Cristiane Magalhães de Melo

Qualidade da informação sobre óbitos por causas externas em município de médio porte em Minas Gerais, Brasil

Objetivou-se avaliar a qualidade da informacao sobre obitos por causas externas em Vicosa, Minas Gerais, Brasil, entre 2000 e 2009, assim como a completude do Sistema de Informacoes sobre Mortalidade (SIM). Como fonte de dados, utilizou-se o SIM/Secretaria Municipal de Saude; Livros de Inquerito da Policia Civil do municipio e, de forma complementar, artigos de um jornal de circulacao local, sendo constituido um banco de dados com 495 obitos por causas externas. Os resultados demonstraram elevada proporcao de obitos com intencao indeterminada (21%) registrados no SIM, implicando problemas na qualidade da informacao. A comparacao dos dados do SIM e da Policia Civil indicou problemas de cobertura do primeiro (21%) e, consequentemente, nas estatisticas oficiais de mortalidade por acidentes e violencias. Os resultados reforcam a importância da busca em outras fontes de informacoes a fim de qualificar o SIM e ampliar sua cobertura; alem disso, destacam, principalmente, a necessidade de pesquisas que objetivem identificar e analisar problemas enfrentados por pequenos e medios municipios no que se refere a producao da informacao sobre mortalidade.Cad. Saúde Pública, Rio de Janeiro, 30(9):1809-1811, set, 2014 Thousands of patients around the world suffer harm from unsafe health care. The place of hospital care has been widely discussed in this context. The same is true for factors contributing to the distribution of risks for incidents in hospitals. However, the same cannot be said for unsafe primary care. Despite the great potential for incidents in primary care (where the majority of health care is provided), there are persistent gaps in knowledge on patient safety at this level. In this issue of Cadernos de Saúde Pública, the article by Marchon & Mendes Junior (p. 1815-35) offers an instigating critical review that expands the debate on advances and impasses in the evaluation of patient safety in primary care. Contrasting with the research output on the theme, the authors examine factors that affect comparability between findings from different approaches, for example: differences in the operationalization of concepts, particularly in the definition of events (i.e., what does a given study aim to measure?); availability of valid and accurate instruments (how to measure?); and the classification of incidents among extremely heterogeneous groups. This synthesis allows reflecting on the theme’s implications for quality of care and the need for more robust research methods. In addition, the identification and understanding of patterns in primary care incidents and contributing factors makes a relevant contribution to the effectiveness of preventive methods. Identifying the processes that generate errors is both necessary and useful. The theme’s relevance urges us to tackle methodological issues that are not always trivial, involving complexity of care in terms of both the group’s composition and the specific context. Which incidents are most common? What proportion of incidents involving harm can be explained by differences in risk distribution and the severity of the patient’s disease (composition)? What is the contribution of the institutional context (availability of supplies, workload, staff shortage, infrastructure, treatment protocols)? We also need to deepen our understanding of such events based on their frequency over time and their geographic scope. Can such events occur more than once in the same individual? Can the same risk factor produce different events? How does one analyze different events arising from the same risk situation? Distinct answers and findings can be obtained for each question based on the same variables, depending on the research methods employed. Likewise, the scale of the effect of determinants in the occurrence of events does not always coincide with the scale for which the data were captured (patients, health professionals, family members, institutions). Finding the best fit between scales is a common objective. In this sense, analyses limited to voluntary reporting systems can present major limitations. There is certainly much to learn from various approaches applied to different primary care scenarios. Marchon & Mendes Junior have identified the first questions and paths for such research.This study aimed to assess the quality of data on deaths from external causes in Viçosa, Minas Gerais State, Brazil, from 2000 to 2009, and the completeness of the Mortality Information System (SIM). The data were obtained from the SIM of the Municipal Health Department, municipal police enquiries, and local newspaper articles, resulting in a databank with 495 deaths from external causes. The results showed a high proportion of deaths with indeterminate intent (21%) in the SIM, suggesting problems with quality of information. Comparison of data from the SIM and police department detected problems with coverage in the SIM (21%) and thus in the official statistics on mortality from accidents and violence. The results emphasize the importance of searches in other data sources to upgrade the SIM and expand its coverage, and especially the need for studies to identify and analyze problems faced by small and medium-sized cities in the production of mortality data.

Vigilância da qualidade da água para consumo humano no âmbito municipal: contornos, desafios e possibilidades

A amplitude das atribuicoes da vigilância da qualidade da agua para consumo humano (VQACH) associada a heterogeneidade dos municipios brasileiros (perfil demografico e epidemiologico, recursos humanos e financeiros) impoe ao nivel local de gestao o desafio de implementar com efetividade e sustentabilidade as acoes previstas no modelo de atuacao da VQACH. Tendo como cenario de estudo um municipio mineiro de pequeno porte, o trabalho apresenta desafios e possibilidades vivenciados durante a implementacao do modelo. O atendimento as acoes estrategicas e basicas e aos principios doutrinarios, organizacionais e executivos previstos no modelo de atuacao foi verificado e as estrategias para o enfrentamento dos desafios impostos ao exercicio da VQACH foram apresentadas. A conformacao de uma equipe de profissionais em quantidade e qualidade compativeis com as acoes de VQACH foi aspecto fundamental, alem da melhor explicitacao de procedimentos como analise integrada dos sistemas de informacao e analise e classificacao do grau de risco a saude das diferentes formas de abastecimento de agua. O estudo permite adiantar aos gestores dos diferentes niveis de governo desafios e estrategias para contorna-los, bem como instrumentaliza a coordenacao da VQACH no nivel federal sobre questoes que necessitam tratamento mais detalhado e especifico.

Vigilância do óbito como indicador da qualidade da atenção à saúde da mulher e da criança

The study aimed to evaluate the implementation of a regional death surveillance network, reflecting on challenges and potentialities of performance as observatory of violence against women. The research involved nine municipalities of a health region set at the Zona da Mata, Minas Gerais, Brazil. We followed the meetings of the regional death surveillance committee and conducted semi-structured interviews with professional members of the committee and municipal health managers. Furthermore, we analyzed information concerning investigations conducted and, in one municipality, we analyzed the notifications of deaths and cases of violence against women. The results point to some difficulties: lack of recognition of the death surveillance activity; work overload; failure in communication between institutions and poor resources, infrastructure and professional training. There were also improvements, namely: greater interaction between municipalities; increased investigations and greater awareness of the importance of death surveillance among workers. We identified cases of domestic, obstetric and institutional violence through the investigation of deaths. The experience as a regional committee reinforces the strategy of strengthening death surveillance and the network of care for women in situation of violence.Resumo Objetivamos avaliar a implementacao de uma rede regional de vigilância do obito, refletindo sobre desafios e potencialidades de atuacao enquanto observatorio da violencia contra a mulher. A pesquisa envolveu nove municipios de uma regiao de saude da Zona da Mata de Minas Gerais. Acompanhamos reunioes do comite regional de vigilância do obito e realizamos entrevistas semiestruturadas com seus profissionais e com gestores municipais de saude. Tambem analisamos informacoes sobre investigacoes realizadas e, para um municipio, analisamos de forma integrada notificacoes de obito e de casos de violencia contra a mulher. Os resultados apontam dificuldades como: falta de reconhecimento da atividade de vigilância do obito; sobrecarga de trabalho; comunicacao falha entre instituicoes e precariedade de recursos, infraestrutura e capacitacao profissional. Tambem foram relatados avancos: maior interacao entre municipios, crescimento das investigacoes e conscientizacao da importância da vigilância do obito entre os/as trabalhadores/as. Identificamos, com as investigacoes dos obitos, casos de violencia domestica, obstetrica e institucional. A vivencia enquanto comite regional amplia o fortalecimento da vigilância dos obitos e da rede de atencao as mulheres em situacao de violencia.

Quality of data on deaths from external causes in a medium-sized city in Minas Gerais State, Brazil

Objetivou-se avaliar a qualidade da informacao sobre obitos por causas externas em Vicosa, Minas Gerais, Brasil, entre 2000 e 2009, assim como a completude do Sistema de Informacoes sobre Mortalidade (SIM). Como fonte de dados, utilizou-se o SIM/Secretaria Municipal de Saude; Livros de Inquerito da Policia Civil do municipio e, de forma complementar, artigos de um jornal de circulacao local, sendo constituido um banco de dados com 495 obitos por causas externas. Os resultados demonstraram elevada proporcao de obitos com intencao indeterminada (21%) registrados no SIM, implicando problemas na qualidade da informacao. A comparacao dos dados do SIM e da Policia Civil indicou problemas de cobertura do primeiro (21%) e, consequentemente, nas estatisticas oficiais de mortalidade por acidentes e violencias. Os resultados reforcam a importância da busca em outras fontes de informacoes a fim de qualificar o SIM e ampliar sua cobertura; alem disso, destacam, principalmente, a necessidade de pesquisas que objetivem identificar e analisar problemas enfrentados por pequenos e medios municipios no que se refere a producao da informacao sobre mortalidade.Cad. Saúde Pública, Rio de Janeiro, 30(9):1809-1811, set, 2014 Thousands of patients around the world suffer harm from unsafe health care. The place of hospital care has been widely discussed in this context. The same is true for factors contributing to the distribution of risks for incidents in hospitals. However, the same cannot be said for unsafe primary care. Despite the great potential for incidents in primary care (where the majority of health care is provided), there are persistent gaps in knowledge on patient safety at this level. In this issue of Cadernos de Saúde Pública, the article by Marchon & Mendes Junior (p. 1815-35) offers an instigating critical review that expands the debate on advances and impasses in the evaluation of patient safety in primary care. Contrasting with the research output on the theme, the authors examine factors that affect comparability between findings from different approaches, for example: differences in the operationalization of concepts, particularly in the definition of events (i.e., what does a given study aim to measure?); availability of valid and accurate instruments (how to measure?); and the classification of incidents among extremely heterogeneous groups. This synthesis allows reflecting on the theme’s implications for quality of care and the need for more robust research methods. In addition, the identification and understanding of patterns in primary care incidents and contributing factors makes a relevant contribution to the effectiveness of preventive methods. Identifying the processes that generate errors is both necessary and useful. The theme’s relevance urges us to tackle methodological issues that are not always trivial, involving complexity of care in terms of both the group’s composition and the specific context. Which incidents are most common? What proportion of incidents involving harm can be explained by differences in risk distribution and the severity of the patient’s disease (composition)? What is the contribution of the institutional context (availability of supplies, workload, staff shortage, infrastructure, treatment protocols)? We also need to deepen our understanding of such events based on their frequency over time and their geographic scope. Can such events occur more than once in the same individual? Can the same risk factor produce different events? How does one analyze different events arising from the same risk situation? Distinct answers and findings can be obtained for each question based on the same variables, depending on the research methods employed. Likewise, the scale of the effect of determinants in the occurrence of events does not always coincide with the scale for which the data were captured (patients, health professionals, family members, institutions). Finding the best fit between scales is a common objective. In this sense, analyses limited to voluntary reporting systems can present major limitations. There is certainly much to learn from various approaches applied to different primary care scenarios. Marchon & Mendes Junior have identified the first questions and paths for such research.This study aimed to assess the quality of data on deaths from external causes in Viçosa, Minas Gerais State, Brazil, from 2000 to 2009, and the completeness of the Mortality Information System (SIM). The data were obtained from the SIM of the Municipal Health Department, municipal police enquiries, and local newspaper articles, resulting in a databank with 495 deaths from external causes. The results showed a high proportion of deaths with indeterminate intent (21%) in the SIM, suggesting problems with quality of information. Comparison of data from the SIM and police department detected problems with coverage in the SIM (21%) and thus in the official statistics on mortality from accidents and violence. The results emphasize the importance of searches in other data sources to upgrade the SIM and expand its coverage, and especially the need for studies to identify and analyze problems faced by small and medium-sized cities in the production of mortality data.

Calidad de los datos sobre muertes por causas externas en una ciudad de tamaño medio en Minas Gerais, Brasil

Objetivou-se avaliar a qualidade da informacao sobre obitos por causas externas em Vicosa, Minas Gerais, Brasil, entre 2000 e 2009, assim como a completude do Sistema de Informacoes sobre Mortalidade (SIM). Como fonte de dados, utilizou-se o SIM/Secretaria Municipal de Saude; Livros de Inquerito da Policia Civil do municipio e, de forma complementar, artigos de um jornal de circulacao local, sendo constituido um banco de dados com 495 obitos por causas externas. Os resultados demonstraram elevada proporcao de obitos com intencao indeterminada (21%) registrados no SIM, implicando problemas na qualidade da informacao. A comparacao dos dados do SIM e da Policia Civil indicou problemas de cobertura do primeiro (21%) e, consequentemente, nas estatisticas oficiais de mortalidade por acidentes e violencias. Os resultados reforcam a importância da busca em outras fontes de informacoes a fim de qualificar o SIM e ampliar sua cobertura; alem disso, destacam, principalmente, a necessidade de pesquisas que objetivem identificar e analisar problemas enfrentados por pequenos e medios municipios no que se refere a producao da informacao sobre mortalidade.Cad. Saúde Pública, Rio de Janeiro, 30(9):1809-1811, set, 2014 Thousands of patients around the world suffer harm from unsafe health care. The place of hospital care has been widely discussed in this context. The same is true for factors contributing to the distribution of risks for incidents in hospitals. However, the same cannot be said for unsafe primary care. Despite the great potential for incidents in primary care (where the majority of health care is provided), there are persistent gaps in knowledge on patient safety at this level. In this issue of Cadernos de Saúde Pública, the article by Marchon & Mendes Junior (p. 1815-35) offers an instigating critical review that expands the debate on advances and impasses in the evaluation of patient safety in primary care. Contrasting with the research output on the theme, the authors examine factors that affect comparability between findings from different approaches, for example: differences in the operationalization of concepts, particularly in the definition of events (i.e., what does a given study aim to measure?); availability of valid and accurate instruments (how to measure?); and the classification of incidents among extremely heterogeneous groups. This synthesis allows reflecting on the theme’s implications for quality of care and the need for more robust research methods. In addition, the identification and understanding of patterns in primary care incidents and contributing factors makes a relevant contribution to the effectiveness of preventive methods. Identifying the processes that generate errors is both necessary and useful. The theme’s relevance urges us to tackle methodological issues that are not always trivial, involving complexity of care in terms of both the group’s composition and the specific context. Which incidents are most common? What proportion of incidents involving harm can be explained by differences in risk distribution and the severity of the patient’s disease (composition)? What is the contribution of the institutional context (availability of supplies, workload, staff shortage, infrastructure, treatment protocols)? We also need to deepen our understanding of such events based on their frequency over time and their geographic scope. Can such events occur more than once in the same individual? Can the same risk factor produce different events? How does one analyze different events arising from the same risk situation? Distinct answers and findings can be obtained for each question based on the same variables, depending on the research methods employed. Likewise, the scale of the effect of determinants in the occurrence of events does not always coincide with the scale for which the data were captured (patients, health professionals, family members, institutions). Finding the best fit between scales is a common objective. In this sense, analyses limited to voluntary reporting systems can present major limitations. There is certainly much to learn from various approaches applied to different primary care scenarios. Marchon & Mendes Junior have identified the first questions and paths for such research.This study aimed to assess the quality of data on deaths from external causes in Viçosa, Minas Gerais State, Brazil, from 2000 to 2009, and the completeness of the Mortality Information System (SIM). The data were obtained from the SIM of the Municipal Health Department, municipal police enquiries, and local newspaper articles, resulting in a databank with 495 deaths from external causes. The results showed a high proportion of deaths with indeterminate intent (21%) in the SIM, suggesting problems with quality of information. Comparison of data from the SIM and police department detected problems with coverage in the SIM (21%) and thus in the official statistics on mortality from accidents and violence. The results emphasize the importance of searches in other data sources to upgrade the SIM and expand its coverage, and especially the need for studies to identify and analyze problems faced by small and medium-sized cities in the production of mortality data.