Luiz Gustavo de Paulo

Femoral fractures in older adults are associated with lethality rates of up to 30% within the first year and significantly compromised quality of life, leading to high levels of disability, institutionalization, and burden on health systems. By 2050, the global population of older adults is projected to exceed 2 billion, leading to an exponential increase in these events. In Brazil, the incidence of fractures is high and often linked to inequalities in access to diagnosis and prevention, particularly in regions with limited infrastructure. This study aimed to analyze the spatiotemporal distribution of femoral fractures in older adults and identify contextual factors associated with their occurrence. This is an ecological and retrospective study using secondary data from 2010 to 2021 on hospitalizations for femoral fractures in older adults (≥ 60 years) in the 399 municipalities of Paraná State, Brazil. Descriptive analyses and nonparametric tests were performed to compare mortality rates according to population size. Spatiotemporal distribution was examined using space–time cubes. Spatial autocorrelation was assessed using global Moran’s I and local indicators of spatial autocorrelation (LISA). Geographically weighted regression (GWR) was applied to explore local associations with contextual variables. A total of 39,226 femoral fractures were recorded during the study period, with a predominance among women (66.8%). Overall lethality was 6%, being significantly higher in men. Space–time cube analysis indicated a persistent increasing trend in fractures (Z = 2.8115, p = 0.0049). Spatial analysis revealed significant positive spatial autocorrelation (I = 0.705, p < 0.001) and identified significant clusters and groupings (p < 0.05). GWR demonstrated a negative association between fracture incidence and access to specialists and osteoporosis medication, and a positive association with falls and densitometry availability in some regions. The findings indicate that the distribution of fractures is not random but rather influenced by factors such as access to diagnosis, medication, and specialized care. This evidence underscores the value of geospatial tools in the planning of health actions, enabling more targeted and equitable interventions in response to population aging. The online version contains supplementary material available at 10.1186/s12877-026-07521-8.

Introdução: O suicídio representa um desafio global, sobretudo em países em desenvolvimento. No Brasil, particularmente na Região Sul, as taxas estão em crescimento, embora a compreensão dos padrões espaciais e fatores associados permaneça limitada. Neste sentido, este estudo tem como objetivo analisar a distribuição espacial dos suicídios na Região Sul do Brasil entre 2015 e 2019, considerando diferentes faixas etárias e fatores associados. Métodos: Trata-se de um estudo ecológico sobre as taxas de suicídio em indivíduos de 15 a 29, 30 a 59 e acima de 60 anos, juntamente com variáveis associadas. Foram aplicadas técnicas de autocorrelação espacial global e local, regressão dos mínimos quadrados ordinários e regressão geográfica ponderada. Resultados: As taxas de suicídio variaram de 6,3 a 75,1 (por 100.000 habitantes), aumentando progressivamente com o avançar da idade. Clusters de alto risco foram identificados em todas as faixas etárias em Santa Catarina e no Rio Grande do Sul, enquanto no Paraná as taxas de suicídio foram mais predominantes entre 15 e 29 anos. Conclusões: A heterogeneidade espacial nas taxas de suicídio em todas as faixas etárias, relacionada a fatores socioeconômicos, destaca a necessidade de estratégias para mitigar as desigualdades sociais e enfrentar esse importante problema social.

Out-of-hospital cardiac arrests (OHCAs) have high mortality rates, worsened by limited access to automated external defibrillators (AEDs). This study analyzed OHCA response times, identified areas with prolonged ambulance travel times, and proposed optimal AED locations in a medium-sized city in southern Brazil. Data from 278 non-traumatic OHCA cases (2019–2022) in patients over 18 years old, with ambulance response times under 20 min, were included. Spatial survival analysis assessed the probability of exceeding the recommended 5-min (300 s) ambulance response time. The maximal covering location problem identified 100 strategic AED sites within a 150-s reach for bystanders. AED and ambulance travel times were compared using the Wilcoxon test (p < 0.01). Defibrillation occurred in 89 cases (31.01%), and bystander CPR was performed in 149 cases (51.92%). Despite these efforts, 77% of patients died. The median ambulance response time was 11.63 min, exceeding 5 min in most cases, particularly at peak times like 11 a.m. AED placement in selected locations could cover 76% of OHCA occurrences, with a mean AED travel time of 320 s compared to 709 s for ambulances. Strategic AED placement could enhance early defibrillation and improve survival outcomes.

The present study aimed to conduct a comprehensive analysis of amiodarone use in the treatment of arrhythmogenic right ventricular dysplasia (ARVD), a complex and potentially lethal cardiac condition. The rationale for this study lies in the need to clarify the controversies in the literature regarding the efficacy and safety of amiodarone, comparing it with other available therapeutic options. The methodology adopted was a literature review that included clinical data and comparative studies on the use of amiodarone. Parameters such as efficacy in preventing ventricular arrhythmias, impact on quality of life, incidence of adverse effects, and mortality were analyzed. The research used academic and scientific databases to select relevant studies in Portuguese and English, such as Google Scholar and SciELO. The results highlight that amiodarone is widely used due to its proven ability to suppress ventricular arrhythmias, although its prolonged use is associated with significant side effects. Reviewed studies suggest that, despite controversies regarding its superiority over other therapies, amiodarone remains a viable option for initial management of ARVD, especially when combined with other interventions such as beta-blockers and implantable cardioverter-defibrillators. In conclusion, this therapeutic analysis provides a comprehensive overview of the role of amiodarone in the treatment of ARVD, emphasizing the need for rigorous monitoring and an individualized approach to maximize therapeutic benefits and minimize associated risks.

Uma em cada dez mulheres, em idade reprodutiva, são afetadas pela Síndrome dos Ovários Policísticos (SOP). Essa síndrome é uma causa comum e tratável de infertilidade. Além disso, deve-se destacar, também, que investigar a relação entre SOP e infertilidade é muito importante para não só preservar ou restaurar a fertilidade, mas também reduzir os sintomas e prevenir complicações que podem se desenvolver. Destarte, este artigo busca apresentar, por meio de uma revisão sistemática, a relação entre SOP e as particularidades no tratamento da infertilidade. Sendo assim, não há na literatura a definição de um tratamento único da infertilidade na SOP, mas sim que ele deve ser iniciado, preferencialmente, pelo não farmacológico com alterações no estilo de vida, e, por vezes, envolve a indução da ovulação e, em alguns casos, as técnicas de reprodução assistida e o drilling ovariano. Foi ressaltado, então, o uso de citrato de clomifeno como possibilidade de primeira opção farmacológica. Foram encontradas evidências de que metformina, letrozol, inositol e antidiabéticos também são medicações eficazes. A cirurgia ovariana e o uso das gonadotrofinas foram constatadas como escolha em casos de falta sucesso em outras terapias. Tratamentos alternativos como acupuntura e uso de ervas medicinais, apesar de não terem uma eficácia terapêutica completamente esclarecida, podem ser benéficos para regular o ciclo menstrual. Logo, este artigo pretende reunir informações atuais sobre o manejo da infertilidade em mulheres com SOP e, dessa forma, explanar opções terapêuticas ficando a critério de escolha do especialista a melhor abordagem, de forma individualizada, e baseada nas melhores evidências disponíveis.

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). 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. 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. 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.

Objective: To analyze the impact of geographic location of coronary reperfusion (CR) services on acute myocardial infarction (AMI) mortality in Parana State, Brazil. Methods: This is a cross-sectional, ecologic study based on AMI mortality, between 2015 and 2019, among individuals aged 30–79 years. An spatial access index to CR services within 60 minutes of ground transportation was calculated using the enhanced two-step floating catchment area technique. AMI mortality rates were compared between municipalities with and without CR services coverage and between municipalities with low and high spatial access to CR services, both using the Wilcoxon test. Results: It was observed that 8.02% (32/399) of municipalities had access to two methods of reperfusion therapy, 24.56% (98/399) had access only to primary percutaneous coronary intervention, and 12.03% (48/399) had access only to chemical reperfusion. Municipalities with access to CR services had lower mortality rate (median = 74.67) than municipalities not covered by this service (median = 102.83) (p < 0.001). There was a significant difference between municipalities with low (median = 68.30) and high spatial access to CR services (median = 80.02) (p = 0.007). Conclusion: Increased spatial access to CR services is crucial for the survival of patients with AMI.

Introduction: Delays in prehospital care attributable to the call-taking process can often be traced back to miscommunication, including uncertainty around the call location. Geolocation applications have the potential to streamline the call-taking process by accurately identifying the caller’s location. Objective: To develop and validate an application to geolocate emergency calls and compare the response time of calls made via the application with those of conventional calls made to the Brazilian Medical Emergency System (Serviço de Atendimento Médico de Urgência—SAMU). Methods: This study was conducted in two stages. First, a geolocating application for SAMU emergency calls (CHAMU192) was developed using a mixed methods approach based on design thinking and subsequently validated using the System Usability Scale (SUS). In the second stage, sending time of the geolocation information of the app was compared with the time taken to process information through conventional calls. For this, a hypothetical case control study was conducted with SAMU in the Maringá, Paraná, Brazil. A control group of 350 audio recordings of emergency calls from 2019 was compared to a set of test calls made through the CHAMU192 app. The CHAMU192 group consisted of 201 test calls in Maringá. In test calls, the location was obtained by GPS and sent to the SAMU communication system. Comparative analysis between groups was performed using the Mann-Whitney test. Results: CHAMU192 had a SUS score of 90, corresponding to a “best imaginable” usability rating. The control group had a median response time of 35.67 seconds (26.00–48.12). The response time of the CHAMU192 group was 0.20 (0.15–0.24). Conclusion: The use of the CHAMU192 app by emergency medical services could significantly reduce response time. The results demonstrate the potential of app improving the quality and patient outcomes related to the prehospital emergency care services.

Construir e validar um instrumento para o transporte ao RN no serviço de atendimento móvel de urgência. Estudo metodológico de construção de instrumento com base na literatura científica, sobre transporte do recém-nascido de alto risco. Realizou-se entre outubro de 2021 e janeiro de 2022 e desenvolvido em duas etapas, a saber: construção do instrumento e validação do conteúdo por especialistas. A construção do instrumento, se deu a partir da revisão integrativa e de documentos, tais como: manuais de orientações do transporte neonatal do Ministério da Saúde, nas Diretrizes da sociedade Brasileira de Pediatria no “Transporte do Recém-nascido de alto risco” e experiência da pesquisadora. O instrumento foi categorizado nos seguintes domínios: Identificação; transferência; hipótese diagnóstica, avaliação e intervenção/procedimentos, além de check-list de equipamentos e materiais necessários para o transporte e escalas para avaliar o RN. A validação de conteúdo do instrumento foi realizada por 20 especialistas no assunto. O instrumento mostrou-se apropriado, obtendo valor médio de 97,5%. A construção e validação do instrumento mostraram-se adequadas e relevantes, indicando que possa ser utilizado no transporte ao RN do serviço de atendimento móvel de urgência.

Objective: to identify scientific evidence on neonatal transport in the emergency medical service Methods: integrative review carried out between December 2020 and March 2021 in five national and international databases, and descriptors: “neonatal transport”, “newborn” and “ambulance”. 198 researches were found, of which 12 constituted the final sample. The material was analyzed and organized using simple descriptive statistics. Results: The publications highlighted that the use of neonatal transport is complex and requires assistive technology and specific qualified care. Conclusion: It is necessary to develop strategies that broaden the perspectives of professionals in neonatal transport.