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Amanda de Carvalho Dutra Lincoln Luís Silva Raíssa Bocchi Pedroso Yolande Pokam Tchuisseu Mariana Teixeira da Silva Marcela Bergamini Joo Felipe Hermann Costa Scheidt Pedro Henrique Iora Rogrio do Lago Franco Catherine Ann Staton Joo Ricardo Nickenig Vissoci Oscar Kenji Nihei Luciano de Andrade 《Global Heart》2021,16(1)
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.
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Pinheiro Juliana Campos de Carvalho Cyntia Helena Pereira Galvão Hébel Cavalcanti Pereira Pinto Leão de Souza Lélia Batista de Andrade Santos Pedro Paulo 《Clinical oral investigations》2020,24(1):181-191
Clinical Oral Investigations - This study aimed to evaluate tryptase and E-cadherin protein expression in odontogenic keratocysts (OKCs) and radicular cysts (RCs) and their relationship with lesion... 相似文献
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G.B. Camilo A.R.S. Carvalho D.C. Machado R. Mogami L. Kasuki M.R. Gadelha P.L. Melo A.J. Lopes 《Brazilian journal of medical and biological research》2015,48(10):877-885
The aims of this study were to evaluate the forced oscillation technique (FOT) and
pulmonary densitovolumetry in acromegalic patients and to examine the correlations
between these findings. In this cross-sectional study, 29 non-smoking acromegalic
patients and 17 paired controls were subjected to the FOT and quantification of lung
volume using multidetector computed tomography (Q-MDCT). Compared with the controls,
the acromegalic patients had a higher value for resonance frequency [15.3 (10.9-19.7)
vs 11.4 (9.05-17.6) Hz, P=0.023] and a lower value for mean
reactance [0.32 (0.21-0.64) vs 0.49 (0.34-0.96) cm
H2O/L/s2, P=0.005]. In inspiratory Q-MDCT, the acromegalic
patients had higher percentages of total lung volume (TLV) for nonaerated and poorly
aerated areas [0.42% (0.30-0.51%) vs 0.25% (0.20-0.32%), P=0.039 and
3.25% (2.48-3.46%) vs 1.70% (1.45-2.15%), P=0.001, respectively].
Furthermore, the acromegalic patients had higher values for total lung mass in both
inspiratory and expiratory Q-MDCT [821 (635-923) vs 696 (599-769) g,
P=0.021 and 844 (650-945) vs 637 (536-736) g, P=0.009,
respectively]. In inspiratory Q-MDCT, TLV showed significant correlations with all
FOT parameters. The TLV of hyperaerated areas showed significant correlations with
intercept resistance (rs=−0.602, P<0.001) and mean resistance
(rs=−0.580, P<0.001). These data showed that acromegalic patients
have increased amounts of lung tissue as well as nonaerated and poorly aerated areas.
Functionally, there was a loss of homogeneity of the respiratory system. Moreover,
there were correlations between the structural and functional findings of the
respiratory system, consistent with the pathophysiology of the disease. 相似文献
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Dermoscopic difficult lesions: an objective evaluation of reflectance confocal microscopy impact for accurate diagnosis 下载免费PDF全文
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