Hospitalizations for Cardiovascular Diseases Sensitive to Primary Health Care in Paraná State, Brazil: A Bayesian Spatiotemporal Model.

PURPOSE: To analyze spatiotemporal trends in hospitalizations for cardiovascular diseases (CVD) sensitive to primary health care (PHC) among individuals aged 50-69 years in Paraná State, Brazil, from 2014 to 2019 and investigate correlations between PHC services and the Social Development Index. METHODS: We conducted a cross-sectional ecological study using publicly available secondary data to analyze the municipal incidence of hospitalizations for CVD sensitive to PHC and to estimate the risk of hospitalization for this group of diseases and associated factors using hierarchical Bayesian spatiotemporal modeling with Markov chain Monte Carlo simulation. RESULTS: There was a 5% decrease in the average rate of hospitalizations for PHC-sensitive CVD from 2014 to 2019. Regarding standardized hospitalization rate (SHR) according to population size, we found that no large municipality had an SHR >2. Likewise, a minority of these municipalities had SHR values of 1-2 (33%). However, many small and medium-sized municipalities had SHR values >2 (47% and 48%, respectively). A greater Social Development Index value served as a protective factor against hospitalizations, with a relative risk of 0.957 (95% credible interval, 0.929-0.984). CONCLUSIONS: The annual risk of hospitalization decreased over time; however, small municipalities had the greatest rates of hospitalization, indicating an increase in health inequity. The inverse association between social development and hospitalizations for CVD sensitive to PHC raises questions about intersectionality in health care.

Geographical disparities in access to surgical treatment and mortality rates from abdominal aortic aneurysms in Brazil: A retrospective longitudinal study.

INTRODUCTION: Abdominal aortic aneurysm (AAA) is a growing public health problem, and not all patients have access to surgery when needed. This study aimed to analyze spatiotemporal variations in AAA mortality and surgical procedures in Brazilian intermediate geographic regions and explore the impact of different surgical techniques on operative mortality. METHODS: A retrospective longitudinal study was conducted to evaluate AAA mortality from 2008 to 2020 using space-time cube (STC) analysis and the emerging hot spot analysis tool through the Getis-Ord Gi* method. RESULTS: There were 34,255 deaths due to AAA, 13,075 surgeries to repair AAA, and a surgical mortality of 14.92%. STC analysis revealed an increase in AAA mortality rates (trend statistic = +1.7693, p = 0.0769) and a significant reduction in AAA surgery rates (trend statistic = -3.8436, p = 0.0001). Analysis of emerging hotspots revealed high AAA mortality rates in the South, Southeast, and Central-West, with a reduction in procedures in São Paulo and Minas Gerais States (Southeast). In the Northeast, there were extensive areas of increasing mortality rates and decreasing procedure rates (cold spots). CONCLUSION: AAA mortality increased in several regions of the country while surgery rates decreased, demonstrating the need for implementing public health policies to increase the availability of surgical procedures, particularly in less developed regions with limited access to services.

Large-scale genome-wide association study, using historical data, identifies conserved genetic architecture of cyanogenic glucoside content in cassava (Manihot esculenta Crantz) root.

Manihot esculenta (cassava) is a root crop originating from South America that is a major staple in the tropics, including in marginal environments. This study focused on South American and African germplasm and investigated the genetic architecture of hydrogen cyanide (HCN), a major component of root quality. HCN, representing total cyanogenic glucosides, is a plant defense component against herbivory but is also toxic for human consumption. We genotyped 3354 landraces and modern breeding lines originating from 26 Brazilian states and 1389 individuals were phenotypically characterized across multi-year trials for HCN. All plant material was subjected to high-density genotyping using genotyping by sequencing. We performed genome-wide association mapping to characterize the genetic architecture and gene mapping of HCN. Field experiments revealed strong broad- and narrow-sense trait heritability (0.82 and 0.41, respectively). Two major loci were identified, encoding for an ATPase and a MATE protein, and contributing up to 7 and 30% of the HCN concentration in roots, respectively. We developed diagnostic markers for breeding applications, validated trait architecture consistency in African germplasm and investigated further evidence for the domestication of sweet and bitter cassava. Fine genomic characterization revealed: (i) the major role played by vacuolar transporters in regulating HCN content; (ii) the co-domestication of sweet and bitter cassava major alleles are dependent upon geographical zone; and (iii) the major loci allele for high HCN in M. esculenta Crantz seems to originate from its ancestor, M. esculenta subsp. flabellifolia. Taken together, these findings expand our insights into cyanogenic glucosides in cassava roots and its glycosylated derivatives in plants.

Patient-level interventions to reduce alcohol-related harms in low- and middle-income countries: A systematic review and meta-summary.

BACKGROUND: Disease and disability from alcohol use disproportionately impact people in low- and middle-income countries (LMICs). While varied interventions have been shown to reduce alcohol use in high-income countries, their efficacy in LMICs has not been assessed. This systematic review describes current published literature on patient-level alcohol interventions in LMICs and specifically describes clinical trials evaluating interventions to reduce alcohol use in LMICs. METHODS AND FINDINGS: In accordance with PRISMA, we performed a systematic review using an electronic search strategy from January 1, 1995 to December 1, 2020. Title, abstract, as well as full-text screening and extraction were performed in duplicate. A meta-summary was performed on randomized controlled trials (RCTs) that evaluated alcohol-related outcomes. We searched the following electronic databases: PubMed, EMBASE, Scopus, Web of Science, Cochrane, WHO Global Health Library, and PsycINFO. Articles that evaluated patient-level interventions targeting alcohol use and alcohol-related harm in LMICs were eligible for inclusion. No studies were excluded based on language. After screening 5,036 articles, 117 articles fit our inclusion criteria, 75 of which were RCTs. Of these RCTs, 93% were performed in 13 middle-income countries, while 7% were from 2 low-income countries. These RCTs evaluated brief interventions (24, defined as any intervention ranging from advice to counseling, lasting less than 1 hour per session up to 4 sessions), psychotherapy or counseling (15, defined as an interaction with a counselor longer than a brief intervention or that included a psychotherapeutic component), health promotion and education (20, defined as an intervention encouraged individuals' agency of taking care of their health), or biologic treatments (19, defined as interventions where the biological function of alcohol use disorder (AUD) as the main nexus of intervention) with 3 mixing categories of intervention types. Due to high heterogeneity of intervention types, outcome measures, and follow-up times, we did not conduct meta-analysis to compare and contrast studies, but created a meta-summary of all 75 RCT studies. The most commonly evaluated intervention with the most consistent positive effect was a brief intervention; similarly, motivational interviewing (MI) techniques were most commonly utilized among the diverse array of interventions evaluated. CONCLUSIONS: Our review demonstrated numerous patient-level interventions that have the potential to be effective in LMICs, but further research to standardize interventions, populations, and outcome measures is necessary to accurately assess their effectiveness. Brief interventions and MI techniques were the most commonly evaluated and had the most consistent positive effect on alcohol-related outcomes. TRIAL REGISTRATION: Protocol Registry: PROSPERO CRD42017055549.

Impact of socioeconomic factors and health determinants on preterm birth in Brazil: a register-based study.

BACKGROUND: More than 15 million children are born preterm annually. While preterm survival rates have increased in high-income countries. Low- and middle-income countries, like Brazil, continue to battle high neonatal mortality rates due to a lack of adequate postnatal care. Globally, neonatal mortality is higher for preterm infants compared to those born at term. Our study aims to map and analyze the spatial, socioeconomic, and health coverage determinants related to preterm birth in Brazil in order to understand how spatial variations in demographics and access to primary care may affect preterm birth occurrences.  METHODS: Using publicly available national-level data from the Brazilian health system for 2008-2017, we conducted an ecological study to visualize the spatial distributions of preterm birth along with socioeconomic status, the structure of health services, and primary care work process, each consisting of multiple variables reduced via principal component analysis. Regression models were created to determine predictive effects of numeric and spatial variation of these scores on preterm birth rates. RESULTS: In Brazil, preterm birth rates increased from 2008-2017, with small and rural municipalities frequently exhibiting higher rates than urban areas. Scores in socioeconomic status and work process were significant predictors of preterm birth rates, without taking into account spatial adjustment, with more positive scores in socioeconomic status predicting higher preterm birth rates (coefficient 0.001145) and higher scores in work process predicting lower preterm birth rates (coefficient -0.002416). Geographically weighted regression showed socioeconomic status to be a more significant predictor in the North, with the work process indicators being most significant in the Northeast. CONCLUSIONS: Results support that primary care work process indicators are more significant in estimating preterm birth rates than physical structures available for care. These results emphasize the importance of ensuring the presence of the minimum human resources needed, especially in the most deprived areas of Brazil. The association between social determinants of health and preterm birth rates raises questions regarding the importance of policies dedicated to foster equity in the accessibility of healthcare services, and improve income as protective proxies for preterm birth.

Effect of low-level light therapy before radiotherapy in oral squamous cell carcinoma: An in vitro study.

Radiation therapy for head and neck squamous cell carcinoma (HNSCC) is associated with several complications. Although photobiomodulation (PBM) has radioprotective effects in normal tissue, it could also enhance the growth of neoplastic cells. Thus, the present study aimed to investigate the cellular response of oral squamous cell carcinoma with pre-exposure to low-level phototherapy before radiotherapy. SCC9, Cal-27, A431, and HaCaT cell lines were subjected to low-level light therapy and radiotherapy. The cells were treated with a single energy density (300 J/cm2) of a light-emitting diode (660 nm) prior to ionizing radiation at different doses (0, 2, 4, and 6 Gy). After 24 h, wound scratch, proliferation, clonogenic cell survival, cell death, and reactive oxygen species (ROS) analyses were performed to evaluate cell response. The cell lines pre-exposed to PBM at the analyzed dosage were radiosensitive. The treatment significantly reduced cell proliferation and clonogenic cell survival. Migration and cell death assays also revealed positive results, with the treatment group showing lower rate of migration and higher cell death than did the control group. Moreover, PBM effectively increased the intracellular levels of ROS. PBM at 300 J/cm2 is a promising radiosensitizing modality to reduce the radiation dose and avoid the intolerable side effects of radiotherapy for HNSCC, thus increasing the probability of successful treatment. However, further studies are needed to support and confirm the results.

Comprehensive genotyping of a Brazilian cassava (Manihot esculenta Crantz) germplasm bank: insights into diversification and domestication.

KEY MESSAGE: Brazilian cassava diversity was characterized through population genetics and clustering approaches, highlighting contrasted genetic groups and spatial genetic differentiation. Cassava (Manihot esculenta Crantz) is a major staple root crop of the tropics, originating from the Amazonian region. In this study, 3354 cassava landraces and modern breeding lines from the Embrapa Cassava Germplasm Bank (CGB) were characterized. All individuals were subjected to genotyping-by-sequencing (GBS), identifying 27,045 single-nucleotide polymorphisms (SNPs). Identity-by-state and population structure analyses revealed a unique set of 1536 individuals and 10 distinct genetic groups with heterogeneous linkage disequilibrium (LD). On this basis, a density of 1300-4700 SNP markers were selected for large-effect quantitative trait loci (QTL) detection. Identified genetic groups were further characterized for population genetics parameters including minor allele frequency (MAF), observed heterozygosity [Formula: see text], effective population size estimate [Formula: see text]) and polymorphism information content (PIC). Selection footprints and introgressions of M. glaziovii were detected. Spatial population structure analysis revealed five ancestral populations related to distinct Brazilian ecoregions. Estimation of historical relationships among identified populations suggests an early population split from Amazonian to Atlantic forest and Caatinga ecoregions and active gene flows. This study provides a thorough genetic characterization of ex situ germplasm resources from cassava's center of origin, South America, with results shedding light on Brazilian cassava characteristics and its biogeographical landscape. These findings support and facilitate the use of genetic resources in modern breeding programs including implementation of association mapping and genomic selection strategies.

Helicopter Transportation of Brazilian Trauma Patients: A Comparison of Times to Care.

OBJECTIVE: The purpose of this study was to analyze helicopter emergency medical service (HEMS) transport with secondary land ambulance transfer, comparing landings performed inside and outside the hospital complex to the emergency department. METHODS: This was a cross-sectional observational study of HEMS transports of trauma patients between 2016 and 2018 in southern Brazil. Patients were attended by the HEMS team at the trauma site or stabilized in hospitals nearby and subsequently referred to trauma centers. In this region, no trauma centers have their own helipads so helicopters land in remote areas close to the hospital, which may be inside or outside the hospital complex. Both landings require ground emergency medical service transport, with off-site landings necessitating ground emergency medical service transport via public access roads to reach the hospital. Data were analyzed using descriptive statistics, and on-site and off-site transport times were compared using a t-test for independent samples. RESULTS: Of 176 transports, 28.5% resulted in on-site landings, whereas 71.5% occurred off-site. The ground transport time when the landing zone was off-site was 5 minutes longer than on-site (P < .001). CONCLUSION: Off-site landings result in longer transports to the emergency room. The construction of helipads in trauma centers can reduce transport time, in addition to reducing the costs and sequelae of trauma.

Geospatial Analysis of Unmet Surgical Need in Uganda: An Analysis of SOSAS Survey Data.

BACKGROUND: Globally, a staggering five billion people lack access to adequate surgical care. Sub-Saharan Africa represents one of the regions of greatest need. We sought to understand how geographic factors related to unmet surgical need (USN) in Uganda. METHODS: We performed a geographic information system analysis of a nationwide survey on surgical conditions performed in 105 enumeration areas (EAs) representing the national population. At the district level, we determined the spatial autocorrelation of the following study variables: prevalence of USN, hub distance (distance from EA to the nearest surgical center), area of coverage (geographic catchment area of each center), tertiary facility transport time (average respondent-reported travel time), and care availability (rate of hospital beds by population and by district). We then used local indicators of spatial association (LISA) and spatial regression to identify any significant clustering of these study variables among the districts. RESULTS: The survey enumerated 4248 individuals. The prevalence of USN varied from 2.0-45 %. The USN prevalence was highest in the Northern and Western Regions. Moran's I bivariate analysis indicated a positive correlation between USN and hub distance (p = 0.03), area of coverage (p = 0.02), and facility transport time (p = 0.03). These associations were consistent nationally. The LISA analysis showed a high degree of clustering among sets of districts in the Northern Sub-Region. CONCLUSIONS: This study demonstrates a statistically significant association between USN and the geographic variables examined. We have identified the Northern Sub-Region as the highest priority areas for financial investment to reduce this unmet surgical disease burden.

The epidemiology of road traffic injury hotspots in Kigali, Rwanda from police data.

BACKGROUND: Road traffic injuries (RTIs) are the eighth-leading cause of death worldwide, with low- and middle-income countries sharing a disproportionate number of fatalities. African countries, like Rwanda, carry a higher burden of these fatalities and with increased economic growth, these numbers are expected to rise. We aim to describe the epidemiology of RTIs in Kigali Province, Rwanda and create a hotspot map of crashes from police data. METHODS: Road traffic crash (RTC) report data from January 1, 2013 to December 31, 2013 was collected from Kigali Traffic Police. In addition to analysis of descriptive data, locations of RTCs were mapped and analyzed through exploratory spatial data analysis to determine hotspots. RESULTS: A total of 2589 of RTCs were reported with 4689 total victims. The majority of victims were male (94.7 %) with an average age of 35.9 years. Cars were the most frequent vehicle involved (43.8 %), followed by motorcycles (14.5 %). Motorcycles had an increased risk of involvement in grievous crashes and pedestrians and cyclists were more likely to have grievous injuries. The hotspots identified were primarily located along the major roads crossing Kigali and the two busiest downtown areas. CONCLUSIONS: Despite significant headway by the government in RTC prevention, there continue to be high rates of RTIs in Rwanda, specifically with young males and a vulnerable road user population, such as pedestrians and motorcycle users. Improvements in police data and reporting by laypersons could prove valuable for further geographic information system analysis and efforts towards crash prevention and targeting education to motorcycle taxis could help reduce RTIs in a severely affected population.

High road utilizers surveys compared to police data for road traffic crash hotspot localization in Rwanda and Sri Lanka.

BACKGROUND: Road traffic crashes (RTCs) are a leading cause of death. In low and middle income countries (LMIC) data to conduct hotspot analyses and safety audits are usually incomplete, poor quality, and not computerized. Police data are often limited, but there are no alternative gold standards. This project evaluates high road utilizer surveys as an alternative to police data to identify RTC hotspots. METHODS: Retrospective police RTC data was compared to prospective data from high road utilizer surveys regarding dangerous road locations. Spatial analysis using geographic information systems was used to map dangerous locations and identify RTC hotspots. We assessed agreement (Cohen's Kappa), sensitivity/specificity, and cost differences. RESULTS: In Rwanda police data identified 1866 RTC locations from 2589 records while surveys identified 1264 locations from 602 surveys. In Sri Lanka, police data identified 721 RTC locations from 752 records while survey data found 3000 locations from 300 surveys. There was high agreement (97 %, 83 %) and kappa (0.60, 0.60) for Rwanda and Sri Lanka respectively. Sensitivity and specificity are 92 % and 95 % for Rwanda and 74 % and 93 % for Sri Lanka. The cost per crash location identified was $2.88 for police and $2.75 for survey data in Rwanda and $2.75 for police and $1.21 for survey data in Sri Lanka. CONCLUSION: Surveys to locate RTC hotspots have high sensitivity and specificity compared to police data. Therefore, surveys can be a viable, inexpensive, and rapid alternative to the use of police data in LMIC.

Quantifying the pediatric surgical need in Uganda: results of a nationwide cross-sectional, household survey.

PURPOSE: Little is known about the prevalence of pediatric surgical conditions in low- and middle-income countries. Many children never seek medical care, thus the true prevalence of surgical conditions in children in Uganda is unknown. The objective of this study was to determine the prevalence of surgical conditions in children in Uganda. METHODS: Using the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey, we enumerated 4248 individuals in 2315 households in 105 randomly selected clusters throughout Uganda. Children aged 0-18 were included if randomly selected from the household; for those who could not answer for themselves, parents served as surrogates. RESULTS: Of 2176 children surveyed, 160 (7.4 %) reported a currently untreated surgical condition. Lifetime prevalence of surgical conditions was 14.0 % (305/2176). The predominant cause of surgical conditions was trauma (48.4 %), followed by wounds (19.7 %), acquired deformities (16.2 %), and burns (12.5 %). Of 90 pediatric household deaths, 31.1 % were associated with a surgically treatable proximate cause of death (28/90 deaths). CONCLUSION: Although some trauma-related surgical burden among children can be adequately addressed at district hospitals, the need for diagnostics, human resources, and curative services for more severe trauma cases, congenital deformities, and masses outweighs the current capacity of hospitals and trained pediatric surgeons in Uganda.

Open or closed abdomen post laparotomy to control severe abdominal sepsis: a survival analysis.

INTRODUCTION: severe abdominal sepsis, accompained by diffuse peritonitis, poses a significant challenge for most surgeons. It often requires repetitive surgical interventions, leading to complications and resulting in high morbidity and mortality rates. The open abdomen technique, facilitated by applying a negative-pressure wound therapy (NPWT), reduces the duration of the initial surgical procedure, minimizes the accumulation of secretions and inflammatory mediators in the abdominal cavity and lowers the risk of abdominal compartment syndrome and its associated complications. Another approach is primary closure of the abdominal aponeurosis, which involves suturing the layers of the abdominal wall. METHODS: the objective of this study is to conduct a survival analysis comparing the treatment of severe abdominal sepsis using open abdomen technique versus primary closure after laparotomy in a public hospital in the South of Brazil. We utilized data extracted from electronic medical records to perform both descriptive and survival analysis, employing the Kaplan-Meier curve and a log-rank test. RESULTS: the study sample encompassed 75 laparotomies conducted over a span of 5 years, with 40 cases employing NPWT and 35 cases utilizing primary closure. The overall mortality rate observed was 55%. Notably, survival rates did not exhibit statistical significance when comparing the two methods, even after stratifying the data into separate analysis groups for each technique. CONCLUSION: recent publications on this subject have reported some favorable outcomes associated with the open abdomen technique underscoring the pressing need for a standardized approach to managing patients with severe, complicated abdominal sepsis.

Phenotypic Variability in Resistance to Anthracnose, White, Brown, and Blight Leaf Spot in Cassava Germplasm.

Despite fungal diseases affecting the aerial parts of cassava (Manihot esculenta Crantz) and causing significant yield losses, there is a lack of comprehensive studies assessing resistance in the species' germplasm. This study aimed to evaluate the phenotypic diversity for resistance to anthracnose disease (CAD), blight leaf spot (BliLS), brown leaf spot (BLS), and white leaf spot (WLS) in cassava germplasm and to identify genotypes suitable for breeding purposes. A total of 837 genotypes were evaluated under field conditions across two production cycles (2021 and 2022). Artificial inoculations were carried out in the field, and data on yield and disease severity were collected using a standardized rating scale. The top 25 cassava genotypes were selected based on a selection index for disease resistance and agronomic traits. High environmental variability resulted in low heritabilities (h2) for CAD, WLS, and BLS (h2 = 0.42, 0.34, 0.29, respectively) and moderate heritability for BliLS (h2 = 0.51). While the range of data for disease resistance was narrow, it was considerably wider for yield traits. Cluster analysis revealed that increased yield traits and disease severity were associated with higher scores of the first and second discriminant functions, respectively. Thus, most clusters comprised genotypes with hybrid characteristics for both traits. Overall, there was a strong correlation among aerial diseases, particularly between BLS and BliLS (r = 0.96), while the correlation between CAD and other diseases ranged from r = 0.53 to 0.58. Yield traits showed no significant correlations with disease resistance. Although the mean selection differential for disease resistance was modest (between -2.31% and -3.61%), selection based on yield traits showed promising results, particularly for fresh root yield (82%), dry root yield (39%), shoot yield (49%), and plant vigor (26%). This study contributes to enhancing genetic gains for resistance to major aerial part diseases and improving yield traits in cassava breeding programs.

Applicability of machine learning algorithm to predict the therapeutic intervention success in Brazilian smokers.

Smoking cessation is an important public health policy worldwide. However, as far as we know, there is a lack of screening of variables related to the success of therapeutic intervention (STI) in Brazilian smokers by machine learning (ML) algorithms. To address this gap in the literature, we evaluated the ability of eight ML algorithms to correctly predict the STI in Brazilian smokers who were treated at a smoking cessation program in Brazil between 2006 and 2017. The dataset was composed of 12 variables and the efficacies of the algorithms were measured by accuracy, sensitivity, specificity, positive predictive value (PPV) and area under the receiver operating characteristic curve. We plotted a decision tree flowchart and also measured the odds ratio (OR) between each independent variable and the outcome, and the importance of the variable for the best model based on PPV. The mean global values for the metrics described above were, respectively, 0.675±0.028, 0.803±0.078, 0.485±0.146, 0.705±0.035 and 0.680±0.033. Supporting vector machines performed the best algorithm with a PPV of 0.726±0.031. Smoking cessation drug use was the roof of decision tree with OR of 4.42 and importance of variable of 100.00. Increase in the number of relapses also promoted a positive outcome, while higher consumption of cigarettes resulted in the opposite. In summary, the best model predicted 72.6% of positive outcomes correctly. Smoking cessation drug use and higher number of relapses contributed to quit smoking, while higher consumption of cigarettes showed the opposite effect. There are important strategies to reduce the number of smokers and increase STI by increasing services and drug treatment for smokers.

Designing, development and validation of an app to reduce the response time of the emergency medical services.

INTRODUCTION: Delays in prehospital care attributable to the call-taking process can often be traced back to miscommunication, including uncertainty around the call location. Geolocation applications have the potential to streamline the call-taking process by accurately identifying the caller's location. OBJECTIVE: To develop and validate an application to geolocate emergency calls and compare the response time of calls made via the application with those of conventional calls made to the Brazilian Medical Emergency System (Serviço de Atendimento Médico de Urgência-SAMU). METHODS: This study was conducted in two stages. First, a geolocating application for SAMU emergency calls (CHAMU192) was developed using a mixed methods approach based on design thinking and subsequently validated using the System Usability Scale (SUS). In the second stage, sending time of the geolocation information of the app was compared with the time taken to process information through conventional calls. For this, a hypothetical case control study was conducted with SAMU in the Maringá, Paraná, Brazil. A control group of 350 audio recordings of emergency calls from 2019 was compared to a set of test calls made through the CHAMU192 app. The CHAMU192 group consisted of 201 test calls in Maringá. In test calls, the location was obtained by GPS and sent to the SAMU communication system. Comparative analysis between groups was performed using the Mann-Whitney test. RESULTS: CHAMU192 had a SUS score of 90, corresponding to a "best imaginable" usability rating. The control group had a median response time of 35.67 seconds (26.00-48.12). The response time of the CHAMU192 group was 0.20 (0.15-0.24). CONCLUSION: The use of the CHAMU192 app by emergency medical services could significantly reduce response time. The results demonstrate the potential of app improving the quality and patient outcomes related to the prehospital emergency care services.

Bayesian Modeling and Estimation of Spatial Risk for Hospitalization and Mortality from Ischemic Heart Disease in Paraná, Brazil.

Objective: Despite significant advancements in understanding risk factors and treatment strategies, ischemic heart disease (IHD) remains the leading cause of mortality worldwide, particularly within specific regions in Brazil, where the disease is a burden. Therefore, the aim of this study was to estimate the risk of hospitalization and mortality from IHD in the state of Paraná (Brazil), using spatial analysis to identify areas with higher risk based on socioeconomic, demographic and health variables. Methods: This is an ecological study based on secondary and retrospective IHD hospitalization and mortality data obtained from the Brazilian Hospitalization and Mortality Information Systems during the 2010-2021 period. Data were analyzed for 399 municipalities and 22 health regions in the state of Paraná. To assess the spatial patterns of the disease and identify relative risk (RR) areas, we constructed a risk model by Bayesian inference using the R-INLA and SpatialEpi packages in R software. Results: A total of 333,229 hospitalizations and 73,221 deaths occurred in the analyzed period, and elevated RR of hospitalization (RR = 27.412, CI 21.801; 34.466) and mortality (RR = 15.673, CI 2.148; 114.319) from IHD occurred in small-sized municipalities. In addition, medium-sized municipalities also presented elevated RR of hospitalization (RR = 6.533, CI 1.748; 2.006) and mortality (RR = 6.092, CI 1.451; 2.163) from IHD. Hospitalization and mortality rates were higher in white men aged 40-59 years. A negative association was found between Municipal Performance Index (IPDM) and IHD hospitalization and mortality. Conclusion: Areas with increased risk of hospitalization and mortality from IHD were found in small and medium-sized municipalities in the state of Paraná, Brazil. These results suggest a deficit in health care attention for IHD cases in these areas, potentially due to a low distribution of health care resources.

Mortality in Women with Coronary Artery Disease in Paraná State, Brazil: A Bayesian Spatiotemporal Analysis.

Background: Mortality resulting from coronary artery disease (CAD) among women is a complex issue influenced by many factors that encompass not only biological distinctions but also sociocultural, economic, and healthcare-related components. Understanding these factors is crucial to enhance healthcare provisions. Therefore, this study seeks to identify the social and clinical variables related to the risk of mortality caused by CAD in women aged 50 to 79 years old in Paraná state, Brazil, between 2010 and 2019. Methods: This is an ecological study based on secondary data sourced from E-Gestor, IPARDES, and DATASUS. We developed a model that integrates both raw and standardized coronary artery disease (CAD) mortality rates, along with sociodemographic and healthcare service variables. We employed Bayesian spatiotemporal analysis with Markov Chain Monte Carlo simulations to assess the relative risk of CAD mortality, focusing specifically on women across the state of Paraná. Results: A total of 14,603 deaths from CAD occurred between 2010 and 2019. Overall, temporal analysis indicates that the risk of CAD mortality decreased by around 22.6% between 2010 (RR of 1.06) and 2019 (RR of 0.82). This decline was most prominent after 2014. The exercise stress testing rate, accessibility of cardiology centers, and IPARDES municipal performance index contributed to the reduction of CAD mortality by approximately 4%, 8%, and 34%, respectively. However, locally, regions in the Central-West, Central-South, Central-East, and Southern regions of the Central-North parts of the state exhibited risks higher-than-expected. Conclusion: In the last decade, CAD-related deaths among women in Paraná state decreased. This was influenced by more exercise stress testing, better access to cardiology centers, improved municipal performance index. Yet, elevated risks of deaths persist in certain regions due to medical disparities and varying municipal development. Therefore, prioritizing strategies to enhance women's access to cardiovascular healthcare in less developed regions is crucial.

Confronting mobile phone signal coverage and helicopter emergency medical service travel time: A geospatial analysis in the northwest macro-region of Paraná State, Brazil.

OBJECTIVE: The aim of this study was to conduct a detailed geospatial analysis of mobile phone signal coverage in the northwest macro-region of Paraná State, Brazil, seeking to identify areas where limitations in coverage may be related to lengthy travel times of the helicopter emergency medical service (HEMS) for the assistance of victims of road traffic injuries (RTIs). METHODS: An observational study was conducted to examine mobile phone signal coverage and HEMS travel times from 2017 to 2021. HEMS travel times were categorized into four groups: T1 (0-15 min), T2 (16-30 min), T3 (31-45 min), and T4 (over 45 min). Empirical Bayesian Kriging was used to map areas with low mobile signal coverage. The Kruskal-Wallis test and Dwass-Steel-Critchlow-Fligner comparative analyses were performed to explore how mobile signal coverage relates to HEMS travel times to RTI locations. RESULTS: There were 470 occurrences of RTIs attended by HEMS, of which 108 (23%) resulted in on-site fatalities. Among these deaths, 47 (26.85%) occurred in areas with low mobile phone signal coverage ("shadow areas"). Low mobile phone signal coverage identified at 175 (37.24%) RTIs locations, was unevenly distributed across the macro-region. The lowest medians of mobile signal quality were predominantly found in areas with HEMS travel times exceeding 30 min, corresponding to signal strength values of -98.44 (T3) and -100.75 (T4) dBm. This scenario represents a challenge for effective communication to activate HEMS. In the multiple comparison analysis among travel time groups, significant differences were observed between T1 and T2 (p < 0.001), T1 and T3 (p < 0.001), T1 and T4 (p < 0.001), and T2 and T3 (p < 0.001), indicating a potential association between lower mobile phone signal coverage and longer HEMS travel times. CONCLUSION: It can be concluded that poor mobile phone signals in remote areas can hinder HEMS activation, potentially delaying the start of treatment for RTIs. Identification of the shadow areas can help communication and health managers in designing and implementing the necessary changes to improve mobile phone signal coverage and consequently reduce delays in the initial response to RTIs.

Mortality of Young Women due to Breast Cancer in Low, Middle and High-Income Countries: Systematic Literature Review and Meta-Analysis.

OBJECTIVE: To identify the difference in breast cancer mortality rates among young women according to countries' economic classification. METHODS: A systematic literature review included retrospective studies on breast cancer mortality rates in women aged 20 to 49 years. Databases used were PubMed, Web of Science, Scopus, and Virtual Health Library, with articles selected in English, Portuguese, and Spanish. The study selection and analysis were conducted by two pairs of researchers. Data from 54 countries were extracted, including 39 high-income, 12 upper-middle-income, and 3 lower-middle-income countries. A meta-analysis was performed with the quantitative data from two studies. RESULTS: Six articles met the inclusion criteria. Four were analyzed descriptively due to data diversity, and two were included in the meta-analysis. The pooled mortality rate for high-income countries was 10.2 per 100,000 women (95% CI: 9.8-10.6), while for upper-middle-income countries, it was 15.5 per 100,000 women (95% CI: 14.9-16.1). Lower-middle-income countries had a pooled mortality rate of 20.3 per 100,000 women (95% CI: 19.5-21.1). The decrease in mortality rates in high-income countries was statistically significant (p<0.05). CONCLUSION: Mortality rates for breast cancer among young women have decreased significantly in high-income countries but have increased in lower-income countries. This disparity underscores the impact of insufficient investment in preventive measures, health promotion, early diagnosis, and treatment on young women's mortality in lower-income countries.