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.

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.

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.

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.

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.

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.

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.

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.

Temporal and spatial analysis of municipal dengue cases in Paraná and social and environmental indicators, 2012 to 2021: ecological study / Análise temporal e espacial dos casos municipais de dengue no Paraná e indicadores sociais e ambientais, 2012 a 2021: estudo ecológico

ABSTRACT 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.

RESUMO Objetivo: Analisar a tendência temporal e a distribuição espacial da taxa de incidência de casos de dengue no Paraná e suas regiões entre 2012 e 2021 e investigar variáveis sociodemográficas e ambientais associadas. Métodos: Estudo ecológico com análises temporais e espaciais da taxa de incidência da dengue registrada no Sistema de Informação de Agravos de Notificação, de 2012 e 2021, e investigação de variáveis sociodemográficas e ambientais. Para analisar as taxas de incidência municipais foram utilizados os testes de Mann-Whitney e Kruskal-Wallis, seguidos do teste de Dunn para múltiplas comparações. Utilizou-se para análise da tendência temporal a regressão de Prais-Winsten, e para a análise espacial, o índice de Moran Local univariado e bivariado. Resultados: Foram confirmados 548.683 casos de dengue no período, apresentando a maior taxa de incidência estadual em 2020, com 15 regionais de saúde registrando mais de 500 casos/100 mil habitantes. Maiores incidências ficaram entre mulheres, faixa etária de 20-59 anos e cor/raça branca. Apesar de variações anuais, observou-se tendência estacionária para incidência segundo sexo, faixa etária, cor e macrorregião. Mais da metade dos municípios paranaenses formou aglomerados espaciais (Moran's 1=0,679) — 73 (18,3%) municípios com alta taxa de incidência formaram agrupamentos. Foram identificados agrupamentos da taxa de incidência da dengue com o grau de urbanização (alto-alto) e com o percentual de cobertura vegetal natural (alto-baixa). Conclusão: Determinantes sociodemográficos e ambientais relacionaram-se com as altas taxas de incidência da dengue e com a distribuição espacial heterogênea no estado do Paraná, indicando a necessidade do fortalecimento das ações de vigilância em saúde.

Experiência de mães após o diagnóstico de malformação congênita e as expectativas de cuidado / Experience of mothers after the diagnosis of congenital malformation and the expectations of care

RESUMO Objetivo compreender a experiência de mães após o diagnóstico de malformação congênita e as expectativas de cuidado da rede de saúde e social. Métodos pesquisa qualitativa com embasamento na Fenomenologia Social, com a participação de seis mães residentes em municípios de fronteira, por meio de entrevista semiestruturada. Resultados os relatos trouxeram informações sobre o diagnóstico de malformação congênita, a experiência da gravidez, o tornar-se mãe de criança com malformação e as expectativas de cuidado de saúde e social. Conclusão o grupo social estudado experienciou o diagnóstico de malformação com sofrimento, repercussões emocionais e com mudanças no cotidiano vivido. Contribuições para a prática: a comunicação por parte da equipe de saúde contribui para a compreensão e enfrentamento da malformação. Destacou-se a importância do apoio da rede familiar e social. É preciso desenvolver competências profissionais relacionadas à comunicação e a maiores investimentos para a formação e condições de trabalho que possibilitem maior tempo destinado ao atendimento deste público.

ABSTRACT Objective to understand the experience of mothers after the diagnosis of congenital malformation and the expectations of care from the health and social network. Methods qualitative research based on Social Phenomenology, with the participation of six mothers living in border towns, by means of semi-structured interviews. Results the reports brought information about the diagnosis of congenital malformation, the experience of pregnancy, becoming a mother of a child with malformation and the expectations of health and social care. Conclusion the social group studied experienced the diagnosis of malformation with suffering, emotional repercussions and changes in their daily lives. Contributions to practice: communication by the health team contributes to understanding and facing the malformation. The importance of the family and social network support was highlighted. It is necessary to develop professional skills related to communication and to make more investments in training and working conditions that allow more time for the care of this public.

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.

Revisão integrativa sobre doenças parasitárias em crianças de creches brasileiras / Integrative review on parasitic diseases in children in brazilian day care centers

As parasitoses intestinais constituem um importante problema de Saúde Pública, especialmente entre os pré-escolares, devido à imaturidade do sistema imune. Assim, este estudo objetivou realizar uma revisão integrativa dos estudos publicados entre os anos de 2010 a 2017 sobre parasitoses intestinais e os fatores associados ao desenvolvimento em crianças matriculadas em creches brasileiras. Foi realizada busca bibliográfica através das bases de dados Medline, Lilacs e SciELO, utilizando os descritores: infecção, parasitoses, diarreia e creches, e seus correspondentes em inglês: "infection", "parasitc diseases", "diarrhea" e "child day care centers". No caso das buscas no Medline o descritor Brazil também foi usado. Foram identificados 59 estudos, dos quais 11 foram incluídos no presente trabalho. Foi observado variação de 19,4% a 98,4% de parasitos e, a Giardia duodenalis foi o mais prevalente em crianças entre um e seis anos de idade, gênero masculino, com baixo peso, advindas de residências com alta densidade familiar e nível socioeconômico baixo. As análises mostraram a importância da compreensão dos fatores de risco para a incidência de parasitos, indicando a necessidade da promoção de estratégias efetivas para prevenção e controle das infecções parasitárias no país, visto que, tais infecções influenciam diretamente no desenvolvimento da criança, e em alguns casos, evoluindo a óbito.

Intestinal parasitosis is an important public health issue especially among pre-school children due to the immaturity of their immune system. Thus, this study aimed at carrying out an integrative review of studies published between 2010 and 2017 regarding intestinal parasites and associated factors in children registered in Brazilian day care centers. A bibliographic survey was performed through the Medline, Lilacs, and SciELO databases using the following descriptors: infection, parasitic diseases, diarrhea, and child day care centers, as well as their corresponding translations in Portuguese: "infecção", "parasitoses", "diarreia" and "creches". In the case of Medline searches, the descriptor Brazil was also used. Fifty-nine studies were identified, from which, 11 were included in this study. A variation of 19.4% to 98.4% of parasites could be observed, with Giardia duodenalis being the most prevalent in children between one and six years old, male, with low weight, coming from homes with high family density and low socioeconomic status. The analyzes showed the importance of understanding the risk factors for the incidence of parasites, showing the need to promote effective strategies for the prevention and control of parasitic infections in the country, since such infections have direct influence on the child's development, and in some cases, even evolving to death.

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.

Prevalence of intestinal parasites in children from public preschool in the Triple Border Brazil, Argentina, and Paraguay / Prevalência de parasitos intestinais em crianças de pré-escolas públicas na Tríplice Fronteira Brasil, Argentina e Paraguai

INTRODUCTION: The prevalence of parasitosis in children from Brazilian border cities is unknown. OBJECTIVE: To identify the prevalence of intestinal parasites in children from public pre-school on the Brazilian border and their socioeconomic and health profile. METHODS:: Fecal samples were obtained from 178 children from public early childhood educational center (CMEI) in Brazilian border municipalities in Foz do Iguaçu, Brazil. Samples were processed by Hoffman sedimentation and zinc sulfate centrifugation and flotation methods. A questionnaire was administered to children´s parents or guardians regarding parasitic diseases, socioeconomic status, and sanitary habits. RESULTS: The prevalence of intestinal parasites was 26.9% (n=48). A high prevalence of Giardia duodenalis was found (16.3%), followed by Endolimax nana (8.4%), Enterobius vermiculares (1.7%), Ascaris lumbricoides, and Entamoeba coli (0.5%). Forty-seven children (26.4%) presented monoparasitism. The percentage of parasitosis was significantly higher among male children (33.7% - p<0.036) who exhibited weight loss (50.0%), were from low-income families (35.4% - p=0.05), and had mothers with a low education (54.0% - p=0.0001). The highest percentage of Giardia was in children who exhibited weight loss (42.9% - p<0.05) and had mothers with low education (35.0% - p=0.0001). Multivariate analysis indicated that in the variable gender (male gender), weight loss and low maternal education contributed to the variability of parasitosis in children from the surveyed MCEC. CONCLUSION: The higher prevalence of Giardia was due to child and family variables. The detection of Enterobius vermiculares and Ascaris lumbricoides, despite the low frequency, indicates the need for better basic sanitation policies.

INTRODUÇÃO: A prevalência de parasitoses em crianças de municípios brasileiros de fronteira é desconhecida. OBJETIVO: Identificar a prevalência de parasitos intestinais em crianças de pré-escola pública de fronteira brasileira e seu perfil socioeconômico e sanitário. MÉTODOS: Foram obtidas amostras fecais de 178 crianças de Centro Municipal de Educação Infantil (CMEI) de Foz do Iguaçu, Brasil. As amostras foram processadas pelos métodos de sedimentação de Hoffman e centrifugação e flutuação no sulfato de zinco. Foi aplicado questionário aos pais ou responsáveis, referente a doenças parasitárias, nível socioeconômico e hábitos sanitários. RESULTADOS: A prevalência de parasitos intestinais foi de 26,9% (n=48). Houve maior prevalência de Giardia duodenalis (16,3%), seguido por Endolimax nana (8,4%), Enterobius vermiculares (1,7%), Ascaris lumbricoides e Entamoeba coli (0,5%). 47 (26,4%) crianças apresentaram monoparasitismo. O percentual de parasitose foi significantemente maior nas crianças do sexo masculino (33,7% - p<0,036), perda de peso (50,0%), famílias de baixa renda (35,4% - p=0,05) e mães com baixa escolaridade (54,0% - p=0,0001), enquanto, o maior percentual de Giardia foi em crianças com perda de peso (42,9% - p<0,05) e mães com baixa escolaridade (35,0% - p=0,0001). Análise multivariada indicou que na variável gênero (sexo masculino), perda de peso e baixa escolaridade das mães refletem parte da variabilidade da condição de parasitado das crianças dos CMEI pesquisados. CONCLUSÃO: Presença de maior prevalência de Giardia foi decorrente de variáveis da criança e da família e a detecção de Enterobius vermiculares e Ascaris lumbricoides, apesar da baixa frequência, indica necessidade de melhores políticas de saneamento básico.

Influência do clima na ocorrência de dengue em um município brasileiro de tríplice fronteira / Influencia del clima sobre la incidencia del dengue en un municipio brasileño de la triple frontera / Influence of the weather on the occurrence of dengue in a triple-border brazilian municipality

RESUMO Objetivo analisar a evolução temporal da incidência da dengue e sua correlação com variáveis climáticas em Foz do Iguaçu, um município brasileiro de tríplice fronteira, no período de agosto de 2006 a julho de 2016 Método estudo descritivo e analítico, realizado em 2018. Foram utilizados dados secundários obtidos dos sistemas de informações em saúde. Utilizou-se análise temporal e foi aplicado teste de regressão linear simples para avaliar a correlação entre as taxas de incidência da dengue e as variáveis climáticas Resultados os anos epidêmicos representaram 60% do período estudado. Ocorreu correlação positiva da incidência de dengue com a média da umidade relativa do ar (r=0,276; p=0,025), média da temperatura (até dois meses antes r=0,288; p=0,014) e pluviosidade (até três meses antes r=0,308; p=0,008) Conclusão as variáveis climáticas identificadas com relação positiva podem subsidiar a previsão e controle da epidemia de dengue

RESUMEN Objetivo analizar la evolución en el tiempo de la incidencia del dengue y su correlación con variables climáticas en Foz do Iguaçu, un municipio brasileño de la triple frontera, durante el período de agosto de 2006 a julio de 2016 Método estudio descriptivo y analítico realizado en el año 2018. Se utilizaron datos secundarios obtenidos de los sistemas de datos de salud. Se empleó análisis temporal y se aplicó la prueba de regresión lineal simple para evaluar la correlación entre los índices de incidencia del dengue y las variables climáticas Resultados los años epidémicos representaron el 60% del período estudiado. Se registró una correlación positiva entre la incidencia del dengue y la humedad relativa del aire media (r=0,276; p=0,025), la temperatura media (hasta dos meses antes r=0,288; p=0,014) y la pluviosidad (hasta tres meses antes r=0,308; p=0,008) Conclusión las variables climáticas identificadas con una relación positiva pueden servir de soporte para predecir y controlar epidemias de dengue

ABSTRACT Objective to analyze the temporal evolution of the incidence of dengue and its correlation with climatic variables in Foz do Iguaçu, a triple-border Brazilian municipality, in the period from August 2006 to July 2016 Method a descriptive and analytical study conducted in 2018. Secondary data obtained from the health information systems were used. Time analysis was employed and a simple linear regression test was applied to assess the correlation between the dengue incidence rates and the climatic variables Results the epidemic years represented 60% of the period studied. There was a positive correlation between incidence of dengue and mean relative humidity in the air (r=0.276; p=0.025), mean temperature (up to two months before r=0.288; p=0.014) and pluviosity (up to three months before r=0.308; p=0.008) Conclusion the climatic variables identified as with a positive relationship can support prediction and control of the dengue epidemic

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.

Avaliação do nível de conhecimento sobre Toxoplasmose por pais e/ou responsáveis de crianças em Centros Municipais de Educação Infantil em Foz do Iguaçu-Pr / Brasil / Knowledge level of toxoplasmosis by parents and/or legal guardians in child education Municipal Centers in Foz do Iguaçu, Paraná, Brazil

O objetivo deste estudo foi avaliar o nível de conhecimento prévio e a assimilação de informações novas sobre toxoplasmose pelos pais e/ou responsáveis de crianças matriculadas em Centros Municipais de Educação Infantil (CMEI) do município de Foz do Iguaçu, PR, Brasil. Trata-se de um estudo comparativo, descritivo e de abordagem quantitativa com 163 pais e/ou responsáveis por crianças em CMEI. Aplicou-se questionário contendo 12 questões objetivas sobre a toxoplasmose, aplicado em dois momentos sequenciais da pesquisa M1 (pré-intervenção educativa) e M2 (pós-intervenção educativa). Inicialmente, o questionário foi aplicado para a avaliação do conhecimento prévio sobre a toxoplasmose, seguindo de palestra referente ao tema e, ao término, reaplicado o mesmo questionário para verificação da assimilação das informações. Os dados foram analisados pelo programa BioEstat 5.0®, considerando-se um nível de significância de 5%. Foi identificado um desconhecimento de 62,6% dos pais e/ou responsáveis pelas crianças na avaliação no M1 para as variáveis investigadas (p<0,05). No M2, o percentual de respostas satisfatórias elevou-se consideravelmente (p<0,05). Este estudo evidenciou a necessidade de ampliação de conhecimento de pais e/ou responsáveis por crianças e a eficácia das orientações sobre toxoplasmose.

The purpose of this study was to evaluate the level of prior knowledge and assimilation of new information about toxoplasmosis by parents and/or legal guardians of children enrolled in Child Education Municipal Centers (CMEI) in the city of Foz do Iguaçu, Paraná, Brazil. This is a comparative study using a descriptive and quantitative approach with 163 parents and/or legal guardians of children in CMEIs. A questionnaire containing 12 objective questions about toxoplasmosis, applied in two sequential moments - M1 (pre-educational intervention) and M2 (post-educational intervention) was used. Initially, the questionnaire was applied for the evaluation of prior knowledge about toxoplasmosis, followed by a lecture on the topic and, at the end, the same questionnaire was reapplied to verify the assimilation of the information. The data were analyzed using the BioEstat 5.0® program, considering a 5% level of significance. The results identified a deficit of knowledge in 62.6% of parents and/or legal guardians in the M1 evaluation for the investigated variables (p<0.05). In M2, the percentage of satisfactory responses increased considerably (p<0.05). This study evidenced the need to increase the knowledge of parents and/or legal guardians of children and the effectiveness of orientation about toxoplasmosis.

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.