Objective. To compare concordance between physicians and coders in their assignment of diagnoses under International Classification of Diseases, 11th Revision (ICD-11). Methods. A pilot study was conducted at San Juan de Dios Hospital in Curic & oacute;, Chile, between March and June 2025, incorporating ICD-11 coding into the clinical services of internal medicine and psychiatry. Eight physicians and two coders were trained in the use of ICD-11, and the domestically developed "Deisy CIE-11" platform was used to validate diagnoses. A total of 457 hospital discharges were analyzed, comparing diagnostic coding performed by physicians, coders, and a national reference expert Results. For the principal diagnoses, concordance was 96% (439/457) between physicians and coders and 93% (424/457) between physicians and the national reference expert. For secondary diagnoses, concordance exceeded 90% in all fields evaluated. Cohen's kappa coefficient for concordance between physicians and coders was 0.963. The main errors were associated with omissions in postcoordination and incorrect assignment of the external cause code. The national reference expert reviewed 100% of the records for which information was available. Conclusions. The pilot study demonstrated a high level of diagnostic concordance among physicians, coders, and the national reference expert in the assignment of diagnostic codes to hospital discharges. However, significant gaps were identified in postcoordination, the recording of external causes, and the standardization of review criteria. These findings provide preliminary evidence to inform future strategies for implementing ICD-11 in hospital morbidity coding.
Objectives: To analyze the spatiotemporal dynamics of chikungunya incidence in municipalities in the Brazilian Northeast from 2015 to 2023. Methods: Ecological time-series study of probable cases of chikungunya reported to Brazil's Notifiable Diseases Information System (SINAN). Monthly trends were assessed byjoinpoint regression analysis with estimation of the monthly percent change (MPC) and 95% confidence intervals (95% CIs). High-risk space-time clusters were identified using a Poisson-based scan statistic (relative risk [RR], p < 0.05). Results: A total of 769 986 cases were reported in 2015-2023, mostly in the states of Cear & aacute; (27.9%), Bahia (25.3%), and Pernambuco (14.5%). Explosive outbreaks occurred in 2016, 2017, and 2022, interspersed with periods of low transmission. The temporal analysis revealed high initial MPC estimates, e.g., in Maranh & atilde;o (127.4%; 95% CI: 112.5-172.6). In 2022, explosive outbreaks occurred once again, particularly in Alagoas (MPC = 342.4%; 95% CI: 187.2-557.3) and Piau & iacute; (MPC = 242.9%; 95% CI: 162.6-441.8). Significant space-time clusters were identified, 70% of which began in 2016. A disconnect was observed between geographic spread and magnitude of risk: the highest RR (45.5; 95% CI: 43.7-47.3) occurred in a cluster in Bahia in 2020, whereas the largest cluster involved 431 municipalities across four states in 2016. Conclusion: The dynamics of chikungunya in the Brazilian Northeast were characterized by spatiotemporal heterogeneity, with shifting epicenters and persistent pockets of high risk, providing further evidence of the need for integrated, regionalized surveillance and control to address sustained transmission in high-risk pockets and interstate clusters.
Objective. To describe compliance with the interventions defined as drivers of the HEARTS-based integrated model for noncommunicable disease control in Peru. Method. All Ministry of Health institutional health service providers (IHSPs) that are implementing the HEARTS initiative were invited to participate. The assessment was conducted between January and May 2025. Compliance was measured using the maturity index (MI), scored on a five-level scale ranging from incipient to fully mature. The percentage of IHSPs meeting the intervention targets for drivers of the MI for hypertension (HTN), type 2 diabetes mellitus (T2DM), and chronic kidney disease (CKD) was calculated. Results. Of 1000 IHSPs implementing the model, 92% reported their MIs for HTN, 92% for T2DM, and 93% for CKD. Overall, 82.3% of facilities were at maturity level 1 for HTN, 75% were at level 1 for T2DM, and 99.5% were at level 1 for CKD. For HTN, the target with the highest level of compliance was immediate initiation of pharmacological therapy, achieved by 75% of IHSPs. For T2DM, the targets most frequently met were timely delivery of screening results and early treatment optimization, achieved by 49% of IHSPs. For CKD, the target with the highest level of compliance was availability of a standardized treatment protocol, achieved by 17% of IHSPs. Conclusion. Although most IHSPs were only at the incipient maturity level, compliance was achieved for some interventions. Priority activities to improve care were identified.
Pediatric cancer poses a public health challenge, especially in low-and middle-income countries. Uruguay, a high-income country, has achieved an overall 5-year survival rate of over 79.6% among pediatric patients. The clinical results exceed the 60% target set by the World Health Organization (WHO)'s Global Initiative for Childhood Cancer (GICC). The model is fully aligned with WHO's CureAll strategy, emphasizing universal coverage at no cost to the patient and the integration of psychosocial support. The purpose of this report is to outline the structure of the care model for children and adolescents with cancer in Uruguay, in the context of the GICC guidelines. Uruguay's National Integrated Health System guarantees universal coverage. Under specific legislation, a strategic partnership has been established between the State Health Services Administration (ASSE) and the P & eacute;rez Scremini Foundation (FPS) for the management of the national referral center. The FPS provides care for approximately 70% of pediatric cancer patients in partnership with the public children's hospital. It has mixed financing: ASSE contributes approximately 35% of the budget, covering general hospital supplies and services, while the FPS relies on donations to fund the remaining 65%, including home-based care and the administration of benefits. This structure ensures operational independence and the ability to make rapid investments without losing the support and nationwide coverage provided by the public system.
La enfermedad renal crónica representa una carga creciente para los sistemas de salud de la Región de las Américas y guarda una estrecha relación con la hipertensión arterial, la diabetes mellitus y el riesgo cardiovascular. Esta comunicación propone un modelo operativo para adaptar el enfoque de HEARTS 2.0 a la atención en red de pacientes con enfermedades, orientado a fortalecer la detección temprana, la protección cardiorrenal y la gestión del riesgo de progresión en la atención primaria de salud. El modelo se organiza en tres niveles interdependientes: atención primaria, integración funcional mediante telenefrología y manejo especializado en policlínicos de nefrología y en unidades de cuidado renal avanzado. La adaptación propuesta de los factores impulsores de HEARTS busca estructurar procesos de detección en población de riesgo, de estratificación del riesgo de progresión a falla renal, de tratamiento protocolizado, de continuidad del cuidado y de seguimiento del desempeño. La propuesta procura contribuir a la transición desde un modelo dialítico-céntrico hacia una estrategia preventiva, integrada y basada en el riesgo. Su implementación deberá evaluarse mediante experiencias piloto que permitan determinar su factibilidad, efectividad, impacto económico y sostenibilidad en distintos contextos asistenciales.
