Are Socio-Economic Indicators Associated with Food Safety in Public Schools? A Study in Sergipe State, Brazil.

The Brazilian National School Feeding Programme aims to ensure food security and the right to food for public school students. To protect these fundamental rights, a comprehensive approach is needed that includes ensuring food safety. Recognising that low socio-economic conditions, inadequate food safety and child vulnerability can pose a cumulative burden on child development, this study examined food safety in public schools in Sergipe, Brazil, in the context of local socio-economic indicators. All state public schools in Sergipe (n = 314) were included. Food safety and socio-economic data were analysed using secondary sources and geographical maps. The cluster analysis identified two different groups of schools based on socio-economic indicators. While most schools presented regular foodborne illness risks, food production and temperature control had particularly high levels of non-compliance. Schools in areas with higher socio-economic indicators (Cluster 2) had better overall food safety scores (p < 0.001) compared to schools in areas with lower socio-economic indicators (Cluster 1). Cluster 1 schools also had a higher FBI risk when analysing temperature-controlled equipment violations (p = 0.001), food handlers (p = 0.005) and process and production (p = 0.004), which emerged as critical areas. These results emphasise the urgent need for targeted interventions to improve food safety in schools located in areas with lower socio-economic conditions.

The BC Radon Data Repository (BCRDR) and BC Radon Map: Integrating disparate data sources for improved public health communication.

SETTING: The potential for exposure to indoor radon varies dramatically across British Columbia (BC) due to varied geology. Individuals may struggle to understand their exposure risk and agencies may struggle to understand the value of population-level programs and policies to mitigate risk. INTERVENTION: The BC Centre for Disease Control (BCCDC) established the BC Radon Data Repository (BCRDR) to facilitate radon research, public awareness, and action in the province. The BCRDR aggregates indoor radon measurements collected by government agencies, industry professionals and organizations, and research and advocacy groups. Participation was formalized with a data sharing agreement, which outlines how the BCCDC anonymizes and manages the shared data integrated into the BCRDR. OUTCOMES: The BCRDR currently holds 38,733 measurements from 18 data contributors. The repository continues to grow with new measurements from existing contributors and the addition of new contributors. A prominent use of the BCRDR was to create the online, interactive BC Radon Map, which includes regional concentration summaries, risk interpretation messaging, and health promotion information. Anonymized BCRDR data are also available for external release upon request. IMPLICATIONS: The BCCDC leverages existing radon measurement programs to create a large and integrated database with wide geographic coverage. The development and application of the BCRDR informs public health research and action beyond the BCCDC, and the repository can serve as a model for other regional or national initiatives.

RéSUMé: LIEU: Le potentiel d'exposition au radon à l'intérieur des bâtiments varie beaucoup d'une région à l'autre de la Colombie-Britannique en raison de la géologie variée. Les particuliers peuvent avoir du mal à comprendre leur risque d'exposition, et les organismes, à comprendre l'utilité des programmes et des politiques populationnels pour atténuer le risque. INTERVENTION: Le BC Centre for Disease Control (« le Centre ¼) a créé un organe d'archivage, le BC Radon Data Repository (BCRDR), pour faciliter la recherche, l'information, la sensibilisation du public et l'action liées au radon dans la province. Le BCRDR totalise les relevés du radon à l'intérieur des bâtiments pris par les organismes gouvernementaux, les professionnels et les organismes de l'industrie, ainsi que les groupes de recherche et de revendication. La participation est officialisée par un accord de partage de données qui décrit comment le Centre anonymise et gère les données communes du BCRDR. RéSULTATS: Le BCRDR contient actuellement 38 733 relevés de 18 contributeurs de données. Il continue de croître, avec de nouveaux relevés venant de contributeurs existants et l'ajout de nouveaux contributeurs. Il a servi, entre autres, à créer une carte du radon interactive en ligne pour la Colombie-Britannique, avec des résumés des concentrations régionales, des messages d'interprétation du risque et des informations de promotion de la santé. Sur demande, les données anonymisées du BCRDR sont également disponibles pour diffusion externe. CONSéQUENCES: Le Centre a exploité les programmes de prise de relevés du radon existants pour créer une grande base de données intégrée ayant une vaste couverture géographique. Le développement et les applications du BCRDR éclairent la recherche et l'action en santé publique au-delà du Centre, et l'organe d'archivage peut servir de modèle pour d'autres initiatives régionales ou nationales.

Geospatial evaluation of radiologic access in Rwanda.

BACKGROUND: Rwanda has aimed to rebuild its health care system since the Rwandan genocide against the Tutsis in 1994, though one of the challenges has been a scarcity of radiologic resources. OBJECTIVE: To assess the location and accessibility of radiologic facilities in Rwanda using geospatial mapping and population-based data. METHODS: A cross-sectional study was conducted in May 2023 using location and radiologic modality data provided by the Department of Radiology at the University Teaching Hospital of Kigali and the WorldPop database, a publicly available database providing open-access geospatial population data. Radiologic equipment included magnetic resonance (MR), computed tomography (CT), positron emission tomography (PET), radiotherapy, X-ray, mammography, and fluoroscopy machines. Geospatial analysis was performed using ArcGIS Pro 2.8.6 software. RESULTS: Fifty-six radiologic facilities were identified, including 5 MR, 7 CT, 1 radiotherapy, 52 X-ray, 5 mammography, 5 fluoroscopy, and 0 PET machines. There were 0.4 MR, 0.5 CT, 0 PET, 0.1 radiotherapy, 3.9 X-ray, 0.4 mammography, and 0.4 fluoroscopy units per 1 million people. CONCLUSION: Rwanda is one of the countries with the lowest radiologic access in East Africa; however, there is evidence of progress, particularly in more advanced diagnostic imaging techniques such as computed tomography and magnetic resonance imaging. CRITICAL RELEVANCE STATEMENT: This study provides a 10-year update on current radiologic resources and access in Rwanda, identifying areas of progress and ongoing scarcity, serving as a guide for future direction of growth. KEY POINTS: • As Rwanda works on rebuilding its health care system, this study provides an assessment of the current radiologic resources within the country. • There is less than one radiologic unit for every million of the Rwandan population for every imaging modality other than X-ray. • While radiologic access in Rwanda lags behind that of its neighbors, there has been growth focused on advanced imaging modalities and the training of human resources.

Prevalence and Types of Strabismus in Cerebral Palsy: A Global and Historical Perspective Based on a Systematic Review and Meta-Analysis.

PURPOSE: Strabismus is more frequent in cerebral palsy (CP) than in the normal population, but reports differ how much it is increased. We here examined the global prevalence and types of strabismus in CP, whether esotropia or exotropia is more frequent, and whether the prevalence differs between ethnicities and/or country income levels, and between generations. METHODS: We compiled in a systematic review and meta-analysis the results of 147 CP studies that report the prevalence of strabismus or the ratio of esotropia to exotropia, and we conducted subgroup analyses for region (income level) and ethnicity. We performed a pooled analysis for the CP strabismus prevalence, and estimated the global number of CP cases with strabismus. RESULTS: The pooled prevalence of strabismus in CP is 49.8% in high-income countries and 39.8% in lower-income countries. We estimate the global number of strabismus cases in CP as 12.2 million, with 7.6 million males and 4.6 million females, based on current estimates of 29.6 million global CP cases. Esotropia is more frequent than exotropia in Caucasians, while exotropia is more frequent than esotropia in Hispanic and in some Asian and African populations. The strabismus prevalence in CP increases with increasing country income levels. CONCLUSION: Generational changes in strabismus prevalence appear to reflect a transition of CP types and an increase in prevalence as countries attain higher income and more effective maternal health care. The distribution of esotropia and exotropia in CP patients largely reflects the horizontal strabismus type that is predominant in the subject's ethnicity.

Prevalence and types of strabismus in cerebral palsy: A global and historical perspective based on a systematic review and meta-analysis.

Purpose: Strabismus is more frequent in cerebral palsy (CP) than in the normal population, but reports differ how much it is increased. We here examined the global prevalence and types of strabismus in CP, whether esotropia or exotropia is more frequent, and whether the prevalence differs between ethnicities and/or country income levels, and between generations. Methods: We compiled in a systematic review and meta-analysis the results of 147 CP studies that report the prevalence of strabismus or the ratio of esotropia to exotropia, and we conducted subgroup analyses for region (income level) and ethnicity. We performed a pooled analysis for the CP strabismus prevalence, and estimated the global number of CP cases with strabismus. Results: The pooled prevalence of strabismus in CP is 49.8% in high-income countries and 39.8% in lower-income countries. We estimate the global number of strabismus cases in CP as 12.2 million, with 7.6 million males and 4.6 million females, based on current estimates of 29.6 million global CP cases. Esotropia is more frequent than exotropia in Caucasians, while exotropia is more frequent than esotropia in Hispanic and in some Asian and African populations. The strabismus prevalence in CP increases with increasing country income levels. Conclusion: Generational changes in strabismus prevalence appear to reflect a transition of CP types and an increase in prevalence as countries attain higher income and more effective maternal health care. The distribution of esotropia and exotropia in CP patients largely reflects the horizontal strabismus type that is predominant in the subject's ethnicity.

Temporal analysis and spatial distribution of acquired syphilis in the state of Mato Grosso, Brazil, 2010-2021: an ecological study / Análisis temporal y distribución espacial de la sífilis adquirida en el estado de Mato Grosso, 2010-2021: estudio ecológico / Análise temporal e distribuição espacial da sífilis adquirida no estado de Mato Grosso, 2010-2021: estudo ecológico

Abstract Objective: To analyze the temporal trend and the spatial distribution of acquired syphilis in Mato Grosso, Brazil, between 2010 and 2021. Methods: This was an ecological study using notifications of acquired syphilis held on the Notifiable Health Conditions Information System. Detection rates were calculated by health macro-region and three-year periods (2010-2012, 2013-2015, 2016-2018, 2019-2021). The jointpoint method was used to calculate annual percentage change (APC). Thematic maps of Bayesian rates were built and distribution was analyzed using Local Moran. Results: The detection rate increased from 16.2 per 100,000 inhabitants in the first three-year period (2010-2012) to 70.0 in the last three-year period (2019-2021). The Central-North macro-region had the highest rate in the last three years (94.3/100,000 inhab.), while the highest upward trend occurred in the Central-Northwest macro-region, from 2013 to 2018 (APC = 50.2; 95%CI 26.3;78.6). There was an increase in Bayesian rates in most municipalities. Conclusion: There was a trend towards an increase in acquired syphilis, especially in the last two three-year periods.

Resumen Objetivo: Analizar la tendencia temporal y la distribución espacial de la sífilis adquirida en Mato Grosso, de 2010 a 2021. Métodos: Estudio ecológico utilizando informes de sífilis adquirida del Sistema de Información de Enfermedades de Declaración Obligatoria - Sinan. Las tasas de detección se calcularon por macrorregión de salud y trienios (2010-2012, 2013-2015, 2016-2018, 2019-2021). Se utilizó el método jointpoint para calcular el cambio porcentual anual (CPA). Se construyeron mapas temáticos de tasas bayesianas y se analizó la distribución por Moran Local. Resultados: La tasa de detección aumentó de 16,2 por 100.000 en el primer trienio (2010-2012) a 70,0 en el último trienio (2019-2021). La macrorregión Centro-Norte presentó la tasa más alta en los últimos tres años (94,3/100.000 hab.), mientras que la mayor tendencia al alza se presentó en la macrorregión Centro-Noroeste, de 2013 a 2018 (CPA = 50,2; IC95% 26,3; 78,6). Hubo un aumento en las tasas bayesianas en la mayoría de los municipios. Conclusión: Hubo una tendencia al aumento de la sífilis adquirida, especialmente en los dos últimos trienios.

Resumo Objetivo: Analisar a tendência temporal e a distribuição espacial da sífilis adquirida em Mato Grosso, de 2010 a 2021. Métodos: Estudo ecológico utilizando notificações de sífilis adquirida do Sistema de Informação de Agravos de Notificação. As taxas de detecção foram calculadas por macrorregiões de saúde e triênios (2010-2012, 2013-2015, 2016-2018, 2019-2021). O método jointpoint foi utilizado no cálculo da variação percentual anual (VPA). Foram construídos mapas temáticos das taxas bayesianas e a distribuição analisada por Moran local. Resultados: A taxa de detecção passou de 16,2/100 mil habitantes, no primeiro triênio (2010-2012), para 70, no último triênio (2019-2021). A macrorregião Centro-Norte apresentou a maior taxa no último triênio (94,3/100 mil hab.), enquanto a maior tendência de aumento ocorreu na macrorregião Centro-Noroeste, de 2013 a 2018 (VPA = 50,2; IC95% 26,3;78,6). As taxas bayesianas aumentaram na maioria dos municípios. Conclusão: Houve tendência de aumento da sífilis adquirida, principalmente nos dois últimos triênios.

Spatial patterns of prematurity and its determinants in the metropolitan region of São Paulo, Brazil, 2010-2019 / Padrões espaciais da prematuridade e seus determinantes na região metropolitana de São Paulo, Brasil, 2010-2019

ABSTRACT Objective: To analyze spatial distribution of preterm births and their association with maternal, social, and health services indicators in the metropolitan region of São Paulo, Brazil, 2010-2019. Methods: Ecological study using data on preterm newborns from 39 municipalities in the metropolitan region of São Paulo. Univariate global Moran's index (Im) was used to evaluate spatial association of prematurity, and univariate local Moran's index by using the cluster map (LISA) to identify spatial patterns and clusters. Bivariate global Moran's index was also used to analyze spatial autocorrelation with maternal, social, and health services indicators. Results: A total of 3,103,898 live births were registered in period 2010-2019, of which 331,174 (10.7%) were preterm. The global Moran's index showed spatial independence (Im=0.05; p-value=0.233) of the proportion of preterm births between municipalities. However, in the local spatial analysis it was possible to identify a statistically significant spatial cluster between the municipalities of Biritiba Mirim, Guararema and Salesópolis, with high proportions of preterm births. In the bivariate analysis, a significant positive spatial association was identified with proportions of mothers under 20 years old (Im=0.17; p-value=0.024) and mothers with low schooling (Im=0.17; p-value=0.020), and a significant negative spatial association with HDI (Im=-0.14; p-value=0.039). Conclusions: The local spatial approach identified a spatial cluster located in the far east of the metropolitan region of São Paulo, where actions by health managers are needed to minimize occurrence of preterm births.

RESUMO Objetivo: Analisar a distribuição espacial dos nascimentos prematuros e sua associação com indicadores maternos, sociais e de serviços de saúde na região metropolitana de São Paulo, Brasil, 2010-2019. Métodos: Estudo ecológico utilizando dados sobre recém-nascidos pré-termo dos 39 municípios da região metropolitana de São Paulo. Utilizou-se o índice de Moran (Im) global univariado para avaliar a associação espacial da prematuridade, e o índice de Moran local univariado por meio do mapa de clusters (LISA) para a identificação de padrões e aglomerados espaciais. Também foi utilizado o índice de Moran global bivariado para analisar a autocorrelação espacial com os indicadores maternos, sociais e de serviços de saúde. Resultados: Foram registrados 3.103.898 nascidos vivos no período 2010-2019, dos quais 331.174 (10,7%) foram prematuros. O índice de Moran global mostrou independência espacial (Im=0,05; p-valor=0,233) da proporção dos nascimentos prematuros entre municípios. No entanto, na análise espacial local foi possível identificar aglomerado espacial estatisticamente significativo entre os municípios de Biritiba Mirim, Guararema e Salesópolis, com proporções altas de nascimentos pré-termo. Na análise bivariada, identificou-se associação espacial significativa positiva com proporções de mães menores de 20 anos (Im=0,17; p-valor=0,024) e mães com baixa escolaridade (Im=0,17; p-valor=0,020), e associação espacial significativa negativa com IDH (Im=-0,14; p-valor=0,039). Conclusão: A abordagem espacial local identificou agrupamento espacial situado no extremo leste da região metropolitana de São Paulo, onde ações dos gestores de saúde são necessárias para minimizar a ocorrência de partos prematuros.

Spatial distribution of commercial food establishments in a Northern State of Brazil: do we have food deserts and swamps? / Distribuição espacial de estabelecimentos comerciais alimentícios em um estado da região Norte do Brasil: temos desertos e pântanos alimentares?

ABSTRACT Objective This study aimed to evaluate the spatial distribution of commercial food establishments in the state of Tocantins, in order to identify the presence of food deserts and swamps and its relationship with sociodemographic characteristics. Methods The present study is an ecological (observational) study of secondary state data. Sociodemographic and stablishment data were extracted from open government databases. After extracting the data, establishments were filtered according to CNAE, and a total of 4.202 establishments were distributed in 139 municipalities in the state of Tocantins. Each establishment was classified as unprocessed, mixed or ultra-processed. Since there is a high number of small-sized I municipalities, the density data of both types of establishments, associated relationships were calculated per 1000 inhabitants and then divided into quartiles. Lastly, maps were constructed for included establishments, using the QGIS software. Results In the north of the state, a tendency towards spatial clustering of municipalities in the first quartile of the distribution of healthy establishments was observed, indicating food deserts. Food deserts are spread across the whole territory of Tocantins, but food swamps are absent. Conclusion This study suggests that food deserts are present in Tocantins and food swamps could not be found, despite unhealthy stablishments being concentrated along BR highway 153.

RESUMO Objetivo Este estudo teve como objetivo avaliar a distribuição espacial dos estabelecimentos comerciais de alimentação no estado do Tocantins, a fim de identificar a presença de desertos alimentares e pântanos e sua relação com características sociodemográficas. Métodos O presente estudo é um estudo ecológico (observacional) de dados secundários do estado. Os dados sociodemográficos e dos estabelecimentos foram extraídos de bancos de dados abertos do governo. Após a extração dos dados, os estabelecimentos foram filtrados conforme CNAE, e foram distribuídos um total de 4.202 estabelecimentos em 139 municípios do estado do Tocantins. Cada estabelecimento foi classificado como in natura, misto ou ultraprocessado. Visto que há muitos municípios de pequeno porte, os dados de densidade de ambos os tipos de estabelecimentos e relações associadas foram calculados por 1000 habitantes e depois divididos em quartis. Por fim, foram construídos mapas dos estabelecimentos incluídos, utilizando o software QGIS. Resultados No norte do estado, observou-se tendência à aglomeração espacial dos municípios no primeiro quartil da distribuição dos estabelecimentos saudáveis, indicando desertos alimentares. Os desertos alimentares estão espalhados por todo o território do Tocantins, mas os pântanos alimentares estão ausentes. Conclusão Este estudo sugere que desertos alimentares estão presentes no Tocantins e que não foram encontrados pântanos alimentares, apesar dos estabelecimentos insalubres estarem concentrados ao longo da rodovia BR 153.

Patient diversity and author representation in clinical studies supporting the Surviving Sepsis Campaign guidelines for management of sepsis and septic shock 2021: a systematic review of citations.

BACKGROUND: The generalizability of the Surviving Sepsis Campaign (SSC) guidelines to various patient populations and hospital settings has been debated. A quantitative assessment of the diversity and representation in the clinical evidence supporting the guidelines would help evaluate the generalizability of the recommendations and identify strategic research goals and priorities. In this study, we evaluated the diversity of patients in the original studies, in terms of sex, race/ethnicity, and geographical location. We also assessed diversity in sex and geographical representation among study first and last authors. METHODS: All clinical studies cited in support of the 2021 SSC adult guideline recommendations were identified. Original clinical studies were included, while editorials, reviews, non-clinical studies, and meta-analyses were excluded. For eligible studies, we recorded the proportion of male patients, percentage of each represented racial/ethnic subgroup (when available), and countries in which they were conducted. We also recorded the sex and location of the first and last authors. The World Bank classification was used to categorize countries. RESULTS: The SSC guidelines included six sections, with 85 recommendations based on 351 clinical studies. The proportion of male patients ranged from 47 to 62%. Most studies did not report the racial/ ethnic distribution of the included patients; when they did so, most were White patients (68-77%). Most studies were conducted in high-income countries (77-99%), which included Europe/Central Asia (33-66%) and North America (36-55%). Moreover, most first/last authors were males (55-93%) and from high-income countries (77-99%). CONCLUSIONS: To enhance the generalizability of the SCC guidelines, stakeholders should define strategies to enhance the diversity and representation in clinical studies. Though there was reasonable representation in sex among patients included in clinical studies, the evidence did not reflect diversity in the race/ethnicity and geographical locations. There was also lack of diversity among the first and last authors contributing to the evidence.

Hospitalizations for congenital syphilis in children under one year old in the state of Pará, Brazilian Amazon: ecological study.

BACKGROUND: The high incidence of congenital syphilis shows flaws in the resolution of primary health care, being a predictor of greater use of hospital services, whose regional differences in access to health actions and services may be reflected in health inequalities. OBJECTIVE: to investigate hospitalizations due to congenital syphilis in children under one year of age, in the state of Pará, Brazilian Amazon. METHODS: an ecological study was carried out, using hospitalization, lethality and mortality rates related to congenital syphilis in children under one year of age. Temporal analysis and mapping of hospitalization flows were carried out using Joinpoint®, version 4.7.0.0, Terraview 4.2.2, Tabwin 4.1.5. RESULTS: A total of 6,487 hospitalizations were recorded. For the ten years of the study period (2009 to 2018), the lethality rate showed a decreasing trend of - 13.5% (p = 0.01). The crude hospitalization rate showed an increasing trend of 12.8% (p < 0.000. The regression analysis demonstrated that there was a change point in the trend with a significant growth of 12.8% until 2016 (p = 0.0006). In the mortality rate the trend was stable (p = 0.56). The analysis of hospitalization care flows made it possible to identify that most hospitalizations due to congenital syphilis occurred in the municipalities of residence, but 1,378 (21.2%) had to move. Two large care gaps were highlighted in Metropolitan health regions II and III, belonging to macroregion II. The hospitalizations of residents of these regions were carried out by the assistance networks of Belém (capital) and Marituba, both of which are part of Metropolitana I. Residents of macroregions III and IV had the greatest distances traveled to access hospital care. CONCLUSIONS: The increase in the rate of hospitalizations with an increasing trend demonstrates the impact that syphilis still causes in Brazil, not being resolved even after national government interventions in primary health care, but there was a decreasing trend in the fatality rate. The results demonstrate a heterogeneous organization of health care networks in the state's health regions and macroregions.

Geospatial mapping of surgical systems for earthquake emergency planning in Guerrero, Mexico: an ecological study.

Background: Accessibility to surgical services can impact earthquake preparedness and response. We aimed to estimate the population with timely access to surgical care in Guerrero, a Mexican state with high tectonic activity, and identify populations at risk in the event of an earthquake. Methods: We conducted an ecological study using open government data. We extracted data from Guerrero municipalities regarding their earthquake risk, social vulnerability, social inequality, marginalisation, and resilience indices. The latest combines municipalities' resistance to unexpected events and capacity to maintain optimal functionality without immediate federal or international support. Geographical coordinates of active public and private surgical facilities in Guerrero were combined with ancillary spatial data on roads and municipalities' population density to estimate population coverage within 30-min and 1-h driving time to surgical facilities in Redivis. We built an ordered beta regression model for each driving time estimate. Findings: We identified 25 public and 16 private facilities capable of providing surgical care in Guerrero. The population with access to facilities with surgical capacity within 30 min and 1-h driving times were 48.4% and 69.1%, respectively. We found that municipalities with very high levels of earthquake risk, social vulnerability, social inequality, and marginalisation, and very low levels of resilience had decreased coverage. In the multivariable analysis, the resilience index was statistically significant only for the 30-min model, with an effect size of 0.524 (95% CI 0.082, 1.089). Interpretation: Access to surgical care remains unequally distributed in Guerrero municipalities at the highest risk for earthquakes. Municipalities' resilience was the most significant predictor of higher surgical care coverage in 30-min driving time. Our study provides insights on how surgical system strengthening can enhance earthquake emergency disaster planning. Funding: No funding.

A Geospatial Model to Identify Areas Associated with Late- Stage Breast Cancer: A Spatial Epidemiology Approach.

OBJECTIVE: The aim of this study was to show how a geospatial model can be used to identify areas with a higher probability for late-stage breast cancer (BC) diagnoses. METHODS: Our study considered an ecological design. Clinical records at a tertiary care hospital were reviewed in order to obtain the place of residence and stage of the disease, which was classified as early (0-IIA) and late (IIB-IV) and whose diagnoses were made during the 2013-2017 period. Then, they were geolocated to identify the distribution and spatial trend. Subsequently, the pattern of location, i.e. scattered, random and concentrated, was statistically assessed and a geospatial model was elaborated to determine the probability of late diagnoses in the state of Jalisco, Mexico. RESULT: There were 1 954 (N) geolocated BC diagnoses: 58.3% were late. During the five-year period, a southwest-northeast trend was identified, nearly 9.5% of the surface of Jalisco, where 6 out of 10 (n= 751) late- stage diagnoses were concentrated. A concentrated and statistically significant pattern was identified in the southern, central and northern Pacific area of Jalisco, where the geospatial model delimited the places with the highest probability of late clinical stages (p <0.05). CONCLUSION: The geographical differences associated with the late diagnoses of BC suggest it is necessary to adapt and focus the strategies for early detection as an alternative to create a major impact on the population. Reproducible analysis tools were used in other contexts where geolocation data are available to complement public policies and strategies aimed to control BC.

Temporal trends and geographic variations in mortality rates from tobacco and firearms in the United States.

We explored temporal trends and geographic variations in United States of America (US) mortality rates from smoking and firearms from 1999 to 2019. To do so, we used the publicly available Centers for Disease Control and Prevention (CDC) Wide Ranging Online Data for Epidemiologic Research (WONDER) with Multiple Cause of Death files from 1999 to 2019. Using age-specific rates and ArcGIS Pro Advanced software for Optimized Hot Spot Analyses from Esri, we generated maps of statistically significant spatial clusters with 90-99% confidence intervals with the Getis-Ord Gi* statistic for mortality from smoking-related causes and firearms. These data show temporal trends and geographic variations in mortality from smoking and firearms in the US. Smoking and firearm-related mortality from assault and suicide increased throughout the US and clustered in the Southeast. Firearm-related suicide also clustered in the continental West and Alaska. These descriptive data generate many hypotheses which are testable in analytic epidemiologic studies designed a priori to do so. The trends suggest smoking and firearm-related causes pose particular challenges to the Southeast and firearms also to the West and Alaska. These data may aid clinicians and public health authorities to implement evidence-based smoking avoidance and cessation programs as well as address firearm mortality, with particular attention to the areas of highest risks. As has been the case with cigarettes, individual behavior changes as well as societal changes are likely to be needed to achieve decreases in premature mortality.

Improving data capture of race and ethnicity for the Food and Drug Administration Sentinel database: a narrative review.

PURPOSE: The U.S. Food and Drug Administration's Sentinel System is a national medical product safety surveillance system consisting of a large multisite distributed database of administrative claims supplemented by electronic health-care record data. The program seeks to improve data capture of race and ethnicity for pharmacoepidemiology studies. METHODS: We conducted a narrative literature review of published research on data augmentation and imputation methods to improve race and ethnicity capture in U.S. health-care systems databases. We focused on methods with limited (five-digit ZIP codes only) or full patient identifiers available to link to external sources of self-reported data. We organized the literature by themes: (1) variation in data capture of self-reported data, (2) data augmentation from external sources of self-reported data, and (3) imputation methods, including Bayesian analysis and multiple regression. RESULTS: Researchers reduced data missingness with high validity for Asian, Black, White, and Pacific Islander racial groups and Hispanic ethnicity. Native American and multiracial groups were difficult to validate due to relatively small sample sizes. CONCLUSIONS: Limitations on accessible self-reported data for validation will dictate methods to improve race and ethnicity data capture. We recommend methods leveraging multiple sources that account for variations in geography, age, and sex.

Geographic Variation in Racial Disparities in Receipt of High-Dose Influenza Vaccine Among US Older Adults.

BACKGROUND: Racial disparities in receipt of high-dose influenza vaccine (HDV) have been documented nationally, but whether small-area geographic variation in such disparities exists remains unknown. We assessed the distribution of disparities in HDV receipt between Black and White traditional Medicare beneficiaries vaccinated against influenza within states and hospital referral regions (HRRs). METHODS: We conducted a nationally representative retrospective cohort study of 11,768,724 community-dwelling traditional Medicare beneficiaries vaccinated against influenza during the 2015-2016 influenza season (94.3% White and 5.7% Black). Our comparison was marginalized versus privileged racial group measured as Black versus White race. Vaccination and type of vaccine were obtained from Medicare Carrier and Outpatient files. Differences in the proportions of individuals who received HDV between Black and White beneficiaries within states and HRRs were used to measure age- and sex-standardized disparities in HDV receipt. We restricted to states and HRRs with ≥ 100 beneficiaries per age-sex strata per racial group. RESULTS: We detected a national disparity in HDV receipt of 12.8 percentage points (pps). At the state level, the median standardized HDV receipt disparity was 10.7 pps (minimum, maximum: 2.9, 25.6; n = 30 states). The median standardized HDV receipt disparity among HRRs was 11.6 pps (minimum, maximum: 0.4, 24.7; n = 54 HRRs). CONCLUSION: Black beneficiaries were less likely to receive HDV compared to White beneficiaries in almost every state and HRR in our analysis. The magnitudes of disparities varied substantially across states and HRRs. Local interventions and policies are needed to target geographic areas with the largest disparities to address these inequities.

A novel method for measuring the burden of breast cancer in neighborhoods.

Community-based breast cancer prevention efforts often focus on women who live in the same neighborhoods, as they tend to have similar demographic characteristics, health behaviors, and environmental exposures; yet little research describes methods of selecting neighborhoods of focus for community-based cancer prevention interventions. Studies frequently use demographics from census data, or single breast cancer outcomes (e.g., mortality, morbidity) in order to choose neighborhoods of focus for breast cancer interventions, which may not be optimal. This study presents a novel method for measuring the burden of breast cancer among neighborhoods that could be used for selecting neighborhoods of focus. In this study, we 1) calculate a metric composed of multiple breast cancer outcomes to describe the burden of breast cancer in census tracts Philadelphia, PA, USA; 2) map the neighborhoods with the greatest breast cancer burden; and 3) compare census tracts with the highest burden of breast cancer to those with demographics sometimes used for geo-based prioritization, i.e., race and income. The results of our study showed that race or income may not be appropriate proxies for neighborhood breast cancer burden; comparing the breast cancer burden with demographics at the census tract level, we found few overlaps with the highest percentage African American or the lowest median incomes. Agencies implementing community-based breast cancer interventions should consider this method to inform the selection of neighborhoods for breast cancer prevention interventions, including education, screening, and treatment.

Impacts of Hurricane Matthew Exposure on Infections and Antimicrobial Prescribing in North Carolina Veterans.

The impact of hurricane-related flooding on infectious diseases in the US is not well understood. Using geocoded electronic health records for 62,762 veterans living in North Carolina counties impacted by Hurricane Matthew coupled with flood maps, we explore the impact of hurricane and flood exposure on infectious outcomes in outpatient settings and emergency departments as well as antimicrobial prescribing. Declines in outpatient visits and antimicrobial prescribing are observed in weeks 0-2 following the hurricane as compared with the baseline period and the year prior, while increases in antimicrobial prescribing are observed 3+ weeks following the hurricane. Taken together, hurricane and flood exposure appear to have had minor impacts on infectious outcomes in North Carolina veterans, not resulting in large increases in infections or antimicrobial prescribing.

Schistosomiasis mansoni and hydrographical conditions in São Carlos, São Paulo, Brazil.

BACKGROUND: In Brazil, schistosomiasis mansoni cases still occur, even in non-endemic areas. This study aimed to evaluate schistosomiasis mansoni cases and to delimit water collections investigated for infested planorbidae in São Carlos, São Paulo, Brazil. METHODS: A cross-sectional descriptive study and spatial analysis of schistosomiasis mansoni cases notified in the city from January 2005 to December 2017 was conducted. The study used geographical information system software to map residential and leisure exposures to water courses and bodies and related them to planorbidae surveys of São Paulo state. RESULTS: During the study period, 32 cases were notified. The main forms were intestinal and hepatosplenic. Twenty-eight cases were allochthonous, two autochthonous and two indeterminate. Eleven patients (33.3%) had contact with water collections in São Carlos, mainly the 29 and Broa reservoirs. Three of them had contact only with water collections in the region. A third of cases lived in the Água Fria and Água Quente microbasins, highly impacted by the presence of domestic sewage, and the whole region seems to be colonized by Biomphalaria tenagophila. CONCLUSIONS: The resolution of anthropogenic contamination of water bodies is crucial for controlling schistosomiasis mansoni autochthony in São Carlos.

Food environment near schools in the largest Brazilian metropolis: analyses and contributions based on census data / Ambiente alimentar próximo às escolas na maior metrópole brasileira: análises e contribuições com base em dados censitários / Entorno alimentario cerca de las escuelas en la mayor metrópoli brasileña: análisis y contribuciones a partir de datos censales

Abstract: We aimed to investigate and compare the distribution of establishments that sell food near municipal, state, and private schools in the municipality of São Paulo, Brazil. This cross-sectional, exploratory, and census study was conducted in 3,121 schools. Circular buffers were traced around schools and concentrations or dispersions of food stores (in absolute numbers and densities) were analyzed. A p-trend was calculated to analyze how food stores density behaved as the buffer radius distance increased. Stratified regression models were built to analyze the characteristics of the food environment. Snack bars and street vendors are the most common types of establishments surrounding schools. Some categories of food stores are concentrated (such as candy stores around municipal and private schools, mini markets around municipal schools, and snack bars around private schools), whereas others (such as super and hypermarkets and fruit and vegetable stores) are dispersed around public schools. The food environment around schools shows differences regarding the instance that administers them and private schools have more food stores around them. Poor-quality food environment around schools exposes students to risk factors regarding excessive unhealthy food consumption.

Resumo: Este estudo transversal, exploratório e censitário realizado em 3.121 escolas buscou investigar e comparar a distribuição de estabelecimentos de venda de alimentos no entorno de escolas municipais, estaduais e particulares da cidade de São Paulo, Brasil. Foram traçados buffers circulares ao redor das escolas e analisadas as concentrações ou dispersões de estoques de alimentos (em números absolutos e densidades). Foi calculado o valor de p de tendencia para analisar o comportamento das densidades dos estabelecimentos com o aumento da distância do raio do buffer. As características do ambiente alimentar foram analisadas por modelos de regressão estratificada. Lanchonetes e vendedores ambulantes são os tipos de estabelecimentos mais presentes nos entornos das escolas. Algumas categorias de lojas de alimentos estão concentradas (como lojas de doces em torno de escolas municipais e particulares, minimercados em torno de escolas municipais e lanchonetes em torno de escolas particulares), e outras (como super e hipermercados e hortifrútis) estão dispersas em torno de escolas públicas. O ambiente alimentar ao redor das escolas difere de acordo com a instância que as administra, e as particulares têm mais lojas de alimentos nos arredores. O ambiente alimentar de baixa qualidade ao redor das escolas expõe os alunos a fatores de risco para o consumo excessivo de alimentos não saudáveis.

Resumen: Este estudio transversal, exploratorio y censal realizado en 3.121 escuelas, buscó investigar y comparar la distribución de los establecimientos de venta de alimentos en el entorno de escuelas municipales, estatales y privadas de la ciudad de São Paulo, Brasil. Se trazaron buffers circulares alrededor de las escuelas y se analizaron las concentraciones o dispersiones de las existencias de alimentos (en números absolutos y densidades). Se calculó el valor de p de la tendencia para analizar el comportamiento de las densidades de los establecimientos al aumentar la distancia al radio del buffer. Las características del entorno alimentario se analizaron por medio de modelos de regresión estratificada. Las cafeterías y los vendedores ambulantes son los tipos de establecimientos más presentes en el entorno de las escuelas. Algunas categorías de tiendas de alimentos están concentradas (como tiendas de dulces alrededor de las escuelas municipales y privadas, minimercados alrededor de escuelas municipales y cafeterías alrededor de escuelas privadas), y otras (como super e hipermercados y tiendas de frutas y hortalizas) están dispersas alrededor de las escuelas públicas. El entorno alimentario alrededor de las escuelas difiere según la instancia que las administra, y hay más tiendas de alimentos en las inmediaciones de las escuelas privadas. El entorno alimentario de baja calidad alrededor de las escuelas expone a los estudiantes a factores de riesgo para el consumo excesivo de alimentos poco saludables.

Geographical distribution of nutritional status of adolescents in a Brazilian city in the early years of the pandemic / Distribuição espacial do estado nutricional de adolescentes de um município brasileiro nos anos iniciais da pandemia

ABSTRACT Objective This study aims to build geographic models related to the nutritional status of adolescents and describe territories regarding the prevalence of malnutrition, overweight, and obesity, in order to spatially represent how the nutritional status of adolescents is distributed in the city. Methods Using geocoding techniques, graphic models were built using data from the SISVAN platform, as well as the addresses and nutritional status of adolescents aged 10 to 19 years in the municipality of Divinópolis, in the state of Minas Gerais (Brazil), between 2020 and 2021. Results There was a prevalence of 34% of obesity and overweight in the 2020 and 2021 samples. The graphical models showed that there is no specific pattern of points for the spread of nutritional diagnoses, but it was possible to identify areas of heat and places with a higher concentration of overweight. Underweight had a homogeneous spread and did not stand out in the formation of profiles. Conclusion Geographic tools with the adolescents' nutritional profile were successfully modeled, which have the potential to contribute to better health indicator management in the assessed territory, even with the limitations of the study.

RESUMO Objetivo Este trabalho tem como objetivo construir modelos geográficos relativos ao perfil nutricional de adolescentes e descrever territórios quanto à prevalência de déficit de peso e excesso de peso, de modo a representar espacialmente como o diagnóstico nutricional de adolescentes está distribuído na área estudada. Métodos Através da técnica de geocodificação foram construídos modelos gráficos utilizando a plataforma SISVAN, os endereços e o estado nutricional de adolescentes de 10 a 19 anos do município de Divinópolis, Minas Gerais, nos anos de 2020 e 2021. Resultados Houve prevalência de 34% de excesso de peso na amostra de 2020 e 2021. Os modelos gráficos mostraram que não há um padrão específico de pontos de propagação dos diagnósticos nutricionais, porém foi possível identificar áreas de calor e locais de maior concentração de excesso de peso. O déficit de peso teve um espalhamento homogêneo e não se destacou na formação de perfis. Conclusão Foi possível modelar ferramentas geográficas com o perfil nutricional dos adolescentes, as quais têm potencial de contribuir para a melhor gestão de indicadores de saúde no território avaliado, mesmo com as limitações do estudo.