Clinico-pathological discrepancies in a general university hospital in São Paulo, Brazil

INTRODUCTION: The autopsy rate has continuously diminished over the past few decades, reducing the quality of medical care and the accuracy of statistical health data. OBJECTIVE: To assess the accuracy of clinical diagnoses by comparing pre- and postmortem findings, and to identify potential risk factors for misdiagnoses. METHODS: Retrospective evaluations performed between June 2001 and June 2003 in a 2500-bed tertiary university hospital in São Paulo, Brazil, including 288 patients who died at that institution and had a postmortem examination. RESULTS: Clinical and autopsy records were reviewed and compared for categorization using the adapted Goldman criteria. The overall major and minor discrepancy rates were 16.3 percent and 28.1 percent, respectively. The most common missed diagnoses were pulmonary embolism, pneumonia, and myocardial infarction, and the most prevalent underlying diseases were infectious diseases, cerebro-cardiovascular conditions, and malignancies. Patients age 60 or older had an increased risk of diagnostic disagreement, as did female patients. The period of hospitalization, last admission unit at the hospital and underlying disease were not significantly related to the pre-mortem diagnostic accuracy. DISCUSSION: The discrepancy rate found in this study is similar to those reported globally. The factors influencing diagnostic accuracy as well as the most commonly missed diagnoses are also consistent with the literature. CONCLUSION: Autopsy remains a crucial tool for improving medical care, and effort must be focused on increasing its practice worldwide.

Violência doméstica e saúde da mulher / Domestic violence and women's health

Objetivo: estudar a prevalência doméstica física e/ou sexual contra a mulher e suas repercussões para a saúde. Materiais e métodos: O estudo foi realizado no município de São Paulo com 1343 mulheres (15-49 anos) usuárias de 12 serviços públicos de atenção primária à saúde. Resultados: Ao analisar a prevalência de violência física e/ou sexual, 50,2 por cento das mulheres (IC95 por cento = 47,5-52,9por cento) relataram a ocorrência de pelo menos um episódio / Objectives: To investigate the prevalence of physical and sexual forms domestic violence against women and its outcomes in health. Methods: the study was carried out in São Paulo, Brazil, with a sample of 1343 women aged 15 to 49 years old among users of 12 public primary care health services. Results: As regards the prevalence of physical and/or sexual violence, 50,2 per cent of the women (95 per cent CI=44,1-49,5 per cent) reported the occurrence of at least one epysode in their lives, being the intimate partner the agressor in the most of the cases (57,2per cent)...