Fernanda Pinheiro Aguiar

Modifying Effect of Prenatal Care on the Association Between Young Maternal Age and Adverse Birth Outcomes

OBJECTIVES The objectives were to investigate the prevalence of adverse birth outcomes according to maternal age range in the city of Rio de Janeiro, Brazil, in 2002, and to evaluate the association between maternal age range and adverse birth outcomes using additive interaction to determine whether adequate prenatal care can attenuate the harmful effect of young age on pregnancy outcomes. METHODS A cross-sectional analysis was performed in women up to 24 years of age who gave birth to live children in 2002 in the city of Rio de Janeiro. To evaluate adverse outcomes, the exposure variable was maternal age range, and the outcome variables were very preterm birth, low birth weight, prematurity, and low 5-minute Apgar score. The presence of interaction was investigated with the composite variable maternal age plus prenatal care. The proportions and respective 95% confidence intervals were calculated for adequate schooling, delivery in a public maternity hospital, and adequate prenatal care, and the outcomes according to maternal age range. The chi-square test was used. The association between age range and birth outcomes was evaluated with logistic models adjusted for schooling and type of hospital for each prenatal stratum and outcome. Attributable proportion was calculated in order to measure additive interaction. RESULTS Of the 40,111 live births in the sample, 1.9% corresponded to children of mothers from 10-14 years of age, 38% from 15-19 years, and 59.9% from 20-24 years. An association between maternal age and adverse outcomes was observed only in adolescent mothers with inadequate prenatal care, and significant additive interaction was observed between prenatal care and maternal age for all the outcomes. CONCLUSION Adolescent mothers and their newborns are exposed to greater risk of adverse outcomes when prenatal care fails to comply with current guidelines.

Tentativas e suicídios por intoxicação exógena no Rio de Janeiro, Brasil: análise das informações através do linkage probabilístico

Poisoning is one of the three main means used in suicide and suicides attempts. In order to improve the quality of such information, a cross-sectional descriptive study was conducted on case records in the State of Rio de Janeiro, Brazil, from 2006 to 2008, in the databases of the Information System on Diseases of Notification (SINAN), the Mortality Information System (SIM), and the Poison Control Center in Niterói (CCIn-Niterói). Probabilistic linkage was used to develop a model for monitoring suicides and suicide attempts by poisoning. Although 68.8% of the 948 records at CCIn had been reported by health professionals, only 2.6% were included in the other databases. Linking CCIn and SIM showed 61.3% underreporting. Information is important for surveillance, public policy-making, and decision-making. Probabilistic linkage allowed identifying problems in each system and provided better data quality and a more accurate diagnosis of the real situation in a complex and serious problem like suicidal behavior.La intoxicacion exogena es uno de los tres metodos principales utilizados en los intentos de suicido y suicidios. Con el objetivo de mejorar la calidad de esta informacion, se realizo un estudio seccional descriptivo de los registros de casos en el estado de Rio de Janeiro, Brasil, 2006-2008, presentes en las bases de datos del Sistema de Informacion sobre Dolencias Notificables (SINAN por sus siglas en portugues), Sistema de Informacion sobre Mortalidad (SIM) y Centro de Control de Intoxicacion de Niteroi (CCIn-Niteroi). A traves del metodo probabilistico, se desarrollo un modelo para el seguimiento de los casos de intentos/suicidios por envenenamiento. Aunque un 68,8% de la CCIn (948 discos) ha sido reportado por profesionales de salud, solo un 2,6% de ese tipo contenido esta presente en otros sistemas. El emparejamiento CCIn y SIM presento un subregistro de un 61,3%. Conocemos la importancia de esta informacion para la vigilancia, formulacion de politicas publicas y la toma de decisiones. El metodo de relacion probabilistica de bancos de datos permitio la identificacion de los problemas existentes en cada sistema, proporciono una mejor calidad de la informacion y proximidad a la situacion real de las enfermedades graves y complejas como el comportamiento suicida.A intoxicacao exogena e um dos tres principais meios utilizados nas tentativas e suicidios. Com o objetivo de melhorar a qualidade destas informacoes foi realizado um estudo seccional descritivo dos registros sobre casos do Estado do Rio de Janeiro, Brasil, periodo 2006-2008, presentes nos bancos de dados do Sistema de Informacoes sobre Agravos de Notificacao (SINAN), Sistema de Informacoes sobre Mortalidade (SIM) e Centro de Controle de Intoxicacao de Niteroi (CCIn-Niteroi). Atraves do metodo de relacionamento probabilistico desenvolveu-se um modelo de monitoramento dos casos de tentativas/suicidios devido intoxicacao. Embora 68,8% dos 948 registros do CCIn tenham sido reportados por profissionais de saude, apenas 2,6% constavam nos demais sistemas. O pareamento CCIn e SIM apresentou uma subnotificacao de 61,3%. Sabe-se da importância da informacao para a vigilância, formulacao de politicas publicas, alem de tomadas de decisao. O metodo de relacionamento de bancos de dados permitiu a identificacao dos problemas existentes em cada sistema, proporcionou melhor qualidade das informacoes e maior proximidade com a situacao real de agravos complexos e graves como o comportamento suicida.

Do que morrem os pacientes com tuberculose: causas múltiplas de morte de uma coorte de casos notificados e uma proposta de investigação de causas presumíveis

O objetivo deste trabalho foi analisar as causas multiplas de morte de uma coorte de pacientes notificados com tuberculose (TB) e apresentar uma proposta de investigacao de causas presumiveis. Realizou-se linkage probabilistico entre o Sistema de Informacao de Agravos de Notificacao (SINAN) 2006 e o Sistema de Informacao sobre Mortalidade (SIM), 2006-2008. Ocorreram 825 mortes, das quais 23% por TB, 16% com TB e 61% sem mencao da TB. Duzentos e quinze (42,7%) obitos ocorreram antes do termino do esquema basico de tratamento e nao tinham mencao da TB, cujo perfil foi distinto do padrao quando a TB era uma das causas associadas. A elevada frequencia de doencas do aparelho respiratorio, AIDS e causas mal definidas sugerem falha na qualidade da informacao. Elaborou-se proposta de correcao das causas associadas no SIM e de investigacao de obito com base na relacao de causas presumiveis. De acordo com a proposta, 26 obitos poderiam ter a causa basica modificada. Este estudo destaca a gravidade do quadro da TB e a importância do linkage para a vigilância da TB e melhoria das informacoes do SIM e do SINAN.The objective of this study was to analyze the multiple causes of death in a cohort of patients with tuberculosis (TB) and to introduce an investigation proposal death for TB from a list of presumable causes. We performed a probabilistic record linkage with the databases of the Information System for Notifiable Diseases (SINAN) 2006 and the Mortality Information System (SIM) 2006-2008. There were 825 deaths, of which 23% for death for TB, deaths due to TB with 16% and 61% without mention of TB. Two hundred and fifteen (42.7%) deaths occurred within the period of treatment, whose profile differed from the pattern of causes when TB was an associated cause, with high frequency of respiratory diseases, AIDS and ill-defined causes. We elaborated a proposal for correction of associated causes of death and an investigation proposal death for TB from a list of presumable causes. According to the proposal, 26 deaths could have modified the underlying cause. This study highlights the importance of record linkage to TB surveillance and improvement of information the SIM and SINAN.

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.

Confiabilidade do desfecho do tratamento usando linkagede bases de dados para a tuberculose

The quality of information is crucial in the monitoring and evaluation of control actions of diseases such as tuberculosis (TB). However, studies have pointed out deficiencies in the quality of data obtained by the TB surveillance system. Thus the aim of this study was to analyze the agreement between treatment outcome of the Notifiable Diseases Information System (SINAN) and information on the underlying and associated cause of death in the Mortality Information System (SIM). We conducted a probabilistic record linkage with the databases of the SINAN 2006 and the SIM 2006-2008. The accuracy of treatment outcome was analyzed by kappa index. Of the 417 cases closed as death in the SINAN, 88.7% were found in the SIM. Of the 82 cases closed as death from other causes, 42.7% presented TB as the underlying or associated cause in the SIM, while 41.5% did not mention TB. PABAK coefficients revealed excellent agreement between the treatment outcome of death of the SINAN and the presence or absence of TB death in the SIM. We recommend that the states and municipalities that use the linkage between the SINAN and SIM to increase the completeness and consistency of the SINAN-TB search on the SIM, not only for cases without treatment outcome, but also for those discontinued and transferred.

The absence of birthweight paradox as a marker of disadvantages faced by low maternal education children

Background This study tested the hypothesis that the birthweight paradox would not be observed when assessing the effect of maternal education on neonatal mortality in the presence of socioeconomic inequality in access to health care. Methods Non‐concurrent cohort study. Passive follow‐up of live‐born infants using probabilistic record linkage of birth and death records for Rio de Janeiro (2004‐2010; n = 1 445 367). Maternal age, birthweight and neonatal death were evaluated according to maternal educational level strata (<4, 4‐11 and ≥12 years of study). We estimated the association between maternal educational level and neonatal mortality using logistical regression models adjusted for maternal age and birthweight (<2500 g and ≥2500 g). Results Neonatal mortality was 1.8 times higher in low educational level group compared with high educational level. We did not find birthweight‐specific mortality curves crossing over in the stratum under 2500 g (birthweight paradox). The odds of a low birthweight child being born in facilities without neonatal intensive care units was about 70% higher in the group of low education when compared with mothers with high education. Conclusions The absence of crossing birthweight‐specific mortality curves may be a reason for concern about the severity of the disadvantages faced by low maternal education women.

Cuáles son las causas de muerte de pacientes con tuberculosis: múltiples causas en una cohorte de casos notificados y una propuesta de investigación

O objetivo deste trabalho foi analisar as causas multiplas de morte de uma coorte de pacientes notificados com tuberculose (TB) e apresentar uma proposta de investigacao de causas presumiveis. Realizou-se linkage probabilistico entre o Sistema de Informacao de Agravos de Notificacao (SINAN) 2006 e o Sistema de Informacao sobre Mortalidade (SIM), 2006-2008. Ocorreram 825 mortes, das quais 23% por TB, 16% com TB e 61% sem mencao da TB. Duzentos e quinze (42,7%) obitos ocorreram antes do termino do esquema basico de tratamento e nao tinham mencao da TB, cujo perfil foi distinto do padrao quando a TB era uma das causas associadas. A elevada frequencia de doencas do aparelho respiratorio, AIDS e causas mal definidas sugerem falha na qualidade da informacao. Elaborou-se proposta de correcao das causas associadas no SIM e de investigacao de obito com base na relacao de causas presumiveis. De acordo com a proposta, 26 obitos poderiam ter a causa basica modificada. Este estudo destaca a gravidade do quadro da TB e a importância do linkage para a vigilância da TB e melhoria das informacoes do SIM e do SINAN.The objective of this study was to analyze the multiple causes of death in a cohort of patients with tuberculosis (TB) and to introduce an investigation proposal death for TB from a list of presumable causes. We performed a probabilistic record linkage with the databases of the Information System for Notifiable Diseases (SINAN) 2006 and the Mortality Information System (SIM) 2006-2008. There were 825 deaths, of which 23% for death for TB, deaths due to TB with 16% and 61% without mention of TB. Two hundred and fifteen (42.7%) deaths occurred within the period of treatment, whose profile differed from the pattern of causes when TB was an associated cause, with high frequency of respiratory diseases, AIDS and ill-defined causes. We elaborated a proposal for correction of associated causes of death and an investigation proposal death for TB from a list of presumable causes. According to the proposal, 26 deaths could have modified the underlying cause. This study highlights the importance of record linkage to TB surveillance and improvement of information the SIM and SINAN.

What are the causes of death of patients with tuberculosis: multiple causes of death in a cohort of cases and a research proposal of presumed causes

O objetivo deste trabalho foi analisar as causas multiplas de morte de uma coorte de pacientes notificados com tuberculose (TB) e apresentar uma proposta de investigacao de causas presumiveis. Realizou-se linkage probabilistico entre o Sistema de Informacao de Agravos de Notificacao (SINAN) 2006 e o Sistema de Informacao sobre Mortalidade (SIM), 2006-2008. Ocorreram 825 mortes, das quais 23% por TB, 16% com TB e 61% sem mencao da TB. Duzentos e quinze (42,7%) obitos ocorreram antes do termino do esquema basico de tratamento e nao tinham mencao da TB, cujo perfil foi distinto do padrao quando a TB era uma das causas associadas. A elevada frequencia de doencas do aparelho respiratorio, AIDS e causas mal definidas sugerem falha na qualidade da informacao. Elaborou-se proposta de correcao das causas associadas no SIM e de investigacao de obito com base na relacao de causas presumiveis. De acordo com a proposta, 26 obitos poderiam ter a causa basica modificada. Este estudo destaca a gravidade do quadro da TB e a importância do linkage para a vigilância da TB e melhoria das informacoes do SIM e do SINAN.The objective of this study was to analyze the multiple causes of death in a cohort of patients with tuberculosis (TB) and to introduce an investigation proposal death for TB from a list of presumable causes. We performed a probabilistic record linkage with the databases of the Information System for Notifiable Diseases (SINAN) 2006 and the Mortality Information System (SIM) 2006-2008. There were 825 deaths, of which 23% for death for TB, deaths due to TB with 16% and 61% without mention of TB. Two hundred and fifteen (42.7%) deaths occurred within the period of treatment, whose profile differed from the pattern of causes when TB was an associated cause, with high frequency of respiratory diseases, AIDS and ill-defined causes. We elaborated a proposal for correction of associated causes of death and an investigation proposal death for TB from a list of presumable causes. According to the proposal, 26 deaths could have modified the underlying cause. This study highlights the importance of record linkage to TB surveillance and improvement of information the SIM and SINAN.

Intentos de suicidio y suicidios por envenenamiento exógeno en Río de Janeiro, Brasil: análisis de la información a través de una relación probabilística

Poisoning is one of the three main means used in suicide and suicides attempts. In order to improve the quality of such information, a cross-sectional descriptive study was conducted on case records in the State of Rio de Janeiro, Brazil, from 2006 to 2008, in the databases of the Information System on Diseases of Notification (SINAN), the Mortality Information System (SIM), and the Poison Control Center in Niterói (CCIn-Niterói). Probabilistic linkage was used to develop a model for monitoring suicides and suicide attempts by poisoning. Although 68.8% of the 948 records at CCIn had been reported by health professionals, only 2.6% were included in the other databases. Linking CCIn and SIM showed 61.3% underreporting. Information is important for surveillance, public policy-making, and decision-making. Probabilistic linkage allowed identifying problems in each system and provided better data quality and a more accurate diagnosis of the real situation in a complex and serious problem like suicidal behavior.La intoxicacion exogena es uno de los tres metodos principales utilizados en los intentos de suicido y suicidios. Con el objetivo de mejorar la calidad de esta informacion, se realizo un estudio seccional descriptivo de los registros de casos en el estado de Rio de Janeiro, Brasil, 2006-2008, presentes en las bases de datos del Sistema de Informacion sobre Dolencias Notificables (SINAN por sus siglas en portugues), Sistema de Informacion sobre Mortalidad (SIM) y Centro de Control de Intoxicacion de Niteroi (CCIn-Niteroi). A traves del metodo probabilistico, se desarrollo un modelo para el seguimiento de los casos de intentos/suicidios por envenenamiento. Aunque un 68,8% de la CCIn (948 discos) ha sido reportado por profesionales de salud, solo un 2,6% de ese tipo contenido esta presente en otros sistemas. El emparejamiento CCIn y SIM presento un subregistro de un 61,3%. Conocemos la importancia de esta informacion para la vigilancia, formulacion de politicas publicas y la toma de decisiones. El metodo de relacion probabilistica de bancos de datos permitio la identificacion de los problemas existentes en cada sistema, proporciono una mejor calidad de la informacion y proximidad a la situacion real de las enfermedades graves y complejas como el comportamiento suicida.A intoxicacao exogena e um dos tres principais meios utilizados nas tentativas e suicidios. Com o objetivo de melhorar a qualidade destas informacoes foi realizado um estudo seccional descritivo dos registros sobre casos do Estado do Rio de Janeiro, Brasil, periodo 2006-2008, presentes nos bancos de dados do Sistema de Informacoes sobre Agravos de Notificacao (SINAN), Sistema de Informacoes sobre Mortalidade (SIM) e Centro de Controle de Intoxicacao de Niteroi (CCIn-Niteroi). Atraves do metodo de relacionamento probabilistico desenvolveu-se um modelo de monitoramento dos casos de tentativas/suicidios devido intoxicacao. Embora 68,8% dos 948 registros do CCIn tenham sido reportados por profissionais de saude, apenas 2,6% constavam nos demais sistemas. O pareamento CCIn e SIM apresentou uma subnotificacao de 61,3%. Sabe-se da importância da informacao para a vigilância, formulacao de politicas publicas, alem de tomadas de decisao. O metodo de relacionamento de bancos de dados permitiu a identificacao dos problemas existentes em cada sistema, proporcionou melhor qualidade das informacoes e maior proximidade com a situacao real de agravos complexos e graves como o comportamento suicida.

Suicide and suicide attempts by exogenous poisoning in Rio de Janeiro, Brazil: information analysis through probabilistic linkage

Poisoning is one of the three main means used in suicide and suicides attempts. In order to improve the quality of such information, a cross-sectional descriptive study was conducted on case records in the State of Rio de Janeiro, Brazil, from 2006 to 2008, in the databases of the Information System on Diseases of Notification (SINAN), the Mortality Information System (SIM), and the Poison Control Center in Niterói (CCIn-Niterói). Probabilistic linkage was used to develop a model for monitoring suicides and suicide attempts by poisoning. Although 68.8% of the 948 records at CCIn had been reported by health professionals, only 2.6% were included in the other databases. Linking CCIn and SIM showed 61.3% underreporting. Information is important for surveillance, public policy-making, and decision-making. Probabilistic linkage allowed identifying problems in each system and provided better data quality and a more accurate diagnosis of the real situation in a complex and serious problem like suicidal behavior.La intoxicacion exogena es uno de los tres metodos principales utilizados en los intentos de suicido y suicidios. Con el objetivo de mejorar la calidad de esta informacion, se realizo un estudio seccional descriptivo de los registros de casos en el estado de Rio de Janeiro, Brasil, 2006-2008, presentes en las bases de datos del Sistema de Informacion sobre Dolencias Notificables (SINAN por sus siglas en portugues), Sistema de Informacion sobre Mortalidad (SIM) y Centro de Control de Intoxicacion de Niteroi (CCIn-Niteroi). A traves del metodo probabilistico, se desarrollo un modelo para el seguimiento de los casos de intentos/suicidios por envenenamiento. Aunque un 68,8% de la CCIn (948 discos) ha sido reportado por profesionales de salud, solo un 2,6% de ese tipo contenido esta presente en otros sistemas. El emparejamiento CCIn y SIM presento un subregistro de un 61,3%. Conocemos la importancia de esta informacion para la vigilancia, formulacion de politicas publicas y la toma de decisiones. El metodo de relacion probabilistica de bancos de datos permitio la identificacion de los problemas existentes en cada sistema, proporciono una mejor calidad de la informacion y proximidad a la situacion real de las enfermedades graves y complejas como el comportamiento suicida.A intoxicacao exogena e um dos tres principais meios utilizados nas tentativas e suicidios. Com o objetivo de melhorar a qualidade destas informacoes foi realizado um estudo seccional descritivo dos registros sobre casos do Estado do Rio de Janeiro, Brasil, periodo 2006-2008, presentes nos bancos de dados do Sistema de Informacoes sobre Agravos de Notificacao (SINAN), Sistema de Informacoes sobre Mortalidade (SIM) e Centro de Controle de Intoxicacao de Niteroi (CCIn-Niteroi). Atraves do metodo de relacionamento probabilistico desenvolveu-se um modelo de monitoramento dos casos de tentativas/suicidios devido intoxicacao. Embora 68,8% dos 948 registros do CCIn tenham sido reportados por profissionais de saude, apenas 2,6% constavam nos demais sistemas. O pareamento CCIn e SIM apresentou uma subnotificacao de 61,3%. Sabe-se da importância da informacao para a vigilância, formulacao de politicas publicas, alem de tomadas de decisao. O metodo de relacionamento de bancos de dados permitiu a identificacao dos problemas existentes em cada sistema, proporcionou melhor qualidade das informacoes e maior proximidade com a situacao real de agravos complexos e graves como o comportamento suicida.