Access to colposcopy in the State of São Paulo, Brazil: probabilistic linkage study of administrative data / Acesso à colposcopia no Estado de São Paulo, Brasil: um estudo de relacionamento probabilístico de dados administrativos / Acceso a la colposcopía en el Estado de São Paulo, Brasil: estudio de vinculación probabilística con datos administrativos

Cervical cancer screening is a multistage process, therefore access to both the primary test and subsequent diagnostic procedures is essential. Considering women undergoing screening on the public health system in the State of São Paulo, Brazil, we aimed to estimate the proportion of women accessing colposcopy within six months of an abnormal smear result. We retrieved records from two administrative databases, the Information System on Uterine Cervical Cancer (SISCOLO) that contains smear results and the Outpatient Information System of the Brazilian Unified National Health System (SIA/SUS) that records colposcopies. A reference cohort consisted of women, aged 25 years or older, with an abnormal smear result between May 1, 2014, and June 30, 2014. We excluded prevalent cases. We linked the reference cohort and records in the SIA/SUS extending to December 31, 2014. After excluding prevalent cases, 1,761 women with abnormal cytology results were left. A total of 700 (39.8%) women were linked to a colposcopy record within the follow-up period; this dropped to 671 (38.1%) women when follow-up was censored at six months. We could notice a slightly higher attendance in women living in the metropolitan region of São Paulo compared with residents of the rest of the state. We found no association between colposcopy attendance and age or cytology class. These results emphasize that access to colposcopy in the public health system in São Paulo is limited. This compromises the quality of screening, and the issue needs to be prioritized in service planning.

A triagem do câncer de colo uterino é um processo que envolve múltiplas etapas. É essencial o acesso ao teste primário e aos procedimentos diagnósticos subsequentes. Com foco nas mulheres que fazem triagem no sistema de saúde pública no Estado de São Paulo, Brasil, buscamos estimar a proporção daquelas que acessam a colposcopia dentro de seis meses após um resultado anormal no teste de Papanicolau. Recuperamos os registros de duas bases de dados administrativos: o Sistema de Informação do Controle do Câncer do Colo do Útero (SISCOLO), que contém os resultados de Papanicolau, e o Sistema de Informação Ambulatorial do Sistema Único de Saúde (SIA/SUS), com os registros das colposcopias. Uma coorte de referência foi constituída de mulheres com idade de 25 anos ou mais com Papanicolau anormal entre 1º de maio de 2014 e 30 de junho de 2014. Excluímos casos prevalentes. Relacionamos a coorte de referência aos registros no SIA/SUS, estendendo até 31 de dezembro de 2014. Após a exclusão dos casos prevalentes, restaram 1.761 mulheres com citologia anormal. Setecentas delas (39,8%) foram relacionadas a um registro de colposcopia dentro do período de seguimento; esse número diminuiu para 671 (38,1%) quando o seguimento foi censurado aos seis meses. Foi observada uma cobertura ligeiramente maior entre mulheres residentes na Grande São Paulo, em comparação com mulheres residentes do interior do estado. Não houve associação entre realização de colposcopia e idade ou classe citológica. Os resultados destacam o acesso restrito à colposcopia no sistema público de saúde no Estado de São Paulo. O cenário compromete a qualidade da triagem, e a questão deve ser priorizada no planejamento dos serviços.

Las pruebas de detección del cáncer cervical forman parte de un proceso multietapa. El acceso a tanto el test primario, como a los subsiguientes procedimientos de diagnóstico, es esencial. Considerando a las mujeres que se realizan las pruebas de detección en el sistema público de la salud en el Estado de São Paulo, Brasil, el objetivo del estudio fue estimar la proporción de mujeres que acceden a una colposcopía dentro de los seis meses, tras el resultado anormal en una citología. Recuperamos los registros de dos bases de datos administrativas: el Sistema de Información del Cáncer de Cuello de Útero (SISCOLO), que contiene resultados citológicos, y el Sistema de Información Ambulatoria del Sistema Único de Salud (SIA/SUS), que registra colposcopías. La cohorte de referencia consistía en mujeres, con 25 años de edad o mayores, quienes recibieron un resultado anormal en su citología entre el 1º mayo de 2014 y el 30 de junio 2014. Excluimos los casos prevalentes. Vinculamos la cohorte de referencia y los registros en la SIA/SUS, extendiéndolos hasta el 31 de diciembre 2014. Tras excluir los casos prevalentes, quedaron 1.761 mujeres con resultados citológicos anormales; 700 (39.8%), vinculados a un registro de colposcopía dentro del periodo de seguimient. Esta cifra cayó a 671 (38.1%) cuando el seguimiento fue censurado a los seis meses. Se observó una participación ligeramente superior en mujeres que viven en la región metropolitana de la gran São Paulo, comparada con los residentes del resto del estado. No hubo asociación entre la participación en la colposcopía y edad o tipo de citología. Estos resultados resaltan que el acceso a la colposcopía en el sistema público de São Paulo es limitado. Esto compromete la calidad de las pruebas de detección por lo que se necesita darles prioridad en la planificación de los servicios sanitarios.

Surveillance of hemorrhagic fever and/or neuroinvasive disease: challenges of diagnosis

ABSTRACT OBJECTIVE To evaluate the performance of post mortem laboratory analysis in identifying the causes of hemorrhagic fever and/or neuroinvasive disease in deaths by arbovirus infection. METHODS Retrospective cross-sectional study based on the differential analysis and final outcome obtained in patients whose samples underwent laboratory testing for arboviruses at the Pathology Center of the Adolfo Lutz Institute, in São Paulo, Brazil. RESULTS Of the 1355 adults clinically diagnosed with hemorrhagic fever and/or neuroinvasive disease, the most commonly attributed cause of death and the most common final outcome was dengue fever. Almost half of the samples tested negative on all laboratory tests conducted. CONCLUSION The failure to identify the causative agent in a great number of cases highlights a gap in the diagnosis of deaths of unknown etiology. Additional immunohistochemical and molecular assessments need to be added to the post-mortem protocol if all laboratory evaluations performed fail to identify a causative agent. While part of our findings may be due to technical issues related to sample fixation, better information availability when making the initial diagnosis is crucial. Including molecular approaches might lead to a significant advancement in diagnostic accuracy.

Surveillance of hemorrhagic fever and/or neuroinvasive disease: challenges of diagnosis

OBJECTIVE: To evaluate the performance of post mortem laboratory analysis in identifying the causes of hemorrhagic fever and/or neuroinvasive disease in deaths by arbovirus infection. METHODS: Retrospective cross-sectional study based on the differential analysis and final outcome obtained in patients whose samples underwent laboratory testing for arboviruses at the Pathology Center of the Adolfo Lutz Institute, in São Paulo, Brazil. RESULTS: Of the 1355 adults clinically diagnosed with hemorrhagic fever and/or neuroinvasive disease, the most commonly attributed cause of death and the most common final outcome was dengue fever. Almost half of the samples tested negative on all laboratory tests conducted. CONCLUSION: The failure to identify the causative agent in a great number of cases highlights a gap in the diagnosis of deaths of unknown etiology. Additional immunohistochemical and molecular assessments need to be added to the post-mortem protocol if all laboratory evaluations performed fail to identify a causative agent. While part of our findings may be due to technical issues related to sample fixation, better information availability when making the initial diagnosis is crucial. Including molecular approaches might lead to a significant advancement in diagnostic accuracy. DESCRIPTORS: Autopsy. Hemorrhagic Fevers, Viral, etiology. Arbovirus Infections, mortality