Cláudia Medina Coeli

Reclink: aplicativo para o relacionamento de bases de dados, implementando o método probabilistic record linkage

This paper presents a system for database linkage based on the probabilistic record linkage technique, developed in the C++ language with the Borland C++ Builder version 3.0 programming environment. The system was tested in the linkage of data sources of different sizes, evaluated both in terms of processing time and sensitivity for identifying true record pairs. Significantly less time was spent in record processing when the program was used, as compared to manual processing, especially in situations where larger databases were used. Manual and automatic processes had equivalent sensitivities in situations where we used databases with fewer records. However, as the number of records grew we noticed a clear reduction in the sensitivity of the manual process, but not in the automatic one. Although in its initial stage of development, the system performed well in terms of both processing speed and sensitivity. Although overall performance of algorithms was satisfactory, we intend to evaluate other routines in the attempt to improve the systems performance.

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

In Brazil, quality monitoring of data from the various health information systems does not follow a regular evaluation plan. This paper reviews quality evaluation initiatives related to the Brazilian information systems, identifying the selected quality dimensions and the method employed. The SciELO and LILACS databases were searched, as were the bibliographical references from articles identified in the search. 375 articles were initially identified, leaving a final total of 78 after exclusions. The four most frequent dimensions in articles totaled approximately 90% of the analyses. The studies prioritized certain quality dimensions: reliability, validity, coverage, and completeness. Half of the studies were limited to data from Rio de Janeiro and Sao Paulo. The limited number of studies on some systems and their unequal distribution between regions of the country hinder a comprehensive quality assessment of Brazils health information systems. The importance of accurate information highlights the need to implement a data management policy for health information systems in Brazil.

Avaliação de diferentes estratégias de blocagem no relacionamento probabilístico de registros

A blocagem (blocking), que consiste na criacao de blocos logicos de registros dentro de arquivos a serem relacionados, e um dos processos que faz parte do relacionamento probabilistico de grandes bases de dados. Os objetivos deste trabalho sao comparar a eficiencia de diferentes esquemas de blocagem e estudar a eficiencia da utilizacao de uma rotina de padronizacao desenvolvida pelos autores, que aplica a mesma grafia para as primeiras silabas de nomes com o mesmo som. Procedemos ao relacionamento de uma base de dados de mortalidade com 59.065 obitos com uma base de obitos hospitalares com 531 registros, que apresentavam um registro correspondente na base de mortalidade. Diferentes estrategias de blocagem foram comparadas em relacao ao custo para o processamento e a proporcao de pares verdadeiros perdidos. A estrategia de blocagem em multiplos passos foi mais eficiente, permitindo a identificacao de todos os pares verdadeiros com a formacao de um numero total de pares que foi inferior ao obtido em duas rotinas diferentes de passo unico. Ja entre as estrategias de passo unico avaliadas, a que se baseou no emprego da chave formada pela combinacao do codigo soundex do primeiro nome e sexo apresentou o melhor resultado. A utilizacao da rotina de padronizacao que aplica a mesma grafia para as primeiras silabas de nomes com o mesmo som nao apresentou um impacto importante, quer em custos, quer na reducao da perda de pares verdadeiros.

Incidência e mortalidade por câncer de tireóide no Brasil

In this study we evaluated the incidence and mortality due to thyroid cancer (TC) in Brazil using incidence data provided by seven Brazilian cancer registries and mortality data from the Brazilian Mortality Information System. Five-year age-adjusted mortality rates were calculated over a 20-year period (1980-1999) for the country as a whole. We have calculated a 3-year age-adjusted incidence rate using data available since 1993. Age-adjusted mortality rates decreased from 0.22/100,000 to 0.28/100,000 (-21%) among males, and from 0.42/100,000 to 0.51/100,000 (-17%) among females. Among males, age-adjusted incidence rates varied from 0.7/100,000 in Belém to 3.0/100,000 in São Paulo. These cities also presented the lowest (0.8/100,000) and the highest (10.9/100,000) age-adjusted incidence rates among females. The downward tendency of mortality is probably explained by an improvement in diagnosis and treatment of TC over the study period, whereas geographical variations in incidence are probably related to availability of medical care resources in the different regions and the quality of cancer registers data.

Influence of Thyroid Autoimmunity and Maternal Age on the Risk of Miscarriage

Objectives:  Recently, studies have shown an association between antiperoxidase for the detection of thyroid autoimmunity (TAI) and abortion. Another point to be considered is the association of high risk of abortion and maternal age. The aim of the present study was to evaluate if the association between TAI and miscarriage could also be verified whether a population of unselected pregnant young women who normally present a low risk of miscarriage.

The value of peer review

Tradicionalmente, en el fascículo de diciembre de CSP, ponemos en valor la lista de todos quienes contribuyeron con su precioso tiempo a la evaluación de los trabajos originales que nos fueron remitiendo autores. Aprovechamos esta oportunidad para exponer en este editorial una evaluación sobre este proceso. La revisión por pares, utilizada desde hace más de tres siglos para mantener estándares de calidad en las publicaciones, tiene un papel importante en el proceso de comunicación científica. Los revisores son los “guardianes” de la publicación científica, filtrando contenidos de baja calidad y pobremente descritos. Solamente las publicaciones que usan este sistema están incluidas en las bases de datos bibliográficos más importantes. No obstante, este sistema está lejos de ser perfecto 1, comenzando por la identificación de quien es verdaderamente un “par”. Pareceres contradictorios, evaluaciones muy superficiales, que poco contribuyen a la decisión editorial, y el retraso en la emisión de pareceres, son problemas frecuentes. El sistema, que se basa esencialmente en la confianza entre pares, es vulnerable a violaciones éticas cometidas por revisores, tales como el robo de ideas, el plagio y el bloqueo para atrasar la publicación. Pese a que estas situaciones sean raras, pueden producirse incluso en publicaciones de elevado prestigio, como se evidenció en un episodio reciente en Lancet Infections Diseases 2. Más recientemente, se han producido episodios de fraude cometidos por autores que, aprovechándose de fallos en los sistemas electrónicos de remisión de artículos, han intentado realizar maniobras malintencionadas, con el fin de obtener pareceres favorables a la publicación de sus artículos 3. La revisión de un trabajo original es un trabajo poco visible, poco reconocido y no remunerado. Asimismo, es dispendioso para el revisor, por las horas que “pierde” anónimamente evaluando un manuscrito, y desgastante para el autor, que muchas veces reclama, con razón, por el tiempo invertido entre la remisión del artículo y su aprobación final. El incremento del número de publicaciones y de artículos enviados ha causado un aumento de la demanda de revisiones, llevando a una sobrecarga del sistema. CSP recibirá hasta el final de 2014 aproximadamente 1.900 trabajos originales. De ellos, la mayoría es rechazada tras la evaluación de las editoras-jefe inmediatamente después de su llegada, reduciendo así el volumen de artículos enviados a los consultores. No obstante, en 2010, de cada uno de los 607 artículos enviados para que obtuvieran su parecer, dos consultores no respondieron o se declararon no disponibles. Respecto a los 315 enviados hasta finales de octubre de 2014, tuvimos 5,4 rechazos por artículo. El alto rechazo se deriva de adoptar una política de preservación de nuestros consultores: entre los 1.052 consultores que emitieron su parecer entre 2013 y 2014 (18 meses), solamente un 20% proporcionaron más de 2 pareceres. Dos cuestiones simples exponen el tamaño del problema. Manteniendo este mismo ritmo hasta el final del año, enviaremos solamente cerca de 400 artículos para su revisión. Por otro lado, para que obtengamos tres pareceres por artículo, considerando la actual tasa de rechazo de los consultores, será necesario un envío de media de 15 invitaciones por artículo. El cuestionamiento de la revisión por pares es un asunto central hoy entre los que piensan los futuros rumbos que tomará la ciencia 4,5. Se discuten alternativas como la revisión abierta, colectiva, preo pos-publicación 6. Mientras maduramos esta discusión, en 2015,The December issue of CSP has a tradition of acknowledging all those who have contrib-uted their precious time to reviewing papers submitted to the journal. We wish to take ad-vantage of the opportunity in this Editorial to assess the peer review process.Peer review has been used for more than three centuries to sustain quality standards for publication and plays an important role in scientific communication. Reviewers are the “guardians” of scientific publication, filtering out low-quality and poorly reported con-tents. Only the periodicals that use this system are included in the most important bib-liographic databases. However, the system is far from perfect

The epidemiology of hepatitis A in Rio de Janeiro: environmental and domestic risk factors

A serological study of hepatitis A was carried out in low-income areas scheduled for a major sanitation programme in Rio de Janeiro, Brazil. Blood spots were collected by finger puncture and transported on filter paper, and total antibodies to hepatitis A virus were detected by ELISA. Households were also interviewed to collect information on their environmental conditions and socio-economic status. A generalized linear model using a complementary log-log function was fitted to the data, using the logarithm of age as an explanatory variable to derive adjusted rate ratios (RR). The risk of infection was greater among households with 2-3 members per room (RR = 1.4; 95% CI = 1.04-1.8) or more than three per room (RR = 1.5; 95% CI = 1.2-2.0). People living on hilltops (RR = 1.5; 95% CI = 1.02-2.2), near to open sewers (RR = 1.2; 95% CI = 1.03-1.5) or lacking a kitchen (RR = 1.4; 95% CI = 1.08-1.9) were also at greater risk than others. The number of taps and water-using fittings in the house was associated with a protective effect (RR = 0.9 for each tap; 95% CI = 0.9-0.98). A significant protective association was found with maternal education but not with gender or household income. The results do not suggest a strong association with water quality. Ownership of a ceramic water filter was associated with a protective effect on the margin of significance, but the practice of boiling drinking-water was not, nor was the type of water source used. The results suggest that that the risk of infection with hepatitis A is determined by environmental variables in the domestic and public domains.

Association between self-rated health and mortality: 10 years follow-up to the Pró-Saúde cohort study

BackgroundThe association between self-rated health (SRH) and mortality is well documented in the literature, but studies on the subject among young adults in Latin America are rare, as are those evaluating this association using repeated SRH measures, beyond the baseline measurement. This study aims to evaluate the association between SRH evaluated at three data collection stages and mortality.MethodsCox regression models were used to examine the association between SRH (Very good, Good, Fair/Poor) varying over time and mortality, over a 10 year period, in a cohort of non-faculty civil servants at a public university in Rio de Janeiro, Brazil (Pró-Saúde Study, n = 4009, men = 44.4%).ResultsAbout 40% of the population changed their self-rating over the course of follow-up. After adjustment for self-reported physician-diagnosed chronic diseases and other covariates, men who reported “Fair/Poor” SRH showed relative hazard of death of 2.13 (CI95% 1.03-4.40) and women, 3.43 (CI95% 1.23-9.59), as compared with those who reported “Very good” SRH.ConclusionsIn a population of young adults, our findings reinforce the role of SRH as a predictor of mortality, even controlling for objective measures of health.

Reconhecimento, tratamento e controle da hipertensão arterial: estudo Pró-Saúde, Brasil

OBJETIVO: Avaliar a prevalencia, o reconhecimento, o tratamento e o controle da hipertensao em uma populacao brasileira em idade laboral. METODO: Este projeto se insere em um estudo prospectivo com funcionarios de uma universidade do Rio de Janeiro, Brasil (Estudo Pro-Saude). A partir de afericoes padronizadas de pressao arterial e da historia de diagnostico e tratamento da hipertensao, foi estimada a prevalencia de hipertensao em 2 384 participantes de linha de base (1999 a 2001) do estudo. A partir dai, foram determinadas as proporcoes da populacao, segundo sexo e idade, que reconhecem o diagnostico de hipertensao arterial, tratam essa condicao e cuja doenca encontra-se controlada com medicacao anti-hipertensiva. RESULTADOS: Da populacao do estudo, 704 individuos (29,6%) foram classificados como hipertensos; desses, 573 (81,5%) reconheciam previamente sua condicao (88,6% das mulheres e 71,6% dos homens). Dos hipertensos que reconheciam previamente a sua condicao, 445 (77,8%; 88,8% das mulheres e 59,1% dos homens) estavam em tratamento com anti-hipertensivos. Por sua vez, dos hipertensos que estavam em tratamento, 287 (60,1%; 61,5% das mulheres e 57,4% dos homens) estavam controlados. Entre aqueles na menor faixa etaria, os percentuais de reconhecimento e tratamento foram menores e o controle foi maior. CONCLUSAO: Nessa populacao, reconhecimento, tratamento e controle da hipertensao foram superiores ao observado em grande parte dos estudos nacionais e internacionais. Considerando-se que a maioria da populacao reconhecia sua condicao e se tratava, era esperada uma proporcao maior de controle da doenca. O controle adequado da hipertensao deve ser uma prioridade dos programas e servicos de saude, especialmente entre os homens.

Uso do sistema de informação sobre mortalidade para identificar subnotificação de casos de tuberculose no Brasil

The aim of the study was to analyze the underreporting of deaths from tuberculosis (TB) in Brazil, as well as to assess the impact these cases would cause in the reporting rate and proportion of TB deaths in 2006. We analyzed the deaths recorded in the Mortality Information System (SIM) in 2006 and all reports of TB in Brazil during the 2001 to 2006 period. The variables used for the relationship were: report number, city and State of residence, patient name, date and year of birth, sex, mothers name and address. Six blocking steps were performed. Scores above 12.4 were considered pairs, and those below 9.7, doubtful pairs. After each step, we performed a manual review of doubtful pairs. The Reportable Disease Information System (Sinan) had 547,589 records. The SIM had 6,924 records, 39.3% (n = 2,727) of which were not found in Sinan during the period evaluated. We observed that 64.5% (2,707) of deaths were reported in 2006 and after analyzing the proportion of deaths underreported by region and federal units, we found that the highest percentage was in the Northern region, followed by the Southeast and Northeast. The addition of deaths that had not been reported to the Sinan database increased the reporting rate 3.7%. Regarding the proportion of deaths due to TB, such inclusion was responsible for a 60.7% increase in this indicator. The relationship between both databases seems to be an important strategy for improving the quality of the TB surveillance system.