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.

Anaplastic lymphoma associated with breast implants-Early diagnosis and treatment.

Anaplastic large cell lymphoma associated with breast implants is a relatively new disease that deserves attention from the academic community. Brazil figures as one of the protagonists in plastic surgery, however publications are insufficient and very few cases are reported in comparison to other countries. It is a disease with excellent prognosis when diagnosed early and treated effectively, but for this to happen, it is essential that health care professionals and the patient understand its pathology. We reported two cases in a small town during a short period of time. In both cases reported by this study, the patients presented late seroma, associated with pain as a clinical presentation, at 13 and 9 years after the placement of silicone implants with textured polyurethane surfaces. After the procedure, the patients were screened for cancer. Further research with more robust samples is still needed to fully determine the risks and benefits of using textured versus smooth implants.

Maternal Risk Factors Associated with Negative COVID-19 Outcomes and Their Relation to Socioeconomic Indicators in Brazil.

BACKGROUND: This study aimed to analyze maternal risk factors associated with negative outcomes of COVID-19 and association with socioeconomic indicators in Brazil. METHODS: A cross-sectional study, with data from the Influenza Epidemiological Surveillance Information System (SIVEP-Flu) of pregnant women with COVID-19 and cases of hospitalization and death. For the analysis of risk factors and outcomes, the multiple logistic regression method was used. RESULTS: Pregnant women who had some risk factor represented 47.04%. The chance of death was 2.48 times greater when there was a risk factor, 1.55 for ICU admission and 1.43 for use of ventilatory support. The percentage of cure was 79.64%, 15.46% without any negative outcome, 4.65% death and 0.26% death from other causes. Pregnant women who did not take the vaccine represented 30.08%, 16.74% took it and 53.18% were not specified. The variables HDI, illiteracy, per capita income and urbanization did not influence the cases of COVID-19. CONCLUSIONS: Factors such as age, obesity, asthma and pregnancy were responsible for the increase in hospitalizations, respiratory complications and death. Vaccination reduced the risk of negative outcomes by 50%. There were no correlations between socioeconomic indicators and the negative outcomes of COVID-19 in pregnant women.

Influence of the global crisis of 2008 and the brazilian political oscillations of 2014 on suicide rates: An analysis of the period from 2002 to 2017.

Global suicide rates have increased in recent decades becoming a serious social and public health problem. In Brazil, rates have been increasing annually. We aimed to analyze the correlation between suicide mortality rates and global economic and political crisis periods of 2008 and 2014 in Brazil. The analysis of suicide mortality in Brazil was done using a time-series segmented linear regression model that estimated the trend of rates over time. To obtain the model, changes in the trend of both abrupt and gradual suicide rates were investigated. The results indicate statistically significant changes showing an upward trend of suicide rates during the world economic crisis (2008-2013) and during the economic and political crisis in Brazil (2014-2017) compared to previous periods, especially at the extremes of schooling (3 < years and > 8 years). Among white and parda, there were significant trend rates increases in both periods and in different regions. In the Northeast and South regions, we observed a significant increase in the trend rate for males after the Brazilian economic and political crisis (2014 to 2017). We can conclude that the national suicide rates were influenced by the economic and political instability that our country has been going through since 2008, affecting each region differently. Further studies are needed to explore the reasons for interregional differences and the relation of suicide with unemployment rates and possible economic predictors.

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.

Relationship between leadership, bullying in the workplace and turnover intention among nurses.

AIM: To identify the factors associated with bullying and turnover intention among nurses. BACKGROUND: Previous studies have demonstrated an association between leadership, bullying and turnover intention. However, few studies to date have addressed this topic among nurses. METHODS: A cross-sectional study was conducted using web-based data collection followed by data analysis using logistic regression and multinomial logistic regression models. RESULTS: Having more than one job (odds ratio (OR) = 2.9) and a low relationship-oriented leadership style (OR = 5.8) were positively associated with personal and work-related bullying, respectively. A low relationship-oriented leadership style (OR = 4.0), age of 19-29 years (OR = 4.5) and length of employment at the institution of 5-10 years (OR = 4.9) were positively correlated with a high turnover intention. The following variables were correlated with a moderate turnover intention: a low relationship-oriented leadership style (OR = 3.4), having a bachelor's degree (OR = 2.0) and working in a philanthropic institution (OR = 2.5). Working in a private institution (OR = 0.8) was negatively associated with a moderate turnover intention. CONCLUSIONS: A low relationship-oriented leadership style and social and work factors were associated with bullying and turnover intention. IMPLICATIONS FOR NURSE MANAGERS: Nurse managers, in addition to developing technical skills, need to develop skills to manage human relationships to prevent bullying and turnover among nurses.

Spatial prediction of risk areas for vector transmission of Trypanosoma cruzi in the State of Paraná, southern Brazil.

After obtaining certification of the absence of transmission of the Trypanosoma cruzi by Triatoma infestans in 2006, other native species of protozoan vectors have been found in human dwellings within municipalities of the State of Paraná, Southern Brazil. However, the spatial distribution of T. cruzi vectors and how climatic and landscape combined variables explain the distribution are still poorly understood. The goal of this study was to predict the potential distribution of T. cruzi vectors as a proxy for Chagas disease transmission risk using Ecological Niche Models (ENMs) based on climatic and landscape variables. We hypothesize that ENM based on both climate and landscape variables are more powerful than climate-only or landscape-only models, and that this will be true independent of vector species. A total of 2,662 records of triatomines of five species were obtained by community-based entomological surveillance from 2007 to 2013. The species with the highest number of specimens was Panstrongylus megistus (73%; n = 1,943), followed by Panstrongylus geniculatus (15.4%; 411), Rhodnius neglectus (6.0%; 159), Triatoma sordida (4.5%; 119) and Rhodnius prolixus (1.1%; 30). Of the total, 71.9% were captured at the intradomicile. T. cruzi infection was observed in 19.7% of the 2,472 examined insects. ENMs were generated based on selected climate and landscape variables with 1 km2 spatial resolution. Zonal statistics were used for classifying the municipalities as to the risk of occurrence of synanthropic triatomines. The integrated analysis of the climate and landscape suitability on triatomines geographical distribution was powerful on generating good predictive models. Moreover, this showed that some municipalities in the northwest, north and northeast of the Paraná state have a higher risk of T. cruzi vector transmission. This occurs because those regions present high climatic and landscape suitability values for occurrence of their vectors. The frequent invasion of houses by infected triatomines clearly indicates a greater risk of transmission of T. cruzi to the inhabitants. More public health attention should be given in the northern areas of the State of Paraná, which presents high climate and landscape suitabilities for the disease vectors. In conclusion, our results-through spatial analysis and predictive maps-showed to be effective in identifying areas of potential distribution and, consequently, in the definition of strategic areas and actions to prevent new cases of Chagas' disease, reinforcing the need for continuous and robust surveillance in these areas.

Treatment and Follow-up of Human Papillomavirus Infected Women in a Municipality in Southern Brazil.

BACKGROUND: This study aimed toanalyze the risk behavior for cervical cancer (CC) and the human papillomavirus (HPV) prevalence and resolution among women who received care through the private healthcare network of a municipality in southern Brazil. MATERIALS AND METHODS: This descriptive and retrospective study was conducted with 25 women aged 20 to 59 years who received care through the private healthcare network and were treated at a specialty clinic in the period from January to December 2012 in a municipality in Northwest Parana, Southern Brazil. Data from medical records with cytological and HPV results were used. Following treatment, these women were followed-up and reassessed after 6 months. Data were statistically analyzed using the t-test and chi-squared test at a 5% significance level. RESULTS: The mean age of the studied women was 27.8±7.75 years old, and the majority were married, with paid employment and were non-smokers. The mean age at menarche was 13.0±0.50 years old, and the mean age at first intercourse was 17.5±1.78 years, with only 8.0% (2) initiating sexual activity at an age ≤15 years old. The majority had 1 to 2 children (60.0%), while 88.0% reported having had one sexual partner in their lifetime, and all the women were sexually active. A total of 68.0% used a hormonal contraceptive method. All the women had leukorrhea and pain and were infected by a single HPV type. Regarding the lesion grade, 80.0% showed high risk and 20.0% low risk. The most prevalent high-risk HPV strain was 16. CONCLUSIONS: These findings provide relevant information on HPV risk factors and infection, as well as the treatment and 6-month follow-up results, in economically and socially advantaged women with no traditional risk factors, corroborating previous reports that different risk factors may be described in different populations. Thus, this study reinforces the fact that even women without the traditional risk factors should undergo HPVmonitoring and assessment to determine the persistence of infection, promoting early diagnosis of the lesions presented and appropriate treatment to thus prevent the occurrence of CC.

Pregnancy after Bariatric Surgery: Obstetric and Perinatal Outcomes and the Growth and Development of Children.

BACKGROUND: Several outcomes of pregnancy after bariatric surgery are currently being studied. METHODS: This cross-sectional, retrospective study evaluated the obstetric and perinatal outcomes of pregnancies in 19 women who underwent bariatric surgery, as well as the growth and development of their children, in the Southern Brazil. RESULTS: Among these women, 11 children were born prior to surgery and 32 were born post-surgery. The mean time between the surgery and the first pregnancy was 42.96 months. Preterm newborns were more common among the pre-surgery childbirths. Regarding growth, normal weights were observed in 27.3 % of the children in the pre-surgery births and obesity was observed in 54.5 %. In contrast, normal weights were observed in 59.4 % of the children born during the postoperative period and obesity was observed in 31.2 %. The average excess weight that the women lost prior to pregnancy was 64.88. Speech delays were found in three male children evaluated using the Denver Developmental Screening Test II. A statistical association was found between the interval from the surgery to the pregnancy and the outcome of the questionable Denver II test results (p = 0.011). CONCLUSIONS: Except for the large index of low birth weight, it can be concluded that pregnancy after bariatric surgery is safe. The growth rate was found to be adequate in the children born after the surgery, with reduced obesity. Although changes in speech development were detected, no factors were supported an association with pregnancy after bariatric surgery.

Variables that affect the satisfaction of Brazilian women with external breast prostheses after mastectomy.

BACKGROUND: : In 2012, the breast cancer estimate worldwide stood at 1.67 million new cases, these accounting for 25% of all types of cancer diagnosed in women. For 2014, 57,120 new cases are expected, with a risk estimated at 56.1 cases for every 100,000 women. The objective of this study was to analyze the satisfaction regarding the use of external breast prostheses by women undergoing mastectomy. MATERIALS AND METHODS: This cross-sectional study was conducted with 76 women who used an external breast prosthesis (EBP), registered in the services of the Cuiaba Center for Comprehensive Rehabilitation, Mato Grosso, Brazil, from 2009 to 2012. Data were collected from the records of women who had requested the opening of a process of external breast prosthesis concession. RESULTS: Satisfaction with the EBP was identified in 56.6% of the women. Those satisfied with the EBP reported that its weight was not annoying (p<0.01). Although the women felt body sensations of stitches, pains, pulling, dormancy and phantom limb, they are satisfied with the EBP. The variable related to the displacement of the breast prosthesis during activity of everyday life has demonstrated that even though the women have reported the possibility of displacements, they are satisfied with the EBP. The satisfaction with the use of external breast prosthesis did not affect the sexuality of the women with mastectomy. CONCLUSIONS: Learning the specificities of the EBP, taking into consideration the satisfaction of its use, allows the rehabilitation team, by listening to their clientele more attentively, following up this woman throughout her life journey, supporting and guiding the best way of use, with an eye to her personal, emotional and social life, as well as to her self-esteem.

System dynamics modeling in the evaluation of delays of care in ST-segment elevation myocardial infarction patients within a tiered health system.

BACKGROUND: Mortality rates amongst ST segment elevation myocardial infarction (STEMI) patients remain high, especially in developing countries. The aim of this study was to evaluate the factors related with delays in the treatment of STEMI patients to support a strategic plan toward structural and personnel modifications in a primary hospital aligning its process with international guidelines. METHODS AND FINDINGS: The study was conducted in a primary hospital localized in Foz do Iguaçu, Brazil. We utilized a qualitative and quantitative integrated analysis including on-site observations, interviews, medical records analysis, Qualitative Comparative Analysis (QCA) and System Dynamics Modeling (SD). Main cause of delays were categorized into three themes: a) professional, b) equipment and c) transportation logistics. QCA analysis confirmed four main stages of delay to STEMI patient's care in relation to the 'Door-in-Door-out' time at the primary hospital. These stages and their average delays in minutes were: a) First Medical Contact (From Door-In to the first contact with the nurse and/or physician): 7 minutes; b) Electrocardiogram acquisition and review by a physician: 28 minutes; c) ECG transmission and Percutaneous Coronary Intervention Center team feedback time: 76 minutes; and d) Patient's Transfer Waiting Time: 78 minutes. SD baseline model confirmed the system's behavior with all occurring delays and the need of improvements. Moreover, after model validation and sensitivity analysis, results suggested that an overall improvement of 40% to 50% in each of these identified stages would reduce the delay. CONCLUSIONS: This evaluation suggests that investment in health personnel training, diminution of bureaucracy, and management of guidelines might lead to important improvements decreasing the delay of STEMI patients' care. In addition, this work provides evidence that SD modeling may highlight areas where health system managers can implement and evaluate the necessary changes in order to improve the process of care.

Brazilian road traffic fatalities: a spatial and environmental analysis.

BACKGROUND: Road traffic injuries (RTI) are a major public health epidemic killing thousands of people daily. Low and middle-income countries, such as Brazil, have the highest annual rates of road traffic fatalities. In order to improve road safety, this study mapped road traffic fatalities on a Brazilian highway to determine the main environmental factors affecting road traffic fatalities. METHODS AND FINDINGS: Four techniques were utilized to identify and analyze RTI hotspots. We used spatial analysis by points by applying kernel density estimator, and wavelet analysis to identify the main hot regions. Additionally, built environment analysis, and principal component analysis were conducted to verify patterns contributing to crash occurrence in the hotspots. Between 2007 and 2009, 379 crashes were notified, with 466 fatalities on BR277. Higher incidence of crashes occurred on sections of highway with double lanes (ratio 2∶1). The hotspot analysis demonstrated that both the eastern and western regions had higher incidences of crashes when compared to the central region. Through the built environment analysis, we have identified five different patterns, demonstrating that specific environmental characteristics are associated with different types of fatal crashes. Patterns 2 and 4 are constituted mainly by predominantly urban characteristics and have frequent fatal pedestrian crashes. Patterns 1, 3 and 5 display mainly rural characteristics and have higher prevalence of vehicular collisions. In the built environment analysis, the variables length of road in urban area, limited lighting, double lanes roadways, and less auxiliary lanes were associated with a higher incidence of fatal crashes. CONCLUSIONS: By combining different techniques of analyses, we have identified numerous hotspots and environmental characteristics, which governmental or regulatory agencies could make use to plan strategies to reduce RTI and support life-saving policies.

Erros de utilização de assentos de segurança infantil por menores de 4 anos / Child safety seat usage errors in under-4s

Objetivo: Analisar erros de utilização de assentos de segurança infantil por crianças matriculadas em creches e fatores relacionados. Métodos: Estudo observacional transversal de coleta de dados prospectiva e eixo analítico retrospectivo. Resultados: Um total de 42,7% das crianças apresentava erros de utilização. O modelo de regressão logística evidenciou maiores chances de erros na presença de duas ou mais crianças no veículo (odds ratio = 5,10, p = 0,007) e menores níveis de escolaridade e renda dos pais (renda e escolaridade médias: odds ratio = 7,00, p = 0,003; renda e escolaridade baixas: odds ratio = 3,40, p = 0,03). Conclusão: Os dados são coerentes com publicações internacionais.

Objective: To analyze child safety seat usage errors among children enrolled at daycare. Methods: This was a cross-sectional, observational study with prospective data collection and a retrospective analytical axis. Results: Overall, 42.7% of the children studied were in incorrectly used seats. A logistic regression model showed that the likelihood of usage errors was higher if there were two or more children in the vehicle (odds ratio = 5.10, p = 0.007) and was dependent on parents' educational level and income (medium income and educational level: odds ratio = 7.00, p = 0.003; low income and educational level: odds ratio = 3.40, p = 0.03). Conclusion: The results of this study are in line with findings reported in international publications.

Regional disparities in mortality after ischemic heart disease in a Brazilian state from 2006 to 2010.

BACKGROUND: High technology in the field of interventional cardiology applied in tertiary hospitals has brought enormous benefits in the treatment of ischemic heart disease (IHD). However, IHD mortality rates remain high. We analyzed the relationship between IHD mortality rate and the socioeconomic, demographic, and geographic conditions in 399 cities in Parana state, Brazil, from 2006 to 2010. METHODS AND RESULTS: Data were obtained from the Mortality Information System and the Brazilian Institute of Geography and Statistics and evaluated through Exploratory Spatial Data Analysis. GeoDa™ was used to analyze 29.351 deaths across 399 cities. We found a positive spatial autocorrelation regarding IHD mortality (I = 0.5913, p = 0.001). There was a significant positive association between each of three socioeconomic and demographic indicators and IHD mortality rate: Population Elderly Index (I = 0.3436), Illiteracy Rate (I = 0.1873) and City Development Index (I = 0.0900). In addition, two indicators presented significant negative association with IHD mortality rate: Adjusted Population Size (I = -0.1216) and Gross Domestic Product (I = -0.0864). We also found a positive association between IHD mortality rates and the geographic distances between patients' city of residence and their corresponding regional referral centers in interventional cardiology (I = 0.3368). Cities located within Regional Health Units with Reference Interventional Cardiology Center presented a significantly lower average specific mortality rate by IHD. The high mortality rate by IHD within the Regional Health Units was not restricted to socioeconomic and demographic variables, but dependent on the distance between each city and their reference interventional cardiology center. CONCLUSIONS: We conclude that geographic factors play a significant role in IHD mortality within cities. These findings have important policy implications regarding the geographic distribution of cardiac health care networks in Latin America and in other emerging countries.

Prevalence of risk factors for breast neoplasm in the city of Maringá, Paraná state, Brazil.

The aim of this study was to identify the prevalence of the risk factors for breast cancer among women between 40 and 69 years old in the city of Maringá, Paraná State, Brazil. An analytical, exploratory and cross-sectional study was carried out through a population research at homes in Maringá. The sample was composed of 439 women between 40 and 69 years old. The data were collected by home interviews, stored using the Statistical Package for the Social Sciences (SPSS) software and presented in tables as absolute and relative frequency. The predominant ethnical group was Caucasian with an average age of 52 years. Among risk factors identified in the present study, an expressive number of overweight women were found. It is important and necessary to put in practice actions that identify the modifiable risk factors for the development of breast tumors in order to reduce morbidity and mortality levels due to this pathology.