Edna Afonso Reis

A new proposal to adjust Moran's I for population density

We analyse the effect of using prevalence rates based on populations with different sizes in the power of spatial independence tests. We compare the well known spatial correlation Morans index to three indexes obtained after adjusting for population density, one proposed by Oden, another proposed by Waldhör, and a third proposed by us in this paper. We find an effect of spatially correlated populations in the type I error probability on the test based on Morans and Waldhörs indexes. We conclude also that the test proposed by Oden is powerful to test risk heterogeneity, but it has disadvantages when the interest is solely on the spatial correlation of morbidity risks. In this latter case, we recommend using our proposed test which is more powerful than the usual Morans index applied directly to the rates.

Utilização de serviços de saúde por população quilombola do Sudoeste da Bahia, Brasil

Use of health services is increasing in Brazil as a whole, but geographic and social inequalities persist, especially among minority groups. The aim of this study was to analyze the use of health services by members of quilombos (slavedescendant African-Brazilian communities) in Vitória da Conquista, Bahia State, Brazil. This cross-sectional health survey in 2011 focused on 797 adults (≥ 18 years old) belonging to quilombos. The magnitude of the associations between explanatory variables and use of services was estimated by the prevalence ratio obtained from Poisson regression with 95% confidence interval. Of the total sample, 455 (57.1%) reported having used health services in the 12 months prior to the interview. Higher rates of health services utilization were associated with female gender, non-single conjugal status, fair, poor, or very poor self-rated health, enrolment in the Family Health Program, and referral to a health facility for regular or on-going care. The results showed underutilization of health services by members of quilombos, thus demonstrating the need to improve health services provision for this population group.O uso de servicos de saude vem aumentando no pais, mas permanecem as desigualdades geograficas e sociais, especialmente entre os grupos minoritarios. O objetivo deste trabalho foi analisar o uso de servicos de saude pela populacao quilombola de Vitoria da Conquista, Bahia, Brasil. Trata-se de inquerito de saude transversal, realizado em 2011, com individuos quilombolas > 18 anos. A magnitude das associacoes entre variaveis explanatorias e o uso de servicos foi estimada pelas razoes de prevalencia obtidas por regressao de Poisson com intervalo de 95% de confianca. Dos 797 individuos entrevistados, 455 (57,1%) usaram algum servico de saude nos 12 meses anteriores as entrevistas. Verificou-se maiores prevalencias de uso de servicos para os quilombolas do sexo feminino, com companheiros(as), que avaliaram sua saude como regular, ruim ou muito ruim, cadastrados no Programa Saude da Familia e que fizeram referencia a um servico de saude de uso regular. Os resultados apontaram subutilizacao de servicos de saude pelos quilombolas, demonstrando a necessidade de melhorar a prestacao de servicos de saude a essa populacao.

Consumer Willingness to Pay for Dengue Vaccine (CYD-TDV, Dengvaxia®) in Brazil; Implications for Future Pricing Considerations

Introduction and Objective: Dengue virus is a serious global health problem with an estimated 3.97 billion people at risk for infection worldwide. In December 2015, the first vaccine (CYD-TDV) for dengue prevention was approved in Brazil, developed by Sanofi Pasteur. However, given that the vaccine will potentially be paid via the public health system, information is need regarding consumers’ willingness to pay for the dengue vaccine in the country as well as discussions related to the possible inclusion of this vaccine into the public health system. This was the objective of this research. Methods: We conducted a cross-sectional study with residents of Greater Belo Horizonte, Minas Gerais, about their willingness to pay for the CYD-TDV vaccine. Results: 507 individuals were interviewed. These were mostly female (62.4%) had completed high school (62.17%), were working (74.4%), had private health insurance (64.5%) and did not have dengue (67.4%). The maximum median value of consumers’ willingness to pay for CYD-TDV vaccine is US

A Minimal Spanning Tree Algorithm Applied to Spatial Cluster Analysis

33.61 (120.00BRL) for the complete schedule and US

Bayesian dynamic models for space-time point processes

11.20 (40.00BRL) per dose. At the price determined by the Brazil’s regulatory chamber of pharmaceutical products market for the commercialization of Dengvaxia® for three doses, only 17% of the population expressed willingness to pay for this vaccine. Conclusion: Brazil is currently one of the largest markets for dengue vaccine and the price established is a key issue. We believe the manufacturer should asses the possibility of lower prices to reach a larger audience among the Brazilian population.

[Use of health services by quilombo communities in southwest Bahia State, Brazil].

Abstract Abstract Many applications, such as geographical regionalization and communication network districting, have problems that can be formulated as the clustering of n objects with contiguity constraints. In this paper, we present an algorithm based on recursive partitioning of a minimal spanning tree and a tool implementing it named SKATER. We also present some simulations where SKATER has been successfully used.

Factors associated with the use of potentially inappropriate medications by older adults in primary health care: An analysis comparing AGS Beers, EU(7)-PIM List , and Brazilian Consensus PIM criteria

In this work we propose a model for the intensity of a space-time point process, specified by a sequence of spatial surfaces that evolve dynamically in time. This specification allows flexible structures for the components of the model, in order to handle temporal and spatial variations both separately and jointly. These structures make use of state-space and Gaussian process tools. They are combined to create a richer class of models for the intensity process. This structural approach allows for a decomposition of the intensity into purely temporal, purely spatial and spatio-temporal terms. Inference is performed under a fully Bayesian approach, with the description of simulation-based and analytic methods for approximating the posterior distributions. The proposed methodology is applied to model the incidence of impulses in the small intestine, illustrated by a data-set obtained through an experiment conducted in cats, in order to understand the interaction between the nervous and digestive systems. This application illustrates the usefulness of the proposed methodology and shows it compares favorably against existing alternatives. The paper is concluded with a few directions for further investigation.

Effectiveness to identify acute myocardial infarction using the Manchester screening in patients with chest pain at the emergency service

Use of health services is increasing in Brazil as a whole, but geographic and social inequalities persist, especially among minority groups. The aim of this study was to analyze the use of health services by members of quilombos (slavedescendant African-Brazilian communities) in Vitória da Conquista, Bahia State, Brazil. This cross-sectional health survey in 2011 focused on 797 adults (≥ 18 years old) belonging to quilombos. The magnitude of the associations between explanatory variables and use of services was estimated by the prevalence ratio obtained from Poisson regression with 95% confidence interval. Of the total sample, 455 (57.1%) reported having used health services in the 12 months prior to the interview. Higher rates of health services utilization were associated with female gender, non-single conjugal status, fair, poor, or very poor self-rated health, enrolment in the Family Health Program, and referral to a health facility for regular or on-going care. The results showed underutilization of health services by members of quilombos, thus demonstrating the need to improve health services provision for this population group.O uso de servicos de saude vem aumentando no pais, mas permanecem as desigualdades geograficas e sociais, especialmente entre os grupos minoritarios. O objetivo deste trabalho foi analisar o uso de servicos de saude pela populacao quilombola de Vitoria da Conquista, Bahia, Brasil. Trata-se de inquerito de saude transversal, realizado em 2011, com individuos quilombolas > 18 anos. A magnitude das associacoes entre variaveis explanatorias e o uso de servicos foi estimada pelas razoes de prevalencia obtidas por regressao de Poisson com intervalo de 95% de confianca. Dos 797 individuos entrevistados, 455 (57,1%) usaram algum servico de saude nos 12 meses anteriores as entrevistas. Verificou-se maiores prevalencias de uso de servicos para os quilombolas do sexo feminino, com companheiros(as), que avaliaram sua saude como regular, ruim ou muito ruim, cadastrados no Programa Saude da Familia e que fizeram referencia a um servico de saude de uso regular. Os resultados apontaram subutilizacao de servicos de saude pelos quilombolas, demonstrando a necessidade de melhorar a prestacao de servicos de saude a essa populacao.

18F-FDG PET/CT as a prognostic factor in penile cancer

Background: Potentially inappropriate medications (PIM) for the older adults are those with an unfavorable risk‐benefit ratio when more effective and safe therapeutic alternatives are available and is an important public health problem. Purpose: To analyze the factors associated with the use of PIM by the older adults and to investigate the agreement of PIM use frequency using the 2015 American Geriatric Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults ‐ 2015 AGS Beers Criteria, the Brazilian consensus on potentially inappropriate medication for older adults (BCPIM) and the European union list of potentially inappropriate medications ‐ EU (7)‐PIM List. Methods: This is a cross‐sectional study conducted in two primary health care centers in southeastern Brazil. The 2015 AGS Beers Criteria, BCPIM, and EU (7)‐PIM List were used for the classification of PIM. The association between PIM use and independent variables was assessed by multiple logistic regression. The level of agreement of PIM use among the three criteria was measured with the Cohens kappa coefficient. Results: A total of 227 patients ≥60 years of age were included in the study. The frequency of PIM use was 53.7% for 2015 AGS Beers, 55.9% for BCPIM and 63.4% for the EU (7)‐PIM List. The agreement between 2015 AGS Beers and BCPIM and between this and the EU (7)‐PIM List was high, and moderate between the 2015 AGS Beers and the EU (7)‐PIM List. Logistic regression showed association of PIM use with polypharmacy, self‐reported neuropsychiatric and musculoskeletal diseases, age ≤70 years, preserved cognition and positive self‐perception of health. Conclusion: The frequency of PIM use by the older adults of health centers investigated is high. Strategies for improving the pharmacotherapy of the older adults in primary health care should be implemented.

Uso de medicamentos e fatores associados à polifarmácia em indivíduos com diabetes mellitus em Minas Gerais, Brasil

Among cardiovascular diseases (CVD), acute coronary syndrome (ACS) is the main manifestation, corresponding to signs and symptoms that occur with ischemia and outcome of angina or acute myocardial infarction (AMI). The aim of this study was to investigate the performance of biochemical markers eligible in a chest pain protocol, using Point of care Test (POCT), in patients in a reference emergency room.