Roberto de Andrade Medronho

O Sistema de Informações Hospitalares e a assistência ao infarto agudo do miocárdio

OBJECTIVE To analyze the applicability of the Brazilian Unified Health Systems national hospital database to evaluate the quality of acute myocardial infarction hospital care. METHODS It was evaluated 1,936 hospital admission forms having acute myocardial infarction (AMI) as primary diagnosis in the municipal district of Rio de Janeiro, Brazil, in 1997. Data was collected from the national hospital database. A stratified random sampling of 391 medical records was also evaluated. AMI diagnosis agreement followed the literature criteria. Variable accuracy analysis was performed using kappa index agreement. RESULTS The quality of AMI diagnosis registered in hospital admission forms was satisfactory according to the gold standard of the literature. In general, the accuracy of the variables demographics (sex, age group), process (medical procedures and interventions), and outcome (hospital death) was satisfactory. The accuracy of demographics and outcome variables was higher than the one of process variables. Under registration of secondary diagnosis was high in the forms and it was the main limiting factor. CONCLUSIONS Given the study findings and the widespread availability of the national hospital database, it is pertinent its use as an instrument in the evaluation of the quality of AMI medical care.

A epidemia de dengue/dengue hemorrágico no município do Rio de Janeiro, 2001/2002

The following study was intended to evaluate the occurrence of typical signs and symptoms in the cases of classic dengue and hemorrhagic dengue fever, during the 2001-2002 epidemic in the city of Rio de Janeiro. The authors reviewed 155,242 cases notified to the Information System of Notification Diseases, from January/2001 to June/2002: 81,327 cases were classified as classic dengue and 958 as hemorrhagic dengue fever, with a total of 60 deaths. Common symptoms, such as fever, headache, prostration, myalgia, nausea and retro-orbital pain, had a high incidence in both classic and hemorrhagic dengue fever. On the other hand, hemorrhagic signs and other signs of severe disease, such as shock, gastrointestinal bleeding, petechiae, epistaxis, abdominal pain and pleural effusion, were strongly associated to hemorrhagic dengue fever. Besides, the occurrence of death was 34.8 times higher in hemorrhagic dengue fever than in classic dengue (OR = 34.8; CI 19.7-61.3).

Spatial analysis of dengue and the socioeconomic context of the city of Rio de Janeiro (Southeastern Brazil)

OBJETIVO: Analizar la epidemia de dengue con relacion al contexto socioeconomico segun areas geograficas. METODOS: Fue realizado estudio ecologico en el municipio de Rio de Janeiro (Sureste de Brasil), en areas delimitadas como urbanizaciones, a partir de informaciones de casos de dengue notificados y residentes en el municipio. Fue calculada la tasa de incidencia promedio de dengue entre las semanas epidemiologicas: 48a de 2001 a 20a de 2002. La ocurrencia de dengue fue correlacionada con variables socioeconomicas utilizandose el coeficiente de correlacion de Pearson. Se utilizo el Indice de Moran global y local para evaluar la autocorrelacion espacial del dengue y de las variables correlacionadas significativamente con la enfermedad. Fueron usados el modelo de regresion lineal multiple y el modelo espacial condicional auto-regresivo para analizar la relacion entre dengue y contexto socioeconomico. RESULTADOS: Las urbanizaciones de la zona oeste del municipio presentaron elevadas tasas de incidencia promedio de dengue. Presentaron correlacion significativa las variables: porcentaje de domicilios ligados a la red sanitaria general, domicilios con lavadora de ropas y densidad poblacional por area urbana. El indice de autocorrelacion espacial Moran revelo dependencia espacial entre el dengue y variables seleccionadas. Los modelos utilizados apuntaron el porcentaje de domicilios ligados a la red sanitaria general como unica variable asociada significativamente a la enfermedad. Los residuos de ambos modelos revelaron autocorrelacion espacial significativa, con indice de Moran positivo (p<0,001) para el de regresion y negativo (p=0,005) para el espacial condicional auto-regresivo. CONCLUSIONES: Problemas relacionados al saneamiento basico contribuyen decisivamente para el aumento del riesgo de la enfermedad.

Análise espacial da dengue e o contexto socioeconômico no município do Rio de Janeiro, RJ

OBJETIVO: Analizar la epidemia de dengue con relacion al contexto socioeconomico segun areas geograficas. METODOS: Fue realizado estudio ecologico en el municipio de Rio de Janeiro (Sureste de Brasil), en areas delimitadas como urbanizaciones, a partir de informaciones de casos de dengue notificados y residentes en el municipio. Fue calculada la tasa de incidencia promedio de dengue entre las semanas epidemiologicas: 48a de 2001 a 20a de 2002. La ocurrencia de dengue fue correlacionada con variables socioeconomicas utilizandose el coeficiente de correlacion de Pearson. Se utilizo el Indice de Moran global y local para evaluar la autocorrelacion espacial del dengue y de las variables correlacionadas significativamente con la enfermedad. Fueron usados el modelo de regresion lineal multiple y el modelo espacial condicional auto-regresivo para analizar la relacion entre dengue y contexto socioeconomico. RESULTADOS: Las urbanizaciones de la zona oeste del municipio presentaron elevadas tasas de incidencia promedio de dengue. Presentaron correlacion significativa las variables: porcentaje de domicilios ligados a la red sanitaria general, domicilios con lavadora de ropas y densidad poblacional por area urbana. El indice de autocorrelacion espacial Moran revelo dependencia espacial entre el dengue y variables seleccionadas. Los modelos utilizados apuntaron el porcentaje de domicilios ligados a la red sanitaria general como unica variable asociada significativamente a la enfermedad. Los residuos de ambos modelos revelaron autocorrelacion espacial significativa, con indice de Moran positivo (p<0,001) para el de regresion y negativo (p=0,005) para el espacial condicional auto-regresivo. CONCLUSIONES: Problemas relacionados al saneamiento basico contribuyen decisivamente para el aumento del riesgo de la enfermedad.

Identification of Risk Areas for Visceral Leishmaniasis in Teresina, Piaui State, Brazil

This study used spatial analysis to identify areas at greatest risk of visceral leishmaniasis (VL) in the urban area of Teresina, Brazil during 2001-2006. The results from kernel ratios showed that peripheral census tracts were the most heavily affected. Local spatial analysis showed that in the beginning of the study period local clusters of high incidence of VL were mostly located in the southern and northeastern parts of the city, but in subsequent years those clusters also appeared in the northern region of the city, suggesting that the pattern of VL is not static, and the disease may occasionally spread to other areas of the municipality. We also observed a spatial correlation between VL rates and all socioeconomic and demographic indicators evaluated (P < 0.01). The concentration of interventions in high-risk areas could be an effective strategy to control the disease in the urban setting.

Diferenças clínicas observadas em pacientes com dengue causadas por diferentes sorotipos na epidemia de 2001/2002, ocorrida no município do Rio de Janeiro

The authors evaluated clinical and epidemiological differences among the serotypes of dengue in Rio de Janeiros 2001-2002 outbreak of the disease. Out of 362 cases that had viral isolation samples, notified by the Information System for Notification Diseases (SINAN), from January/2001 to June/2002, 62 were caused by serotype 1,62 by serotype 2 and 238 by serotype 3. In comparison with serotype 2, an individual infected by serotype 3 had a 6.07 times higher chance (OR = 6.07; CI: 1.10-43.97) of presenting shock and a 3.55 times higher chance (OR = 3.55; CI: 1.28-9.97) of developing exanthema. When compared to serotype 1, serotype 3 had a 3.06 times higher chance (OR = 3.06; CI: 0.99-9.66) of causing abdominal pain and a 3.61 times higher chance of exanthema (OR = 3.61; CI: 1.16-11.51). It was found that individuals infected by serotype 3 of the virus presented signs indicating a more severe disease.

Modelagem geoestatística da infecção por Ascaris lumbricoides

The following study intends to model the spatial distribution of ascariasis, through the use of geoprocessing and geostatistic analysis. The database used in the study was taken from the PAISQUA project, including a coproparasitologic and domiciliary survey, conducted in 19 selected census tracts of Rio de Janeiro State, Brazil, randomly selecting a group of 1,550 children aged 1 to 9 years old plotting them in their respective domiciles centroids. Risk maps of Ascaris lumbricoides were generated by indicator kriging. The estimated and observed values from the cross-validation were compared using a ROC curve. An isotropic spherical semivariogram model with a range of 30m and nugget effect of 50% was employed in ordinary indicator kriging to create a map of probability of A. lumbricoides infection. The area under the ROC curve indicated a significant global accuracy. The occurrence of disease could be estimated in the study area, and a risk map was elaborated through the use ordinary kriging. The spatial statistics analysis has proven itself adequate for predicting the occurrence of ascariasis, unrestricted to the regions political boundaries.

Vigilância epidemiológica e avaliação da assistência às meningites

OBJECTIVE To analyze the clinical-epidemiological profile and in-hospital death predictors of infectious meningitis patients admitted to a public hospital. METHODS There were studied 694 cases of meningitis notified and investigated by a public hospitals epidemiology service from 1986 to 2002, using the National Information System of Notifiable Diseases (SINAN) as part of the local routine of epidemiologic surveillance. Statistics analysis included multivariate logistic regression. RESULTS The most frequent etiologies were: cryptococcal (12.3%; case-fatality =37.7%); meningococcal (8.7%; fatality =13.3%); pneumococcal (7.2%; fatality =46%); tuberculous (6.1%; fatality =40.5%); staphylococcal (5.2%; fatality =38.9%), viral (5.5%; fatality =7.9%); Haemophilus (2.9%; fatality =20%). The proportion of cases of non-specified etiology was 38.8% (fatality =36%) and 17.3% were associated to HIV infection. It was found that 27.1% were nosocomial meningitis and 9.2% of the surviving cases had sequelae. The logistic regression model identified the following death predictors of infectious meningitis: etiology (reference: viral category) -- tuberculous, cryptococcal, staphylococcal, meningococcal, non-specified, other Gram-negative, Candida and pneumococcal; HIV co-infection; coma. Fever, vomiting and neck stiffness were associated to a lower odds of death. CONCLUSIONS The high proportion of non-specified etiology and high case-fatality may reflect problems in the hospital care process and/or case selection. The epidemiologic surveillance system operating at the hospital level was able to feedback the services with clinical indicators. The use of SINAN at the local level was considered useful and pertinent.

AIH versus prontuário médico no estudo do risco de óbito hospitalar no infarto agudo do miocárdio no Município do Rio de Janeiro, Brasil

The objective of this study was to analyze the usefulness of the Brazilian Hospital Information System (SIH) in comparison to medical records to study factors associated with in-hospital mortality due to acute myocardial infarction (AMI). We evaluated a stratified random sample of 391 medical records (out of 1,936 hospital admissions forms) with AMI as the primary diagnosis in the city of Rio de Janeiro. Factors associated with in-hospital death were studied through logistic modeling. Models were developed directly from the SIH and from medical records. ROC curves were constructed to allow comparison of the different models. We found an AMI diagnostic confirmation = 91.7% and hospital mortality = 20.6%. The logistic model derived from medical records produced the best fit (concordance = 90.1%). Although the SIH model had a worse fit (concordance = 70.6%), the correction of keying-in and information errors using data from medical records did not significantly modify its performance. Under-recording of secondary diagnosis was high in the SIH forms and was the main limiting factor.

Reliability of the final dengue diagnosis in the epidemic occurring in Rio de Janeiro, Brazil, 2001-2002

This study analyzed the reliability of the final diagnosis in the 155,242 dengue reports during the 2001-2002 epidemic in the city of Rio de Janeiro, Brazil, using the official information system on communicable diseases (SINAN). The system allows the following options for the final diagnosis: classic dengue, dengue hemorrhagic fever, discarded, inconclusive, and unknown. We built a classification routine in Epi Info to compare the final diagnosis from SINAN with Ministry of Health criteria. According to the final diagnosis, the case breakdown was: 52.4% classic dengue; 0.6% dengue hemorrhagic fever; 0.9% discarded; 46% inconclusive and unknown. The revised diagnosis showed that 78% of classic dengue, 69% of dengue hemorrhagic fever, and 21.1% of discarded cases met the classification criteria. Although the reliability of the SINAN final diagnosis was generally satisfactory (kappa = 0.681; 95%CI: 0.685-0.677), it was worse for fatal cases (kappa = 0.152; 95%CI: 0.046-0.258). Considering the epidemics magnitude, the final diagnosis of classic dengue and dengue hemorrhagic fever was satisfactory, but the high proportion of inconclusive or unknown cases and the poor quality of information for fatal cases limit the usefulness of SINAN in this context.