Computer-aided structure-based design of multitarget leads for Alzheimer's disease.

Alzheimer's disease is a neurodegenerative pathology with unmet clinical needs. A highly desirable approach to this syndrome would be to find a single lead that could bind to some or all of the selected biomolecules that participate in the amyloid cascade, the most accepted route for Alzheimer disease genesis. In order to circumvent the challenge posed by the sizable differences in the binding sites of the molecular targets, we propose a computer-assisted protocol based on a pharmacophore and a set of required interactions with the targets that allows for the automated screening of candidates. We used a combination of docking and molecular dynamics protocols in order to discard nonbinders, optimize the best candidates, and provide a rationale for their potential as inhibitors. To provide a proof of concept, we proceeded to screen the literature and databases, a task that allowed us to identify a set of carbazole-containing compounds that initially showed affinity only for the cholinergic targets in our experimental assays. Two cycles of design based on our protocol led to a new set of analogues that were synthesized and assayed. The assay results revealed that the designed inhibitors had improved affinities for BACE-1 by more than 3 orders of magnitude and also displayed amyloid aggregation inhibition and affinity for AChE and BuChE, a result that led us to a group of multitarget amyloid cascade inhibitors that also could have a positive effect at the cholinergic level.

The spectral profile of cortical activation during a visuospatial mental rotation task and its correlation with working memory.

Introduction: The search for a cortical signature of intelligent behavior has been a longtime motivation in Neuroscience. One noticeable characteristic of intelligence is its association with visuospatial skills. This has led to a steady focus on the functional and structural characteristics of the frontoparietal network (FPN) of areas involved with higher cognition and spatial behavior in humans, including the question of whether intelligence is correlated with larger or smaller activity in this important cortical circuit. This question has broad significance, including speculations about the evolution of human cognition. One way to indirectly measure cortical activity with millisecond precision is to evaluate the event-related spectral perturbation (ERSP) of alpha power (alpha ERSP) during cognitive tasks. Mental rotation, or the ability to transform a mental representation of an object to accurately predict how the object would look from a different angle, is an important feature of everyday activities and has been shown in previous work by our group to be positively correlated with intelligence. In the present work, we evaluate whether alpha ERSP recorded over the parietal, frontal, temporal, and occipital regions of adolescents performing easy and difficult trials of the Shepard-Metzler's mental rotation task, correlates or are predicted by intelligence measures of the Weschler's intelligence scale. Methods: We used a database obtained from a previous study of intellectually gifted (N = 15) and average intelligence (N = 15) adolescents. Results: Our findings suggest that in challenging task conditions, there is a notable difference in the prominence of alpha event-related spectral perturbation (ERSP) activity between various cortical regions. Specifically, we found that alpha ERSP in the parietal region was less prominent relative to those in the frontal, temporal and occipital regions. Working memory scores predict alpha ERSP values in the frontal and parietal regions. In the frontal cortex, alpha ERSP of difficult trials was negatively correlated with working memory scores. Discussion: Thus, our results suggest that even though the FPN is task-relevant during mental rotation tasks, only the frontal alpha ERSP is correlated with working memory score in mental rotation tasks.

The role of frontal and parietal cortex in the performance of gifted and average adolescents in a mental rotation task.

Visual-spatial abilities are usually neglected in academic settings, even though several studies have shown that their predictive power in science, technology, engineering, and mathematics domains exceeds that of math and verbal ability. This neglect means that many spatially talented youths are not identified and nurtured, at a great cost to society. In the present work, we aim to identify behavioral and electrophysiological markers associated with visual spatial-ability in intellectually gifted adolescents (N = 15) compared to age-matched controls (N = 15). The participants performed a classic three-dimensional mental rotation task developed by Shepard and Metzler (1971) [33] while event-related potentials were measured in both frontal and parietal regions of interest. While response time was similar in the two groups, gifted subjects performed the test with greater accuracy. There was no indication of interhemispheric asymmetry of ERPs over parietal regions in both groups, although interhemispheric differences were observed in the frontal lobes. Moreover, intelligence quotient and working memory measures predicted variance in ERP's amplitude in the right parietal and frontal hemispheres. We conclude that while gifted adolescents do not display a different pattern of electroencephalographic activity over the parietal cortex while performing the mental rotation task, their performance is correlated with the amplitude of ERPs in the frontal cortex during the execution of this task.

Health inequalities by region and social group based on data from household surveys (Brazil, 1998-2013). / Desigualdades regionais e sociais em saúde segundo inquéritos domiciliares (Brasil, 1998-2013).

This article discusses trends in health inequalities and access to health services across the regions of Brazil using data from household surveys conducted between 1998 and 2013. Social inequality was measured based on the ratio between the extremes of years of schooling considering two age groups (18 to 59 years and 60 years and over). The findings show a decline in health status and increase in prevalence of diabetes and hypertension in both age groups, which may be related to the expansion of primary healthcare. The findings regarding the percentage of people who had had a medical appointment in the last 12 months show that low levels of inequalities persist despite a general improvement in access. Despite an increase in the percentage of people with up to 3 years of schooling who had had a dental appointment in the last year, significant inequalities persist. The percentage of people who reported being admitted to hospital in the last 12 months was greater among people with up to 3 years of schooling throughout the study period. The hospitalization rate decreased in both age groups across almost all regions. The proportion of women aged between 50 and 69 years with up to 3 years of schooling who had had a mammogram increased, leading to a decrease in inequality. The findings show the need to ensure the continuity of household surveys to monitor inequalities in access to health care services by region and social group.

Este artigo busca discutir a evolução das desigualdades em saúde e no acesso aos serviços de saúde nas grandes regiões a partir de inquéritos domiciliares realizados de 1998 a 2013. As desigualdades sociais foram analisadas pelas razões de extremos de anos de escolaridade, considerando duas faixas etárias (18 a 59 anos e 60 anos ou mais). Nas condições de saúde, observa-se, nos dois grupos etários, uma pior avaliação do estado de saúde e um aumento da prevalência de diabetes e hipertensão, o que pode estar relacionado à expansão da atenção básica. Quanto à realização de consultas médicas no último ano, encontra-se, no geral, maior acesso, com manutenção de pequenas desigualdades. A maior utilização de consulta odontológica entre os de menor escolaridade provoca uma redução nas desigualdades, que ainda são significativas. As internações hospitalares, ao longo da série, são maiores entre os menos escolarizados, e há uma redução nas taxas nos dois grupos etários, em quase todas as regiões. Percebe-se um aumento na realização de mamografia por mulheres menos escolarizadas, com diminuição da desigualdade. Os resultados corroboram a necessidade da continuidade dos inquéritos domiciliares para o monitoramento das desigualdades regionais e sociais no acesso ao sistema de saúde.

Resin-bound chiral derivatizing agents for assignment of configuration by NMR spectroscopy.

A general methodology for assigning the configuration of chiral mono- and polyfunctional compounds by NMR is presented. The approach is based on the use of polystyrene-bound chiral derivatizing agents (CDA-resins) specifically designed to achieve the high-yield formation of the covalent linkages (amide or ester bonds) between the substrate and the chiral auxiliary within the NMR tube, without the need for other manipulations, on a microscale level and in a short time. The deuterated NMR solvents (CDCl3, CD3CN, CS2/CD2Cl2) are also the reaction solvents and separations, purifications or workups of any kind are not necessary prior to recording the spectra. The CDA-resins prepared included MPA, 9-AMA, BPG, MTPA, and 2-NTBA as auxiliary agents incorporated either as single enantiomers or as mixed combinations of the (R)- and the (S)-enantiomers at unequal and known ratios. The high versatility of these systems was successfully demonstrated in a variety of ways based on double and single derivatization, low temperature experiments, or the formation of metal complexes. The approach allowed the absolute configurations of chiral primary amines, primary and secondary alcohols, cyanohydrins, thiols, diols, triols, and amino alcohols to be determined. Extensive high-resolution magic angle spinning (HR-MAS) NMR experiments allowed the characterization of the new CDA-resins and enabled the study of their stability and regioselectivity.

Chiral thiols: the assignment of their absolute configuration by 1H NMR.

A general NMR spectroscopy protocol for determination of absolute configuration of thiols, that includes the introduction of new aryl-tert-butoxyacetic acids as chiral derivatizing agents (CDAs), is described.

[Evaluation of a methodology for financial resources allocation in Brazilian health sector]. / Avaliação de uma metodologia de alocação de recursos financeiros do setor saúde para aplicação no Brasil.

In the early 1990s, a group of British researchers developed a new methodology for healthcare resource allocation based on need. The methodology's main characteristics are to draw on the theoretical model for healthcare services demand and apply data on health services utilization to estimate needs-based use. The objective of the current study was to assess the applicability of this methodology for allocating Federal resources at the local level in Brazil. Data from all acute hospital admissions in 1999 came from the Inpatient Information System of the Unified National Health System (SUS). The country was divided into 134 geographic areas. The statistical models tested to estimate needs-based use applied the following need variables: infant mortality rate; standardized mortality rate; illiteracy rate; proportion of households headed by women; and mean number of household members. All tested models showed negative regression coefficients, indicating that the methodology is inadequate for resource allocation based on need in places like Brazil with large social inequalities in healthcare utilization.

"Mix and shake" method for configurational assignment by NMR: application to chiral amines and alcohols.

[reaction: see text] A new methodology for determining absolute configurations by NMR in just a few minutes is presented. The required derivatives are obtained by mixing a solid matrix-bound auxiliary reagent (MPA, MTPA, or BPG) with the chiral substrate (primary amines or secondary alcohols) directly in the NMR tube. The NMR spectra of the derivatives are obtained without any type of separation, workup, or manipulation. The use of a 1:2 (R)/(S)-MPA resin permits the configurational assignment to be carried out with just one spectrum.

[Equity and geographic distribution of financial resources in health systems]. / Equidad y distribución geográfica de recursos financieros en los sistemas de salud.

This study focuses on equity in health and specifically the geographic distribution of financial resources. The author reviews the main contemporary theories of social justice and discusses the concept of equity in general and specifically in the health field. Based on the discussion of selected international experiences (United Kingdom, Spain, and Italy), the Resource Allocation Working Party (RAWP) formula used in the United Kingdom is identified as the most adequate distributive methodology, sizing the relative needs based on the population's demographic and epidemiological profiles. Finally, the results are presented from a simulation performed for the Brazilian case, showing that a more equitable geographic distribution of financial resources would require a redistribution favoring the States of the North and Northeast. The article concludes by highlighting that a comparison of actual fund outlays by the Ministry of Health in 1994 and the results of the simulation with the RAWP methodology for the Brazilian case show that the principles written into Brazilian legislation were absent from the geographic distribution of financial resources.

Desigualdades regionais e sociais em saúde segundo inquéritos domiciliares (Brasil, 1998-2013) / Health inequalities by region and social group based on data from household surveys (Brazil, 1998-2013)

Resumo Este artigo busca discutir a evolução das desigualdades em saúde e no acesso aos serviços de saúde nas grandes regiões a partir de inquéritos domiciliares realizados de 1998 a 2013. As desigualdades sociais foram analisadas pelas razões de extremos de anos de escolaridade, considerando duas faixas etárias (18 a 59 anos e 60 anos ou mais). Nas condições de saúde, observa-se, nos dois grupos etários, uma pior avaliação do estado de saúde e um aumento da prevalência de diabetes e hipertensão, o que pode estar relacionado à expansão da atenção básica. Quanto à realização de consultas médicas no último ano, encontra-se, no geral, maior acesso, com manutenção de pequenas desigualdades. A maior utilização de consulta odontológica entre os de menor escolaridade provoca uma redução nas desigualdades, que ainda são significativas. As internações hospitalares, ao longo da série, são maiores entre os menos escolarizados, e há uma redução nas taxas nos dois grupos etários, em quase todas as regiões. Percebe-se um aumento na realização de mamografia por mulheres menos escolarizadas, com diminuição da desigualdade. Os resultados corroboram a necessidade da continuidade dos inquéritos domiciliares para o monitoramento das desigualdades regionais e sociais no acesso ao sistema de saúde.

Abstract This article discusses trends in health inequalities and access to health services across the regions of Brazil using data from household surveys conducted between 1998 and 2013. Social inequality was measured based on the ratio between the extremes of years of schooling considering two age groups (18 to 59 years and 60 years and over). The findings show a decline in health status and increase in prevalence of diabetes and hypertension in both age groups, which may be related to the expansion of primary healthcare. The findings regarding the percentage of people who had had a medical appointment in the last 12 months show that low levels of inequalities persist despite a general improvement in access. Despite an increase in the percentage of people with up to 3 years of schooling who had had a dental appointment in the last year, significant inequalities persist. The percentage of people who reported being admitted to hospital in the last 12 months was greater among people with up to 3 years of schooling throughout the study period. The hospitalization rate decreased in both age groups across almost all regions. The proportion of women aged between 50 and 69 years with up to 3 years of schooling who had had a mammogram increased, leading to a decrease in inequality. The findings show the need to ensure the continuity of household surveys to monitor inequalities in access to health care services by region and social group.

[Regional differences in access to coronary bypass surgery in Brazil, 2002-2010]. / Diferenças regionais no acesso a cirurgia cardiovascular no Brasil, 2002-2010.

The hospitalization rates for angioplasty and coronary bypass surgery have been used as proxies for access to highly specialized services. The scope of this study is to analyze the evolution of these rates and discuss what are the possible causes associated with regional inequalities. Standardized rates of angioplasty and coronary bypass surgery by age and sex per 100,000 inhabitants aged 20 and over, in the period from 2002 to 2010 were calculated. Comparison with international data shows that Brazil has lower rates than those observed in OECD countries. In Brazil, the standardized rates of hospitalization for angioplasty in the population aged 20 and over showed an upward trend, rising from 27.5 per 100,000 in 2002 to 39 in 2010. When mortality rates by age and sex from different geographical regions were compared, besides the marked differences in the north - south axis, what is notable is the maintenance of a stable pattern of these rates and regional differences over the period analyzed. The definition of regional health care networks for cardiac surgery is an important strategy to ensure the quality of care, optimization of operating costs and reduction of inequalities in access to healthcare between Brazilian regions.

[Evaluation of performance of health systems: a model for analysis]. / Avaliação de Desempenho de Sistemas de Saúde: um modelo de análise.

This paper presents a review of the Dimension Matrix for Evaluation of the Brazilian Health System that was initially developed in 2003, as well as a conceptual update of some of the sub-dimensions for the evaluation of health service performance, namely effectiveness, access, efficiency and appropriateness of health care. It also describes the indicator selection process as well as the results obtained in each performance dimension. The behavior of the indicators used to assess the performance of health services in Brazil, with respect to each sub-dimension, was not uniform. Areas of marked improvement were found in indicators that are influenced by activities in the field of primary care. The most significant improvements were seen in the sub-dimensions of Effectiveness and Access. With respect to the Efficiency of health services, situations of high efficiency coexist with others with substandard performance. The performance of health services in the sub-dimension of Appropriateness of Health Care was the lowest of all indicators.

[An analysis of use of the health services by financing system: Brazil 1998-2008]. / Uma analise da utilização de serviços de saúde por sistema de financiamento: Brasil 1998 -2008.

This article analyzes the use of health services from the perspective of financing based on PNAD/IBGE micro-data related to 1998, 2003 and 2008. Among the main results, the following can be highlighted: 1) The Unified Health System (SUS) continues to be the major financing agent of most consultations and hospitalizations in Brazil; its participation increased significantly between 1998 and 2003 and remained almost stable between 2003 and 2008; 2) SUS participation in financing the use of the health services has been predominant in all Brazilian regions, especially in the North and North-East, which feature the most precarious socio-economic and health conditions; 3) SUS is the major financing agent of the two extreme levels of complexity of health care: primary care and high complexity services. 4) In spite of a significant rise in utilization rates of SUS services for consultations and hospitalizations, great inequities can still be observed between the population that exclusively uses SUS and that which has private health insurance; 5) There has been an increase in the use of SUS health services by part of the population with private health insurance plans.

[Communicative approach of Situational Strategic Planning at the local level: health and equity in Venezuela]. / Enfoque comunicativo del Planeamiento Estratégico Situacional en el nivel local: salud y equidad en Venezuela.

The article discusses the results of operationalizing Situational Strategic Planning adapted to the local level in health, considering the communicative approach and equity in a parish in Venezuela. Two innovative criteria were used: estimated health needs and analysis of the actors' potential for participation. The problems identified were compared to the corresponding article on rights in the Venezuelan Constitution. The study measured inequalities using health indicators associated with the selected problems; equity criteria were incorporated into the action proposals and communicative elements. Priority was assigned to the problem of "low case-resolving capacity in the health services network", and five critical points were selected for the action plan, which finally consisted of 6 operations and 21 actions. The article concludes that the combination of epidemiology and planning expands the situational explanation. Incorporation of the communicative approach and the equity dimension into Situational Strategic Planning allows empowering health management and helps decrease the gaps from inequality.

[The public-private mix in the Brazilian Health System: financing, delivery and utilization of health services]. / O mix público-privado no Sistema de Saúde Brasileiro: financiamento, oferta e utilização de serviços de saúde.

This paper analyzes the public-private mix in the Brazilian Health System from the perspective of health care delivery, utilization and financing. Moreover, this quantitative study based on secondary data from official databases contemplates the subsidies granted by the government to the private sector. It shows the existence of some inequalities favoring the population having private health plans, a result of the peculiar participation of the private sector in the Brazilian Health System not only offering supplementary care but duplicating the coverage offered by the public system (called SUS). The analysis is made on the basis of the classification of public-private mix in Health Systems developed by the OECD in 2004, that helps understanding the kinds of inequalities occurring in each type of public-private mix. The inequalities that occur in the Brazilian system must be understood as the result of the duplicated coverage offered by the private market and of the weak public funding for the SUS while granting important subsidies to the private sector.

A efetividade do sistema de saúde brasileiro: uma avaliação através de indicadores referentes a condições evitáveis / The effectiveness of the brazilian health system: an evaluation of indicators of preventable conditions

Este artigo analisa a efetividade do sistema de saúde brasileiro através de indicadores que remetem à ocorrência de condições indesejáveis e evitáveis por ações de saúde: 1) mortes evitáveis, 2) casos evitáveis e 3) internações evitáveis. Para as mortes evitáveis, foram selecionadas as taxas de mortalidade em menores de cinco anos, por diarreia e por infecções respiratórias agudas, reveladoras do estado de saúde de um segmento populacional especialmente vulnerável a ações de prevenção primária e secundária. Para os casos evitáveis, considerou-se a taxa de incidência de AIDS, por tratar-se de um problema prioritário de saúde pública para o qual se dispõe de intervenções para evitar casos novos e, também, a evolução dos soropositivos para casos de AIDS. No que se refere às internações evitáveis, dentre as condições caracterizadas como sensíveis à atenção básica, foram selecionadas as taxas padronizadas de internação por asma e por insuficiência cardíaca, ambas evitáveis por adequada abordagem na atenção ambulatorial. Embora a taxa de incidência de AIDS tenha permanecido estável no período 1998/2010, os demais indicadores apresentaram uma constante tendência de queda, sugerindo melhora na efetividade do sistema de saúde. Entretanto, permanecem fortes disparidades regionais, desfavoráveis às regiões mais pobres.

Avaliação de Desempenho de Sistemas de Saúde: um modelo de análise / Evaluation of performance of health systems: a model for analysis

Este artigo apresenta uma revisão da Matriz de Dimensões da Avaliação do Sistema de Saúde no Brasil desenvolvida em 2003, e uma atualização conceitual de parte das subdimensões de avaliação do desempenho dos serviços de saúde: efetividade, acesso, eficiência e adequação. Descreve o processo de seleção dos indicadores utilizados e uma síntese dos resultados para cada subdimensão do desempenho. O comportamento dos indicadores utilizados para avaliar o desempenho dos serviços de saúde no Brasil, no que se refere às quatro subdimensões selecionadas, não é uniforme e as melhorias mais acentuadas são observadas naquelas influenciadas pela atuação dos serviços no campo da atenção primária, as melhorias mais significativas foram observadas nas Efetividade e Acesso. Em relação à Eficiência dos serviços de saúde coexistem situações de alta eficiência com outras de baixo desempenho. A atuação dos serviços de saúde na subdimensão Adequação foi pior do que nas demais apresentadas.

This paper presents a review of the Dimension Matrix for Evaluation of the Brazilian Health System that was initially developed in 2003, as well as a conceptual update of some of the sub-dimensions for the evaluation of health service performance, namely effectiveness, access, efficiency and appropriateness of health care. It also describes the indicator selection process as well as the results obtained in each performance dimension. The behavior of the indicators used to assess the performance of health services in Brazil, with respect to each sub-dimension, was not uniform. Areas of marked improvement were found in indicators that are influenced by activities in the field of primary care. The most significant improvements were seen in the sub-dimensions of Effectiveness and Access. With respect to the Efficiency of health services, situations of high efficiency coexist with others with substandard performance. The performance of health services in the sub-dimension of Appropriateness of Health Care was the lowest of all indicators.

Diferenças regionais no acesso a cirurgia cardiovascular no Brasil, 2002 -2010 / Regional differences in access to coronary bypass surgery in Brazil, 2002-2010

As taxas internação por angioplastia e cirurgia de revascularização vêm sendo usadas como proxies de acesso a serviços de alta complexidade. O objetivo é analisar sua evolução e discutir quais seriam as possíveis causas associadas às desigualdades regionais. Foram calculadas as taxas padronizadas de realização de angioplastia e cirurgia de revascularização por sexo e idade por 100 mil habitantes de 20 anos e mais, no período 2002 a 2010. A comparação com os dados internacionais mostra que o Brasil tem taxas menores que as observadas nos países da OECD. No Brasil, as taxas padronizadas de internação por angioplastia na população de 20 anos ou mais apresentaram uma tendência de crescimento, passando de 27,5 por 100 mil habitantes em 2002 para 39 por 100 mil em 2010. Na comparação das taxas padronizadas por idade e sexo entre as grandes regiões do Brasil, além das diferenças marcantes no eixo Norte - Sul, o que chama atenção é que mantenham um padrão estável e também as diferenças regionais. A constituição de redes assistenciais regionais hierarquizadas para cirurgias cardíacas constitui uma estratégia importante para: garantir a qualidade do cuidado, a optimização dos custos operacionais e reduzir as desigualdades no acesso entre as regiões brasileiras.

The hospitalization rates for angioplasty and coronary bypass surgery have been used as proxies for access to highly specialized services. The scope of this study is to analyze the evolution of these rates and discuss what are the possible causes associated with regional inequalities. Standardized rates of angioplasty and coronary bypass surgery by age and sex per 100,000 inhabitants aged 20 and over, in the period from 2002 to 2010 were calculated. Comparison with international data shows that Brazil has lower rates than those observed in OECD countries. In Brazil, the standardized rates of hospitalization for angioplasty in the population aged 20 and over showed an upward trend, rising from 27.5 per 100,000 in 2002 to 39 in 2010. When mortality rates by age and sex from different geographical regions were compared, besides the marked differences in the north - south axis, what is notable is the maintenance of a stable pattern of these rates and regional differences over the period analyzed. The definition of regional health care networks for cardiac surgery is an important strategy to ensure the quality of care, optimization of operating costs and reduction of inequalities in access to healthcare between Brazilian regions.

Avaliação de Desempenho de Sistemas de Saúde: um modelo de análise / Evaluation of performance of health systems: a model for analysis

Este artigo apresenta uma revisão da Matriz de Dimensões da Avaliação do Sistema de Saúde no Brasil desenvolvida em 2003, e uma atualização conceitual de parte das subdimensões de avaliação do desempenho dos serviços de saúde: efetividade, acesso, eficiência e adequação. Descreve o processo de seleção dos indicadores utilizados e uma síntese dos resultados para cada subdimensão do desempenho. O comportamento dos indicadores utilizados para avaliar o desempenho dos serviços de saúde no Brasil, no que se refere às quatro subdimensões selecionadas, não é uniforme e as melhorias mais acentuadas são observadas naquelas influenciadas pela atuação dos serviços no campo da atenção primária, as melhorias mais significativas foram observadas nas Efetividade e Acesso. Em relação à Eficiência dos serviços de saúde coexistem situações de alta eficiência com outras de baixo desempenho. A atuação dos serviços de saúde na subdimensão Adequação foi pior do que nas demais apresentadas.

Diferenças regionais no acesso a cirurgia cardiovascular no Brasil, 2002-2010 / Regional differences in access to coronary bypass surgery in Brazil, 2002-2010

As taxas internação por angioplastia e cirurgia de revascularização vêm sendo usadas como proxies de acesso a serviços de alta complexidade. O objetivo é analisar sua evolução e discutir quais seriam as possíveis causas associadas às desigualdades regionais. Foram calculadas as taxas padronizadas de realização de angioplastia e cirurgia de revascularização por sexo e idade por 100 mil habitantes de 20 anos e mais, no período 2002 a 2010. A comparação com os dados internacionais mostra que o Brasil tem taxas menores que as observadas nos países da OECD. No Brasil, as taxas padronizadas de internação por angioplastia na população de 20 anos ou mais apresentaram uma tendência de crescimento, passando de 27,5 por 100 mil habitantes em 2002 para 39 por 100 mil em 2010. Na comparação das taxas padronizadas por idade e sexo entre as grandes regiões do Brasil, além das diferenças marcantes no eixo Norte - Sul, o que chama atenção é que mantenham um padrão estável e também as diferenças regionais. A constituição de redes assistenciais regionais hierarquizadas para cirurgias cardíacas constitui uma estratégia importante para: garantir a qualidade do cuidado, a optimização dos custos operacionais e reduzir as desigualdades no acesso entre as regiões brasileiras.