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PURPOSE To analyze spatiotemporal trends in hospitalizations for cardiovascular diseases (CVD) sensitive to primary health care (PHC) among individuals aged 50-69 years in Parana 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. Key words: cardiovascular disease; primary health care; hospitalizations; health care disparities; spatiotemporal analysis; Social Development Index, INTRODUCTION Cardiovascular disease (CVD) leads the rankings of morbidity and mortality worldwide. An estimated 17.9 million people died of CVD in 2019, with more than three-quarters of these deaths occurring [...]

Background: Ensuring patient safety is essential to prevent and minimize adverse events, and pre-hospital services play a vital role in the healthcare network, serving as the starting point for quality care. This study aimed to adapt the Emergency Medical Services Safety Attitudes Questionnaire to the Brazilian context and evaluate its psychometric properties. Methods: Beaton and colleagues' guidelines were used as a reference. Construct validity was evaluated by confirmatory factor analysis (CFA) based on the responses of 93 participants. Questions with reverse scoring were excluded in a further CFA. Results: The content validity index was 0.99, and Cronbach's alpha was 0.90. The initial CFA resulted in a Tucker–Lewis index (TLI) of 0.95 and a comparative fit index (CFI) of 0.951. After the exclusion of reverse-coded questions (Q4 and Q9), TLI increased to 0.96 and CFI to 0.97. Conclusions: The adapted instrument demonstrated good content, face, and construct validity, confirming its suitability for evaluating patient safety in prehospital services in Brazil. It can guide adjustments in care protocols, contributing to the safety and effectiveness of prehospital care while aligning with patient-centered best practices. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to conduct a detailed geospatial analysis of mobile phone signal coverage in the northwest macro-region of Paraná State, Brazil, seeking to identify areas where limitations in coverage may be related to lengthy travel times of the helicopter emergency medical service (HEMS) for the assistance of victims of road traffic injuries (RTIs). Methods: An observational study was conducted to examine mobile phone signal coverage and HEMS travel times from 2017 to 2021. HEMS travel times were categorized into four groups: T1 (0–15 min), T2 (16–30 min), T3 (31–45 min), and T4 (over 45 min). Empirical Bayesian Kriging was used to map areas with low mobile signal coverage. The Kruskal–Wallis test and Dwass–Steel–Critchlow–Fligner comparative analyses were performed to explore how mobile signal coverage relates to HEMS travel times to RTI locations. Results: There were 470 occurrences of RTIs attended by HEMS, of which 108 (23%) resulted in on-site fatalities. Among these deaths, 47 (26.85%) occurred in areas with low mobile phone signal coverage ("shadow areas"). Low mobile phone signal coverage identified at 175 (37.24%) RTIs locations, was unevenly distributed across the macro-region. The lowest medians of mobile signal quality were predominantly found in areas with HEMS travel times exceeding 30 min, corresponding to signal strength values of −98.44 (T3) and −100.75 (T4) dBm. This scenario represents a challenge for effective communication to activate HEMS. In the multiple comparison analysis among travel time groups, significant differences were observed between T1 and T2 (p < 0.001), T1 and T3 (p < 0.001), T1 and T4 (p < 0.001), and T2 and T3 (p < 0.001), indicating a potential association between lower mobile phone signal coverage and longer HEMS travel times. Conclusion: It can be concluded that poor mobile phone signals in remote areas can hinder HEMS activation, potentially delaying the start of treatment for RTIs. Identification of the shadow areas can help communication and health managers in designing and implementing the necessary changes to improve mobile phone signal coverage and consequently reduce delays in the initial response to RTIs. [ABSTRACT FROM AUTHOR]

Introduction: Abdominal aortic aneurysm (AAA) is a growing public health problem, and not all patients have access to surgery when needed. This study aimed to analyze spatiotemporal variations in AAA mortality and surgical procedures in Brazilian intermediate geographic regions and explore the impact of different surgical techniques on operative mortality. Methods: A retrospective longitudinal study was conducted to evaluate AAA mortality from 2008 to 2020 using space–time cube (STC) analysis and the emerging hot spot analysis tool through the Getis-Ord Gi* method. Results: There were 34,255 deaths due to AAA, 13,075 surgeries to repair AAA, and a surgical mortality of 14.92%. STC analysis revealed an increase in AAA mortality rates (trend statistic = +1.7693, p = 0.0769) and a significant reduction in AAA surgery rates (trend statistic = −3.8436, p = 0.0001). Analysis of emerging hotspots revealed high AAA mortality rates in the South, Southeast, and Central-West, with a reduction in procedures in São Paulo and Minas Gerais States (Southeast). In the Northeast, there were extensive areas of increasing mortality rates and decreasing procedure rates (cold spots). Conclusion: AAA mortality increased in several regions of the country while surgery rates decreased, demonstrating the need for implementing public health policies to increase the availability of surgical procedures, particularly in less developed regions with limited access to services. [ABSTRACT FROM AUTHOR]

Summary: Web scraping is a widely used technique for decision‐making, collecting, and structuring public data from the internet. As the volume of data continues to grow, the need for more efficient methods of data extraction becomes crucial. This article introduces a novel web scraping framework that utilizes Burstable virtual machines (VMs) on Amazon Web Services with the objective of reducing the monetary cost of execution while ensuring compliance with service level agreements (SLAs). To achieve this, the framework utilizes a combination of fixed and temporary Burstable VMs in a mixed cluster, which can be elastically scaled up to fulfill the SLA and scaled down to minimize monetary costs. Two strategies for handling VM allocation are proposed and evaluated: (i) a queue and SLA‐based strategy that employs queue size information and SLA criteria to determine the required number of VMs for the current scraping requests, and (ii) a credit‐based strategy that incorporates information about Burstable VM credits to effectively manage instance creation and termination. Experimental tests show that the proposed framework meets the defined SLA while achieving cost reductions of up to 74% compared to an approach that executes on fixed‐size clusters of Burstable instances. [ABSTRACT FROM AUTHOR]

Background Disease and disability from alcohol use disproportionately impact people in low- and middle-income countries (LMICs). While varied interventions have been shown to reduce alcohol use in high-income countries, their efficacy in LMICs has not been assessed. This systematic review describes current published literature on patient-level alcohol interventions in LMICs and specifically describes clinical trials evaluating interventions to reduce alcohol use in LMICs. Methods and findings In accordance with PRISMA, we performed a systematic review using an electronic search strategy from January 1, 1995 to December 1, 2020. Title, abstract, as well as full-text screening and extraction were performed in duplicate. A meta-summary was performed on randomized controlled trials (RCTs) that evaluated alcohol-related outcomes. We searched the following electronic databases: PubMed, EMBASE, Scopus, Web of Science, Cochrane, WHO Global Health Library, and PsycINFO. Articles that evaluated patient-level interventions targeting alcohol use and alcohol-related harm in LMICs were eligible for inclusion. No studies were excluded based on language. After screening 5,036 articles, 117 articles fit our inclusion criteria, 75 of which were RCTs. Of these RCTs, 93% were performed in 13 middle-income countries, while 7% were from 2 low-income countries. These RCTs evaluated brief interventions (24, defined as any intervention ranging from advice to counseling, lasting less than 1 hour per session up to 4 sessions), psychotherapy or counseling (15, defined as an interaction with a counselor longer than a brief intervention or that included a psychotherapeutic component), health promotion and education (20, defined as an intervention encouraged individuals' agency of taking care of their health), or biologic treatments (19, defined as interventions where the biological function of alcohol use disorder (AUD) as the main nexus of intervention) with 3 mixing categories of intervention types. Due to high heterogeneity of intervention types, outcome measures, and follow-up times, we did not conduct meta-analysis to compare and contrast studies, but created a meta-summary of all 75 RCT studies. The most commonly evaluated intervention with the most consistent positive effect was a brief intervention; similarly, motivational interviewing (MI) techniques were most commonly utilized among the diverse array of interventions evaluated. Conclusions Our review demonstrated numerous patient-level interventions that have the potential to be effective in LMICs, but further research to standardize interventions, populations, and outcome measures is necessary to accurately assess their effectiveness. Brief interventions and MI techniques were the most commonly evaluated and had the most consistent positive effect on alcohol-related outcomes. Trial registration Protocol Registry: PROSPERO CRD42017055549, Author(s): Catherine A. Staton 1,2,3,*, João Ricardo Nickenig Vissoci 1,2,3, Deena El-Gabri 2, Konyinsope Adewumi 2, Tessa Concepcion 2, Shannon A. Elliott 2, Daniel R. Evans 2, Sophie W. Galson [...]