Certificate Information Research Articles

Infective Endocarditis as the Cause of Death: A Populationbased Study in Portugal, from 2002 to 2018.

Infective endocarditis presents a high rate of morbidity and mortality. Population-based studies addressing mortality caused by infective endocarditis in Portugal are scarce. We aimed to study deaths caused by Infective endocarditis, as well as corresponding demographics and temporal trends. Retrospective cohort study of all patients whose main cause of death was Infective endocarditis in Portugal from 2002 to 2018. The data was obtained from the national death certificate information system. In Portugal, 3634 people died from infective endocarditis throughout the 17-year study period - infective endocarditis specific mortality rate of 2.1 per 100 000 habitants. Of all deceased, 89% were at least 60 years old, and most were women (55%). Overall, 72% died in a healthcare institution. An annual 9% increase in the incidence death rate from Infective endocarditis was observed, with a significant upward trend during the colder months. In Portugal, mortality by infective endocarditis increased, mainly affecting older patients and women, and which can partially be explained by factors such as ageing of the population. The management of older patients with infective endocarditis is challenging as they present a higher number of comorbidities, more valvular heart disease and valve implants, invasive medical procedures and are less likely to undergo cardiac surgery. In addition to data on the evolution of demographics in Portugal, it is crucial to study the incidence of infective endocarditis over time to help explain these findings. The identification of factors that can be used to better model national health policies to improve clinical outcomes of infective endocarditis in Portugal is also required.

A trustable architecture over blockchain to facilitate maritime administration for MASS systems

Maritime Autonomous Surface Ship (MASS) is widely deemed as the future of global shipping. The cyber vulnerability has however been identified as an emerging problem and a potential barrier influencing MASS development. This paper, through the investigation of the fundamental trust problem with regards to the cyber security of MASS systems, aims to develop a blockchain-based scheme for the trust management of MASS. The innovative idea of using blockchain within the MASS context is that the mobile entities in the MASS operational environment constitute a decentralized opportunity network, which makes blockchain an appealing tool to provide a solution to evaluating and maximizing the trust over the dynamics of the entities. This paper elaborates the mechanism by which the MASS entities participate in keeping the main chain. Firstly, the paper illustrates how the Belief of Trust (BoT) among the entities is encoded and assembled into the chain, to allow MASS entities to have an initial judgement towards another entity before they get acquainted. Secondly, at the consensus layer of blockchain technique, it addresses how the witness, who has a temporary right of producing a block and append it to the chain, can be elected among the nodes and how to incent the nodes to maintain the blockchain from a proof-of-stake perspective. Finally, this paper describes how the MASS entities can use the certificate dependence information to evaluate the trust transition in the MASS operating environment. Typical scenarios are delineated to show the procedure of certificate inquiry, handover of controls between maritime supervision centers and shore-side remote control centers in case of the occurrence of unexpected events. The findings provide any entity in an MASS network with an effective solution to evaluating the degree of trust he can have for any targeted node/participant. They can therefore help choose better (more trustable) nodes to maintain the MASS network's knowledge of evidence to judge the trust on an unknown member.

Improving poultry meat and sales channels to address food safety concerns: consumers' preferences on poultry meat attributes

PurposeThis study explains Indonesian consumers' choice of poultry meat attributes and the willingness to pay (WTP) for these attributes using a discrete choice experiment.Design/methodology/approachThe survey was conducted for the traditional and modern channels and involved a sample of 440 respondents in the Greater Jakarta area. A discrete choice experiment was employed as the study framework and in designing the questionnaire. A multinomial logistic regression analysis was used to evaluate consumers' preference for poultry attributes in modern and traditional channels.FindingsConsumers preferred warm poultry meat, government certification and product information labeling on poultry meat. The WTP for warm poultry meat was the highest, which is indicating that freshness is crucial for consumers to ensure quality. Moreover, consumers had more trust in government certification than private certification for food safety and were willing to pay more for product information labeling on poultry meat.Practical implicationsThe government can use the model as a decision support to improve poultry meat quality at sales channels in Indonesia including to close sales channels where sick poultry are sold and thus address food safety concerns caused by the avian influenza outbreak.Originality/valueThis study shows that understanding the WTP for poultry meat attributes enables the government to control the poultry sales channels and stimulates producers to supply the market with a safer poultry meat quality using the price mechanism.

Burden and Trends of Severe Rotavirus Infections and Allcause Acute Gastroenteritis Hospital Episodes in Children Under Five Years Old in Mainland Portugal

Introduction: Rotavirus infections are a leading cause of severe acute gastroenteritis in children under five years old. In December 2019, Portugal announced the inclusion of the rotavirus vaccine, already available for private purchase, in the National Immunization Program. We present the first nationwide analysis of the burden and trends of rotavirus and acute gastroenteritis hospital episodes in children under five years old in mainland Portugal (2014 - 2017).Material and Methods: We used the hospital morbidity database and the Death Certificate Information System to identify hospital episodes and deaths of rotavirus and acute gastroenteritis based on the codes of the International Classification of Diseases. We described the number and rates of hospital episodes disaggregated by age group, sex, geographical units, and the seasonality and trends over the study period.Results: On average, during the study period, there were 1985 annual hospital episodes among children under five years old. The annual rate was 48.0/10 000 children (95% CI 46.9 - 49.0). Rates were consistently higher in younger children, and 67.8% episodes occurred in children under 24 months. We found a seasonal pattern with a major peak in the early spring.Discussion: Our results were consistent with the current knowledge on rotavirus and acute gastroenteritis hospital episodes in Europe. Additional studies are needed to identify the risk factors and high-risk groups for hospital attendance.Conclusion: Rotavirus and acute gastroenteritis hospital episodes in children under five years old in mainland Portugal represent an important health and economic burden. In the future, monitoring this burden and these trends in relation with rotavirus vaccine coverage could be useful in order to assess the impact of the vaccination programme on the change in hospital episodes.

Long-term survival after low-dose-rate brachytherapy for prostate cancer: the Royal Surrey experience.

To assess the long-term treatment efficacy of low-dose-rate (LDR) brachytherapy for the treatment of localized prostate cancer. Cause-of-death annotation in our prospective database was supplemented with death certificate information obtained via an internal audit of patients treated from 1999 to 2017 with LDR prostate brachytherapy as monotherapy or as combination with androgen deprivation therapy and/or external beam radiotherapy. Overall and disease-specific survival were the primary outcomes, estimated with Kaplan-Meier and competing risks multi-state models. Clinical variables influencing mortality were assessed with Cox proportional hazards regression in a sub-analysis of men to assess the predictive value of prostate-specific antigen (PSA) level at 48 months post implant. The audit process began in October 2017 and culminated in June 2020 with a curated series of 2936 patients. All-cause and prostate cancer-specific death prevalence were 11% and 2.9%, respectively. The median (range) follow-up time was 10 (3-21) years and the median (range) time to death from any cause was 9 (3-21) years. At 15 years post implant the overall and prostate cancer-specific survival probability were 81% and 95%, respectively. The 15-year cumulative incidence rates of death not due and due to prostate cancer were 14% and 5%, respectively. A greater risk of death due to prostate cancer was conferred by increasing age at therapy (hazard ratio [HR] 1.1, P < 0.001), advanced clinical stages relative to T1a-T2a (HR 1.9, P = 0.048 for T2b; HR 2.7, P = 0.023 for T2c-T3b) and a 48-month PSA level >1.0 ng/mL (HR 6.8, P < 0.001). This study constitutes the largest retrospective analyses of long-term mortality outcomes from prospectively collected prostate brachytherapy data and confirms the excellent treatment efficacy of LDR prostate brachytherapy for localized prostate cancer. T2 clinical stage subdivisions and 48-month PSA level >1.0 ng/mL appear to be strong indicators of prostate cancer-related survival.

The validity of cancer information on death certificates in Norway and the impact of death certificate initiated cases on cancer incidence and survival

BackgroundDeath certificates are an important source of information for cancer registries. The aim of this study was to validate the cancer information on death certificates, and to investigate the effect of including death certificate initiated (DCI) cases in the Cancer Registry of Norway when estimating cancer incidence and survival. MethodsAll deaths in Norway in the period 2011–2015 with cancer mentioned on the death certificates were linked to the cancer registry. Notifications not registered from other sources were labelled death certificate notifications (DCNs), and considered as either cancer or not, based on available information in the registry or from trace-back to another source. ResultsFrom the total of 65 091 cancers mentioned on death certificates in the period 2011–2015, 58,425 (89.8%) were already in the registry. Of the remaining 6 666 notifications, 2 636 (2 129 with cancer as underlying cause) were not regarded to be new cancers, which constitutes 4.0% of all cancers mentioned on death certificates and 39.5% of the DCNs. Inclusion of the DCI cases increased the incidence of all cancers combined by 2.6%, with largest differences for cancers with poorer prognosis and for older age groups. Without validation, including the 2 129 disregarded death certificates would over-estimate the incidence by 1.3%. Including DCI cases decreased the five-year relative survival estimate for all cancer sites combined with 0.5% points. ConclusionIn this study, almost 40% of the DCNs were regarded not to be a new cancer case, indicating unreliability of death certificate information for cancers that are not already registered from other sources. The majority of the DCNs where, however, registered as new cases that would have been missed without death certificates. Both including and excluding the DCI cases will potentially bias the survival estimates, but in different directions. This biases were shown to be small in the Cancer Registry of Norway.

Hash Algorithm In Verification Of Certificate Data Integrity And Security

The hash function is the most important cryptographic primitive function and is an integral part of the blockchain data structure. Hashes are often used in cryptographic protocols, information security applications such as Digital Signatures and message authentication codes (MACs). In the current development of certificate data security, there are 2 (two) types of hashes that are widely applied, namely, MD and SHA. However, when it comes to efficiency, in this study the hash type SHA-256 is used because it can be calculated faster with a better level of security. In the hypothesis, the Merkle-Damgård construction method is also proposed to support data integrity verification. Moreover, a cryptographic hash function is a one-way function that converts input data of arbitrary length and produces output of a fixed length so that it can be used to securely authenticate users without storing passwords locally. Since basically, cryptographic hash functions have many different uses in various situations, this research resulted in the use of hash algorithms in verifying the integrity and authenticity of certificate information.

Design And Build Information System For Land Certificaton Of Land Office In Sidoarjo Regency

The purpose of this study is to build an information system for Land Certification in the Land Office of Sidoarjo Regency. This information system is a form of development in facilitating prospective applicants for making land easier and faster. To support the performance of the Sidoarjo Regency Land Office staff and make it easier for users to make land certificates. In this study, the method used was SDLC according to Ian Sommerville (2011). The cycle of stages contains requirement definition, system and software design, implementation and unit testing, integration and system testing, operation and maintenance so that the implementation can be maximized. The results of this study have built a Land Certification-based information system which greatly facilitates the performance of the Sidoarjo Regency Land Office staff. The conclusion from the research and discussion is that the Land Certification information system is running well and smoothly. With the existence of a land information system, it is hoped that it can help the work of BPN office officers, so that the efficiency and effectiveness of service performance can be improved as well as accelerating officer services for land-making transactions in Sidoarjo Regency.

Halal Certification Value Chain in Brunei Darussalam

As Brunei Darussalam is positioning itself to be a halal hub, Brunei needs to act fast to strengthen its halal certification value-chain or system. Therefore, the Brunei Government appointed Bahagian Kawalan Makanan Halal (Halal Food Control Division), Jabatan Hal Ehwal Syariah (Department of Shariah Affairs), as a body to handle the halal certification process. Due to the rapid growth of the halal industry both local and international, it is important to research the halal certification process. The main objective of this study is to provide an understanding of the halal certification process in Brunei Darussalam. The study will highlight and determine to examine (1) the halal certification process, (2) actors, and (3) information on halal. The method used in this study is derived from the literature review in the form of related articles, journals, proceedings and books, and interviews with related actors of the halal certification. The results of the study will reveal (1) the halal certification value chain, (2) the related agencies and acts of the halal certification process, and (3) the information required in applying halal certification in Brunei Darussalam.

Protected designation of origin as driver of change in goat production systems: Beyond added value

&#x0D; Protected Designation of Origin (PDO) is one of the EU tools for rural development. Most of the literature on this subject is focused on premium prices and consumers’ willingness to pay for local products, since PDO and other labels aim to provide premium incomes for farmers. Our assumption is that PDO drives unexpected changes of farming styles not only related to processing or market strategies but also related to local resources using and to stablishing of different approach to agriculture and food production. We analyzed the PDO Queso Palmero (La Palma cheese) as a case of a dual label system (brand–certification common label) because it gives us the opportunity to compare farmers involved in a PDO scheme with farmers who works outside such systems. We conclude that private brands are more important than common label certification in price formation, but both are complementary, since PDO reinforces farmers’ efforts to improve quality. Beyond premium price, PDO also drives a radical change in farm structures, since it reconnects products to local resources (grazing vs intensification) and redesigns relationships with markets (shortening and diversifying chains and widening product offer). This change is characterized by implementation of new farming strategies in the context of PDO structure that coexist with classical farming strategies closer to intensification, not only in terms of productivity but also in terms of decoupling from local resources and productive and market specialization. Therefore, PDO is a powerful tool for rural development in a wide sense (resilience, empowerment, local capacity and network formation among others) far beyond its narrow remit of promoting economic growth (local or regional). Therefore, the coupling with local resources and the strength of local network and relationships as source of resilience, knowledge and capabilities improvement, have to be included in performance assessment of GIs in order to broaden the appraisal of role in regional development.&#x0D; Highlights&#x0D; &#x0D; PDO as institution is a powerful tool of farm transformation not only a protection structure of collective heritage or asset.&#x0D; Private brand effect on price is larger than common label effect (PDO label).&#x0D; PDO as institution leads radical changes of goat production systems from more production – oriented toward more market – oriented styles.&#x0D; Market chains and product diversification, focusing on quality, concern about consumers and coupling with local resources are distinctive features of farms involved in PDO.&#x0D;

Building a Website Based Gemstone Authenticity Certificate Information System

In practice, the Gems Identification Laboratory (GIL) process of recording gemstone authenticity certificates is still manually and data only stored on hard disk, making it easier to create fake certificate. because the certificate can be printed by anyone, and the certificate code cannot be verified by the gemstone buyer or user, when the user buys gemstones outside the area from the Lab location. User must also send a short message to the admin to verify the authenticity of the certificate document printed by the Lab. The method used in this study uses observational data collection. The system was tested using XAMPP software. The results of this study are a website based gemstone authenticity certificate information system that can make it easier for users to check certificates anywhere by using a code that will be traced on the website without having to come to the Lab. Lab admins can also input and save certificate data in the admin menu.

Evaluation of the 2020 Pediatric Emergency Physician Workforce in the US

Given the mortality disparities among children and adolescents in rural vs urban areas, the unique health care needs of pediatric patients, and the annual emergency department volume for this patient population, understanding the availability of pediatric emergency physicians (EPs) is important. Information regarding the available pediatric EP workforce is limited, however. To describe the demographic characteristics, training, board certification, and geographic distribution of the 2020 clinically active pediatric EP workforce in the US. This national cross-sectional study of the 2020 pediatric EP workforce used the American Medical Association Physician Masterfile database, which was linked to American Board of Medical Specialties board certification information. Self-reported training data in the database were analyzed to identify clinically active physicians who self-reported pediatric emergency medicine (EM) as their primary or secondary specialty. The Physician Masterfile data were obtained on March 11, 2020. The Physician Masterfile was used to identify all clinically active pediatric EPs in the US. The definition of EM training was completion of an EM program (inclusive of both an EM residency and/or a pediatric EM fellowship) or a combined EM program (internal medicine and EM, family medicine and EM, or pediatrics and EM). Physician location was linked and classified by county-level Urban Influence Codes. Pediatric EP density was calculated and mapped using US Census Bureau population estimates. A total of 2403 clinically active pediatric EPs were working in 2020 (5% of all clinically active emergency physicians), of whom 1357 were women (56%) and the median (interquartile range) age was 46 (40-55) years. The overall pediatric EP population included 1718 physicians (71%) with EM training and 641 (27%) with pediatric training. Overall, 1639 (68%) were board certified in pediatric EM, of whom 1219 (74%) reported EM training and 400 (24%) reported pediatrics training. Nearly all pediatric EPs worked in urban areas (2369 of 2402 [99%]), and pediatric EPs in urban compared with rural areas were younger (median [interquartile range] age, 46 [40-55] years vs 59 [48-65] years). Pediatric EPs who completed their training 20 years ago or more compared with those who completed training more recently were less likely to work in urban settings (633 [97%] vs 0-4 years: 440 [99%], 5-9 years: 547 [99%], or 10-19 years: 723 [99%]; P = .006). Three states had 0 pediatric EPs (Montana, South Dakota, and Wyoming), and 3 states had pediatric EPs in only 1 county (Alaska, New Mexico, and North Dakota). Less than 1% of counties had 4 or more pediatric EPs per 100 000 population. This study found that almost all pediatric EPs worked in urban areas, leaving rural areas of the US with limited availability of pediatric emergency care. This finding may have profound implications for children and adolescents needing emergency care.

Esiti avversi perinatali correlati all'indice di massa corporea pregravidico.

a high body mass index (BMI) during pregnancy has been associated with an increased risk of complications and adverse outcomes for both mother and infant. to analyse the main adverse maternal and neonatal outcomes associated with maternal excess weight and obesity. retrospective epidemiological study. data extrapolated from the Birth Attendance Certificate information flow of the Autonomous Province of Trento (Northern Italy) between 2015 and 2019. A total of 20,756 women with data regarding maternal height and weight at the start of pregnancy were included in the analysis. gestational outcome variables studied were gestational diabetes, hypertensive disorders, premature birth, and still births. Outcomes considered during labour and delivery were type of delivery, induction, episiotomy and post-partum haemorrhage. Neonatal outcomes were birth weight, Apgar score, need for resuscitation, and hospitalisation in the neonatal intensive care unit (NICU). Lastly, exclusive breastfeeding at discharge was analysed. considering the population of pregnant women, 68.3% of women were classified as normal-weight, 9.5% as underweight, 16.0% as overweight, and 6.3% as obese. Maternal excess weight and obesity were seen to be associated with an increased risk of gestational diabetes, gestational hypertension, preeclampsia, caesarean section, induction, post-partum bleeding, foetal macrosomia, and the need for neonatal resuscitation and hospitalisation in the NICU. Infants born to overweight and obese mothers were also less likely to be breastfed. excess weight and obesity are important risk factors for health and contribute to the onset of complications during pregnancy and adverse perinatal and long-term outcomes. Programming and implementing public health promotion schemes aimed at preventing excessive weight gain in the reproductive age could significantly improve maternal and foetal health.

Maternal Mortality in the United States: Recent Trends, Current Status, and Future Considerations.

Rigorous studies carried out by the National Center for Health Statistics show that previously reported increases in maternal mortality rates in the United States were an artifact of changes in surveillance. The pregnancy checkbox, introduced in the revised 2003 death certificate and implemented by the states in a staggered manner, resulted in increased identification of maternal deaths and in reported maternal mortality rates. This Commentary summarizes the findings of the National Center for Health Statistics reports, describes temporal trends and the current status of maternal mortality in the United States, and discusses future concerns. Although the National Center for Health Statistics studies, based on recoding of death certificate information (after excluding information from the pregnancy checkbox), showed that crude maternal mortality rates did not change significantly between 2002 and 2018, age-adjusted analyses show a temporal reduction in the maternal mortality rate (21% decline, 95% CI 13-28). Specific causes of maternal death, which were not affected by the pregnancy checkbox, such as preeclampsia, showed substantial temporal declines. However, large racial disparities continue to exist: Non-Hispanic Black women had a 2.5-fold higher maternal mortality rate compared with non-Hispanic White women in 2018. This overview of maternal mortality underscores the need for better surveillance and more accurate identification of maternal deaths, improved clinical care, and expanded public health initiatives to address social determinants of health. Challenges with ascertaining maternal deaths notwithstanding, several causes of maternal death (unaffected by surveillance artifacts) show significant temporal declines, even though there remains substantial scope for preventing avoidable maternal death and reducing disparities.

Land Certification Information System of Sidoarjo Regency Land Office

The purpose of this research is to build land certification information system of Sidoarjo Regency Land Office. The information system is a form of development in making it easier for prospective applicants to make land easier and faster. To support the performance of employees of the Sidoarjo Regency Land Office and facilitate users in the manufacture of land certificates. In this research the method used is software development life cycle. The stage cycle contains requirement definition, system and software design, implementation and unit testing, intergration and system testing, operation and maintenance so that the implementation can be maximized. The result of this research has been built an information system based on Land Certification that greatly facilitates the performance of employees of the Sidoarjo Regency Land Office. Conclusion of research and discussion that Land Certification information system runs well and smoothly. With the land information system is expected to help the work of officers of the office of the national land agency, so that the efficiency and effectiveness of service performance can be improved and accelerate the service of officers to land-making transactions in Sidoarjo Regency. Respondents to the trial there were 3 people of Sidoarjo Regency and 7 officers of the Sidoarjo Regency Land Office. Data collection methods are carried out with interviews, literature studies and questionnaires. Based on the results of soil certification information system analysis, some aspects of PIECES analysis have obtained quite good results. One of them can be seen from the results of service category analysis, where the overall percentage of test questionnaires that have been shared, on average fall into the range of the category ''Very Easy". The percentage of eligibility obtains a percentage of 100%. Thus it can be concluded that the information system has good quality and is very feasible for the process of processing land certification data.

Does a reduction of state control affect IPO underpricing? Evidence from the Chinese A-share market

The Chinese government has reduced state control and introduced partial private-sector oversight in the IPO market. We find that the underpricing of IPOs is lower under the Sponsorship System compared to the Approval System and show that a move towards a more market-oriented system reduces underpricing. We further examine the certification hypothesis and information production hypothesis by the underwriters and find evidence in favor of both. Using CSRC approval times, we find that the impact of public supervision on mitigating IPO underpricing is relatively minor in terms of both statistical and economic significance. In summary, our results show that the reduction of state control increased the efficiency of the Chinese IPO market.

Abstract PS7-85: Population based survival of breast cancer in Greater Mumbai, India

Abstract Introduction: Population based survival provides a measure of the efficacy of cancer control in a defined geographical area. The Mumbai Cancer Registry (MCR), India’s oldest population based cancer registry (PBCR), was established by the Indian Cancer Society (ICS) in 1963. It covers 603 sq. km. of Greater Mumbai with a population of 146, 51,584 (2015) and over half a century it has consistently provided cancer statistics from its coverage area. Breast cancer is the commonest cancer in women in Mumbai constituting 30% of all female cancers, and is now the most common cancer in women in India (1, 62,468 in 2018), constituting 27.66% of all female cancers. There have been few reports on breast cancer survival from India, and in this study, we report the survival rate of women diagnosed with breast cancer in Greater Mumbai during the years 2009-13. Patients and Methods: Breast cancer cases registered during the years 2009-13 with the MCR were followed for outcome till 31 Dec 2018. Social investigators visited hospitals, nursing homes, clinics, hospices and laboratory centers for documenting cancer cases. Mortality data was collected from the Vital Statistics Division of the Municipal Corporation. Data and was verified and duplicate cases were deleted. Follow up was conducted with repeated scrutiny of medical records, death certificates issued by the Municipal Corporation, postal and telephone enquiries, house visits and linkage with electoral database. Observed survival was calculated by the Kaplan Meir (1958) method. Expected survival was calculated using the national life-table of India for (Maharashtra) based on Census of India, 2011. Using observed and expected survival, relative survival was calculated by Ederer (1961) method using STATA 12.0. The survival rate was compared to that from other regions of India and with developed countries. Results: Of the 9707 breast cancer cases registered during the period 2009-13, 8031 (83%) cases were included in this study. 1676 (17%) cases were excluded as 469 (5%) had only Death Certificate Information and 1207 (12%) were lost to follow up. The median follow up was 5.1 years (range 8 months - 9 years). The median age was 55 years (range 18 -96 years) with 2725(34%) ≤ 50 years and 5306 (66%) &amp;gt; 50 years. The overall observed survival rates at 1, 3, 5 years were 82.5%, 72.8% and 67.0% respectively and the corresponding figures for relative survival were 83.5%, 75.4%, and 70.9%. Increasing age had an inverse relationship with breast cancer survival. The highest 5-year relative survival was shown by ≤29 age group (74%) and lowest by &amp;gt;70 age group (60%). Those with localised disease at diagnosis had a higher 5-year relative survival rate (84%) compared to 79.7% for direct extension and 20.8% for distant metastasis. The clinical extent of disease and education were significant risk factors affecting survival (p &amp;lt; 0.001). Conclusion:The 5-year population-based survival of patients treated in Greater Mumbai during the period 2009-2013, is 70%. This compares favourably with previously reported 5-year survival from Mumbai (51-55.7%) and other Indian registry data (33-55%), but is inferior to that reported in the developed world (84-88 %). The association of survival with educational status and stage at diagnosis highlights the importance of awareness and early detection. Enhanced awareness and detection coupled with easy access to adequate and affordable treatment could help improve breast cancer outcomes. Citation Format: Vinay Deshmane, Shravani Koyande, Shweta Jadhav. Population based survival of breast cancer in Greater Mumbai, India [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-85.

Abstract PS7-63: Cause of death discordance between death certificates and medical files: Impact on cancer survival assessment in a Belgian case study

Abstract Introduction Accurate information on cause of death is essential for correct breast cancer-specific mortality assessment. However, registration and coding of cause of death is prone to error since determining the exact underlying condition related to the death is challenging. In this study, an expert review of medical files was done to determine the principal cause of death for breast cancer patients of a Belgian tertiary hospital. The retrieved cause of death was compared to death certificate information to assess concordance between both sources. Secondly, the impact of discordant reporting on cause-specific survival (CSS) and other net survival approaches were examined. Methods Breast cancer patients diagnosed and treated at University Hospitals Leuven (UHL) between 2009 and 2014 with follow-up until December 31st, 2016, were included in the study. Information on cause of death was obtained from death certificates (following ICD-10 rules) and medical files. The latter were reviewed by a board of experts at UHL. Agreement was calculated using Cohen’s kappa coefficient, and reasons for discordant reporting were assessed. CSS was calculated based on cause of death information from both sources using the Kaplan-Meier method. These survival estimates were compared to the relative survival probability (RS) using the Ederer II and Pohar Perme method. Results A total of 2,862 patients were included, of whom 354 died after a median follow-up of 54.6 months. We found overall substantial agreement (kappa-value of 0.69 (95% C.I.: 0.62-0.77)) between cause of death reported by death certificates and medical files (Table 1). In 84.8% of cases, there was concordance between both methods. When comparing to medical files, misattribution of breast cancer-specific death in death certificates (4.5% of cases) was linked to the presence of comorbidities (43.7%), metastases (37.5%), or unspecified causes (18.8%). Five-year CSS based on medical files (93.1% (95% C.I.: 91.9-94.1)) was only slightly higher compared to CSS based on death certificates (92.3% (95% C.I.: 91.2-93.4)). RS measures using Ederer II and Pohar Perme were comparable to CSS measures. Conclusions Overall, substantial agreement of cause of death was seen between death certificates and medical files. Attribution of cause death to comorbidities was the most common reason for discordant reporting of breast cancer-specific death. Five-year breast cancer-specific survival was slightly higher based on cause of death information from medical files, compared to death certificates. Periodic reviews and implementation of ICD-10 guidelines for classification of cause of death could improve accuracy in cause of death annotation. Table 1: Discordance for the principal cause of death between medical files and death certificatesmedical filesother causesbreast cancerdeath certificatesother causes136 (38.4%)16 (4.5%)152 (42.9%)breast cancer38 (10.7%)164 (46.3%)202 (57.1%)174 (49.2%)180 (50.9%)354 (100%) Citation Format: Hava Izci, Tim Tambuyzer, Jessica Vandeven, Jérôme Xicluna, Hans Wildiers, Kevin Punie, Nynke Willers, Eva Oldenburger, Els Van Nieuwenhuysen, Patrick Berteloot, Ann Smeets, Ines Nevelsteen, Liesbet Van Eycken, Harlinde De Schutter, Patrick Neven, Geert Silversmit, Freija Verdoodt. Cause of death discordance between death certificates and medical files: Impact on cancer survival assessment in a Belgian case study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-63.

Sensitivity and Specificity of the National Death Index for Multiple Causes of Death in People With HIV.

Inaccuracies in cause-of-death information in death certificates can reduce the validity of national death statistics and result in poor targeting of resources to reduce morbidity and mortality in people with HIV. Our objective was to measure the sensitivity, specificity, and agreement between multiple causes of deaths from death certificates obtained from the National Death Index (NDI) and causes determined by expert physician review. Physician specialists determined the cause of death using information collected from the medical records of 50 randomly selected HIV-infected people who died in San Francisco from July 1, 2016, through May 31, 2017. Using expert review as the gold standard, we measured sensitivity, specificity, and agreement. The NDI had a sensitivity of 53.9% and a specificity of 66.7% for HIV deaths. The NDI had a moderate sensitivity for non-AIDS-related infectious diseases and non-AIDS-related cancers (70.6% and 75.0%, respectively) and high specificity for these causes (100.0% and 94.7%, respectively). The NDI had low sensitivity and high specificity for substance abuse (27.3% and 100.0%, respectively), heart disease (58.3% and 86.8%, respectively), hepatitis B/C (33.3% and 97.7%, respectively), and mental illness (50.0% and 97.8%, respectively). The measure of agreement between expert review and the NDI was lowest for HIV (κ = 0.20); moderate for heart disease (κ = 0.45) and hepatitis B/C (κ = 0.40); high for non-AIDS-related infectious diseases (κ = 0.76) and non-AIDS-related cancers (κ = 0.72); and low for all other causes of death (κ < 0.35). Our findings support education and training of health care providers to improve the accuracy of cause-of-death information on death certificates.

The impact of excluding or including Death Certificate Initiated (DCI) cases on estimated cancer survival: A simulation study

BackgroundPopulation-based cancer registries strive to cover all cancer cases diagnosed within the population, but some cases will always be missed and no register is 100 % complete. Many cancer registries use death certificates to identify additional cases not captured through other routine sources, to hopefully add a large proportion of the missed cases. Cases notified through this route, who would not have been captured without death certificate information, are referred to as Death Certificate Initiated (DCI) cases. Inclusion of DCI cases in cancer registries increases completeness and is important for estimating cancer incidence. However, inclusion of DCI cases will generally lead to biased estimates of cancer survival, but the same is often also true if excluding DCI cases. Missed cases are probably not a random sample of all cancer cases, but rather cases with poor prognosis. Further, DCI cases have poorer prognosis than missed cases in general, since they have all died with cancer mentioned on the death certificates. MethodsWe performed a simulation study to estimate the impact of including or excluding DCI cases on cancer survival estimates, under different scenarios. ResultsWe demonstrated that including DCI cases underestimates survival. The exclusion of DCI cases gives unbiased survival estimates if missed cases are a random sample of all cancer cases, while survival is overestimated if these have poorer prognosis. ConclusionIn our most extreme scenarios, with 25 % of cases initially missed, the usual practice of including DCI cases underestimated 5-year survival by at most 3 percentage points.