Amoebic Abscess of the Liver

Selective angiography of the coeliac axis usually with superior mesenteric arteriography and hepatic isotopic scanning, have proved helpful in the diagnosis and differential diagnosis of amoebic liver abscess. In 16 patients who have had selective angiograms, arteriography showed tumours in 13, failed in 1 and was doubtful in 2. Isotopic scanning demonstrated tumours in 10, failed in 3 and was doubtful in 3. The results obtained with these 2 methods were confirmed by clinical, haematological, surgical, laparoscopic, postmortem, and therapeutic data. After treatment the selective arteriography was repeated in 12 patients and isotopic scanning in 9. Both methods showed agreement in demonstrating the disappearance of the abscess in all patients except one. In this one the isotopic scanning image persisted, whereas arteriography no longer showed the existence of a tumour. Arteriography and scintigraphy are complementary techniques for the diagnosis of tumours of the liver, the former being particularly useful for the aetiological diagnosis of the lesion

Newborn skin reflection: Proof of concept for a new approach for predicting gestational age at birth. A cross-sectional study

Current methods to assess the gestational age during prenatal care or at birth are a global challenge. Disadvantages, such as low accessibility, high costs, and imprecision of clinical tests and ultrasonography measurements, may compromise health decisions at birth, based on the gestational age. Newborns organs and tissues can indirectly indicate their physical maturity, and we hypothesized that evolutionary changes in their skin, detected using an optoelectronic device meter, may aid in estimating the gestational age. This study analyzed the feasibility of using newborn skin reflectance to estimate the gestational age at birth noninvasively. A cross-sectional study evaluated the skin reflectance of selected infants, preferably premature, at birth. The first-trimester ultrasound was the reference for gestational age. A prototype of a new noninvasive optoelectronic device measured the backscattering of light from the skin, using a light emitting diode at wavelengths of 470 nm, 575 nm, and 630 nm. Univariate and multivariate regression analysis models were employed to predict gestational age, combining skin reflectance with clinical variables for gestational age estimation. The gestational age at birth of 115 newborns from 24.1 to 41.8 weeks of gestation correlated with the light at 630 nm wavelength reflectance 3.3 mm/6.5 mm ratio distant of the sensor, at the forearm and sole . The best-combined variables to predict the gold standard gestational age at birth was the skin reflectance at wavelengths of 630 nm and 470 nm in combination with birth weight, phototherapy, and adjusted to include incubator stay, and sex. The main limitation of the study is that it was very specific to the premature population we studied and needs to be studied in a broader spectrum of newborns

Leading causes of child mortality in Brazil, in 1990 and 2015 : estimates from the Global Burden of Disease study

Objetivo: analisar as taxas de mortalidade e as principais causas de morte na infância no Brasil e estados, entre 1990 e 2015, utilizando estimativas do estudo Carga Global de Doença (Global Burden of Disease - GBD) 2015. Métodos: as fontes de dados foram óbitos e nascimentos estimados com base nos dados do Sistema de Informações sobre Mortalidade (SIM), censos e pesquisas. Foram calculadas proporções e taxas por mil nascidos vivos (NV) para o total de óbitos e as principais causas de morte na infância. Resultados: o número estimado de óbitos para menores de 5 anos, no Brasil, foi de 191.505, em 1990, e 51.226, em 2015, sendo cerca de 90% mortes infantis. A taxa de mortalidade na infância no Brasil sofreu redução de 67,6%, entre 1990 e 2015, cumprindo a meta estabelecida nos Objetivos de Desenvolvimento do Milênio (ODM). A redução total das taxas foi, em geral, acima de 60% nos estados, sendo maior na região Nordeste. A disparidade entre as regiões foi reduzida, sendo que a razão entre o estado com a maior e a menor taxa diminuiu de 4,9, em 1990, para 2,3, em 2015. A prematuridade, apesar de queda de 72% nas taxas, figurou como a principal causa de óbito em ambos os anos, seguida da doença diarreica, em 1990, e das anomalias congênitas, da asfixia no parto e da sepse neonatal, em 2015. Conclusão: a queda nas taxas de mortalidade na infância representa um importante ganho no período, com redução de disparidades geográficas. As causas relacionadas ao cuidado em saúde na gestação, no parto e no nascimento figuram como as principais em 2015, em conjunto com as anomalias congênitas. Políticas públicas intersetoriais e de saúde específicas devem ser aprimoradas.Objective: to analyze under-5 mortality rates and leading causes in Brazil and states in 1990 and 2015, using the Global Burden of Disease Study (GBD) 2015 estimates. Methods: the main sources of data for all-causes under-5 mortality and live births estimates were the mortality information system, surveys, and censuses. Proportions and rates per 1,000 live births (LB) were calculated for total deaths and leading causes. Results: estimates of under-5 deaths in Brazil were 191,505 in 1990, and 51,226 in 2015, 90% of which were infant deaths. The rates per 1,000 LB showed a reduction of 67.6% from 1990 to 2015, achieving the proposed target established by the Millennium Development Goals (MDGs). The reduction generally was more than 60% in states, with a faster reduction in the poorest Northeast region. The ratio of the highest and lowest rates in the states decreased from 4.9 in 1990 to 2.3 in 2015, indicating a reduction in socioeconomic regional disparities. Although prematurity showed a 72% reduction, it still remains as the leading cause of death (COD), followed by diarrheal diseases in 1990, and congenital anomalies, birth asphyxia and septicemia neonatal in 2015. Conclusion: under-5 mortality has decreased over the past 25 years, with reduction of regional disparities. However, pregnancy and childbirth-related causes remain as major causes of death, together with congenital anomalies. Intersectoral and specific public health policies must be continued to improve living conditions and health care in order to achieve further reduction of under-5 mortality rates in Brazil

Preeclampsia and COVID-19: results from the INTERCOVID prospective longitudinal study

Background: It is unclear whether the suggested link between COVID-19 during pregnancy and preeclampsia is an independent association or if these are caused by common risk factors. Objective: This study aimed to quantify any independent association between COVID-19 during pregnancy and preeclampsia and to determine the effect of these variables on maternal and neonatal morbidity and mortality. Study Design: This was a large, longitudinal, prospective, unmatched diagnosed and not-diagnosed observational study assessing the effect of COVID-19 during pregnancy on mothers and neonates. Two consecutive not-diagnosed women were concomitantly enrolled immediately after each diagnosed woman was identified, at any stage during pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed until hospital discharge using the standardized INTERGROWTH-21st protocols and electronic data management system. A total of 43 institutions in 18 countries contributed to the study sample. The independent association between the 2 entities was quantified with the risk factors known to be associated with preeclampsia analyzed in each group. The outcomes were compared among women with COVID-19 alone, preeclampsia alone, both conditions, and those without either of the 2 conditions. Results: We enrolled 2184 pregnant women; of these, 725 (33.2%) were enrolled in the COVID-19 diagnosed and 1459 (66.8%) in the COVID-19 not-diagnosed groups. Of these women, 123 had preeclampsia of which 59 of 725 (8.1%) were in the COVID-19 diagnosed group and 64 of 1459 (4.4%) were in the not-diagnosed group (risk ratio, 1.86; 95% confidence interval, 1.32–2.61). After adjustment for sociodemographic factors and conditions associated with both COVID-19 and preeclampsia, the risk ratio for preeclampsia remained significant among all women (risk ratio, 1.77; 95% confidence interval, 1.25–2.52) and nulliparous women specifically (risk ratio, 1.89; 95% confidence interval, 1.17–3.05). There was a trend but no statistical significance among parous women (risk ratio, 1.64; 95% confidence interval, 0.99–2.73). The risk ratio for preterm birth for all women diagnosed with COVID-19 and preeclampsia was 4.05 (95% confidence interval, 2.99–5.49) and 6.26 (95% confidence interval, 4.35–9.00) for nulliparous women. Compared with women with neither condition diagnosed, the composite adverse perinatal outcome showed a stepwise increase in the risk ratio for COVID-19 without preeclampsia, preeclampsia without COVID-19, and COVID-19 with preeclampsia (risk ratio, 2.16; 95% confidence interval, 1.63–2.86; risk ratio, 2.53; 95% confidence interval, 1.44–4.45; and risk ratio, 2.84; 95% confidence interval, 1.67–4.82, respectively). Similar findings were found for the composite adverse maternal outcome with risk ratios of 1.76 (95% confidence interval, 1.32–2.35), 2.07 (95% confidence interval, 1.20–3.57), and 2.77 (95% confidence interval, 1.66–4.63). The association between COVID-19 and gestational hypertension and the direction of the effects on preterm birth and adverse perinatal and maternal outcomes, were similar to preeclampsia, but confined to nulliparous women with lower risk ratios. Conclusion: COVID-19 during pregnancy is strongly associated with preeclampsia, especially among nulliparous women. This association is independent of any risk factors and preexisting conditions. COVID-19 severity does not seem to be a factor in this association. Both conditions are associated independently of and in an additive fashion with preterm birth, severe perinatal morbidity and mortality, and adverse maternal outcomes. Women with preeclampsia should be considered a particularly vulnerable group with regard to the risks posed by COVID-19

Global, regional, and national under-5 mortality, adult mortality, age-specific mortality, and life expectancy, 1970–2016: a systematic analysis for the Global Burden of Disease Study 2016

BACKGROUND: Detailed assessments of mortality patterns, particularly age-specific mortality, represent a crucial input that enables health systems to target interventions to specific populations. Understanding how all-cause mortality has changed with respect to development status can identify exemplars for best practice. To accomplish this, the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016) estimated age-specific and sex-specific all-cause mortality between 1970 and 2016 for 195 countries and territories and at the subnational level for the five countries with a population greater than 200 million in 2016. METHODS: We have evaluated how well civil registration systems captured deaths using a set of demographic methods called death distribution methods for adults and from consideration of survey and census data for children younger than 5 years. We generated an overall assessment of completeness of registration of deaths by dividing registered deaths in each location-year by our estimate of all-age deaths generated from our overall estimation process. For 163 locations, including subnational units in countries with a population greater than 200 million with complete vital registration (VR) systems, our estimates were largely driven by the observed data, with corrections for small fluctuations in numbers and estimation for recent years where there were lags in data reporting (lags were variable by location, generally between 1 year and 6 years). For other locations, we took advantage of different data sources available to measure under-5 mortality rates (U5MR) using complete birth histories, summary birth histories, and incomplete VR with adjustments; we measured adult mortality rate (the probability of death in individuals aged 15-60 years) using adjusted incomplete VR, sibling histories, and household death recall. We used the U5MR and adult mortality rate, together with crude death rate due to HIV in the GBD model life table system, to estimate age-specific and sex-specific death rates for each location-year. Using various international databases, we identified fatal discontinuities, which we defined as increases in the death rate of more than one death per million, resulting from conflict and terrorism, natural disasters, major transport or technological accidents, and a subset of epidemic infectious diseases; these were added to estimates in the relevant years. In 47 countries with an identified peak adult prevalence for HIV/AIDS of more than 0·5% and where VR systems were less than 65% complete, we informed our estimates of age-sex-specific mortality using the Estimation and Projection Package (EPP)-Spectrum model fitted to national HIV/AIDS prevalence surveys and antenatal clinic serosurveillance systems. We estimated stillbirths, early neonatal, late neonatal, and childhood mortality using both survey and VR data in spatiotemporal Gaussian process regression models. We estimated abridged life tables for all location-years using age-specific death rates. We grouped locations into development quintiles based on the Socio-demographic Index (SDI) and analysed mortality trends by quintile. Using spline regression, we estimated the expected mortality rate for each age-sex group as a function of SDI. We identified countries with higher life expectancy than expected by comparing observed life expectancy to anticipated life expectancy on the basis of development status alone. FINDINGS: Completeness in the registration of deaths increased from 28% in 1970 to a peak of 45% in 2013; completeness was lower after 2013 because of lags in reporting. Total deaths in children younger than 5 years decreased from 1970 to 2016, and slower decreases occurred at ages 5-24 years. By contrast, numbers of adult deaths increased in each 5-year age bracket above the age of 25 years. The distribution of annualised rates of change in age-specific mortality rate differed over the period 2000 to 2016 compared with earlier decades: increasing annualised rates of change were less frequent, although rising annualised rates of change still occurred in some locations, particularly for adolescent and younger adult age groups. Rates of stillbirths and under-5 mortality both decreased globally from 1970. Evidence for global convergence of death rates was mixed; although the absolute difference between age-standardised death rates narrowed between countries at the lowest and highest levels of SDI, the ratio of these death rates-a measure of relative inequality-increased slightly. There was a strong shift between 1970 and 2016 toward higher life expectancy, most noticeably at higher levels of SDI. Among countries with populations greater than 1 million in 2016, life expectancy at birth was highest for women in Japan, at 86·9 years (95% UI 86·7-87·2), and for men in Singapore, at 81·3 years (78·8-83·7) in 2016. Male life expectancy was generally lower than female life expectancy between 1970 and 2016, an

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: A systematic analysis for the Global Burden of Disease Study 2017

Background: The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods: We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings: Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1-4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0-8·4) while the total sum of global YLDs increased from 562 million (421-723) to 853 million (642-1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6-9·2) for males and 6·5% (5·4-7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782-3252] per 100 000 in males vs 1400 [1279-1524] per 100 000 in females), transport injuries (3322 [3082-3583] vs 2336 [2154-2535]), and self-harm and interpersonal violence (3265 [2943-3630] vs 5643 [5057-6302]). Interpretation: Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Exclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030

Global, regional, and national age-sex-specific mortality and life expectancy, 1950-2017: a systematic analysis for the Global Burden of Disease Study 2017

Background: Assessments of age-specific mortality and life expectancy have been done by the UN Population Division, Department of Economics and Social Affairs (UNPOP), the United States Census Bureau, WHO, and as part of previous iterations of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD). Previous iterations of the GBD used population estimates from UNPOP, which were not derived in a way that was internally consistent with the estimates of the numbers of deaths in the GBD. The present iteration of the GBD, GBD 2017, improves on previous assessments and provides timely estimates of the mortality experience of populations globally. Methods: The GBD uses all available data to produce estimates of mortality rates between 1950 and 2017 for 23 age groups, both sexes, and 918 locations, including 195 countries and territories and subnational locations for 16 countries. Data used include vital registration systems, sample registration systems, household surveys (complete birth histories, summary birth histories, sibling histories), censuses (summary birth histories, household deaths), and Demographic Surveillance Sites. In total, this analysis used 8259 data sources. Estimates of the probability of death between birth and the age of 5 years and between ages 15 and 60 years are generated and then input into a model life table system to produce complete life tables for all locations and years. Fatal discontinuities and mortality due to HIV/AIDS are analysed separately and then incorporated into the estimation. We analyse the relationship between age-specific mortality and development status using the Socio-demographic Index, a composite measure based on fertility under the age of 25 years, education, and income. There are four main methodological improvements in GBD 2017 compared with GBD 2016: 622 additional data sources have been incorporated; new estimates of population, generated by the GBD study, are used; statistical methods used in different components of the analysis have been further standardised and improved; and the analysis has been extended backwards in time by two decades to start in 1950. Findings: Globally, 18·7% (95% uncertainty interval 18·4–19·0) of deaths were registered in 1950 and that proportion has been steadily increasing since, with 58·8% (58·2–59·3) of all deaths being registered in 2015. At the global level, between 1950 and 2017, life expectancy increased from 48·1 years (46·5–49·6) to 70·5 years (70·1–70·8) for men and from 52·9 years (51·7–54·0) to 75·6 years (75·3–75·9) for women. Despite this overall progress, there remains substantial variation in life expectancy at birth in 2017, which ranges from 49·1 years (46·5–51·7) for men in the Central African Republic to 87·6 years (86·9–88·1) among women in Singapore. The greatest progress across age groups was for children younger than 5 years; under-5 mortality dropped from 216·0 deaths (196·3–238·1) per 1000 livebirths in 1950 to 38·9 deaths (35·6–42·83) per 1000 livebirths in 2017, with huge reductions across countries. Nevertheless, there were still 5·4 million (5·2–5·6) deaths among children younger than 5 years in the world in 2017. Progress has been less pronounced and more variable for adults, especially for adult males, who had stagnant or increasing mortality rates in several countries. The gap between male and female life expectancy between 1950 and 2017, while relatively stable at the global level, shows distinctive patterns across super-regions and has consistently been the largest in central Europe, eastern Europe, and central Asia, and smallest in south Asia. Performance was also variable across countries and time in observed mortality rates compared with those expected on the basis of development. Interpretation: This analysis of age-sex-specific mortality shows that there are remarkably complex patterns in population mortality across countries. The findings of this study highlight global successes, such as the large decline in under-5 mortality, which reflects significant local, national, and global commitment and investment over several decades. However, they also bring attention to mortality patterns that are a cause for concern, particularly among adult men and, to a lesser extent, women, whose mortality rates have stagnated in many countries over the time period of this study, and in some cases are increasing

Avaliação do sistema informático perinatal (SIP CLAP OPS) no monitoramento da assistência hospitalar perinatal em Minas Gerais

Exportado OPUSMade available in DSpace on 2019-08-13T16:17:12Z (GMT). No. of bitstreams: 1 maria_albertina_santiago_rego.pdf: 1824067 bytes, checksum: 7ee9ac9a5aec58e5b916854039545e3f (MD5) Previous issue date: 25Objetivos: Avaliar a qualidade da informação e alguns indicadores perinatais do Sistema Informático Perinatal do Centro Latino Americano de Perinatologia da Organização Panamericana de Saúde (SIP-CLAP), e sua utilização para monitoramento da assistência hospitalar perinatal em Minas Gerais. A pesquisa foi desenvolvida em três etapas: 1)analisar a qualidade da informação do SIP-CLAP em maternidades de referência em atenção perinatal de Belo Horizonte (Artigo 1); 2) analisar alguns indicadores maternos e neonatais gerados pelo SIP-CLAP do Hospital das Clínicas da Universidade Federal de Minas Gerais (HC-UFMG) em dois períodos, 1995-98 e 2003-06 (Artigo 2); e 3)identificar as maternidades do Estado que implantaram o programa e avaliar sua utilização pelos profissionais da assistência nessas maternidades (Artigo 3). Metodologia: Para avaliar a qualidade da informação do SIP-CLAP foram analisadas amostras aleatórias sistemáticas de histórias clínicas perinatais (HCP-SIP) e prontuáriosmédicos correspondentes, coletados durante a assistência (componente de completude) e após armazenamento da informação no banco de dados eletrônico do SIP-CLAP (componente de confiabilidade) em duas maternidades de Belo Horizonte onde o programa estava implementado em 2004. Indicadores maternos e neonatais gerados pelo SIP-CLAP foram então analisados em uma dessas maternidades, o HC-UFMG, em dois períodos, 1995-1998 e 2003-2006, antes e após mudanças no fluxo hospitalar assistencial perinatal no município. Para identificar a utilização do SIP-CLAP nas maternidades de Minas Geraisfoi aplicado questionário estruturado aos gestores e, posteriormente, em amostra aleatória de 142 profissionais da assistência hospitalar ao parto e nascimento de três maternidades de referência em atenção perinatal de Belo Horizonte, onde o SIP-CLAP estava implementado em 2005. Resultados: A proporção de completude de variáveis selecionadas da HCP-SIP durante a assistência foi em média 72% no Hospital 1 e 86% no Hospital 2. Após pesquisa em prontuário, o ganho percentual médio no registro global da informação foi de 18% e 7%,respectivamente. A confiabilidade da informação armazenada no banco de dados eletrônico apresentou globalmente índices excelentes de concordância nos dois hospitais. A análise do perfil da população e dos principais indicadores de saúde perinatal gerados pelo SIP-CLAP no HC-UFMG permitiu identificar que, apesar do aumento importante novolume assistencial após reestruturação do fluxo hospitalar perinatal em Belo Horizonte, as características populacionais permaneceram estáveis em geral, com redução significativa da mortalidade neonatal e hospitalar, principalmente de recém-nascidos de muito baixo peso ao nascer. Foram identificados somente três hospitais com implantação do programa em Minas Gerais em 2005. A quase totalidade dos profissionais entrevistados nestes hospitais reconheceu a importância do registro da informação sistematizada durante a assistência ao parto e nascimento. A maioria deles define a HCP-SIP c omo um instrumentoque contempla informações básicas necessárias para a assistência individual, mas não responde totalmente às necessidades de registro clínico durante o processo assistencial, limitação esta detectada principalmente pelos pediatras. Verificou-se que dois terços dos profissionais registram a informação durante a assistência, mas apenas 37% deles utilizam a HCP-SIP com o objetivo principal de definir condutas clínicas e somente 19% utilizam o banco de dados eletrônico gerado pelo programa. A capacitação dos profissionais para opreenchimento da HCP-SIP ocorreu para 66% dos entrevistados e somente um quarto deles foi capacitado para o manuseio dos programas de análise eletrônica. Conclusões: A qualidade da informação do SIP-CLAP, avaliada pelo preenchimento da HCP-SIP durante a assistência e a confiabilidade da informação arquivada no banco de dados eletrônico do SIP-CLAP, somada às características do programa, indicam que o Sistema Informático Perinatal pode ser um bom instrumento para monitoramento da assistência hospitalar ao parto e nascimento objetivando a melhoria da qualidade da assistência perinatal. O reconhecimento pela maioria dos profissionais da importância de registro sistematizado de informação essencial, fundamentada em indicadores assistenciais básicos, identificou a possibilidade de implementação de sistema informático paramonitoramento da assistência perinatal integrado às funções assistenciais na rede hospitalar de Minas Gerais. As falhas identificadas no processo de implementação do programa nos hospitais estudados podem servir de apoio às instituições e gestores na implantação deprogramas de melhoria da qualidade da assistência.Objective: To assess the quality of information and some perinatal indicators of the Perinatal Information System of the Latin-American Center of Perinatology (SIP-CLAP) of the Pan American Health Organization, and their use to monitor perinatal hospital care inMinas Gerais. The research was carried out in three stages: 1) analysis of the quality of the SIP-CLAP information in reference maternity hospitals focused on perinatal care in Belo Horizonte (Article 1); 2) analysis of some maternal and neonatal indicators collected by the SIP-CLAP of the Hospital of Clinics of the University of Minas Gerais (HC-UFMG) in twoperiods, 1995-98 and 2003-06 (Article 2); 3) identification of the State maternity hospitals that have implemented the program and assessment of its use by the healthcare professionals in these maternity hospitals (Article 3). Methodology: In order to assess the quality of the SIP-CLAP information, systematic random samples of perinatal clinical histories (HCP-SIP) were analyzed, as well as their corresponding medical records collected during the medical assistance (completion component) and after the information was stored in the SIP-CLAP`s electronic database (reliability component) in two maternity hospitals of Belo Horizonte where the program was set up in 2004. Maternal and neonatal indicators generated by SIP-CLAP were then analyzed in one of these maternity hospitals, the HC-UFMG, in two periods, 1995-1998 and2003-2006, before and after the changes in the flow of perinatal hospital care in the city. To identify the use of SIP-CLAP in the maternity hospitals of Minas Gerais, a designed questionnaire was applied to the managers, and later to a random sample of 142 professionals of the hospital birth care area in three perinatal care reference maternity hospitals of Belo Horizonte where SIP-CLAP/OPS was implemented in 2005. Results: The completion rate of the selected HCP-SIP variables during the medicalassistance was 72 % on average in Hospital 1 and 86 % in Hospital 2. After the survey using the medical records, the average gain rate in the total record of information was 18% and 7 % respectively. On the whole, reliability of the information stored in the electronic database showed excellent agreement rates in both hospitals. The analysis of the population profile as well as of the major perinatal health indicators generated by SIP-CLAP at HCUFMG enabled us to acknowledge that, despite the considerable increase in the volume of medical assistance after the changes in the structure of the hospital flow of perinatal care inBelo Horizonte, the characteristics of the population remained generally stable, with significant decrease in neonatal and hospital mortality, mainly of underweight newborns. In 2005, the program had been set up in only three hospitals in Minas Gerais. Nearly all professionals interviewed at these hospitals acknowledged the importance of recording the systematized information during birth medical assistance. Most of them define HCP-SIP as a tool which stores the basic necessary information for individual care, but they do not fully meet the needs of clinical records during the assistance process, a limitation that has beenidentified mainly by pediatricians. It was noted that two-thirds of the professionals recorded the information during the medical assistance, but only 37% used HCP-SIP with the main purpose of defining clinical procedures, and just 19% utilized the electronic database generated by the program. Sixty-six percent of the interviewed professionals were qualified to fill out the HCP-SIP form, but only one-quarter of these were qualified to handle the electronic analysis programs. Conclusions: The quality of the SIP-CLAP information assessed by filling out the HCP-SIPform during the medical assistance, and the reliability of the information stored in the SIPCLAP electronic database added to the characteristics of the program indicate that the Perinatal Information System can be a good tool for monitoring hospital birth care aiming at improving the quality of perinatal care. The fact that most professionals acknowledge the importance of systematized record of essential information based on basic indicators of health care identified the possibility of setting up an information system for monitoring perinatal care integrated with the health care activities in the Minas Gerais hospital network. The flaws identified in the process of setting up the program in the studied hospitals may be used as support for institutions and managers in the implementation of programs to improve health care standards