Sistema nacional de informações tóxico-farmacológicas: o desafio da padronização dos dados

A incidência de intoxicações e envenenamentos constitui um grave problema de saúde pública. Para esse segmento, a importância de se dispor, a tempo e a hora, de informações fidedignas é condição primordial para se traçarem estratégias eficazes e efetivas de vigilância epidemiológica e sanitária. Para investigar uma faceta da qualidade dos dados registrados no país, sobre este tipo de agravo, este estudo volta-se para os Centros de Informação e Assistência Toxicológica (CIAT), uma das principais fontes para notificação e registro de tais casos, que fornecem dados que são consolidados pelo Sistema Nacional de Informações Tóxico-Farmacológicas (SINITOX). Partindo do pressuposto que a padronização é uma das principais variáveis que impactam a qualidade dos dados coletados, o estudo visou analisar a maneira como os CIAT interpretam e registram cada um dos eventos a eles notificados. Buscou-se reproduzir as práticas em curso no registro dos casos, com sua lógica e entendimento habitual. Os resultados apontam para o baixo grau de padronização dos dados que chegam ao SINITOX, o que impacta, qualitativamente, as informações geradas por este sistema. Um desenho de estratégias que atuem para aprimorar a padronização dos dados, por certo, conduzirá a um sistema de informação mais robusto e confiável.Human poisoning is a serious public health issue around the world. Readily available and reliable information in this field are essential to the full implementation of epidemiological and sanitary surveillance and to establish efficient and effective strategies of control. The continuous improvement of data quality and consistency % no doubt, a permanent challenge % has a key role in the definition of public policies. To assess the accuracy of Brazilian data on human poisonings, this study explores data from a network of Toxicological Information and Assistance Centers, one of the main sources of such data in Brazil. Data are consolidated by the National Poison Information System (SINITOX). Assuming that standardization is one of the main procedures that influence the data quality collected and analyzed by SINITOX, the study assesses the operations of the Centers affiliated to the SINITOX in charge to interpret and register the events reported to them and highlights the procedures used to standardize case reports. The results show an evident insufficient degree of standardization of the data received at SINITOX. We emphasize the need to design strategies to improve standardization, aiming to develop a reliable system and to minimize the harms associated to human poisoning in Brazil

Adequacy of public maternal care services in Brazil

Abstract Background In Brazil, hospital childbirth care is available to all, but differences in access and quality of care result in inequalities of maternal health. The objective of this study is to assess the infrastructure and staffing of publicly financed labor and birth care in Brazil and its adequacy according to clinical and obstetric conditions potentially associated with obstetric emergencies. Methods Nationwide cross-sectional hospital-based study “Birth in Brazil: national survey into labor and birth” conducted in 2011–2012. Data from 209 hospitals classified as public (public funding and management) or mixed (public or private funding and private management) that generate estimates for 1148 Brazilian hospitals. Interview with hospital managers provided data for the structure adequacy assessment covering four domains: human resources, medications, equipment for women emergency care and support services. We conducted analysis of the structure adequacy rate according to type of hospital (public or mixed), availability of ICU and the woman obstetric risk using the X 2 test to detect differences in categorical variables with the level of statistical significance set at p <0.05. Results Global rate of adequacy of 34.8 %: 42.2 % in public hospitals and 29.0 % in mixed hospitals (p < 0.001). Public and mixed hospitals with ICU had higher scores of adequacy than hospitals without ICU (73.3 % × 24.4 % public hospitals; 40.3 % × 10.6 % mixed hospitals). At a national level, 32.8 % of women with obstetric risk were cared for in hospitals without ICU and 29.5 % of women without risk were cared for in hospitals with ICU. Inequalities were observed with the North, Northeast and non-capital regions having the lower rates of hospitals with ICU. Conclusions The majority of maternity wards across the country have a low rate of adequacy that can affect the quality of labor and birth care. This holds true for women at high obstetric risk, who suffer the possibility of having their care compromised by failures of hospital infrastructure, and for women at low obstetric risk, who may not receive the appropriate care to support the natural evolution of their labor when in a technological hospital environment

First Assessment of Carbon Stock in the Belowground Biomass of Brazilian Mangroves

ABSTRACT Studies on belowground roots biomass have increasingly reported the importance of the contribution of this compartment in carbon stock maintenance in mangrove forests. To date, there are no estimates of this contribution in Brazilian mangrove forests, although the country has the second largest area of mangroves worldwide. For this study, trenches dug in fringing forests in Guaratiba State Biological Reserve (Rio de Janeiro, Brazil) were used to evaluate the contribution of the different classes of roots and the vertical stratification of carbon stock. The total carbon stock average in belowground roots biomass in these forests was 104.41 ± 20.73 tC.ha−1. From that, an average of 84.13 ± 21.34 tC.ha−1 corresponded to the carbon stock only in fine roots, which have diameters smaller than 5 mm and are responsible for over 80% of the total belowground biomass. Most of the belowground carbon stock is concentrated in the first 40 cm below the surface (about 70%). The root:shoot ratio in this study is 1.14. These estimates demonstrate that the belowground roots biomass significantly contributes, more than 50%, to the carbon stock in mangrove forests. And the mangrove root biomass can be greater than that of other Brazilian ecosystems