy.

Relationship between Professional Training of Dentists and Outpatient Clinical Production

Background. The aim was to evaluate the association between the professional training of dentists and their outpatient production (OP) of clinical and collective/preventive procedures and the total number of procedures registered in a health information system. Methods. It included all 19,947 primary dental care units participating in the Program for Improvement of Access and Quality of Primary Care (PMAQ-AB 2nd cycle) and the number of clinical procedures (CP), collective/preventive procedures (PP), and total procedures (TP) registered in the ambulatory information system between November 2013 and July 2014 for each participant oral health team. The outcome was being above the national median of procedures. The main variables related to training were the dentists specialising in family health, the level of training, and participation in permanent education. Effect estimates were calculated by multiple logistic regression. Results. In the final model, controlled by contextual factor work process, family health specialists had higher chances ( $\text{odds}\text{ratio}\left(\text{OR}\right)=1.13$ , 95% CI: 1.00; 1.27) of producing above the national median of CP than nonspecialists, $\text{OR}=1.06$ (0.96; 1.18) for PP and $\text{OR}=1.17$ (1.08; 1.27) for TP. Dentists taking permanent education had higher chances than those not taking it of producing above the national median for CP, PP, and TT, respectively, with $\text{OR}=1.40$ (1.20; 1.62), $\text{OR}=1.24$ (1.09; 1.40), and $\text{OR}=1.28$ (1.18; 1.39). Conclusion. Training in family health performs more procedures in primary care settings than those without training. However, this OP is influenced by variables related to the municipality and the work process, especially for PP. If the highest production observed is a consequence of training, then public health managers can not only encourage training policies such as permanent education policies to expand the use of services.

Implementation of the e-SUS Primary Care Strategy: an analysis based on official data

OBJETIVE

Analyze the implementation of the strategy e-SUS Atenção Básica (e-SUS AB – e-SUS Primary Care) in Brazil between the first years of the system, from 2013 to 2019.

METHODS

This is a quantitative, descriptive, and exploratory study. We considered official data from the Ministry of Health, submitted by Brazilian municipalities, in the period from April 2013 to December 2019. We categorized the municipalities as ‘not implemented’, ‘initial implementation’, ‘partial implementation’ and ‘implemented’ according to the criteria defined in this study. We also verified whether the type of municipality, according to the IBGE classification, influenced the degree of implementation of the e-SUS AB strategy. We performed descriptive analyses and investigated the association between the degrees of implementation of e-SUS AB and the typology of the IBGE classification and characterization of rural and urban spaces.

RESULTS

The implementation increased in the analyzed period. The implementation status of the e-SUS AB strategy in 2019 was ‘implemented’ in 20.2% (1,117) of the municipalities, ‘partial implementation’ in 32.9% (1,819), ‘initial implementation’ in 39.1% (2,159) and ‘not implemented’ in 7.8% (432). The South and Southeast regions presented the best implementation situation in all years, and the states of Rio Grande do Sul, São Paulo and Santa Catarina reached a higher percentage of municipalities with ‘implemented’ status in 2019.

CONCLUSIONS

We confirmed the progress in the implementation of the e-SUS AB strategy over the years. Most of the municipalities are between the status ‘initial implementation’ and ‘partial implementation’. Therefore, we conclude that investments in technological resources, training of professionals, and support are necessary to qualify the implementation and use of information systems in the country, especially for the e-SUS AB strategy.

The relationship between socioeconomic development, renewable energies and the innovative process

Purpose

This paper aims to examine the relationships between socioeconomic development, renewable energy and the innovative process by providing: a descriptive analysis; a co-occurrence analysis of terms, thematic mapping and conceptual structure; and the typology of the textual corpus.

Design/methodology/approach

To analyze the relationship between “renewable energies, socioeconomic development and the innovative process,” it is necessary to build a theoretical foundation that contains the relevant scientific studies and reflects the current state of the art on the subject. For this, this study developed a systematic literature review (SLR) using the preferred reporting items for systematic reviews and meta-analyses research protocol to answer the relationship on the theme.

Findings

Research shows a global understanding of the need to invest in developing studies to reduce carbon dioxide emissions and improve economic growth. The main contributions lie in providing a typology of the state of the art, identifying the joint relationships between themes, insights into the key themes and indicating themes that must be developed. This study may also support future empirical studies as it provides a theoretical foundation for formulating hypotheses, which can be tested through qualitative and quantitative approaches.

Originality/value

The innovative character consists of addressing a shortage of SLRs on this theme. Thus, this paper fills this gap by providing a theoretical foundation for future scientific and academic knowledge generation. Furthermore, regarding the interdisciplinary aspects of this research as contributions, this paper presented different approaches and theoretical perspectives.

Application of workload indicators to assess the allocation of orthopedists in a national referral hospital in Brazil

BACKGROUND

The study analyzes the allocation of specialized doctors' orthopedists in a high-complex hospital, using the WHO's Workload Indicators of Staffing Need (WISN) methodology and approach, which measures the workload pressure on the healthcare team (positive, negative, or well-adjusted).

METHODS

In the first phase, the hospital's operations and activities were analyzed using the information system. The duration of the tasks performed by the specialist physicians was observed and directly measured in the second phase. Finally, the indicators were analyzed, and the workload was calculated using the WISN application. The measurement was made using the available work time per year divided by the time unit over the previous 12 months.

RESULTS

The hand surgery care unit was WISN 1.0 and the ratios for the spine surgery care unit was 1.22, indicating enough physicians and no work overload among the groups surveyed. The ratio in the knee unit was 1.69, indicating that there was an excess of staffing for the workload.

CONCLUSION

The workload findings and staffing calculations were useful in supporting and orienting the design and implementation of measures to increase the efficiency and effectiveness of health services.

Unemployment and suicide among the Brazilian population in the crisis of capitalism

The current crisis of capitalism has multiple economic, financial, social, environmental, cultural and political facets. In Brazil, the severity of the crisis is no different, resulting from the exhaustion of the neo-developmentalist model and its inability to resist global crisis. This study compares suicide mortality rates (MR) among employed and unemployed persons in Brazil prior to and during the economic crisis using death records from the period 2011 to 2016. The findings show that in the period 2011 to 2016 the suicide MR fell from 2.66/100,000 to 2.46 among unemployed persons and increased from 5.52/100,000 to 6.89/100,000 in employed persons. Suicide is a complex, multi-causal phenomenon determined by a diverse range of social factors, including strategies that increase worker exploitation. Indeed, being employed can have a greater negative impact on the mental health of workers than being unemployed.

Use of linkage to analyze completeness and concordance of deaths from congenital syphilis in the Metropolitan Region of São Paulo, Brazil, 2010-2017: a descriptive study

OBJECTIVE

To evaluate the completeness and concordance of infant deaths from congenital syphilis in the Metropolitan Region of Sao Paulo, Brazil, between 2010 and 2017.

METHODS

This was a descriptive study based on linkage between the Mortality Information System (SIM) and the Live Birth Information System (SINASC). Deaths with mention of congenital syphilis in multiple causes of death were analyzed. The completeness of 11 SIM variables was analyzed and SINASC was adopted as the reference. The Kappa statistic was used to analyze concordance.

RESULTS

There were 134 recorded congenital syphilis deaths, 132 of which were linked. 67 had congenital syphilis as the underlying cause, while 65 involved multiple causes of death, indicating underestimated congenital syphilis mortality. After linkage, the number of variables with excellent completeness increased from two to ten.

CONCLUSION

Linking SIM with SINASC data improved completeness. The magnitude of congenital syphilis mortality was found to be underestimated, and the use of multiple causes improved its measurement.

Agreement and validity of asbestos-related cancers in the hospital information system of the Brazilian Unified Health System

OBJECTIVE

To estimate the degree of agreement and validity of diagnoses of asbestos-related malignant neoplasms registered in the Hospital Information System of the Brazilian Unified Health System (SIH/SUS), in comparison to the Hospital Cancer Registries of the State of São Paulo (HCR/SP).

METHODS

Deaths with records of malignant neoplasms associated with asbestos were identified and extracted from SIH/SUS between 2007 and 2014. Deaths in cases registered in the HCR/SP were extracted for the same period. The databases were linked using software Link Plus. A single ICD-10-coded diagnosis selected from each system was analyzed. The proportion of agreement, and the sensitivity, specificity and predictive values were estimated.

RESULTS

19,458 pairs were found with records in both bases. The proportion of agreement was high, ranging from 92.4% for the unknown primary site, to 99.7% for cancer of the pleura. The Kappa Index ranged from 0.05 (95%CI 0.04 - 0.07) for cancer of the pleura to 0.85 (95%CI 0.84 - 0.87) for lung cancer. Sensitivity varied from 0.08 (95%CI 0.01 - 0.25) for cancer of the pleura, to 0.90 (95%CI 0.90 - 0.91) for lung cancer.

CONCLUSION

Diagnosis of asbestos-related malignancies reached higher levels of agreement and validity when common. Rare diagnoses showed low accuracy in SIH/SUS.

Evaluation of the National Immunization Program Surveillance System - Vaccination Record Module, Brazil, 2017

OBJETIVO

To evaluate the National Immunization Program Immunization Surveillance System, based on its Vaccination Record module, for Brazil in 2017.

METHODS

This was a descriptive study using the Guidelines for Evaluating Public Health Surveillance Systems, published by the Centers for Disease Control and Prevention (CDC/Atlanta/GA/United States) to evaluate the attributes of simplicity, flexibility, data quality, sensitivity, timeliness and usefulness of the system for six vaccines on the child immunization schedule.

RESULTS

The Immunization Surveillance System was considered complex in its description; flexible to changes in the immunization schedule; of poor data quality for the DTP and rotavirus vaccines; regular acceptability; high sensitivity for the BCG vaccine; untimely for the hepatitis B vaccine and useful for the purposes of the National Immunization Program.

CONCLUSION

The data quality, acceptability and timeliness results were not satisfactory, so that actions are needed to enhance the information system.

[Evaluation of the Performance of the Brazilian Notification System for Health Surveillance: A Tool in Brazil's Pharmacovigilance System]

The scope of this paper is to assess the performance of the Brazilian Notification System for Health Surveillance, with respect to the registration of information on adverse drug-related effects on health (Notivisa/medication) based on previously selected attributes. A cross-sectional health evaluation study was conducted between 2008 and 2013 using eight attributes established by international guidelines to assess public health surveillance systems: simplicity, acceptability, representativeness, completeness, validity, consistency, positive predictive error and timeliness. In the study period, 63,512 registrations were identified in Notivisa/medication, the majority being considered severe (60.5%). The performance of Notivisa/medication was considered satisfactory with respect to two of the eight attributes (validity and positive predictive error) and deficient in six of the remaining attributes (simplicity, acceptability, representativeness, completeness, consistency and timeliness). Quality improvement strategies to remedy the system need to be discussed and implemented in order to provide complete, timely and reliable surveillance information for different segments of Brazilian society, especially health surveillance managers.

[Gaps in drug-resistant tuberculosis surveillance: probabilistic database linkage in Brazil]

The study aimed to assess the coverage and reliability of drug-resistant tuberculosis (DR-TB) case closure in the Information System on Special Treatments for Tuberculosis (SITE-TB in Portuguese) in Brazil from 2013 to 2016, based on probabilistic linkage with the Information System on Diseases of Notification (SINAN), Laboratory Environment Manager (GAL), and Mortality Information System (SIM). The study population consisted of DR-TB cases that initiated treatment from 2013 to 2016 in Brazil. Linkage with SINAN assessed the coverage and estimated underreporting of DR-TB cases. The capture-recapture method was applied, using the Chapman estimator. Linkage with GAL identified cases diagnosed by the laboratory that had not been reported to SITE-TB. Linkage with SIM assessed the reliability of case closure by death in SITE-TB, using the kappa coefficient. We estimated a population of 2,945 (95%CI: 2,365-3,602) new cases of DR-TB with the Chapman estimator. We located 1,626 individuals in the GAL database that had not been reported to SITE-TB, even with laboratory confirmation of drug resistance. PABAK (prevalance and bias adjusted kappa) of 0.86 (95%CI: 0.85-0.87) was classified as excellent for the agreement in death as the outcome between the SITE-TB and SIM databases. The results pointed to persistent gaps related to diagnosis and treatment of DR-TB in Brazil. Underreporting of DR-TB cases in the SITE-TB database poses a challenge for TB control. Identification of these individuals and early start of treatment should be prioritized in health services.

The influence of climatic conditions on hospital admissions for asthma in children and adolescents living in Belo Horizonte, Minas Gerais, Brazil

Limited research exists on the influence of climatic conditions on the risk of hospital admission for asthma in Minas Gerais, Brazil. The objectives of this article are: a) to evaluate the influence of climatic conditions on hospital admissions for asthma and lower respiratory tract infections (LRTIs) among children and adolescents living in Belo Horizonte during the period 2002 to 2012 and identify epidemic peaks of admissions for asthma; b) to compare local seasonal patterns of admissions for asthma and LRTIs. Using hospital admission data stratified by aged group, regression analysis was performed to determine the relationship between the variables. Epidemic peaks were identified using an ARIMA model. There was an increase in admissions for asthma with an increase in relative humidity after rainy periods; admissions for bronchiolitis were associated with low levels of maximum temperature and rainfall. Rainy periods can lead to an increase in indoor and outdoor humidity, facilitating fungal proliferation, while cold periods can lead to an increase in the spread of viruses.

[Profile of service providers in high-risk neonatal care in the databases of the Brazilian Unified National Health System]

The study aimed to analyze the profile of service providers in the Brazilian Unified National Health System (SUS) in relation to high-risk neonatal care procedures, based on data from the public-access database on Authorizations for Hospital Admissions (AIH) without identification of the neonatal patient. This cross-sectional study used data on AIH of unidentified newborns up to one day old, issued from January 2013 to December 2015, and from the National Registry of Healthcare Establishments. The TwoStep Cluster method was used to classify the establishments with similar characteristics. Regional differences were observed in the frequency of use of neonatal intensive care units and in special procedures recorded in the databases. The TwoStep Cluster method identified three groupings of providers: the first with 1,151 establishments and with low-complexity hospitalizations, the second with 84 establishments and surgical-profile hospitalizations, and the third with 393 establishments and higher complexity hospitalizations in neonatal care, including surgeries. The records on admissions jointly with multivariate analytical techniques have the potential to support decision-making by SUS administrators in the organization of neonatal care.

Evaluation of malaria surveillance system in Kano State, Nigeria, 2013-2016

Background

Malaria surveillance system strengthening is essential in the progress towards malaria elimination. In Nigeria, more attention is being given to this recently as the country is striving towards achieving elimination. However, the surveillance system performance is fraught with challenges including poor data quality with varying magnitude by state. This study evaluated the operation of the Kano State malaria surveillance system and assessed its key attributes.

Methods

An observational study design comprising a survey, record review and secondary data analysis, and mixed methods data collection approach were used. Four key stakeholders’ and 35 Roll Back Malaria Focal Persons (RBMs) semi-structured interviews on operation of the system and attributes of the surveillance system, were conducted. We analyzed the abstracted 2013–2016 National Health Management Information System web-based malaria datasets. The surveillance system was evaluated using the “2001 United States Centers for Disease Control’s updated guidelines for Evaluating Public Health Surveillance Systems”. Data were described using means, standard deviation, frequencies and proportions. Chi-squared for linear trends was used.

Results

Overall, 24 RBMs (68.6%) had ≤ 15-year experience on malaria surveillance, 29 (82.9%) had formal training on malaria surveillance; 32 RBMs (91.4%) reported case definitions were easy-to-use, reporting forms were easy-to-fill and data flow channels were clearly defined. Twenty-seven respondents (69.2%) reported data tools could accommodate changes and all RBMs understood malaria case definitions. All respondents (4 stakeholders and 34 RBMs [97.1%]) expressed willingness to continue using the system and 33 (84.6%) reported analyzed data were used for decision-making. Public health facilities constituted the main data source. Overall, 65.0% of funding were from partner agencies. Trend of malaria cases showed significant decline (χ²_trend = 7.49; P = 0.0006). Timeliness of reporting was below the target (≥ 80%), except being 82% in 2012.

Conclusions

Malaria surveillance system in Kano State was simple, flexible, acceptable, useful and donor-driven but the data were not representative of all health facilities. Timeliness of reporting was suboptimal. We recommended reporting from private health facilities, strengthening human resource capacity for supportive supervision and ensuring adequate government funding to enhance the system’s representativeness and improve data quality.

[Hospitalizations and deaths related to sporotrichosis in Brazil (1992-2015)]

Sporotrichosis is a subcutaneous mycosis with global distribution, and patients generally receive outpatient treatment. Since 1998 there has been an increase in cases in the state of Rio de Janeiro, Brazil, mainly via zoonotic transmission involving cats. Patients coinfected with the human immunodeficiency virus (HIV) often require hospitalization and evolve to death. This study analyzes and describes data from 1992 to 2015 obtained from the database of the Brazilian Unified National Health System (SUS). There were 782 hospitalizations and 65 deaths in Brazil. Six percent of the hospitalizations and 40% of the deaths involved coinfection with HIV. There were 250 hospitalizations and 36 deaths in Rio de Janeiro, with a progressive increase over the course of the period. The states of São Paulo and Goiás also showed high numbers. Men, non-whites, and individuals with low schooling evolved more frequently to death. In conclusion, sporotrichosis is associated with hospitalizations and deaths throughout Brazil, especially in the state of Rio de Janeiro.

Qualidade dos sistemas de informações sobre nascidos vivos e sobre mortalidade no Rio Grande do Sul, Brasil, 2000 a 2014

Resumo O estudo avalia a qualidade do SIM e do SINASC nos aspectos cobertura, incompletitude e consistência, bem como a contribuição do “linkage” para a recuperação de dados. Foram analisados nascimentos e óbitos de menores de um ano ocorridos no Rio Grande do Sul entre 2000 e 2014. Os registros foram pareados por “linkage” determinístico através do número da DNV e, na ausência deste, por “linkage” probabilístico. A cobertura do SINASC aumentou 37%, passando de 72,2% em 2000 para 98,9%. O grau de incompletitude do SINASC foi excelente para todas as variáveis, exceto quantidade de filhos mortos e ocupação materna. No SIM, até 2003 a maioria das variáveis apresentou preenchimento ruim ou muito ruim. Apesar da melhoria, seis delas ainda possuíam preenchimento regular ou ruim em 2014. Após o “linkage”, a incompletitude reduziu-se para grande parte das variáveis. Houve alta variabilidade quanto à consistência: sexo apresentou percentual superior a 97% em todo período, enquanto para outras cinco variáveis essa fração segue inferior a 75% em 2014. Destaca-se a alta cobertura e a excelente incompletitude do SINASC. Persistem problemas relacionados à consistência de informações. Evidencia-se a relevância do “linkage” como método para recuperar informações.

Avaliação da cobertura e completitude de variáveis de Sistemas de Informação sobre orçamentos públicos em saúde

RESUMO Este artigo avalia a qualidade dos Sistemas de Informação Finanças do Brasil (Finbra) e Sistema de Informação de Orçamento Público em Saúde (Siops), nas dimensões de cobertura e completitude para os municípios do Brasil, entre 2004 e 2012, considerando algumas variáveis fiscais e de investimento em saúde. O Finbra e o Siops apresentaram excelente cobertura; já a completitude variou de excelente a regular. O Siops teve melhor desempenho para as duas dimensões. A variável de pior desempenho foi a Despesa Atenção Básica, tanto para a dimensão de cobertura como para completitude e para a maioria dos anos da série. Conclui-se que os dois Sistemas de Informação apresentaram qualidade satisfatória, o que deve estimular os gestores a utilizarem essas informações para a tomada de decisão. Além do respeito ao pilar da transparência na garantia do exercício dos direitos dos cidadãos.

[Aspects related to the use of antiretrovirals in high complexity patients in the state of Rio de Janeiro]

Treatment of AIDS involves the use of the cocktail of drugs that make up the antiretroviral therapy. Its logistic control is monitored by a computerized national system of dispensation, the Logistic Control System of Medication (SICLOM). This study aimed to investigate, by means of SICLOM data, the use of antiretroviral therapy in patients treated at two University Hospitals in the state of Rio de Janeiro. A cross-sectional study was conducted with sociodemographic and dispensation data collected from SICLOM. The evaluation of drug ownership was done by calculating the Proportion of Days Covered (PDC). Five hundred and thirty-eight patients of both genders with active registration in SICLOM and over 18 years of age were included. The ART most used in both hospitals was lamivudine, considering the total of 58 different schemes identified. The mean of possession of groups was 88% (± 0,16). The factor associated with possession of drugs was the ART scheme, with PDC of 91% (p<0,001) for rescue schemes. This study confirmed that SICLOM was a reliable source to establish the profile of the population assisted.

Avaliação das informações do Sistema de Informações sobre Nascidos Vivos (SINASC), Brasil

Resumo: Neste trabalho, avaliam-se quantitativa e qualitativamente as informações do Sistema de Informações sobre Nascidos Vivos (SINASC). A cobertura das informações por município foi estimada pela razão entre nascidos vivos informados e estimados. Para avaliação da qualidade das informações do SINASC, relacionou-se o sistema à base de dados do estudo Nascer no Brasil, 2011-2012, e foram estimados coeficientes kappa de concordância. Em 2013, a cobertura das informações foi alta e homogênea em todas as Unidades da Federação. Entretanto, a análise por município brasileiro apresentou maior heterogeneidade espacial. Quanto à qualidade de preenchimento das informações do SINASC, os coeficientes kappa de concordância foram estatisticamente diferentes de zero para todas as variáveis testadas (p < 0,001), e as distribuições marginais para todas as variáveis consideradas foram semelhantes nas duas bases de dados. A idade gestacional foi a variável que mostrou pior concordância, com valor de kappa de 0,461. O indicador que descreve as inconsistências, medido pela soma do quadrado das diferenças entre os percentuais de prematuridade informados e esperados por faixa de peso ao nascer, teve o valor mais alto na Região Norte e o menor na Região Sul, apontando para desigualdades geográficas na mensuração da idade gestacional.

Expenditure trends in ambulatory care sensitive conditions in the under-fives in Bahia, Brazil

This study analyses expenditure trends in Hospitalizations for Ambulatory Care Sensitive Conditions (ACSCs) in children. It is an ecological time-series study, including hospitalizations of children under five in Bahia, between 2000 and 2012. We calculate the annual ACSC rates, as well as the total and average expenditure on these hospitalizations. We construct linear regression analysis models for the temporal trends. Between 2000 and 2012, 810,831 ACSC hospitalizations for the under-fives were recorded in Bahia. Hospitalization rates dropped 24.7% over this period, falling from 44.6 to 33.6 per 1,000 children. The total expenditure on such admissions is estimated to be 155.8 million Brazilian Reals. When we compare the first with the last year of the series, we note a reduction of 50.4% in total expenditure. The linear regression analysis demonstrates a reduction trend in average ACSC expenditure (β = -1.20, p = 0.014), (β = -3.45, p <0.01) and total expenditure (β = -0,46, p <0.01). Despite the reductions in these indicators, ACSC rates remain high, which has a significant impact on the volume of resources spent on avoidable hospitalizations. To this end, it is important to reduce ACSC expenditure, to both improve population health and reduce hospital costs.

Data Governance in the Health Industry: Investigating Data Quality Dimensions within a Big Data Context

In the health industry, the use of data (including Big Data) is of growing importance. The term ‘Big Data’ characterizes data by its volume, and also by its velocity, variety, and veracity. Big Data needs to have effective data governance, which includes measures to manage and control the use of data and to enhance data quality, availability, and integrity. The type and description of data quality can be expressed in terms of the dimensions of data quality. Well-known dimensions are accuracy, completeness, and consistency, amongst others. Since data quality depends on how the data is expected to be used, the most important data quality dimensions depend on the context of use and industry needs. There is a lack of current research focusing on data quality dimensions for Big Data within the health industry; this paper, therefore, investigates the most important data quality dimensions for Big Data within this context. An inner hermeneutic cycle research approach was used to review relevant literature related to data quality for big health datasets in a systematic way and to produce a list of the most important data quality dimensions. Based on a hierarchical framework for organizing data quality dimensions, the highest ranked category of dimensions was determined.

Data quality of the reporting of viral hepatitis caused by work-related accidents, Brazil

OBJECTIVE

To assess the completeness and consistency of reports describing viral hepatitis caused by work-related accidents in Brazil between 2007 and 2014.

METHODS

This is an analytical, epidemiological study evaluating the quality of data from the Information System for Notifiable Diseases (Sistema de Informação de Agravos de Notificação). Data were analyzed using absolute and relative frequencies, proportional percentage variation, and a linear χ2 test.

RESULTS

The majority of mandatory and essential variables were classified with good completeness, despite growth during the study period. The occupation and clinical form variables were classified as normal when they had less than 25.1% incomplete data. Inconsistency was considered high among different variables above 15.0%, including, for example, serologic markers with the types of viral hepatitis and age with occupation and date of birth.

CONCLUSIONS

We need to evaluate data quality periodically, in addition to train health professionals on the adequate way to completely fill out reports, because this contributes to the establishment of an efficient surveillance of communicable diseases and improves the population's quality of life.

National Registry of Health Facilities: data reliability evidence

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 distribuição dos nascimentos com marcadores de gravidade em maternidades com unidade de terapia intensiva neonatal no Sistema Único de Saúde

Resumo Introdução No Brasil, os óbitos neonatais são a principal componente da mortalidade infantil sendo necessário informações para subsidiar a reorganização dos sistemas locais e o planejamento da oferta do cuidado neonatal. Objetivo Verificar a potencialidade do Sistema de Informação sobre Nascidos Vivos (SINASC) para descrever a distribuição dos nascimentos com marcadores de gravidade em maternidades com unidade de terapia intensiva neonatal no Sistema Único de Saúde. Método Trata-se de estudo transversal com o uso do SINASC. O peso de nascimento e o escore de Apgar no 5º minuto foram utilizados para a construção dos marcadores de gravidade. A complexidade das maternidades foi descrita pela existência de unidade de terapia intensiva neonatal níveis II ou III. Resultados No Brasil, 55% dos nascimentos e 38% daqueles com marcadores de gravidade ocorreram em estabelecimentos sem terapia intensiva. Os menores de 1.500 g apresentaram maiores percentuais de nascimentos em estabelecimentos que dispõem de terapia intensiva. Observou-se uma maior frequência de nascimento em terapia intensiva nas regiões Sudeste e Sul. Conclusão O SINASC, mesmo tendo problemas no registro de variáveis importantes para definição dos marcadores de gravidade neonatal, apresentou potencial para ser usado por pesquisadores e gestores de saúde na análise do cuidado neonatal.

Factors associated with unspecified and ill-defined causes of death in the State of Amazonas, Brazil, from 2006 to 2012

This study aimed to investigate factors associated with unspecified and ill-defined causes of death in the State of Amazonas (AM), Brazil. This is a cross-sectional study on 90,439 non-fetal deaths of residents in AM from 2006 to 2012. The hierarchical multinomial logistic model estimated odds ratios of unspecified and ill-defined causes of death. Ill-defined and unspecified causes of death proportional mortality was, respectively, 16.6% and 9.1%. Ill-defined causes showed a decreasing trend over the years, while unspecified causes only decreased in the last two years. Unspecified causes of death were associated with residence and death outside the capital, public roads, female gender, age group 10-49 years, brown skin color and when certified by forensic doctors. Ill-defined causes of death were associated with residence and occurrence outside capital, at home, ages 40 years and older, non-whites, not being single, low schooling, under medical care and when examiner was unknown. Ill-defined and unspecified cause mortality in the State of Amazonas decreased between 2006 and 2012 in AM and was associated with space and time, demographic and socioeconomic factors and medical care at the moment of death.

Qualidade dos dados de assistência pré-natal na Atenção Básica em prontuário eletrônico e relação com apoio matricial, Vitória, Espírito Santo, 2013-2014: corte transversal

Objetivo: Avaliar as dimensões de qualidade dos dados de prontuários eletrônicos de gestantes acompanhadas na Atenção Primária à Saúde de Vitória, Espírito Santo, e comparar sua completude por modelos de assistência em saúde (Unidades Básicas Tradicionais e Saúde da Família com e sem Apoio Matricial). Métodos: Estudo transversal, das dimensões de qualidade da ficha clínica de pré-natal do prontuário eletrônico de gestantes do município de Vitória, Espírito Santo, Brasil, no período de 1 de janeiro de 2013 a 31 de dezembro de 2014. Foram avaliadas: cobertura, não duplicidade, acessibilidade, oportunidade, clareza metodológica, completude, consistência e confiabilidade. Resultados: Excluídas as duplicidades de cadastro, foram analisados 690 prontuários. A cobertura pré-natal, considerando o início do pré-natal, foi de 80%. Mesmo com a restrição de acesso, de oportunidade e a falta de clareza metodológica, a ficha clínica apresentou consistência e completude excelentes nos campos de procedimentos obstétricos e exames laboratoriais. As variáveis raça materna, situação conjugal, planejamento da gravidez e risco gestacional apresentaram completude ruim, variando conforme modelo de assistência em saúde. A confiabilidade mostrou discordâncias com o Sistema de Informação de Nascidos Vivos. Conclusão: Há potencial do prontuário eletrônico como fonte de informação epidemiológica sobre a assistência pré-natal. Contudo, sua confiabilidade é prejudicada pela falta de integração dos dados com os demais níveis de atenção e sistemas de informação e sua completude é deficiente em alguns aspectos. Os dados sugerem que a presença do Apoio Matricial não influencia significativamente a completude do prontuário. Maior ênfase no preenchimento do prontuário e integração com outros níveis de atenção é necessária.

Indicators for teenager's oral health's surveillance

The existence of a few indicators that could guide the evaluation of oral health surveillance in the primary health care attention, mainly in adolescence life cycle, raised the realization of this study. To develop indicators to this end, it was conducted: document analysis to guide the development of a logic model and selection of data to compose indicators. This selection and validation of the logic model were performed by a group of four experts that, from the perspective of the modified Delphi method, analyzed if the model illustrated the activities, results and expected impact of a primary oral health service to enable the adolescents oral health surveillance and assigned points (0-10) to each data proposed. Then, those data judged important by the consensus of experts (média≥7; standard deviation <3) were used to construct indicators. After individual analysis and group discussions, the logical model and 36 of the 48 data, initially proposed, were consensually important, resulting in 26 indicators. The indicators matrix intends to be a situational diagnostic tool to assess, plan and manage health actions to adolescents, but it can be used in other life cycles by its adaptation.

The quality of certification of deaths due to external causes in the city of Fortaleza in the State of Ceará, Brazil

The article analyzes the quality of information of deaths from external causes in Fortaleza, in the State of Ceará, Brazil. They analyzed the completeness of the information of the death certificate (DO) and the correlation between the underlying cause of death described in the OF and registered in the Mortality Information System (SIM ).We used all the original statements of deaths from external causes, occurred in 2010, of residents in Fortaleza. The study population was 2109 DO. The statements were individually checked seeking to identify the completion of the fields and the basic cause attested the coding of the underlying cause in this DO and compared with the SIM was held. The fields with the highest completion rates were: name (100%), place of residence (100%), mother's name (99.6%), place of birth (99.1%), and sex (98.8%). The fields with the lowest completion rates were: place of occurrence (55%), race/skin color (38.4%), and schooling (34%). They observed inadequacies in the completion of the underlying cause. In DO are reported injuries found and not the circumstances of the death. There was poor level of concordance between the basic cause of DO and registered on the SIM (kappa 0.07). They suggest awareness strategies and training of medical examiners.

Panorama das internações por condições sensíveis à atenção primária no Espírito Santo, Brasil, 2000 a 2014

Objetivo: Descrever a série temporal das internações por condições sensíveis à atenção primária (ICSAP) no estado do Espírito Santo, no período de 2000 a 2014, segundo sexo, faixa etária, porte municipal, macrorregiões e grupos de causa, e investigar os fatores associados à ocorrência dessas hospitalizações. Métodos: Estudo ecológico de série temporal das ICSAP ocorridas de 2000 a 2014. A análise da série temporal foi realizada pelo método Cochrane-Orcutt, e para a análise de regressão multivariável multinível usou-se o modelo de regressão binomial negativa. Resultados: As ICSAP diminuíram 28,79% no período. As maiores taxas foram observadas entre os idosos e as crianças menores de cinco anos, e reduziram mais entre idosos e adultos. Os principais grupos de causas foram as gastroenterites infecciosas e complicações, a infecção no rim e trato urinário, e a insuficiência cardíaca. Houve redução das taxas de ICSAP na medida em que cresceu a taxa de cobertura da estratégia saúde da família (0,60, IC: 0,56-0,66), a proporção de médicos (0,90, IC: 0,84-0,96), de pretos e pardos (0,88, IC: 0,83-0,93) e de pessoas com ensino médio (0,87, IC: 0,76-0,99), enquanto houve acréscimo dessas hospitalizações a cada aumento do produto interno bruto per capita, do índice de Gini, da taxa de urbanização, dos leitos hospitalares e dos planos de saúde. Conclusão: A expansão e consolidação da estratégia saúde da família são importantes para a redução das ICSAP no estado dentre outros fatores, como recursos de saúde e fatores socioeconômicos.

Quality of the data in the information system for work accidents under exposure to biological materials in Brazil, 2010 to 2015

BACKGROUND

Health information systems allow for the identification of problems in this field, and often represent the single source of information; therefore, accurate determination of their quality is crucial.

AIMS

To analyze accessibility, opportunity and completeness as criteria for the quality of the information provided by System of Information for Notifiable Conditions (Sistema de Informação sobre Agravos de Notificação - SINAN) on Work Accidents under Exposure to Biological Materials (Acidentes de Trabalho com Exposição a Material Biológico - ATEMB) from 2010 to 2015.

METHODS

Observational and descriptive study based on secondary SINAN data on ATEMB. The object of analysis was all ATEMB records from the 26 Brazilian states and Federal District from 1 January 2010 to 31 December 2015.

RESULTS

Information is accessible and timely, while the data for the ongoing year are only made available the following one. The percentage of incomplete data in SINAM-ATEMB was high for the following variables: educational level, length of work in the current job, organic materials, serological status of affected individuals and source-patient, measures adopted, case progression and Work Accident Notification (Comunicação de Acidente de Trabalho - CAT); therefore, these variables cannot be included in analyses of risk factors.

CONCLUSION

Despite the accessibility of the database and the relevance of its variables, SINAN-ATEMP exhibits problems in its quality that indicate an indisputable need to improve the completeness of information.

Qualifying information on deaths and serious injuries caused by road traffic in five Brazilian capitals using record linkage

INTRODUCTION

Road traffic crashes (RTC) are an important public health problem, accounting for 1.2 million deaths per year worldwide. In Brazil, approximately 40,000 deaths caused by RTC occur every year, with different trends in the Federal Units. However, these figures may be even greater if health databases are linked to police records. In addition, the linkage procedure would make it possible to qualify information from the health and police databases, improving the quality of the data regarding underlying cause of death, cause of injury in hospital records, and injury severity.

OBJECTIVE

This study linked different data sources to measure the numbers of deaths and serious injuries and to estimate the percentage of corrections regarding the underlying cause of death, cause of injury, and the severity injury in victims in matched pairs from record linkage in five representative state capitals of the five macro-regions of Brazil.

METHODS

This cross-sectional, population-based study used data from the Hospital Information System (HIS), Mortality Information System (MIS), and Police Road Traffic database of Belo Horizonte, Campo Grande, Curitiba, Palmas, and Teresina, for the year 2013 for Teresina, and 2012 for the other capitals. RecLink III was used to perform probabilistic record linkage by identifying matched pairs to calculate the global correction percentage of the underlying cause of death, the circumstance that caused the road traffic injury, and the injury severity of the victims in the police database.

RESULTS

There was a change in the cause of injury in the HIS, with an overall percentage of correction estimated at 24.4% for Belo Horizonte, 96.9% for Campo Grande, 100.0% for Palmas, and 33.2% for Teresina. The overall percentages of correction of the underlying cause of death in the MIS were 29.9%, 11.9%, 4.2%, and 33.5% for Belo Horizonte, Campo Grande, Curitiba, and Teresina, respectively. The correction of the classification of injury severity in police database were 100.0% for Belo Horizonte and Teresina, 48.0% for Campo Grande, and 51.4% for Palmas after linkage with hospital database. The linkage between mortality and police database found a percentage of correction of 29.5%, 52.3%, 4.4%, 74.3 and 72.9% for Belo Horizonte, Campo Grande, Palmas, Curitiba and Teresina, respectively in the police records.

CONCLUSIONS

The results showed the importance of linking records of the health and police databases for estimating the quality of data on road traffic injuries and the victims in the five capital cities studied. The true causes of death and degrees of severity of the injuries caused by RTC are underestimated in the absence of integration of health and police databases. Thus, it is necessary to define national rules and standards of integration between health and traffic databases in national and state levels in Brazil.

[Characteristics of sexual violence against adolescent and adult women reported by the public health services in Santa Catarina State, Brazil]

Sexual violence against women is a form of gender violence and both a severe human rights violation and public health problem. This ecological, descriptive, and temporal series study aims to analyze sexual violence against pre-adolescent, adolescent, and adult females in Santa Catarina State, Brazil, based on data from the Information System for Notifiable Diseases, in order to describe the characteristics of cases of sexual violence perpetrated against women, reported by health professionals from 2008 a 2013. A total of 15,508 cases of violence were reported, including 2,010 cases of sexual violence (12.9%). Cases of violence totaled 950 reports in the 10 to 14 year bracket (47.3%), 450 in the 15 to 19 year bracket (22.4%), and 610 (30.3%) in women 20 years or older (adults). Adolescent females suffered violence by a single aggressor, at home, at night, with vaginal penetration, and with greater tendency to repeated assault and pregnancy as a result. For females 10 to 14 and 15 to 19 years of age, the aggressors were unknown in 32.9% and 33.1% of the reports, respectively. Adult women were sexually assaulted either at home or on public byways, at night or in the early morning hours, by a single aggressor, with vaginal penetration in more than half of the cases, with more physical injuries, and with more subsequent suicide attempts. The information should contribute to awareness-raising of policymakers, health professionals, researchers, and health field professors concerning the importance of reporting violence in order to help develop interventions to prevent such violence against women.

Hospitalizações por condições sensíveis à atenção primária em Pelotas: 1998 a 2012

RESUMO: Objetivo: Verificar a tendência das taxas de internações por condições sensíveis à atenção primária no município de Pelotas, Rio Grande do Sul, de 1998 a 2012. Métodos: Foi realizado estudo ecológico comparando as taxas de Pelotas com as do restante do estado do Rio Grande do Sul. Na análise, fez-se padronização direta das taxas, os coeficientes foram estratificados por sexo e utilizou-se regressão de Poisson. Resultados: As internações por condições sensíveis diminuíram em Pelotas e no Rio Grande do Sul. Em Pelotas a redução das taxas no período foi de 63,8%, e no restante do Rio Grande do Sul, de 43,1%. Os coeficientes da regressão de Poisson mostraram diminuição de 7% no município de Pelotas e de 4% nas outras partes do Rio Grande do Sul por ano. Conclusão: Durante o período estudado, diversas alterações foram introduzidas no Sistema Único de Saúde (SUS), as quais podem ter contribuído para os resultados encontrados, como modificações na modalidade de gestão, nas formas de financiamento em saúde e na reestruturação da atenção primária mediante a consolidação da Estratégia Saúde da Família.

Infant mortality by color or race from Rondônia, Brazilian Amazon

OBJECTIVE

To analyze the quality of records for live births and infant deaths and to estimate the infant mortality rate for skin color or race, in order to explore possible racial inequalities in health.

METHODS

Descriptive study that analyzed the quality of records of the Live Births Information System and Mortality Information System in Rondônia, Brazilian Amazonian, between 2006-2009. The infant mortality rates were estimated for skin color or race with the direct method and corrected by: (1) proportional distribution of deaths with missing data related to skin color or race; and (2) application of correction factors. We also calculated proportional mortality by causes and age groups.

RESULTS

The capture of live births and deaths improved in relation to 2006-2007, which required lower correction factors to estimate infant mortality rate. The risk of death of indigenous infant (31.3/1,000 live births) was higher than that noted for the other skin color or race groups, exceeding by 60% the infant mortality rate in Rondônia (19.9/1,000 live births). Black children had the highest neonatal infant mortality rate, while the indigenous had the highest post-neonatal infant mortality rate. Among the indigenous deaths, 15.2% were due to ill-defined causes, while the other groups did not exceed 5.4%. The proportional infant mortality due to infectious and parasitic diseases was higher among indigenous children (12.1%), while among black children it occurred due to external causes (8.7%).

CONCLUSIONS

Expressive inequalities in infant mortality were noted between skin color or race categories, more unfavorable for indigenous infants. Correction factors proposed in the literature lack to consider differences in underreporting of deaths for skin color or race. The specific correction among the color or race categories would likely result in exacerbation of the observed inequalities.