Central Access Research Articles

Implantation of central vascular access devices for intravenous administration. Complications and consequences for a patient on the example of a clinical case

Implanted central vascular access devices for intravenous administration of drugs are widely used in cancer patients who require long-term access, specific chemotherapy and parenteral nutrition. Installation of central vascular access devices solves the problem of venous access, but, unfortunately, it can lead to complications, including serious and irreversible ones. Here is a clinical case of cancer in a 49-year-old female patient who was implanted with a vascular access device for intravenous therapy. The incorrect and undiagnosed insertion of the vascular access device in the subclavian artery and also neoadjuvant polychemotherapy sessions led to myelomalacia with the subsequent development of myeloradiculopathy, the emergence and development of persistent neurological disorders. After radiological diagnosis and verification of this complication, percutaneous transluminal angioplasty with single stenting and removal of the central vascular access device was performed. The article presents complications with the insertion of central vascular access devices and discusses in detail a clinical case of complication and methods for its solution when this device is incorrectly implanted in the artery.

Peripheral vascular access as exclusive access mode in pediatric intensive care unit.

The type of vascular access (central or peripheral) in pediatric critical care depends on several factors, including the duration of treatment, the properties of the medication (osmolarity or vesicant), and the need for central pressure monitoring. The utilization of peripheral intravascular catheters (PIVCs) has shown a notable increase in the number of patients being treated. Extended dwell or midline catheters are another peripheral access option in addition to PIVCs. However, there are currently no established guidelines on their placement. The aim of this study is to estimate the duration of dwell time for PIVCs, analyze the specific parameters affecting it, and develop recommendations for switching to extended dwell and midline catheter placement as an alternative to peripheral access. The study enrolled patients aged 0-18 years admitted to the pediatric intensive care unit (PICU) for over 24 h and managed with peripheral access only over 2 years (2019-2021). A total of 484 patients met the specified criteria. Patients who had peripheral access exhibited a lower PRISM score and a shorter length of stay in the PICU, with mean values of 18 (SD: 8.5) and 9.5 (SD: 6.4) days, respectively, compared with patients who had central access with mean values of 8.9 (SD: 5.9) and 5.7 (SD: 3.6) days, respectively. The PIVC dwell time was found to be 50.1 h (SD: 65.3) and required an average of 1.6 insertion attempts. Patients with three or more insertions exhibited an increased odds ratio of 5.2 (95% CI: 3.1-8.5) for receiving an extended dwell or midline insertion. Increased dwell time was associated with female gender, 59.5 h (P < 0.001), first attempt insertion, 53.5 h (P < 0.001), use of 24 Ga bore, 56.3 h (P = 0.04), left-sided insertions, 54.9 (P = 0.07), less agitation, 54.8 h (P = 0.02), and less edema, 61.6 (P < 0.001). Decreased dwell time was associated with the use of vancomycin infusion at 24.2 h (P < 0.001) and blood transfusions at 29.3 h (P < 0.001). Extended catheters last longer than PIVCs in PICU patients. Extended catheter placement requires consideration of the length of treatment, as well as the overall body edema, the level of the patient's restlessness, and the need for vancomycin infusion or blood transfusions, as these factors reduce PIVC dwell time and expose the patients to painful insertions. For such cases, an extended dwell catheter may be a better option, even if the projected treatment time is less than 6 days.

Insurance-Based Disparities in Stroke Center Access in California: A Network Science Approach.

Our objectives were to determine whether there is an association between ischemic stroke patient insurance and likelihood of transfer overall and to a stroke center and whether hospital cluster modified the association between insurance and likelihood of stroke center transfer. This retrospective network analysis of California data included every nonfederal hospital ischemic stroke admission from 2010 to 2017. Transfers from an emergency department to another hospital were categorized based on whether the patient was discharged from a stroke center (primary or comprehensive). We used logistic regression models to examine the relationship between insurance (private, Medicare, Medicaid, uninsured) and odds of (1) any transfer among patients initially presenting to nonstroke center hospital emergency departments and (2) transfer to a stroke center among transferred patients. We used a network clustering method to identify clusters of hospitals closely connected through transfers. Within each cluster, we quantified the difference between insurance groups with the highest and lowest proportion of transfers discharged from a stroke center. Of 332 995 total ischemic stroke encounters, 51% were female, 70% were ≥65 years, and 3.5% were transferred from the initial emergency department. Of 52 316 presenting to a nonstroke center, 3466 (7.1%) were transferred. Relative to privately insured patients, there were lower odds of transfer and of transfer to a stroke center among all groups (Medicare odds ratio, 0.24 [95% CI, 0.22-0.26] and 0.59 [95% CI, 0.50-0.71], Medicaid odds ratio, 0.26 [95% CI, 0.23-0.29] and odds ratio, 0.49 [95% CI, 0.38-0.62], uninsured odds ratio, 0.75 [95% CI, 0.63-0.89], and 0.72 [95% CI, 0.6-0.8], respectively). Among the 14 identified hospital clusters, insurance-based disparities in transfer varied and the lowest performing cluster (also the largest; n=2364 transfers) fully explained the insurance-based disparity in odds of stroke center transfer. Uninsured patients had less stroke center access through transfer than patients with insurance. This difference was largely explained by patterns in 1 particular hospital cluster.

ASSESSMENT OF THE FUNCTIONING OF HEALTH CARE IN THE REPUBLIC OF TATARSTAN IN 2005–2021

The Republic of Tatarstan is located in the Volga Federal District and occupies one of the last places in the ranking in terms of the number of hospital beds per 10,000 people. It should also be noted unfavorable data on the number of medical staff, the number of people per place in the hospital, the number of receptions per shift. At the same time, the region is characterized by good socio-economic indicators in the field of health. Among them, the main ones are not only stable data on morbidity and mortality, but also the conditions for financing health care. The above requires research to assess these trends. The purpose of the study is to assess the factors influencing the health indicators of the Republic of Tatarstan. Materials and methods. In the course of studying theoretical and practical provisions, general scientific methods of cognition were used: comparison, abstraction, synthesis, induction and deduction, as well as methods of statistical analysis. The information base of the study was the data of the Ministry of Finance of the Russian Federation on the use of the consolidated budgets of the Russian Federation and its subjects, as well as indicators of the development of healthcare, transport, etc. published on the Rosstat website. The results of the study. Despite a significant reduction in the number of hospitals, medical personnel, and beds in rural areas, the Republic of Tatarstan manages to maintain morbidity and mortality rates at the same level with a slight increase during the pandemic. This was facilitated by the involvement of the population in sports, as well as alternative ways of providing medical services to rural residents. New health care services are favored by good transport accessibility of district and regional centers, conditions created in them for the provision of medical care to rural residents. New methods of providing curative and preventive care are being actively used, for example, through the use of mobile teams, remote consultations, as well as redirecting patient flows to district and regional centers. Financing of health care has not always been at a sufficient level, but in recent years it has improved, which positively characterizes the state of health care in the republic. Conclusions. The Republic of Tatarstan is characterized by good socio-economic indicators in the field of healthcare. The reduction in the number of medical institutions did not adversely affect the morbidity and mortality rates of the population of the republic. To a certain extent, this is due to the developed transport network, which contributes to the provision of assistance by mobile teams, as well as the redirection of the flow of cases to district and regional centers. Financing of health care has improved in recent years, which has also contributed to the success of the functioning of medical institutions.

Methods of the “New Division of the Empire”: The Reforms of Administrative Division in Vyatka Rеgion from Catherine the Great to Paul I

This article examines the territorial transformations carried out in Vyatka Region in the 1780s–1810s. As is known, before the last quarter of the eighteenth century, the system of administrative-territorial division of the country was based on the historically established system of uyezds. However, in 1775–1802, two major reforms were carried out, which rebuilt the administrative-territorial division following qualitatively new principles – approximate equality of the population of provinces and uyezds and transport accessibility of administrative centres for the population. These changes largely determined the outlines of the social structure of the Russian Empire over the next century, and changes in the management system and social structure naturally attract researchers’ attention today. With the help of a detailed reconstruction (based on maps of the time, both printed, from national atlases of 1792 and 1800, and handprinted, from the collections of several archives) and comparison of the boundaries of provinces in the middle of the eighteenth century, in 1792, in 1792, 1800 and 1805–1806, the author reveals the redistribution of territories between urban centres. It transpires that the system of territorial relations in this region during the reform of Catherine II changed more decisively than in the central regions of the country, and the new borders were initially drawn without a survey of the situation on the ground, in some cases – in the form of straight lines on the map. The correction of inconveniences caused by such a manner of reform was delayed and was completed already during the administrative reforms of Paul I, which, unlike most regions, were not cancelled there in the first decade of the nineteenth century.

The utility of point-of-care ultrasound protocol to confirm central venous catheter placement in the preterm infant.

Central vascular access is frequently required for preterm infants. Confirmation of positioning of central line is typically on chest and abdominal radiographs; POCUS is a relatively novel diagnostic method. Misdiagnosis is the main concern limiting use of this modality. The aim of this study is to validate our standard protocol accuracy in locating the central catheter position by correlating catheter position as determined by POCUS with radiographs. Premature babies < or equal to 30weeks gestation who had peripheral central lines or surgical lines were enrolled. Confirmation of line position by radiographs was compared to images obtained through a specific US protocol technique. The operator of US exam was blinded to the radiograph findings. All images were reviewed by two radiologists who were blinded to the radiograph findings. 35 central line placements were assessed. 22 lines were inserted in the UL, and 13 were inserted in the LL with a total of 91 ultrasound scans and radiographs. The position of the line was interpreted as normal in 79/91 scans with interpreter reliability of [Formula: see text]=0.778 (p < 0.001), sensitivity of 0.83 and specificity of 0.96, and positive predictive value of 0.77 and negative predictive value of 0.97. There was no significant difference between the ultrasound interpretation and the radiograph interpretation of UL and LL. Conclusion: The protocol of POCUS that we propose is a reliable tool for assessing the central line positions in preterm infants. What is Known: • POCUS is a reliable tool assessing the central line positions in preterm infants. What is New: • The protocol of POCUS that we propose is a reliable tool for assessing the central line positions in preterm infants.

Optimizing Spatial Location and Service Capacity of New Schools Toward Maximum Equity in the Distribution of Educational Resources

Educational facilities are an important part of public service facilities. The scientific planning of educational facilities is conducive to the optimal allocation of educational resources and the equalization of educational services. In view of the insufficient supply and uneven spatial distribution of urban educational service facilities, this study adopted an improved two-step optimization method to maximize the equality of school accessibility by optimizing the spatial location and service capacity of urban primary schools. First, the improved p-median model was constructed, and the Teitz–Bart algorithm was used to solve the model to site new primary schools. Second, a quadratic programming method was used to optimize the service capacity of new primary schools. Finally, the two-step floating catchment area (2SFCA) method was used to analyze and evaluate the accessibility of population centers to schools before and after the site selection and service capacity optimization of new schools. The results show that the improved two-step optimization approach can effectively determine the best locations and service capacity of new schools to improve the spatial accessibility of schools and realize the fair distribution of educational resources.

Assessing trauma center accessibility in the Southeastern region of the U.S. to improve healthcare efficacy using an anti-covering approach.

Accessibility to trauma centers is vital for the patients of severe motor vehicle crashes. Many vehicle crash fatalities failed to reach the proper emergency medical services since the accident location was far away from trauma centers. The spatial discordance between the service coverage area of trauma centers and actual locations of motor vehicle accidents delays the definitive medical care and results in death or disability. Many fatalities would have been prevented if the patients had a chance to get proper treatment in time at Southeastern region of the U.S. Also, the accessibility to trauma centers from the actual locations of motor vehicle accidents is different in the Southeastern region. This research aimed to facilitate the accessibility to trauma centers for severe motor vehicle crash patients in the Southeastern region. The analyses are conducted to assess current trauma center accessibility and suggest the optimal locations of future trauma centers using the Anti-covering location model for trauma centers (TraCt model). This study found that existing trauma centers failed to serve many demands, and the actual coverages of the current locations of trauma centers over potential demands are highly different in each Southeastern state. TraCt model is applied to each Southeastern state, and its solutions provide better coverage for demand locations. However, the TraCt model for each state tends to choose too many facilities, with excessively supplied facilities across the Southeastern region. The excessive service supply issue is addressed by applying the TraCt Model to a broader spatial extent. TraCt model applied to the entire Southeastern region and most of the demand, over 98% covered by the service coverage of optimal facility locations with 15 additional facilities. This research proves that the GIS and TraCt model applied to the broader spatial extent works well with increasing trauma medical service beneficiaries while providing a minimum number of additional facilities.

Use of ultrasound to estimate the prevalence of occult spinal dysraphism in children undergoing urogenital and anorectal surgeries: A cross-sectional study.

The use of ultrasound has immensely increased the safety toward regional blocks and central venous access and has been considered as the standard of care for securing central access. The aim of this study is to estimate the prevalence of occult spinal dysraphism using ultrasound in children less than 2 years of age undergoing elective urogenital or anorectal surgery. The lumbosacral region of 159 American Society of Anesthesiologists (ASA) category I/II patients, posted for elective urogenital and anorectal surgery was scanned with ultrasound, prior to giving caudal block. The prevalence of occult spina bifida was 3% in our study. There was no statistically significant association of cutaneous marker with abnormal scan. Prevalence of occult spina bifida was ten-times higher in our study than in the general population. Perioperative ultrasound screening of the lower spinal anatomy by anesthesiologist done prior to performing neuraxial block is worthwhile in ruling out occult spinal anomalies in high-risk children of occult spinal dysraphism.

Spatial Layout and Accessibility Evaluation of COVID-19 Vaccination Sites Based on Three Optimization Models: A Case Study of Tianhe District, Guangzhou

The outbreak of COVID-19 poses a serious threat to global public health, and vaccination is an effective means of prevention. Studying the spatial layout and accessibility of COVID-19 vaccination sites is of great significance. The study analyzes the spatial distribution characteristics and accessibility of vaccination sites in the early stage of mass vaccination in Tianhe District, Guangzhou, based on GIS technology and combines three location allocation models: the p-median model, maximum covering location problem (MCLP) model, and location set covering problem (LSCP) model to identify candidate COVID-19 vaccination sites for the proposed public service facilities. The study found that only 47 COVID-19 vaccination sites exist in the early stage, with a small overall number, uneven spatial distribution, and trend of high accessibility in the central but low accessibility in the north and south; after the proposed addition of 31 vaccination sites, the overall distribution showed an even and dense distribution in the central and western regions, sporadic distribution in other regions, consistent with the distribution characteristics of residential communities. The areas where the accessibility of vaccination sites increased by more than 500 m accounted for 41% of the total area, and the area served by vaccination sites increased by 18%. Therefore, using the existing public service facilities to reasonably add the vaccination sites can improve the efficiency of vaccination and safeguard the establishment of a herd immunity barrier.

Two Affordable, High-Fidelity Central Venous Models for Ultrasound-Guided Interventional Training.

Ultrasound-guided vascular access is an increasingly popular technique due to its reduced complication and higher success rates. Commercially bought training phantoms allow providers to develop tactile skills in a low-risk setting, but are also expensive and poorly accessible. This study analyzes the efficacy of homemade, low-cost, gelatin-based central line vascular models to teach vascular anatomy and intravascular access techniques in training physicians. A gelatin mold was created using a mixture of unflavored gelatin, hot water, psyllium husk powder, and rubbing alcohol. Latex tubing, balloons, precooked hot dog, and tofu were inserted to simulate arteries, veins, nerves, and the sternocleidomastoid muscle, respectively. Medical students from a single institution participated in a 90-minute workshop led by interventional radiology residents. Participants completed presurveys and postsurveys that assessed knowledge acquisition and confidence levels related to acquiring central access. All images were obtained using a USB-C Butterfly iQ probe. Twenty medical students were analyzed after the workshop. There was a statistically significant increase in self-reported confidence in basic ultrasound use (adjusting gain, depth, probe manipulation), localizing major anatomical structures, using ultrasound for vessel access, and reported ease in identifying muscle, nerves, and major blood vessels under ultrasound. There was also a significant increase in correctly identified anatomical landmarks after the workshop, including the sternocleidomastoid muscle, internal jugular vein, carotid artery, femoral nerve, femoral artery, and femoral vein. Our findings suggest that our homemade, low-cost, gelatin-based models were effective in teaching vascular anatomy and ultrasound-guided vascular access techniques to training physicians.

“They Weren’t Necessarily Designed with Lived Experiences of Disability in Mind”

Using semi-structured interviews with disabled archival users and building on the emerging field of critical access studies, this article illustrates the ways in which archival spaces and their in/accessibility affectively impact disabled people. Interviewees describe how they experience barriers to accessibility not only at a basic, architectural level – of not being able to get into a building or archives room – but also through archives’ policies and expectations regarding the ways in which archival work is done. The way that accessibility is implemented, even beyond legal compliance, greatly impacts the extent to which disabled researchers feel they belong in archival spaces. Inaccessibility, this research shows, produces a sense of unbelonging; the deprioritization of disability both as a subject or organizing category and as an identity of a potential researcher, shows disabled people that they do not belong in archival spaces, and this is further complicated for multiply marginalized disabled people. By examining the multifaceted ways that disabled people experience inaccessibility, this article focuses on the “emotionally expensive” aspects of inaccessibility to emphasize the ways in which barriers compound and accumulate and can prevent disabled people from accessing our own histories. These findings demonstrate how central accessibility is to disabled people’s lives: it is almost impossible to talk about our experiences of archival materials and history without discussing how we navigate the multiple barriers to accessing them.

Transplant Center Access to Dermatology.

Transplant Center Access to Dermatology.

A urokinase-associated outbreak of Ralstonia mannitolilytica bloodstream infections in haemodialysis patients in north-eastern Italy, January to April 2023.

An outbreak of Ralstonia mannitolilytica bloodstream infections occurred in four hospitals in north-eastern Italy, involving 20 haemodialysis patients with tunnelled central vascular catheter access. We identified as the outbreak source a batch of urokinase vials imported from India contaminated with R. mannitolilytica. Whole genome sequences of the clinical and urokinase strains were highly related, and only urokinase-treated patients were reported with R. mannitolilytica infections (attack rate = 34%; 95% confidence interval: 22.1-47.4). Discontinuation of the contaminated urokinase terminated the outbreak.

Exploring the spatial correlation between accessibility to urban vibrancy centers and housing price from a time-dynamic perspective

ABSTRACT Urban vibrancy is an important indicator of urban prosperity. Evaluating the correlation between urban vibrancy and housing prices is increasingly necessary. However, most studies have ignored the temporal characteristics of urban vibrancy and only considered its spatial nature. This study optimizes the identification model of urban vibrancy centers and proposes a novel model for evaluating the time-dynamic accessibility of urban vibrancy centers. The model takes into account real-time changes in travel costs and analyses its spatial correlation with housing prices. The case study of Chengdu shows significant variations in the spatiotemporal distribution of urban vibrancy centers. High-vibrancy areas are concentrated near commercial complexes. The time distribution of urban vibrancy accessibility is more concentrated at night (18:00–24:00), and the high-accessibility areas are located around the old city and the newly planned Central Business District in the south. Housing prices and urban vibrancy centers accessibility are mainly negatively correlated spatially. The study emphasizes the temporal nature of urban vibrancy and accessibility and enriches the evaluation model of urban vibrancy centers. It also contributes to the improvement of the framework of urban vibrancy research and deepens the understanding of the important variable of “time” in urban planning.

Online Voting Scheme Using IBM Cloud-Based Hyperledger Fabric with Privacy-Preservation

The current traditional paper ballot voting schemes suffer from several limitations such as processing delays due to counting paper ballots, lack of transparency, and manipulation of the ballots. To solve these limitations, an electronic voting (e-voting) scheme has received massive interest from both governments and academia. In e-voting, individuals can cast their vote online using their smartphones without the need to wait in long lines. Additionally, handicapped voters who face limited wheelchair access in many polling centers could now participate in elections hassle-free. The existing e-voting schemes suffer from several limitations as they are either centralized, based on public blockchains, or utilize local private blockchains. This results in privacy issues (using public blockchains) or large financial costs (using local/private blockchains) due to the amount of computing power and technical knowledge needed to host blockchains locally. To address the aforementioned limitations, in this paper, we propose an online voting scheme using IBM cloud-based Hyperledger Fabric. Our scheme allows voters to cast their encrypted votes in a secure manner. Then any participant can obtain the ballot results in a decentralized and transparent manner, without sacrificing the privacy of individual voters. We implement the proposed scheme using IBM cloud-based Hyperledger Fabric. The experimental results identify the performance characteristics of our scheme and demonstrate that it is feasible to run an election consisting of thousands of participants using cloud-based Fabric.

Effect of Peripherally Infused Norepinephrine on Reducing Central Venous Catheter Utilization.

The purpose of this retrospective study was to evaluate the impact of peripherally administered norepinephrine on avoiding central venous catheter insertion while maintaining safety of the infusion. An institutional guideline allows peripheral infusion of norepinephrine via dedicated, 16- to 20-gauge, mid-to-upper arm intravenous (IV) catheters for up to 24 hours. The primary outcome was the need for central venous access in patients initially started on peripherally infused norepinephrine. A total of 124 patients were evaluated (98 initially on peripherally infused norepinephrine vs 26 with central catheter only administration). Thirty-six (37%) of the 98 patients who were started on peripheral norepinephrine avoided the need for central catheter placement, which was associated with $8,900 in direct supply cost avoidance. Eighty (82%) of the 98 patients who started peripherally infused norepinephrine required the vasopressor for ≤12 hours. No extravasation or local complications were observed in any of the 124 patients, regardless of site of infusion. Administration of norepinephrine via a dedicated peripheral IV site appears safe and may lead to a reduction in the need for subsequent central venous access. To achieve timely resuscitation goals, as well as to minimize complications associated with central access, initial peripheral administration should be considered for all patients.

Physiotherapists’ views regarding accessibility of Parkinson disease patients to physiotherapy centers

Introduction: Parkinson’s disease (PD) is a progressive neurodegenerative disease mainly characterized by motor defects such as tremor and postural instability. The number of patients with Parkinson’s disease (PD) is increasing in all aging societies. This population requires immediate physiotherapy management to maintain and improve their quality of life. The aim of study to explore physiotherapists’ views about the barriers facing Parkinson’s patients on access in centres of physiotherapy in Al-Zawia city, Libya. Method: An exploratory qualitative study is design to explain physiotherapists’ views. Twenty physiotherapists from seven physiotherapy centres were approached individually and invited to participate. Participants were interviewed and asked about their experiences with Parkinson's patients. Result and discussion there are barriers in the communication with elderly Parkinson's patients and also, the doctors with physiotherapists, lack of access (referral) and poor awareness of doctors about physical therapy role as one of the barriers, the economic part of barriers that limit patient’s access to the center because as expensive private facilities, and long-term treatment plans with slow improvement lead to a lack of patient's access to the center, on other hand patient fell bored from ong treatment, beside the patients mood that effected in patients treatment such as anxiety and depression, while the anxiety is the most mood disorder . All of these factors and others led to frequent missing sessions and limiting patients’ access to physiotherapy centres. Conclusions: The study found that there were gaps in communication between patients, physiotherapists, and physicians. And there lack of patient access in the physiotherapy centres because of poor referral and awareness/knowledge about the benefits of physiotherapy programs for patients with PD. Another issue the study found there was the high cost of the therapy sessions and long-term program compared with the low level of improvement that made patients discontinue their treatment.

Aging Affects Insulin Resistance, Insulin Secretion, and Glucose Effectiveness in Subjects with Normal Blood Glucose and Body Weight.

Several studies have demonstrated that factors including diabetes, including insulin resistance (IR), glucose effectiveness (GE), and the first and second phase of insulin secretion (FPIS, SPIS) could easily be calculated using basic characteristics and biochemistry profiles. Aging is accompanied by deteriorations of insulin resistance (IR) and insulin secretion. However, little is known about the roles of aging in the different phases of insulin secretion (ISEC), i.e., the first and second phase of insulin secretion (FPIS, SPIS), and glucose effectiveness (GE). In total, 169 individuals (43 men and 126 women) recruited from the data bank of the Meei-Jaw (MJ) Health Screening Center and Cardinal Tien Hospital Data Access Center between 1999 and 2008, with a similar fasting plasma glucose (FPG: 90 mg/dL) and BMI (men: 23 kg/m2, women 22 kg/m2) were enrolled. The IR, FPIS, SPIS, and GE were estimated using our previously developed equations shown below. Pearson correlation analysis was conducted to assess the correlations between age and four diabetes factors (DFs: IR, FPIS, SPIS, and GE). The equations that are used to calculate the DF in the present study were built and published by our group. The age of the participants ranged from 18 to 78 years. Men had higher FPIS but lower HDL-C levels than women (2.067 ± 0.159, 1.950 ± 0.186 μU/min and 1.130 ± 0.306, 1.348 ± 0.357 mmol/dl, accordingly). The results of the Pearson correlation revealed that age was negatively related to the IR and GE in both genders (IR: r = -0.39, p < 0.001 for men, r = -0.24, p < 0.003 for women; GE: r = 0.66, p < 0.001 for men, r = 0.78, p < 0.001 for women). At the same time, the FPIS was also only found to be negatively correlated with age in females (r = -0.238, p = 0.003), but there was no difference in the SPIS and age among both genders. We have found that in Chinese subjects with a normal FPG level (90 mg/dL) and body mass index (men: 23 kg/m2, women: 22: kg/m2), age is negatively related to the IR and GE among both genders. Only the FPIS was found to be negatively related to age in women. The tightness of their relationships, from the highest to the lowest, are GE, FPIS, and IR. These results should be interpreted with caution because of the small sample size.

Exploring regional disparities in lung cancer mortality in a Brazilian state: A cross-sectional ecological study.

Lung cancer (LC) is one of the main causes of mortality in Brazil; geographic, cultural, socioeconomic and health access factors can affect the development of the disease. We explored the geospatial distribution of LC mortality, and associated factors, between 2015 and 2019, in Parana state, Brazil. We obtained mortality (from the Brazilian Health Informatics Department) and population rates (from the Brazilian Institute of Geography and Statistics [IBGE]) in people over 40 years old, accessibility of oncology centers by municipality, disease diagnosis rate (from Brazilian Ministry of Health), the tobacco production rate (IBGE) and Parana Municipal Performance Index (IPDM) (from Parana Institute for Economic and Social Development). Global Moran's Index and Local Indicators of Spatial Association were performed to evaluate the spatial distribution of LC mortality in Parana state. Ordinary Least Squares Regression and Geographically Weighted Regression were used to verify spatial association between LC mortality and socioeconomic indicators and health service coverage. A strong spatial autocorrelation of LC mortality was observed, with the detection of a large cluster of high LC mortality in the South of Parana state. Spatial regression analysis showed that all independent variables analyzed were directly related to LC mortality by municipality in Paraná. There is a disparity in the LC mortality in Parana state, and inequality of socioeconomic and accessibility to health care services could be associated with it. Our findings may help health managers to intensify actions in regions with vulnerability in the detection and treatment of LC.