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.

How do social-economic differences in urban areas affect tuberculosis mortality in a city in the tri-border region of Brazil, Paraguay and Argentina.

BACKGROUND: The World Health Organization (WHO) launched the "End TB Strategy", which aims to reduce tuberculosis (TB) mortality by 95% by 2035, Brazil has made a commitment to this, however, one challenge is achieving the goal in the border region, where the TB situation is more critical. The proposal was to analyse the spatial mortality due to TB and its socio-economic determinants in the general population, around the border areas of Brazil, Paraguay and Argentina, as well as the temporal trend in this region. METHOD: This ecological study considered the cases of TB deaths of residents of Foz do Iguaçu (BR), with its units of analysis being the census sectors. The standardized mortality rate was calculated for each area. Socioeconomic variables data were obtained from the 2010 Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE). The scan statistic was applied to calculate the spatial relative risk (RR), considering a 95% confidence interval (CI). Spatial dependence was analysed using the Global Bivariate Moran I and Local Bivariate Moran I (LISA) to test the relationship between the socioeconomic conditions of the urban areas and mortality from TB. Analysis of the temporal trend was also performed using the Prais-Winsten test. RESULTS: A total of 74 cases of TB death were identified, of which 53 (71.6%) were male and 51 (68.9%) people of white skin colour. The mortality rate ranged from 0.28 to 22.75 cases per 100,000 inhabitants. A spatial relative risk area was identified, RR = 5.07 (95% CI 1.79-14.30). Mortality was associated with: proportion of people of brown skin colour (I: 0.0440, p = 0.033), income (low income I: - 0.0611, p = 0.002; high income I: - 0.0449, p = 0.026) and density of residents (3 and 4 residents, I: 0.0537, p = 0.007; 10 or more residents, I: - 0.0390, p = 0.035). There was an increase in the mortality rate in people of brown skin colour (6.1%; 95% CI = 0.029, 0.093). CONCLUSION: Death due to TB was associated with income, race resident density and social conditions. Although the TB mortality rate is stationary in the general population, it is increasing among people of brown skin colour.

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.

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.

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.

Spatial distribution of mortality from colorectal cancer in the southern region of Brazil.

Colorectal cancer (CRC) is the leading cause of death due to cancer worldwide. In Brazil, it is the second most frequent cancer in men and women, with a mortality reaching 9.4% of those diagnosed. The aim of this study was to analyze the spatial heterogeneity of CRC deaths among municipalities in south Brazil, from 2015 to 2019, in different age groups (50-59 years, 60-69 years, 70-79 years, and 80 years old or more) and identify the associated variables. Global Spatial Autocorrelation (Moran's I) and Local Spatial Autocorrelation (LISA) analyses were used to evaluate the spatial correlation between municipalities and CRC mortality. Ordinary Least Squares (OLS) and Geographically Weighted Regression (GWR) were applied to evaluate global and local correlations between CRC deaths, sociodemographic, and coverage of health care services. For all age groups, our results found areas with high CRC rates surrounded by areas with similarly high rates mainly in the Rio Grande do Sul state. Even as factors associated with CRC mortality varied according to age group, our results suggested that improved access to specialized health centers, the presence of family health strategy teams, and higher rates of colonoscopies are protective factors against colorectal cancer mortality in southern Brazil.

Built environment influence on the incidence of elderly pedestrian collisions in a medium-large city in southern Brazil: a spatial analysis.

Trauma disproportionately affects vulnerable road users, especially the elderly. We analyzed the spatial distribution of elderly pedestrians struck by vehicles in the urban area of Maringa city, from 2014 to 2018. Hotspots were obtained by kernel density estimation and wavelet analysis. The relationship between spatial relative risks (RR) of elderly run-overs and the built environment was assessed through Qualitative Comparative Analysis (QCA). Incidents were more frequent in the central and southeast regions of the city, where the RR was up to 2.58 times higher. The QCA test found a significant association between elderly pedestrian victims and the presence of traffic lights, medical centers/hospitals, roundabouts and schools. There is an association between higher risk of elderly pedestrians collisions and specific elements of built environments in Maringa, providing fundamental data to help guide public policies to improve urban mobility aimed at protecting vulnerable road users and planning an age-friendly city.

Exploring regional disparities in lung cancer mortality in a Brazilian state: A cross-sectional ecological study.

BACKGROUND: Lung cancer (LC) is one of the main causes of mortality in Brazil; geographic, cultural, socioeconomic and health access factors can affect the development of the disease. We explored the geospatial distribution of LC mortality, and associated factors, between 2015 and 2019, in Parana state, Brazil. METHODS AND FINDINGS: We obtained mortality (from the Brazilian Health Informatics Department) and population rates (from the Brazilian Institute of Geography and Statistics [IBGE]) in people over 40 years old, accessibility of oncology centers by municipality, disease diagnosis rate (from Brazilian Ministry of Health), the tobacco production rate (IBGE) and Parana Municipal Performance Index (IPDM) (from Parana Institute for Economic and Social Development). Global Moran's Index and Local Indicators of Spatial Association were performed to evaluate the spatial distribution of LC mortality in Parana state. Ordinary Least Squares Regression and Geographically Weighted Regression were used to verify spatial association between LC mortality and socioeconomic indicators and health service coverage. A strong spatial autocorrelation of LC mortality was observed, with the detection of a large cluster of high LC mortality in the South of Parana state. Spatial regression analysis showed that all independent variables analyzed were directly related to LC mortality by municipality in Paraná. CONCLUSIONS: There is a disparity in the LC mortality in Parana state, and inequality of socioeconomic and accessibility to health care services could be associated with it. Our findings may help health managers to intensify actions in regions with vulnerability in the detection and treatment of LC.

[Juvenile homicides and informal work in a Brazilian city in the Brazil, Paraguay, and Argentina tri-border area]. / Homicídios juvenis e informalidade em um município brasileiro da tríplice fronteira Brasil, Paraguai e Argentina.

OBJECTIVE: To analyze the spatial distribution of juvenile homicide mortality for males in the city of Foz do Iguaçu (state of Paraná), located in the Brazil, Paraguay, and Argentina tri-border area, between 2000 and 2007. METHODS: The data were obtained from the Ministry of Health's Mortality Information System (SIM) and the Brazilian Geography and Statistics Institute (IBGE). Spatial analysis of 873 deaths distributed in 11 demographic expansion areas (AEDs) was performed using ArcGIS® 9.2 and GeoDaTM software. RESULTS: A negative spatial autocorrelation was observed (I = -0.3563; P = 0.0250), indicating high, but dissimilar, homicide rates in all AEDs. Of 14 socioeconomic indicators analyzed, a negative (I = -0.2574; P = 0.0360) and positive (I = 0.2574; P = 0.0310) spatial autocorrelation was recorded for informal and formal work, respectively, indicating that the higher the number of informal jobs in a specific AED, the lower the homicide rate in neighboring AEDs. We identified a high rate of juvenile homicides, informal jobs, and importation of juvenile homicide victims from other AEDs into AED 6, located near the Paraguayan border. CONCLUSIONS: The high rate of juvenile homicides in some areas of Foz do Iguaçu is influenced by the high rate of informal occupations. This points to a serious social problem; namely, unemployment associated with lack of professional training.

Temporal and spatial analysis of municipal dengue cases in Paraná and social and environmental indicators, 2012 to 2021: ecological study.

OBJECTIVE: Analyze the temporal trend and spatial distribution of the incidence rate of dengue cases in Paraná and its regions between 2012 to 2021 and investigate associated sociodemographic and environmental variables. METHODS: Ecological study with temporal and spatial analysis of the dengue incidence rate reported in the Disease and Notification Information System (SINAN) in the period 2012 to 2021 and investigation of sociodemographic and environmental variables. To identify differences between municipal incidence rates the Mann-Whitney and Kruskal-Wallis test followed by Dunn's test for multiple comparisons were used. Prais-Winsten regression was used for temporal trend analysis and for spatial analysis the univariate and bivariate Local Moran analysis were applied. RESULTS: 548,683 cases of dengue were confirmed in the period, the highest state incidence rate was observed in 2020, with 15 health regions presenting more than 500 cases/100,000 inhabitants. Higher incidences were observed among women, age group of 20-59 years and white color/race. Despite annual variations, a stationary trend was observed for incidence rates according to sex, age group, color/race and macro-region. More than half of the municipalities in Paraná formed spatial clusters (Moran's I=0.679), where 73 (18.3%) municipalities with high incidence rate formed clusters. High-High clusters of dengue incidence rate with urbanization and High-Low clusters of incidence rate with vegetation cover were observed. CONCLUSION: Sociodemographic and environmental determinants were related to the high incidence rates of dengue and heterogeneous spatial distribution in the state of Paraná, indicating the need to strengthen health surveillance actions.

Physiologic roles of P2 receptors in leukocytes.

Since their discovery in the 1970s, purinergic receptors have been shown to play key roles in a wide variety of biologic systems and cell types. In the immune system, purinergic receptors participate in innate immunity and in the modulation of the adaptive immune response. In particular, P2 receptors, which respond to extracellular nucleotides, are widely expressed on leukocytes, causing the release of cytokines and chemokines and the formation of inflammatory mediators, and inducing phagocytosis, degranulation, and cell death. The activity of these receptors is regulated by ectonucleotidases-expressed in these same cell types-which regulate the availability of nucleotides in the extracellular environment. In this article, we review the characteristics of the main purinergic receptor subtypes present in the immune system, focusing on the P2 family. In addition, we describe the physiologic roles of the P2 receptors already identified in leukocytes and how they can positively or negatively modulate the development of infectious diseases, inflammation, and pain.

Depression, anxiety and stress symptoms in Brazilian university students during the COVID-19 pandemic: Predictors and association with life satisfaction, psychological well-being and coping strategies.

BACKGROUND: The COVID-19 pandemic raises concerns about the mental health of the world population. Protection measures to prevention the disease impacted education and undergraduate students were exposed to additional stressors. OBJECTIVES: Analyze depression, anxiety and stress symptoms in undergraduates, their respective predictors and the association with satisfaction with life, psychological well-being and coping strategies. METHODS: An online cross-sectional study was conducted from September 14 to October 19, 2020, involving undergraduate students enrolled in 33 courses from 5 public university campuses in the state of Parana, Brazil, using: questionnaire with sociodemographic, academic, health and pandemic effects variables; Depression, Anxiety and Stress Scale-21 (DASS-21); Satisfaction with Life Scale (SWLS); Psychological Well-Being (PWB); BriefCOPE. The convenience sample was composed of 1,224 participants, with 18 years old or older, that completed all research instruments. Spearman correlation and logistic analysis (univariate and multivariate) were applied to the collected data. RESULTS: Most of the undergraduates presented symptoms of depression (60.5%), anxiety (52.5%) and stress (57.5%). Depression, anxiety and stress presented significant correlations in common: negative with satisfaction with life, all dimensions of psychological well-being, and 3 adaptive copings (active coping, planning, positive reframing); positive with 5 maladaptive copings (behavioral disengagement, denial, self-blame, self-distraction, substance use). In addition, there were 7 common predictors for symptoms of depression, anxiety and stress: female; age 18-24 years old; having a chronic disease; lower scores in 2 dimensions of psychological well-being (positive relations with others, self-acceptance); higher scores in 2 maladaptive copings (self-blame, substance use). CONCLUSIONS: The data indicate a high prevalence of symptoms of depression, anxiety and stress, and suggest that higher scores of satisfaction with life, psychological well-being dimensions and adaptive copings may present protective effects in undergraduates during a pandemic crisis.

High prevalence of gastroschisis in Brazilian triple side border: A socioenvironmental spatial analysis.

This research investigated the spatial association between socioenvironmental factors and gastroschisis in Brazilian triple side border. A geographic analysis for gastroschisis prevalence was performed considering census sector units using Global Moran Index, Local Indicator of Spatial Association Analysis and Getis Ord statistics. Sociodemographic factors included rate of adolescent and parturients over 35 years; population with no income and above 5 minimum wages; rate of late prenatal; and proximity to power transmission lines. Logistic regression models were applied to verify the association between socio-environmental factors and prevalence of gastroschisis. No global spatial correlation was observed in the distribution of gastroschisis (Moran´s I = 0.006; p = 0.319). However, multiple logistic regression showed census sectors with positive cases had higher probability to power transmission lines proximity (OR 3,47; CI 95% 1,11-10,79; p = 0,031). Yet, spatial scan statistic showed low risk for gastroschisis in southern city region (OR = 0; p = 0.035) in opposite to power transmission lines location. The study design does not allow us to attest the causality between power transmission lines and gastroschisis but these findings support the potential exposure risk of pregnant to electromagnetic fields.

The Impact of Socioeconomic Factors, Coverage and Access to Health on Heart Ischemic Disease Mortality in a Brazilian Southern State: A Geospatial Analysis.

Background: No other disease has killed more than ischemic heart disease (IHD) for the past few years globally. Despite the advances in cardiology, the response time for starting treatment still leads patients to death because of the lack of healthcare coverage and access to referral centers. Objectives: To analyze the spatial disparities related to IHD mortality in the Parana state, Brazil. Methods: An ecological study using secondary data from Brazilian Health Informatics Department between 2013-2017 was performed to verify the IHD mortality. An spatial analysis was performed using the Global Moran and Local Indicators of Spatial Association (LISA) to verify the spatial dependency of IHD mortality. Lastly, multivariate spatial regression models were also developed using Ordinary Least Squares and Geographically Weighted Regression (GWR) to identify socioeconomic indicators (aging, income, and illiteracy rates), exam coverage (catheterization, angioplasty, and revascularization rates), and access to health (access index to cardiologists and chemical reperfusion centers) significantly correlated with IHD mortality. The chosen model was based on p < 0.05, highest adjusted R2 and lowest Akaike Information Criterion. Results: A total of 22,920 individuals died from IHD between 2013-2017. The spatial analysis confirmed a positive spatial autocorrelation global between IDH mortality rates (Moran's I: 0.633, p < 0.01). The LISA analysis identified six high-high pattern clusters composed by 66 municipalities (16.5%). GWR presented the best model (Adjusted R2: 0.72) showing that accessibility to cardiologists and chemical reperfusion centers, and revascularization and angioplasty rates differentially affect the IHD mortality rates geographically. Aging and illiteracy rate presented positive correlation with IHD mortality rate, while income ratio presented negative correlation (p < 0.05). Conclusion: Regions of vulnerability were unveiled by the spatial analysis where sociodemographic, exam coverage and accessibility to health variables impacted differently the IHD mortality rates in Paraná state, Brazil. Highlights: The increase in ischemic heart disease mortality rates is related to geographical disparities.The IHD mortality is differentially associated to socioeconomic factors, exam coverage, and access to health.Higher accessibility to chemical reperfusion centers did not necessarily improve patient outcomes in some regions of the state.Clusters of high mortality rate are placed in regions with low amount of cardiologists, income and schooling.

Burnout among nursing students: predictors and association with empathy and self-efficacy.

OBJECTIVE: to analyze burnout, its predictors and association with empathy and self-efficacy among nursing students. METHOD: cross-sectional analytical study with 284 students from five state universities in the state of Parana, Brazil. The instruments applied were: social and academic questionnaire, Maslach Burnout Inventory, Interpersonal Reactivity Index and Occupational Self-Efficacy Scale (Short Form). Spearman's correlation and univariate and multivariate logistic analysis were used. RESULTS: 6.0% of the students presented high burnout, 36.3% presented high emotional exhaustion, 37.7% presented high depersonalization and 28.2% presented low personal accomplishment. The burnout predictors were: absence of physical activity; weekly workload >24 hours; low empathic concern. There were negative correlations between empathy (empathic concern and perspective taking) and depersonalization; self-efficacy and emotional exhaustion; and positive correlations between personal accomplishment and empathy and self-efficacy. CONCLUSION: Personal factors and an academic variable were burnout predictors among nursing students. The correlations suggest that self-efficacy and empathy can prevent burnout.

Geospatial analysis of births with congenital disorders, Paraná, 2008-2015: ecological study.

OBJECTIVE: analyze the pattern of spatial distribution of the prevalence rate of births with congenital disorders and its relationship with social, economic, health care and environmental indicators in Paraná, Brazil, from 2008 to 2015. METHOD: ecological study with variables extracted from secondary banks, related to the births of children of mothers residing in Paraná, in two quadrennial (2008-2011 and 2012-2015). The analysis of the rates was performed with univariate spatial (Moran) and multivariate approach (Ordinary Least Squares and Geographically Weighted Regression). RESULTS: the occurrence of congenital disorders presented a significant association (p<0.05) with: registration in primary care of pregnant women over 20 years of age; urbanization degree; consumption of pesticides; and balance of female formal employment. CONCLUSION/FINAL CONSIDERATIONS: social, health care and environmental variables showed a non-stationary spatial pattern in the analyzed period and influenced positively and negatively the rates.

Mapping risk of ischemic heart disease using machine learning in a Brazilian state.

Cardiovascular diseases are the leading cause of deaths globally. Machine learning studies predicting mortality rates for ischemic heart disease (IHD) at the municipal level are very limited. The goal of this paper was to create and validate a Heart Health Care Index (HHCI) to predict risk of IHD based on location and risk factors. Secondary data, geographical information system (GIS) and machine learning were used to validate the HHCI and stratify the IHD municipality risk in the state of Paraná. A positive spatial autocorrelation was found (Moran's I = 0.6472, p-value = 0.001), showing clusters of high IHD mortality. The Support Vector Machine, which had an RMSE of 0.789 and error proportion close to one (0.867), was the best for prediction among eight machine learning algorithms after validation. In the north and northwest regions of the state, HHCI was low and mortality clusters patterns were high. By creating an HHCI through ML, we can predict IHD mortality rate at municipal level, identifying predictive characteristics that impact health conditions of these localities' guided health management decisions for improvements for IHD within the emergency care network in the state of Paraná.

Preditores de impactos negativos da pandemia de covid-19 em universitários brasileiros / Preditors of negative impacts of the covid-19 pandemic on brazilian university undergraduates / Predictores de impactos negativos de la pandemia de covid- 19 en estudiantes universitarios brasileños

Impactos negativos da pandemia de COVID-19 têm sido observados na população em geral e em estudantes. Este estudo transversal objetivou identificar variáveis preditoras de 3 ou mais impactos negativos da pandemia de COVID-19 em graduandos de universidade pública brasileira. A amostra foi composta de 1.579 graduandos que responderam questionário on-line de setembro a outubro de 2020, sendo realizada análise logística univariada e multivariada. 97,2% dos graduandos indicaram aspectos afetados negativamente pela pandemia de COVID-19, e os mais citados foram estudo (80,1%), saúde mental (65,8%) e convívio social (64,9%). 72,9% indicaram impacto em 3 ou mais aspectos da vida, sendo preditores: sexo feminino; idade 18 a 24 anos; consumo de bebida alcoólica; doença crônica; acompanhamento psicológico antes pandemia; teve COVID-19; fez isolamento social; está em isolamento social; cessou/reduziu renda familiar; cessou/reduziu atividade física; cessou/reduziu lazer. Os dados indicaram que a evitação do consumo de álcool e a prática regular de atividade física e lazer podem ser fatores protetivos para os impactos negativos da pandemia de COVID-19, e sugerem reflexões sobre ações de apoio aos graduandos para minorar os impactos pandêmicos.

Negative impacts of the COVID-19 pandemic have been observed in the general population and in students. The present cross-sectional study aimed to identify predictor variables of 3 or more negative impacts of the COVID-19 pandemic on Brazilian public university undergraduates. The sample consisted of 1.579 undergraduates who answered an online questionnaire from September to October 2020, applying univariate and multivariate logistic analysis. 97.2% of undergraduates indicated aspects negatively affected by the COVID-19 pandemic, and the most cited were studies (80.1%), mental health (65.8%) and social interaction (64.9%). 72.9% indicated impact on 3 or more aspects of life, being predictors: female sex; age 18 to 24 years; consumption of alcoholic beverages; chronic disease; had psychological counseling before the pandemic; had COVID-19; did social isolation; is in social isolation; ceased/reduced family income; ceased/reduced physical activity; ceased/reduced leisure. The data indicated that avoidance of alcohol consumption and regular practice of physical activity and leisure may be protective factors for negative impacts of the COVID-19 pandemic and suggest reflections on actions to support undergraduates to mitigate pandemic impacts.

Se han observado impactos negativos de la pandemia de COVID-19 en la población general y en estudiantes. El presente estudio transversal tuvo como objetivo identificar variables predictoras de 3 o más impactos negativos de la pandemia de COVID-19 en estudiantes universitarios públicos brasileños. La muestra consistió en 1.579 estudiantes universitarios que respondieron a un cuestionario en línea de septiembre a octubre de 2020, aplicando análisis logístico univariado y multivariado. El 97,2% de los estudiantes universitarios indicaron aspectos afectados negativamente por la pandemia COVID-19, y los más citados fueron los estudios (80,1%), la salud mental (65,8%) y la interacción social (64,9%). 72,9% indicaron impacto en 3 o más aspectos de la vida, siendo predictores: sexo femenino; edad de 18 a 24 años; consumo de bebidas alcohólicas; enfermedad crónica; tuvo orientación psicológica antes de la pandemia; tuvo COVID-19; hizo aislamiento social; está en aislamiento social; cesó/redujo la renta familiar; cesó/redujo la actividad física; cesó/redujo el ocio. Los datos indicaron que evitar el consumo de alcohol y la práctica regular de actividad física y ocio pueden ser factores de protección para los impactos negativos de la pandemia de COVID-19 y sugieren reflexiones sobre acciones de apoyo a los estudiantes universitarios para mitigar los impactos de la pandemia.

Spatial distribution of breast cancer mortality: Socioeconomic disparities and access to treatment in the state of Parana, Brazil.

INTRODUCTION: Breast cancer remains an important public health problem that is responsible for high morbidity and mortality rates, especially in developing countries. OBJECTIVE: To analyze the socioeconomic and access disparities related to breast cancer mortality in 399 cities in the state of Parana, Brazil. METHODS: Ecological, descriptive and analytical cross-sectional study based on secondary data from the Mortality Information System from 2009 to 2012 in the state of Parana. Breast cancer mortality rate was calculated considering the mortality cases and women population of each municipality, both based on women older than 20 years old. Moran global and local analyses were used to verify the presence of spatial autocorrelation and spatial regression modeling (Spatial Lag-SAR) with the purpose of analyzing the association between socioeconomic indicators, access and mortality rates for breast cancer. RESULTS: Significant positive spatial autocorrelation was found for breast cancer mortality rates (I = 0.5432, p = 0.001). In the spatial regression analysis, the model explained 61% of the variance of the mortality rates for breast cancer. The mortality rate for breast cancer was negatively associated with the illiteracy rate (Coefficient = -0.0279) and positively associated with the access index (Coefficient = 12.9525). CONCLUSION: The lower illiteracy rate has not been sufficient to reduce the specific mortality rate by breast cancer, and the higher the score of accessibility to cancer services, the higher the specific mortality due to breast cancer. The results show that in the state of Parana, the problem is not related to a lack of education of the patients or the distance walked, but rather with the organization of services. These conclusions have important political implications on the organization and quality of the services provided for the diagnosis and treatment of breast cancer in the state of Parana.

Regional disparities in the intimate partner sexual violence rate against women in Paraná State, Brazil, 2009-2014: an ecological study.

OBJECTIVE: Evaluate disparities in a Brazilian state by conducting an analysis to determine whether socioeconomic status was associated with the reported intimate partner sexual violence (IPSV) rates against women. DESIGN: A retrospective, ecological study. SETTINGS: Data retrieved from the Notifiable Diseases Information System database of the Ministry of Health of Brazil. PARTICIPANTS: All cases of IPSV (n=516) against women aged 15-49 years reported in the Notifiable Diseases Information System between 2009 and 2014. OUTCOME MEASURES: The data were evaluated through an exploratory analysis of spatial data. RESULTS: We identified a positive spatial self-correlation in the IPSV rate (0.7105, P≤0.001). Five high-high-type clusters were identified, predominantly in the Metropolitan, West, South Central, Southwest, Southeast and North Central mesoregions, with only one cluster identified in the North Pioneer mesoregion. Our findings also indicated that the associations between the IPSV rate and socioeconomic predictors (women with higher education, civil registry of legal separations, economically active women, demographic density and average female income) were significantly spatially non-stationary; thus, the regression coefficients verified that certain variables in the model were associated with the IPSV rate in some regions of the state. In addition, the geographically weighted regression (GWR) model improved the understanding of the associations between socioeconomic indicators and the IPSV notification rate, showing a better adjustment than the ordinary least square (OLS) model (OLS vs GWR model: R2: 0.95 vs 0.99; Akaike information criterion: 4117.90 vs 3550.61; Moran's I: 0.0905 vs -0.0273, respectively). CONCLUSIONS: IPSV against women was heterogeneous in the state of Paraná. The GWR model showed a better fit and enabled the analysis of the distribution of each indicator in the state, which demonstrated the utility of this model for the study of IPSV dynamics and the indication of local determinants of IPSV notification rates.