In Brazil, quality A garantia de uma informação de qualidade é condição essencial para a análise objetiva da situação sanitária, para a tomada de decisões baseadas em evidências e para a programação de ações de saúde 1 .Demonstrando a importância dada à qualidade da informação, o Fundo Monetário Internacional (FMI) relaciona em sua página da Internet as iniciativas de 18 países para melhoria das estatísticas econômicas e disponibiliza um modelo para aprimoramento e avaliação das informações: Data Quality Assessment Framework (DQAF. http://desbb.imf.org/Applications/web/dqrs/ dqrsapproaches, acessado em 27/Abr/2007). O escritório de estatística da comunidade européia (Eurostat) adaptou esse modelo para os países europeus, criando o Quality Declaration of the European Statistics System. Na área de tecnologia da informação o desenvolvimento de metodologias para avaliação da qualidade dos bancos de REVISÃO REVIEW

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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, mother's 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.

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.

Since record linkage errors can bias measures of disease occurrence and association, it is important to assess their accuracy. The aim of this study is to assess the accuracy of a multiple pass probabilistic record linkage strategy to identify deaths among persons reported to the Brazilian AIDS surveillance database. An HIV/AIDS national surveillance database (N = 559,442) was linked to a total of 6,444,822 deaths registered (all causes) in the Brazilian mortality database. To estimate standard measures of accuracy, we selected all AIDS cases with a date of death registered in the surveillance database from 2002 to 2005 (N = 19,750) and 38,675 cases known to be alive in 2006. The linkage strategy presented a sensitivity of 87.6% (95%CI: 87.1-88.2), a specificity of 99.6% (95%CI: 99.6-99.7), and a positive predictive value of 99.2% (95%CI: 99.1-99.3). We observed a small variation in the validity measures according to some putative predictors of mortality. Our findings suggest that even large and heterogeneous databases can be linked with a satisfactory accuracy.

Os objetivos deste estudo são analisar o perfil de morbi-mortalidade em idosos hospitalizados em dois hospitais universitários e dois não universitários, da Área de planejamento 2.2 da cidade do Rio de Janeiro, Brasil, no ano de 1999, comparando as taxas de mortalidade hospitalar, ajustando para diferenças no perfil. Os dados foram obtidos do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS). O modelo logístico foi ajustado incluindo as variáveis idade e diagnóstico primário, utilizado para calcular as taxas de mortalidade hospitalar ajustadas. As internações hospitalares em idosos (n = 7.584) representaram 29,3% do total de 25.928 internações realizadas nessas unidades. Catarata senil (7,8%) foi a causa mais freqüente, seguida de hiperplasia de próstata (4,7%), insuficiência cardíaca congestiva (2,9%) e bloqueio atrioventricular total (2,8%). Os hospitais não universitários apresentaram taxas de mortalidade hospitalar maiores do que as dos hospitais universitários, mesmo depois do ajuste para diferenças no perfil de casos em relação à idade e diagnóstico principal. O uso dos bancos de dados do SIH/SUS e da metodologia de ajuste de risco representam uma alternativa para avaliações exploratórias de resultados de cuidados de saúde.

A blocagem (blocking), que consiste na criação de blocos lógicos de registros dentro de arquivos a serem relacionados, é um dos processos que faz parte do relacionamento probabilístico de grandes bases de dados. Os objetivos deste trabalho são comparar a eficiência de diferentes esquemas de blocagem e estudar a eficiência da utilização de uma rotina de padronização desenvolvida pelos autores, que aplica a mesma grafia para as primeiras sílabas de nomes com o mesmo som. Procedemos ao relacionamento de uma base de dados de mortalidade com 59.065 óbitos com uma base de óbitos hospitalares com 531 registros, que apresentavam um registro correspondente na base de mortalidade. Diferentes estratégias de blocagem foram comparadas em relação ao custo para o processamento e a proporção de pares verdadeiros perdidos. A estratégia de blocagem em múltiplos passos foi mais eficiente, permitindo a identificação de todos os pares verdadeiros com a formação de um número total de pares que foi inferior ao obtido em duas rotinas diferentes de passo único. Já entre as estratégias de passo único avaliadas, a que se baseou no emprego da chave formada pela combinação do código soundex do primeiro nome e sexo apresentou o melhor resultado. A utilização da rotina de padronização que aplica a mesma grafia para as primeiras sílabas de nomes com o mesmo som não apresentou um impacto importante, quer em custos, quer na redução da perda de pares verdadeiros.

OBJECTIVE Evaluate the interaction between maternal age and education level in neonatal mortality, as well as investigate the temporal evolution of neonatal mortality in each stratum formed by the combination of these two risk factors.METHODS A nonconcurrent cohort study, resulting from a probabilistic relationship between the Mortality Information System and the Live Birth Information System. To investigate the risk of neonatal death we performed a logistic regression, with an odds ratio estimate for the combined variable of maternal education and age, as well as the evaluation of additive and multiplicative interaction. The neonatal mortality rate time series, according to maternal education and age, was estimated by the Joinpoint Regression program.RESULTS The neonatal mortality rate in the period was 8.09‰ and it was higher in newborns of mothers with low education levels: 12.7‰ (adolescent mothers) and 12.4‰ (mother 35 years old or older). Low level of education, without the age effect, increased the chance of neonatal death by 25% (OR = 1.25, 95%CI 1.14–1.36). The isolated effect of age on neonatal death was higher for adolescent mothers (OR = 1.39, 95%CI 1.33–1.46) than for mothers aged ≥ 35 years (OR = 1.16, 95%CI 1.09–1.23). In the time-trend analysis, no age group of women with low education levels presented a reduction in the neonatal mortality rate for the period, as opposed to women with intermediate or high levels of education, where the reduction was significant, around 4% annually.CONCLUSIONS Two more vulnerable groups – adolescents with low levels of education and older women with low levels of education – were identified in relation to the risk of neonatal death and inequality in reducing the mortality rate.