Homicides in Medellín, Colombia, from 1990 to 2002: victims, motives and circumstances

In Medellín, Colombia, homicide has been the first cause of morbidity and mortality for 20 years. Medellín has the highest homicide rates of all major cities in Latin America. This study describes the victims, motives, and circumstances in homicides in Medellín from 1990 to 2002. The period included 55,365 homicides, of which 1,394 were randomly studied. Of this sample, 93.6% (95%CI: 92.2%-94.8%) were males, 77.0% (95%CI: 75.0%-79.5%) less than 35 years of age, one-fourth had consumed alcohol, and nine out of ten were killed with firearms. The main motives were revenge and armed robbery. 37.0% (95%CI: 34.0%-41.0%) of the victims lived in the lowest socioeconomic stratum of the city. Characteristics of homicides in Medellín have remained unchanged since the 1980s, when the most violent period in the city's history began. The most heavily affected groups are young males who live and die in poor neighborhoods, and the murders are individual acts that leave no wounded behind.     

Death and injury from motor vehicle crashes in Colombia.

We report data on the distribution and determinants of road deaths and injuries for all victims in Colombia, with the aim of defining targets and priorities for highway death prevention in that country and other rapidly urbanizing nations. Using information from Colombia's Fund for the Prevention of Road Injury and the national death registry, we studied data on deaths and injuries from 1991 to 1995 for the nation as a whole and for the country's two largest cities, Santa Fe de Bogotá and Medellín. Deaths and injuries are rising in the nation as a whole. Of the deaths, 75% occur in urban areas, and 80% are in males. Pedestrians aged 15-34 are a peak subgroup. Thirty-four percent of deaths are attributable to speeding and/or alcohol consumption. Death tolls are highest at night and on weekends. Specific priority targets for intervention are indicated by the fact that 75% of road deaths in Colombia occur in urban areas and that 80% of all victims are males.     

First characterization of a cluster of VanA-type glycopeptide-resistant Enterococcus faecium,Colombia

From August 1998 to October 1999, glycopeptide-resistant enterococci (GRE) were isolated from 23 infected patients at a teaching hospital in Medellín, Colombia. Identification at the species level and by multiplex polymerase chain reaction assay indicated that all isolates were Enterococcus faecium. The isolates were highly resistant to ampicillin, ciprofloxacin, gentamicin, penicillin, streptomycin, teicoplanin, and vancomycin; they were susceptible only to chloramphenicol, linezolid, and nitrofurantoin. Determination of glycopeptide genotype indicated the presence of the vanA gene in all isolates. Molecular typing by pulsed field gel electrophoresis showed that all isolates were closely related. This study is the first molecular characterization of GRE in Colombia.     

Methylmercury Concentrations in Six Fish Species from Two Colombian Rivers

The objective of this study was to determine whether fish collected from the La Miel or Nechí Rivers (Colombia) differed in muscle methyl mercury (meHg) concentration. Two fish from six different species were collected from markets adjacent to each river. Overall, fish collected from the market adjacent to the Nechí River contained higher levels of meHg. This result however is being driven by very high meHg concentrations in four individual fish, three of which are Pimelodid, long-whiskered catfish. These catfish may represent ideal sentinel organism for the detection of meHg contamination in Colombian rivers.     

Héctor Abad-Gómez (1921-1987): médico,educador y defensor de los derechos humanos

Héctor Abad-Gómez, Colombian physician, university professor, journalist and human rights defender, was murdered in Medellín in 1987. He was a pioneer public health activist engaged in various fields. While being student his restless and dissatisfied mind, led him to fight for a better and safer water and food. He specialized in the University of Minnesota (USA), at his return to the country he led the establishment of the Rural Medical Service. Forced to exile for several years he was WHO consultant to several countries in the Americas and Asia. In 1956 he founded the Preventive Medicine and Public Health Department of the University of Antioquia. He carried out the first recorded mass community vaccination against polio in the world. He initiated a community health agents program known as “Rural health promoters” that later would be implemented nationally. In 1962 he first proposed the application of epidemiological methods to study violence; he was visiting professor at the University of California; he coined the term “polyiatry” for a specialty dedicated to the health populations; he was director of the Colombian National School of Public Health that currently bears his name. Héctor Abad-Gómez ventured into political life, in accordance with Virchow dictum that “politics is medicine on a large scale”. The lives of both have interesting similarities except for the tragic and premature death of the former that still receives rejection today in social, political and academic levels, both in Colombia and abroad.     

Trauma registry implementation and operation in low and middle income countries: A scoping review

ABSTRACT

Injury is a major public health crisis contributing to more than 4.48 million deaths annually. Trauma registries have proven highly effective in reducing injury morbidity and mortality rates in high income countries. They are a critical source of information for injury prevention, benchmarking care, quality improvement, and resource allocation. Historically, low and middle income countries (LMICs) have largely been excluded from trauma registry development due to limited resources. Recently, this has begun to change with low-resource hospitals adopting innovative strategies to implement trauma registries. Nonetheless, dissemination of these strategies remains fragmented. Hospitals looking to develop their own trauma registries have no current, comprehensive resource that summarises the implementation decisions of other registries in similar contexts. This scoping review aims to identify where trauma registries are located in LMICs, bringing up to date previous estimates, and to identify the most common approaches to registry implementation and operation in these settings.     

Using Multivariate Capture-Recapture Techniques and Statewide Hospital Discharge Data to Assess the Validity of a Cancer Registry for Epidemiologic Use

Background: Cancer surveillance is essential for assessing patterns of cancer. State cancer registries do not capture all cases. We used a statewide hospital discharge file to estimate the capture rate and determine biases in capture by a state cancer registry. Methods: We merged the Virginia hospital discharge file and cancer registry for 1995, then used multivariate two- source capture-recapture techniques to control for heterogeneity and more accurately estimate the number and characteristics of missing breast, lung, colorectal and prostate cancer cases. Results: Results suggest heterogeneity of capture, with rates a function of demographics, surgery and being in a hospital with a cancer program certified by the American College of Surgeons(ACOS). Overall registry capture rates ranged from 66% (prostate)–79% (breast). Capture rates varied by subgroup, with differences larger according to surgery and ACOS certification status than for demographic subgroups. While the registry captured most cases who had surgery (85–89%), capture rates for those without surgery was much lower (37–71%). Conclusion: We conclude that hospital discharge data and multivariate capture-recapture techniques are useful to registries to estimate the number of missing cases and assess bias in capture. Epidemiologic research based on registry data alone would likely provide biased, misleading results.     

Using Hospital Tumor Registries to Identify Research Subjects

Hospital tumor registries may permit efficient identification of relatively large numbers of patients for clinical and health services research. This study investigates the feasibility and cost of using hospital tumor registry data for identifying cancer patients with particular clinical characteristics, corresponding to the protocol entry criteria of four randomly sampled Phase III clinical treatment trials for cancer. We screened tumor registry data on 717 patients diagnosed with cancer in 1997 and 1998 who had been identified and abstracted by the registry of a large academic medical center by April, 1999; and we abstracted the medical records of the 122 patients who passed the registry screen. For each clinical profile, the registry screen eliminated a substantial fraction of patients who did not meet the relevant criteria. Of the patients identified from the tumor registry as potential matches, 41% matched the relevant clinical profile based on detailed medical records review. The cost and effort of the registry-based method were substantially lower than would have been necessary if we had reviewed medical records without the registry screen, suggesting that tumor registry data can be a relatively efficient tool for identifying research subjects.     

Immunization registries in the EMR Era

Background: The CDC established a national objective to create population-based tracking of immunizations through regional and statewide registries nearly 2 decades ago, and these registries have increased coverage rates and reduced duplicate immunizations. With increased adoption of commercial electronic medical records (EMR), some institutions have used unidirectional links to send immunization data to designated registries. However, access to these registries within a vendor EMR has not been previously reported.Purpose: To develop a visually integrated interface between an EMR and a statewide immunization registry at a previously non-reporting hospital, and to assess subsequent changes in provider use and satisfaction.Methods: A group of healthcare providers were surveyed before and after implementation of the new interface. The surveys addressed access of the California Immunization Registry (CAIR), and satisfaction with the availability of immunization information. Information Technology (IT) teams developed a “smart-link” within the electronic patient chart that provides a single-click interface for visual integration of data within the CAIR database.Results: Use of the tool has increased in the months since its initiation, and over 20,000 new immunizations have been exported successfully to CAIR since the hospital began sharing data with the registry. Survey data suggest that providers find this tool improves workflow and overall satisfaction with availability of immunization data. (p=0.009).Conclusions: Visual integration of external registries into a vendor EMR system is feasible and improves provider satisfaction and registry reporting.Key Words: Electronic Medical Records, Immunization Registries, EMR integration, HITECH, Meaningful Use     

Patient characteristics and hospital quality for colorectal cancer surgery.

OBJECTIVE: To assess associations of patient characteristics with quality-related characteristics of the hospitals where they were treated for colorectal cancer and the role of these associations in disparities in treatment quality affecting vulnerable patient groups or variations across health plans. SETTING: Population-based cancer registry in California. PARTICIPANTS: A total of 38 237 patients diagnosed with stage I-III (non-metastatic) colorectal cancer in California between 1994 and 1998. METHODS: Registry data were linked with hospital discharge abstracts, US census data, and Medicare enrollment data. The associations of patients' sociodemographic, clinical, and geographic covariates with treatment at high-volume institutions were assessed with logistic regression. The associations of patients' covariates with the risk-adjusted 30-day mortality rates of the hospitals where they received surgery were tested with linear regression. RESULTS: Patients with more advanced tumor stage or more extensive comorbidity, those of Hispanic or Asian race/ethnicity, and those from less affluent communities were less likely to undergo surgery at high-volume institutions and were treated at hospitals with higher risk-adjusted 30-day postoperative mortality rates than those who were less severely ill, white, or more affluent, respectively (all P < 0.05). Black patients also received surgery at hospitals with above-average mortality. Among patients 65 years and older, Medicare managed-care enrollees underwent surgery in higher-volume hospitals than Medicare fee-for-service enrollees, and there was substantial variation in hospital volume and adjusted hospital mortality among Medicare managed-care plans. CONCLUSION: Improving access of sicker, poorer, and minority patients to high-quality hospitals for cancer surgery may improve their outcomes. Further study of processes affecting hospital referral is warranted.     

Vollzähligkeitsschätzungen von Krebsregisterdaten in Deutschland

In 1995, a federal cancer registry law became effective in Germany obliging all federal states to set up epidemiological cancer registries. As a result,numerous cancer registries have been established. However, it is essential to know the degree to which all relevant cases are recorded within a registry—particularly for those registries established recently—as only a high degree of completeness can prevent variations in the efficacy of registry procedures from distorting comparative studies. In this study, the completeness of the cancer registries was evaluated indirectly. Incidences for geographical areas covered by a cancer registry were estimated using incidence/mortality ratios of another registry known to have complete data sets. Log-linear models, successfully applied in a separate study, were fitted to incidence/mortality ratios using both the age and sex-specific data of the reference registry. These estimates were then compared with the actual data collected by the newly established registry, allowing the level of completeness to be assessed. The German Epidemiological Cancer Registry Study Group has agreed to this method and the "Dachdokumentation Krebs"—as a member of this group—performs the analyses. The first results of the study are presented in this contribution.     

Hospitals in integrated delivery systems

With inpatient use plummeting and HMOs demanding deep discounts, hospitals are restructuring themselves to run more efficiently and promote health as part of integrated delivery systems. This installment of HSL's continuing series discusses major strategies hospital directors can establish to support their institutions.     

Birth registry

Birth registries are among the most common type of registry found in hospitals. Brigham and Women's Hospital has a high number of births annually. The following represents a brief overview of the status of this type of registry in healthcare today.     

Role of hospital claims databases from care units for estimating thyroid cancer incidence in the Rhône-Alpes region of France

BACKGROUND: Incidence measures are essentially based on the data collected by cancer registries. Hospital claims databases from care units (PMSI) can be used as a source of information for registries because they contain standard records of most cancer patients. Regarding thyroid cancer, we have evaluated the PMSI as a source of information for the Rh?ne-Alpes thyroid cancer registry and usefulness of PMSI as a tool for surveillance of thyroid cancer incidence. METHODS: Patients with incident thyroid cancer in 2002 were identified in the claims data of the Rh?ne-Alpes region using an algorithm based on DRG codes of thyroidectomy and on diagnosis codes of thyroid cancer in a principal or secondary position. The patients identified were compared to those in thyroid cancer registry of the Rh?ne-Alpes region regarding sex, age, ZIP code of residence, month of discharge and length of stay versus the diagnosis date. When the percentage of cases of claims data identified in the cancer registry and the percentage of cases of the cancer registry identified in claims data were obtained, the capture-recapture method was applied to estimate the number of missing cases and the total number of incident thyroid cancers in the region. RESULTS: 667 patients were identified in claims data while the cancer registry included 677 patients. 95.2% of patients identified in claims data were in the cancer registry and 82.3% of patients in the cancer registry were identified in claims data. Cases lacking in claims data mostly corresponded to micro-cancers which represented 41% of cases in the cancer registry. Regarding cancer above 1 cm, 92% of the cancer registry cases were identified in claims data. Sensitivity of combining information from cancer registry and claims data was 99.2%. Cases lacking in cancer registry, present in claims data base and considered as true cases after obtaining pathological confirmation represented 2% of the whole thyroid cancer population. CONCLUSION: Claims data obtained from anonymous regional or national bases can be helpful for checking the completeness of thyroid cancer registries and to provide a small amount of unknown cases. They can be considered an acceptable tool for surveillance of thyroid cancer incidence. The significance of the variations in incidence that could be observed from claims data remains to be evaluated in comparison with comparable data obtained from registries.     

Factors associated with unjustified Cesarean section in four hospitals in Cali, Colombia.

OBJECTIVE: To describe the factors associated with unjustified Cesarean section. DESIGN: Cross-sectional study. SETTING: Four hospitals providing obstetric services, two that serve patients insured through their employer (contributive regimen) and two that serve privately insured patients, in Cali, Colombia. STUDY PARTICIPANTS: Four hundred and sixteen patients with Cesarean section performed in 1996 because of previous Cesarean section, dystocia, acute fetal distress, breech presentation and maternal choice. Patients with toxemia, diabetes, hypertension and other related diseases were excluded. MAIN OUTCOME MEASURES: Unjustified Cesarean section. RESULTS: Of primary Cesarean sections 81.2% were unjustified. Dystocia was the indication given for unjustified surgeries in 78% of cases. Hospital No. 2 had the highest proportion of unjustified procedures compared to the other three institutions. Patients for whom the procedure had been decided before prelabor and on whom it was performed between 7:00 a.m. and 5:59 p.m. had higher proportions of unjustified procedures.     

Latin American biomedical publications: the case of Colombia in Medline

Latin America generates a low proportion of the references quoted in Medline, the most popular health-related literature search database in the world. This paper explores references from and about Colombia in Medline during the period 1987–1996. Topics addressed, patterns of authorship and research locations are established. The number of Latin American journals indexed in Medline has been progressively reduced during this 10-year period, with Colombian journals completely excluded since 1991. During this 10-year period, the total output of Colombian research institutions in foreign journals consisted of 531 articles, 41% (219) of which come from the four leading universities. These figures are substantially lower than those from other countries of the region such as Venezuela or Chile. Despite some governmental efforts, Colombia continues to have a low scientific output and has yet to attract the interest of foreign researchers. Alternatives for development of Latin American research and publications are offered.     

Monitoring the impact of human papillomavirus vaccines on high-grade pre-invasive cervical lesions: Designing a framework of linked immunization information system and cancer registry data in Michigan

State immunization and cancer registries contain data that, if linked, could be used to monitor the impact of human papillomavirus (HPV) vaccine on cervical cancer and precancer. Michigan is uniquely positioned to examine these outcomes using two population-based resources: the state-wide cancer registry and immunization information system (IIS).We assessed the feasibility of identifying females in the IIS who had continuous Michigan residence and linking them to the cancer registry. We considered continuous residence necessary for future studies of vaccine impact to avoid misclassifying those who may have been immunized while residing out-of-state and whose immunization therefore may not have been reported in Michigan.We identified females with 1976–1996 birthdates in the IIS and used probabilistic linkage software to match them with Michigan birth records. A stratified random sample of IIS-birth matches was provided to a commercial locator service to identify females with continuous Michigan residence. Cervical carcinoma in situ cases diagnosed in 2006 among females aged 10 through 30 years were also matched with the birth records; cancer registry-birth matches were merged with the IIS-birth matches using the birth record identifier.Overall, 68% of the 1274,282 IIS and 61% of the 1358 cancer registry records could be matched with birth records. Among the sample of IIS-birth matches, most (86%) were continuous residents. Seventy percent or more of cancer registry-birth matches merged with IIS-birth matches for cases born after 1984.This is the first effort in the U.S. to show that linking records across IIS and cancer registries is practical and reasonably efficient. The increasing proportion of matches between the registries and live birth file with birth year, and the use of population-based data, strengthen the utility of this approach. Future steps include use of this method to examine incidence of cervical cancer precursors in HPV immunization-eligible females.     

Epidemiologische Krebsregistrierung in Deutschland

Although cancer registration has a long tradition in Germany, wide areas remained blank spaces on the map concerning population-based cancer registration. The situation changed completely when a federal law on cancer registration (KRG, 1995-1999) took effect. Now all federal states have established population-based cancer registries on a legal basis. In spite of the uniform model of cancer registration anchored in the KRG, 16 different models have developed in Germany. Completeness of cancer registration was constantly improved over the last several years. In addition to the Saarland cancer registry, further registries can now provide a high grade of registration for all cancer sites. Essential tasks, such as public reporting and support of cancer research, can now be better fulfilled. Even taking the great developments in cancer registration in Germany into consideration, some deficits still continue to exist. These deficits are mostly caused by heterogeneity and missing compatibility of the cancer registry laws of the federal states. After the focus of cancer registration was on developing valid registries,now the focus has to be changed to the usability of cancer registry data. These data can be used e. g. for research on etiology and evaluation of programs on early cancer detection. Scientists in the field of cancer epidemiology, public health, and cancer care are invited to use data of cancer registries for research and evaluation projects intensively.