Stroke awareness in a Brazilian Northeastern capital city and the burden of the COVID-19 pandemic.

BACKGROUND: The delay in recognizing stroke symptoms is a significant obstacle to receiving acute treatment. Therefore, it is essential to understand the gaps in the knowledge about stroke among the general population and promote campaigns based on these gaps. OBJECTIVE: To investigate the general knowledge about stroke in a capital in Northeastern Brazil in a sample of individuals who attended a public hospital and the impacts of the coronavirus disease 2019 (COVID-19) pandemic on the use of emergency services. METHODS: We included patients older than 18 years of age and their family members and/or companions. After obtaining consent, the researcher presented a typical case of stroke, and the participants filled out a questionnaire divided into 2 sections: sociodemographic data and 15 questions about stroke detection and seeking health services and treatment. RESULTS: We included 154 individuals with a mean age of 44.45 ± 16.21 years. After presenting the case, 60.4% mentioned the acronym AVC (acidente vascular cerebral, or cerebrovascular accident [stroke], in Portuguese) as a possible explanation, and 54.5% reported that they would call the Mobile Emergency Care Service. However, 62.9% provided the incorrect telephone number for the Mobile Emergency Care Service or lacked knowledge of the accurate number. Regarding the risk factors for stroke, 27.9% did not know any of them, 65.5% were unaware of any treatment, and no reference was made to thrombolytic therapy. About their chosen conduct in the same case in the context of the COVID-19 pandemic, 98.1% of the participants would not change their behavior. CONCLUSION: These results can assist in the planning of public policies and campaigns emphasizing the issue of risk factors and how to access emergency medical services in the state of Alagoas, Brazil.

ANTECEDENTES: O atraso no reconhecimento dos sinais do acidente vascular cerebral (AVC) é um dos principais obstáculos para receber o tratamento de fase aguda. Portanto, é importante compreender as lacunas no conhecimento da população sobre o AVC e promover campanhas de acordo com essas lacunas. OBJETIVO: Investigar o conhecimento geral sobre o AVC em uma amostra de indivíduos acompanhados em um hospital público de uma capital do Nordeste brasileiro e o impacto da pandemia de doença do coronavírus 2019 (coronavirus disease 2019 - COVID-19, em inglês) na utilização dos serviços de emergência. MéTODOS: Foram incluídos pacientes acima de 18 anos e seus acompanhantes e/ou familiares. Após a assinatura do termo de consentimento, o pesquisador apresentou um caso típico de AVC, e os participantes responderam um questionário dividido em 2 partes: dados sociodemográficos e 15 perguntas sobre o reconhecimento do AVC, procura por serviços de saúde e tratamento. RESULTADOS: Foram incluídos 154 participantes com idade média de 44,45 ± 16,21 anos. Após a apresentação do caso, 60,4% mencionaram AVC como uma possível explicação, e 54,5% chamariam o Serviço de Atendimento Móvel de Urgência (SAMU). Entretanto, 62,9% erraram ou não sabiam o número do SAMU. Quanto aos fatores de risco de desenvolver AVC, 27,9% não sabiam identificar nenhum, 65,5% não conheciam qualquer tratamento, e não houve menção ao tratamento trombolítico. Com relação à conduta no mesmo caso, mas no contexto da pandemia de COVID-19, 98,1% dos participantes não mudariam sua conduta. CONCLUSãO: Os resultados deste estudo podem auxiliar no planejamento de políticas públicas com ênfase em campanhas sobre os fatores de risco e o acionamento do SAMU em Alagoas, Brasil.

Long-term complications and outcomes of therapeutic embolization of cerebral arteriovenous malformations: a systematic review.

BACKGROUND: Embolization is a promising treatment strategy for cerebral arteriovenous malformations (AVMs). However, consensus regarding the main complications or long-term outcomes of embolization in AVMs remains lacking. OBJECTIVE: To characterize the most prevalent complications and long-term outcomes in patients with AVM undergoing therapeutic embolization. DESIGN AND SETTING: This systematic review was conducted at the Federal University of Alagoas, Arapiraca, Brazil. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Data were obtained from MEDLINE, PubMed, LILACS, and SciELO databases, which included the epidemiological profile of the population, characteristics of the proposed therapy, complications (hemorrhagic events and neurological deficits), and long-term outcomes (modified Rankin scale pre- and post-treatment, AVM recanalization, complete obliteration, and deaths). RESULTS: Overall, the analysis included 34 articles (2,799 patients). Grade III Spetzler-Martin AVMs were observed in 34.2% of cases. Notably, 39.3% of patients underwent embolization combined with radiosurgery. The most frequently reported long-term complication was hemorrhage, which occurred in 8.7% of patients at a mean follow-up period of 58.6 months. Further, 6.3% of patients exhibited neurological deficits after an average of 34.7 months. Complete obliteration was achieved in 51.4% of the cases after a mean period of 36 months. Recanalization of AVMs was observed in 3.5% of patients. Long-term death occurred in 4.0% of patients. CONCLUSION: Embolization of AVMs is an increasingly safe strategy with low long-term complications and satisfactory outcomes, especially in patients who have undergone combination therapies. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/ Registration number CRD42020204867.

Stroke awareness in a Brazilian Northeastern capital city and the burden of the COVID-19 pandemic / Conceito leigo sobre o acidente vascular cerebral (AVC) em uma capital do Nordeste brasileiro e o impacto da pandemia de COVID-19

Abstract Background The delay in recognizing stroke symptoms is a significant obstacle to receiving acute treatment. Therefore, it is essential to understand the gaps in the knowledge about stroke among the general population and promote campaigns based on these gaps. Objective To investigate the general knowledge about stroke in a capital in Northeastern Brazil in a sample of individuals who attended a public hospital and the impacts of the coronavirus disease 2019 (COVID-19) pandemic on the use of emergency services. Methods We included patients older than 18 years of age and their family members and/or companions. After obtaining consent, the researcher presented a typical case of stroke, and the participants filled out a questionnaire divided into 2 sections: sociodemographic data and 15 questions about stroke detection and seeking health services and treatment. Results We included 154 individuals with a mean age of 44.45 ± 16.21 years. After presenting the case, 60.4% mentioned the acronym AVC (acidente vascular cerebral, or cerebrovascular accident [stroke], in Portuguese) as a possible explanation, and 54.5% reported that they would call the Mobile Emergency Care Service. However, 62.9% provided the incorrect telephone number for the Mobile Emergency Care Service or lacked knowledge of the accurate number. Regarding the risk factors for stroke, 27.9% did not know any of them, 65.5% were unaware of any treatment, and no reference was made to thrombolytic therapy. About their chosen conduct in the same case in the context of the COVID-19 pandemic, 98.1% of the participants would not change their behavior. Conclusion These results can assist in the planning of public policies and campaigns emphasizing the issue of risk factors and how to access emergency medical services in the state of Alagoas, Brazil.

Resumo Antecedentes O atraso no reconhecimento dos sinais do acidente vascular cerebral (AVC) é um dos principais obstáculos para receber o tratamento de fase aguda. Portanto, é importante compreender as lacunas no conhecimento da população sobre o AVC e promover campanhas de acordo com essas lacunas. Objetivo Investigar o conhecimento geral sobre o AVC em uma amostra de indivíduos acompanhados em um hospital público de uma capital do Nordeste brasileiro e o impacto da pandemia de doença do coronavírus 2019 (coronavirus disease 2019 - COVID-19, em inglês) na utilização dos serviços de emergência. Métodos Foram incluídos pacientes acima de 18 anos e seus acompanhantes e/ou familiares. Após a assinatura do termo de consentimento, o pesquisador apresentou um caso típico de AVC, e os participantes responderam um questionário dividido em 2 partes: dados sociodemográficos e 15 perguntas sobre o reconhecimento do AVC, procura por serviços de saúde e tratamento. Resultados Foram incluídos 154 participantes com idade média de 44,45 ± 16,21 anos. Após a apresentação do caso, 60,4% mencionaram AVC como uma possível explicação, e 54,5% chamariam o Serviço de Atendimento Móvel de Urgência (SAMU). Entretanto, 62,9% erraram ou não sabiam o número do SAMU. Quanto aos fatores de risco de desenvolver AVC, 27,9% não sabiam identificar nenhum, 65,5% não conheciam qualquer tratamento, e não houve menção ao tratamento trombolítico. Com relação à conduta no mesmo caso, mas no contexto da pandemia de COVID-19, 98,1% dos participantes não mudariam sua conduta. Conclusão Os resultados deste estudo podem auxiliar no planejamento de políticas públicas com ênfase em campanhas sobre os fatores de risco e o acionamento do SAMU em Alagoas, Brasil.

Long-term complications and outcomes of therapeutic embolization of cerebral arteriovenous malformations: a systematic review

ABSTRACT BACKGROUND: Embolization is a promising treatment strategy for cerebral arteriovenous malformations (AVMs). However, consensus regarding the main complications or long-term outcomes of embolization in AVMs remains lacking. OBJECTIVE: To characterize the most prevalent complications and long-term outcomes in patients with AVM undergoing therapeutic embolization. DESIGN AND SETTING: This systematic review was conducted at the Federal University of Alagoas, Arapiraca, Brazil. METHODS: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Data were obtained from MEDLINE, PubMed, LILACS, and SciELO databases, which included the epidemiological profile of the population, characteristics of the proposed therapy, complications (hemorrhagic events and neurological deficits), and long-term outcomes (modified Rankin scale pre- and post-treatment, AVM recanalization, complete obliteration, and deaths). RESULTS: Overall, the analysis included 34 articles (2,799 patients). Grade III Spetzler-Martin AVMs were observed in 34.2% of cases. Notably, 39.3% of patients underwent embolization combined with radiosurgery. The most frequently reported long-term complication was hemorrhage, which occurred in 8.7% of patients at a mean follow-up period of 58.6 months. Further, 6.3% of patients exhibited neurological deficits after an average of 34.7 months. Complete obliteration was achieved in 51.4% of the cases after a mean period of 36 months. Recanalization of AVMs was observed in 3.5% of patients. Long-term death occurred in 4.0% of patients. CONCLUSION: Embolization of AVMs is an increasingly safe strategy with low long-term complications and satisfactory outcomes, especially in patients who have undergone combination therapies. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/prospero/ Registration number CRD42020204867.

Perception of verticality in the post-COVID-19 condition correlates to infection severity.

Background: SARS-CoV-2 infection affects multiple systems, including musculoskeletal, neurological, and respiratory systems. Changes associated with physical inactivity due to prolonged hospitalization can affect the functional capacity of individuals with long coronavirus disease 2019 (COVID-19) or post-COVID-19 condition and may cause changes in some postural control functions, such as verticality. Objectives: This study aimed to evaluate the perception of verticality in individuals with long COVID. Design: Cross-sectional study. Methods: This study included 60 participants with post-COVID-19 condition divided into 2 groups: hospitalized group (n = 24), those hospitalized owing to SARS-CoV-2 infection; and non-hospitalized group (n = 36), those infected with SARS-CoV-2 but not hospitalized. All participants were examined using a post-COVID-19 functional status (PCFS), sit-to-stand test, grip strength assessment, painful and tactile sensory assessments, visual acuity assessment, and vestibular assessment. Verticality perception was evaluated using the subjective visual vertical (SVV) and subjective haptic vertical (SHV) tests. In both tests, the absolute values (positive values only) and true values (positive and negative values) were considered. To verify potential confounders that could influence the verticality of the results, logistic regression models were used for categorical variables and multiple linear regressions were used for continuous variables. For analysis between groups, the independent samples test (Mann-Whitney U test) was used. Results: There were no confounders between clinical variables and verticality in either group. There was a significant increase in absolute SVV (mean deviation [MD]: 2.83; P < .0001) and true SVV (MD: -4.18; P = .005) in the hospitalized group compared to the non-hospitalized group. Furthermore, there was a significant increase in the true SHV (MD: -3.6; P = .026) in the hospitalized group compared to that in the non-hospitalized group. Conclusion: Less accurate visual and haptic verticality perception task performance was observed in hospitalized patients with post-COVID-19 condition.

Translation, Cross-Cultural Adaptation, and Validation of the Hypertension Self-Care Profile (HBP-SCP) for the Brazilian Population

Abstract Background Self-care in the management of systemic arterial hypertension (SAH) is crucial, and validated instruments can help researchers and health professionals to plan strategies to improve self-care in people with SAH. Objective The main objective of this study was to translate, cross-culturally adapt, and validated the Hypertension Self-Care Profile (HBP-SCP) for Brazilian Portuguese. Methods The translation and cross-cultural adaptation was performed in five phases, and the pre-final version was tested in 30 individuals, native speakers of Portuguese with a diagnosis of hypertension. The final version was administered in 100 individuals. The inclusion criteria were: diagnosis of SAH, characterized by systolic arterial blood pressure ≥ 140 mmHg and/or diastolic arterial blood pressure ≥ 90mmHg, regular use of antihypertensive medications and over 18 years of age. The present study also used two other questionnaires, previously validated for the Brazilian population, to verify the validity of the construct, the Healthy Habits Perception Questionnaire (HHPQ) and the Quality of Life in Hypertension Mini-Questionnaire (MINICHAL-BRASIL). Results During the translation and cross-cultural adaptation phase, there were no disagreements. Adequate reliability — intraclass correlation coefficient (ICC) ≥ 0.89, standard error of measurement (SEM) % ≤ 4.34, minimum detectable change (MDC) % ≤ 12.04 — and internal consistency (Cronbach's alpha ≥ 0.75) were observed. The behavior domain of HBP-SCP obtained significant correlations (p < 0.05) with the self-efficacy domain and HHPQ; the motivation domain with the self-efficacy domain; and the self-efficacy domain with the somatic manifestation domain of MINICHAL-BRASIL. No ceiling and floor effects were observed. Conclusions The Brazilian Portuguese version of the HBP-SCP has adequate psychometric properties, according to the best scientific recommendations.

Measurement properties of the Brazilian version of the Kidney Symptom Questionnaire.

OBJECTIVE: The aim of this study was to measure the reliability, internal consistency, and construct validity of the Kidney Symptom Questionnaire for the Brazilian population. METHODS: This is a cross-cultural adaptation and questionnaire validation study. We included native Brazilians of both sex aged>18 years, as well as hypertensive and/or diabetic patients. All participants were assessed using Screening for Occult Renal Disease, EuroQol 5 Dimensions, 36-Item Short Form Survey, and the Kidney Symptom Questionnaire. We used Spearman's coefficient (rho) to measure the correlations between the Kidney Symptom Questionnaire and other instruments; Cronbach's alpha to measure internal consistency; and intraclass correlation coefficient, standard error of measurement, and minimum detectable change to measure test-retest reliability. RESULTS: The sample was formed by 121 adult participants, mostly female, with systemic arterial hypertension and/or diabetes mellitus. We found excellent reliability (intraclass correlation coefficient≥0.978), adequate internal consistency (Cronbach's alpha≥0.860), and adequate construct validity on the Kidney Symptom Questionnaire domains; besides, we observed significant correlations between the Kidney Symptom Questionnaire and other instruments. CONCLUSION: The Brazilian version of the Kidney Symptom Questionnaire has adequate measurement properties to assess chronic/occult kidney disease in patients who do not require renal replacement therapy.

Measurement properties of the Brazilian version of the Kidney Symptom Questionnaire

SUMMARY OBJECTIVE: The aim of this study was to measure the reliability, internal consistency, and construct validity of the Kidney Symptom Questionnaire for the Brazilian population. METHODS: This is a cross-cultural adaptation and questionnaire validation study. We included native Brazilians of both sex aged>18 years, as well as hypertensive and/or diabetic patients. All participants were assessed using Screening for Occult Renal Disease, EuroQol 5 Dimensions, 36-Item Short Form Survey, and the Kidney Symptom Questionnaire. We used Spearman's coefficient (rho) to measure the correlations between the Kidney Symptom Questionnaire and other instruments; Cronbach's alpha to measure internal consistency; and intraclass correlation coefficient, standard error of measurement, and minimum detectable change to measure test-retest reliability. RESULTS: The sample was formed by 121 adult participants, mostly female, with systemic arterial hypertension and/or diabetes mellitus. We found excellent reliability (intraclass correlation coefficient≥0.978), adequate internal consistency (Cronbach's alpha≥0.860), and adequate construct validity on the Kidney Symptom Questionnaire domains; besides, we observed significant correlations between the Kidney Symptom Questionnaire and other instruments. CONCLUSION: The Brazilian version of the Kidney Symptom Questionnaire has adequate measurement properties to assess chronic/occult kidney disease in patients who do not require renal replacement therapy.

Job satisfaction and work context among rehabilitation care professionals in Alagoas, Brazil: an observational study / Satisfação no trabalho e contexto de trabalho entre profissionais de reabilitação em Alagoas, Brasil: um estudo observacional

ABSTRACT Job satisfaction is multifactorial and is directly related to the quality of health services. The main objective of this study was to characterize the level of job satisfaction and the work context of the multidisciplinary teams in specialized rehabilitation services in the state of Alagoas, Brazil. We evaluated the professional profile of participants and sociodemographic information. The Work Context Assessment Scale (WCAS) which is divided into three dimensions and questions adapted from the satisfaction and remuneration dimensions of the Great Place to Work methodology for the Organizational Climate Survey, was used. We included 190 professionals, the mean age was 35.47±9.25 and 86.3% were women. Most participants worked in the capital (60%) and 84.7% had a monthly wage ranging from R$1,000 to R$3,000. The dimension of "work organization" was crucial. The items "pace of work," "strong demand," "performance monitoring," and "repetitive tasks" presented the worst results, but 92.7% are satisfied with their professional activities. The logistic regression analysis showed that more years since graduation and lower scores of Work conditions and Socio-professional relationships were associated with higher job satisfaction. Job satisfaction was found to be high, the dimension of work organization was crucial, and almost half of the participants have already thought about leaving their careers.

RESUMEN La satisfacción laboral es multifactorial y está directamente relacionada con la calidad de los servicios de salud. El objetivo principal de este estudio fue identificar el nivel de satisfacción y el contexto de trabajo de equipos multidisciplinarios en servicios especializados de rehabilitación en el estado de Alagoas, Brasil. Se evaluó el perfil profesional y el perfil sociodemográfico, y se aplicaron la Escala de Evaluación del Contexto de Trabajo (EACT), dividida en tres dimensiones, y preguntas adaptadas de las dimensiones de satisfacción y remuneración de la metodología de encuesta de clima organizacional, Great Place to Work. Se incluyeron a 190 profesionales, de los cuales el 86,3% eran mujeres, y la edad media fue de 35,47±9,25 años. La mayoría trabajaba en la capital (60%) y el 84,7% ganaba entre R$1.000 y R$3.000. La dimensión "organización del trabajo" fue crítica. Los ítems "ritmo de trabajo", "exigencia de resultados", "control del rendimiento" y "tareas repetitivas" obtuvieron los peores resultados, pero el 92,7% de los participantes estaban satisfechos con su actividad profesional. La regresión logística mostró que a más años de formación y puntuaciones más bajas en las dimensiones "condiciones de trabajo" y "relación socioprofesional" se asociaban a una mayor satisfacción laboral. La satisfacción laboral fue alta, la dimensión "organización del trabajo" crítica, y casi la mitad de los participantes había pensado en dejar su carrera.

RESUMO A satisfação no trabalho é multifatorial e está diretamente relacionada com a qualidade dos serviços de saúde. O objetivo principal deste estudo foi caracterizar o nível de satisfação e o contexto de trabalho de equipes multidisciplinares de serviços especializados em reabilitação no estado de Alagoas, Brasil. Foi avaliado o perfil profissional e sociodemográfico e foram aplicadas a escala de avaliação do contexto de trabalho (EACT), que é dividida em três dimensões, e questões adaptadas das dimensões de satisfação e remuneração da metodologia Great Place to Work da pesquisa de clima organizacional. Incluímos 190 profissionais, sendo 86,3% do sexo feminino, e a idade média foi de 35,47±9,25 anos. A maioria trabalhava na capital (60%) e 84,7% recebiam mensalmente de R$ 1.000,00 a R$ 3.000,00. A dimensão organização do trabalho foi considerada crítica. Os itens ritmo de trabalho, cobrança por resultados, fiscalização do desempenho e tarefas repetitivas tiveram os piores resultados, mas 92,7% dos participantes estavam satisfeitos com suas atividades profissionais. A regressão logística mostrou que mais anos de formado e menores pontuações nas dimensões condições de trabalho e relações socioprofissionais estão associados com maior satisfação no trabalho. A satisfação no trabalho foi alta, a dimensão organização do trabalho crítica, e quase metade dos participantes já pensaram em deixar sua carreira.

Stroke in the state of Alagoas, Brazil: a descriptive analysis of a northeastern scenario.

BACKGROUND: There is little information available on stroke epidemiology in the northeast of Brazil. OBJECTIVE: Our objective was to investigate the prevalence of the stroke subtypes, prevalence of cerebrovascular risk factors and patterns of management in a public neurovascular outpatient referral service, in Alagoas. METHODS: Data were prospectively collected from consecutive patients with stroke who were treated in a specialized neurovascular clinic between November 2016 and June 2018. Recurrence was evaluated by telephone 12 months after patients had been included in the study. RESULTS: We evaluated 190 patients (mean age, 60.22 ( 13.29 years; 60.5% males). Ischemic stroke was the most frequent subtype (85.2%). Sedentary lifestyle was the most common risk factor (71.6%), followed by hypertension (62.6%) and stroke family history (41.1%). Only 21.5% of the patients were transported by ambulance to the hospital, and 42.6% received medical support in hospital units or emergency units with no imaging support. The median NIHSS was 2.5 (IQR, 1-5) and mRS was 2 (IQR, 1-3). We found a high rate of undetermined stroke (35.8%), and few patients completed the etiological investigation. One year after inclusion in the study, 12 patients (6.3%) had died and 14 (7.3%) had had another stroke. CONCLUSIONS: The prevalence of cerebrovascular risk factors and clinical presentation were similar to what had been seen in previous series. A notable number of patients received medical support in institutions with no imaging equipment. The high number of cases of undetermined stroke etiology shows the difficulty in accessing healthcare services in Alagoas.

Stroke in the state of Alagoas, Brazil: a descriptive analysis of a northeastern scenario / Acidente vascular cerebral no estado de Alagoas, Brasil: análise descritiva de um cenário do nordeste brasileiro

ABSTRACT Background There is little information available on stroke epidemiology in the northeast of Brazil. Objective Our objective was to investigate the prevalence of the stroke subtypes, prevalence of cerebrovascular risk factors and patterns of management in a public neurovascular outpatient referral service, in Alagoas. Methods Data were prospectively collected from consecutive patients with stroke who were treated in a specialized neurovascular clinic between November 2016 and June 2018. Recurrence was evaluated by telephone 12 months after patients had been included in the study. Results We evaluated 190 patients (mean age, 60.22 ( 13.29 years; 60.5% males). Ischemic stroke was the most frequent subtype (85.2%). Sedentary lifestyle was the most common risk factor (71.6%), followed by hypertension (62.6%) and stroke family history (41.1%). Only 21.5% of the patients were transported by ambulance to the hospital, and 42.6% received medical support in hospital units or emergency units with no imaging support. The median NIHSS was 2.5 (IQR, 1-5) and mRS was 2 (IQR, 1-3). We found a high rate of undetermined stroke (35.8%), and few patients completed the etiological investigation. One year after inclusion in the study, 12 patients (6.3%) had died and 14 (7.3%) had had another stroke. Conclusions The prevalence of cerebrovascular risk factors and clinical presentation were similar to what had been seen in previous series. A notable number of patients received medical support in institutions with no imaging equipment. The high number of cases of undetermined stroke etiology shows the difficulty in accessing healthcare services in Alagoas.

RESUMO Antecedentes Até o momento existe pouca informação disponível na literatura sobre a epidemiologia do acidente vascular verebral (AVC) no nordeste brasileiro. Objetivo Investigar a prevalência dos subtipos de AVC, dos fatores de risco para doenças cerebrovasculares e o manejo do AVC em um serviço público especializado em Alagoas. Método Os dados foram coletados de forma prospectiva e consecutiva de pacientes com diagnóstico de AVC em um ambulatório especializado em neurovascular, de novembro de 2016 a junho de 2018. Recorrência do AVC foi avaliada por telefone 12 meses após a inclusão no estudo. Resultados Foram avaliados 190 pacientes, idade média de 60,22(13,29 anos, 60,5% homens. AVC isquêmico foi o subtipo mais comum (85,2%). Sedentarismo foi o fator de risco mais prevalente (71,6%), seguido de hipertensão (62,6%) e história familial de AVC (41,1%). Somente 21,5% dos pacientes foram transportados por ambulância até o hospital e 42,6% receberam o primeiro atendimento em serviço médico sem suporte de exame de imagem. A mediana do NIHSS foi 2,5 (IQR, 1-3). Encontramos alta prevalência de AVC indeterminado (35,8%) e poucos pacientes completaram a investigação etiológica. Após um ano da inclusão no estudo, 12 pacientes (6,3%) morreram e 14 (7,3%) tiveram outro AVC. Conclusão A prevalência dos fatores de risco para doenças cerebrovasculares e a apresentação clínica foram similares a séries prévias. Um número expressivo de pacientes recebeu atendimento médico em locais sem exames de imagem. Houve alto número de pacientes com AVC indeterminado, o que mostra a dificuldade de acesso ao sistema de saúde em Alagoas.

Analysis of Verticality Perception in Older Adults With and Without Acute Stroke in Half-Lying Versus Sitting Positions.

Currently, there is no research consensus regarding the influence of body position on verticality perception in acute stroke. In this study, we aimed to compare the influence of half-lying and sitting positions on measurements of the subjective visual vertical (SVV) and the subjective haptic vertical (SHV) of individuals in the acute stroke phase. In this cross-sectional study, we compared these positional experiences in two groups of participants: adults in the acute stroke phase and elderly individuals without stroke. Independent variables were stroke versus no-stroke groups, in half-lying versus sitting positions. Analyzed variables of related interest were cognition (Mini-Mental State Examination or MMSE), stroke severity (National Institutes of Health Stroke Scale or NIHSS), and trunk control (Trunk Impairment Scale or TIS). Dependent variables were visual and haptic verticality, as evaluated by SVV and SHV. There were observed differences in absolute SVV in sitting position between groups (p = 0.021), absolute SVV in half-lying position between groups (p = 0.033), absolute SHV in sitting position between groups (p = 0.003), absolute SHV in half-lying position between groups (p = 0.002), and constant SVV in half-lying position between groups (p = 0.007). In the stroke group there was a higher coefficient of variation of SVV and SHV in the half-lying position compared to sitting position. In the sitting position, we observed a very strong correlation between the TIS and absolute SHV (p = 0.008). We concluded that individuals in the acute phase of stroke had greater misperceptions of visual and haptic verticality than older adults without strokes and that individuals in the acute phase of stroke showed less variability in visual and haptic vertical perception in the sitting position than in the half-lying position. By implication, we should encourage the sitting position in the acute stroke phase and develop early strategies to increase the verticality perception.

Prevalence of Systemic Arterial Hypertension and Diabetes Mellitus in Individuals with COVID-19: A Retrospective Study of Deaths in Pernambuco, Brazil. / Prevalência de Hipertensão Arterial Sistêmica e Diabetes Mellitus em Indivíduos com COVID-19: Um Estudo Retrospectivo de Óbitos em Pernambuco, Brasil.

Hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM) são dois dos principais fatores de risco para a mortalidade por COVID-19. Descrever a prevalência e o perfil clínico-epidemiológico de óbito por COVID-19 ocorridos em Pernambuco, Brasil, entre 12 de março e 14 de maio de 2020 entre pacientes que possuíam hipertensão arterial sistêmica e/ou diabetes mellitus como doenças prévias. Estudo observacional transversal. Foram analisadas as seguintes variáveis: município de procedência, sexo, faixa etária, tempo entre o início dos sinais/sintomas e o óbito, sinais/sintomas, tipo de comorbidades e hábitos de vida. Variáveis categóricas foram descritas por meio de frequências e variáveis contínuas por meio de medidas de tendência central e de dispersão. Os testes de Mann-Whitney e Kruskal-Wallis foram utilizados. Dos 1.276 registros incluídos no estudo, 410 apresentavam HAS e/ou DM. A prevalência de HAS foi 26,5% (n=338) e de DM foi 19,7% (n=252). Dos registros, 158 (12,4%) eram de pacientes que possuíam somente HAS, 72 (5,6%) somente DM e 180 (14,1%) apresentavam HAS e DM. Dos indivíduos com HAS, 53,3% apresentavam DM e 71,4% dos diabéticos apresentam HAS. A mediana (em dias) do tempo entre o início dos sinais/sintomas e o desfecho óbito foi 8,0 (IIQ 9,0), sem diferença significativa entre os grupos de comorbidades (p=0,633), sexo (p=0,364) e faixa etária (p=0,111). Observou-se maior prevalência de DM e HAS na população masculina (DM ­ 61,3% eram homens e 38,9% mulheres; HAS ­ 53,2% eram homens e 46,8% mulheres). Os sinais/sintomas mais frequentes foram dispneia (74,1%; n=304), tosse (72,2%; n=296), febre (68,5%; n=281) e saturação de O2<95% (66,1%; n=271). Dos hipertensos, 73,3% (n=100) apresentavam outras comorbidades/fatores de risco associados, e 54,2% (n=39) dos diabéticos apresentavam outras comorbidades/fatores de risco associados. Destacaramse as cardiopatias (19,5%; n=80), obesidade (8,3%; n=34), doença respiratória prévia (7,3%; n=30) e nefropatia (7,8%; n=32). A prevalência de tabagismo foi 8,8% (n=36) e de etilismo alcançou 3,4% (n=14). O estudo mostrou que a prevalência de HAS foi superior à prevalência de DM nos indivíduos que foram a óbito por COVID-19. Em idosos, a prevalência foi superior à observada em indivíduos não idosos.

Prevalência de hipertensão arterial sistêmica e diabetes mellitus em indivíduos com covid-19: um estudo retrospectivo de óbitos em pernambuco, brasil / Prevalence of systemic arterial hypertension and diabetes mellitus in individuals with covid-19: a retrospective study of deaths in pernambuco, brazil

Resumo Hipertensão arterial sistêmica (HAS) e diabetes mellitus (DM) são dois dos principais fatores de risco para a mortalidade por COVID-19. Descrever a prevalência e o perfil clínico-epidemiológico de óbito por COVID-19 ocorridos em Pernambuco, Brasil, entre 12 de março e 14 de maio de 2020 entre pacientes que possuíam hipertensão arterial sistêmica e/ou diabetes mellitus como doenças prévias. Estudo observacional transversal. Foram analisadas as seguintes variáveis: município de procedência, sexo, faixa etária, tempo entre o início dos sinais/sintomas e o óbito, sinais/sintomas, tipo de comorbidades e hábitos de vida. Variáveis categóricas foram descritas por meio de frequências e variáveis contínuas por meio de medidas de tendência central e de dispersão. Os testes de Mann-Whitney e Kruskal-Wallis foram utilizados. Dos 1.276 registros incluídos no estudo, 410 apresentavam HAS e/ou DM. A prevalência de HAS foi 26,5% (n=338) e de DM foi 19,7% (n=252). Dos registros, 158 (12,4%) eram de pacientes que possuíam somente HAS, 72 (5,6%) somente DM e 180 (14,1%) apresentavam HAS e DM. Dos indivíduos com HAS, 53,3% apresentavam DM e 71,4% dos diabéticos apresentam HAS. A mediana (em dias) do tempo entre o início dos sinais/sintomas e o desfecho óbito foi 8,0 (IIQ 9,0), sem diferença significativa entre os grupos de comorbidades (p=0,633), sexo (p=0,364) e faixa etária (p=0,111). Observou-se maior prevalência de DM e HAS na população masculina (DM — 61,3% eram homens e 38,9% mulheres; HAS — 53,2% eram homens e 46,8% mulheres). Os sinais/sintomas mais frequentes foram dispneia (74,1%; n=304), tosse (72,2%; n=296), febre (68,5%; n=281) e saturação de O2<95% (66,1%; n=271). Dos hipertensos, 73,3% (n=100) apresentavam outras comorbidades/fatores de risco associados, e 54,2% (n=39) dos diabéticos apresentavam outras comorbidades/fatores de risco associados. Destacaramse as cardiopatias (19,5%; n=80), obesidade (8,3%; n=34), doença respiratória prévia (7,3%; n=30) e nefropatia (7,8%; n=32). A prevalência de tabagismo foi 8,8% (n=36) e de etilismo alcançou 3,4% (n=14). O estudo mostrou que a prevalência de HAS foi superior à prevalência de DM nos indivíduos que foram a óbito por COVID-19. Em idosos, a prevalência foi superior à observada em indivíduos não idosos.

COVID-19 in Brazil: spatial risk, social vulnerability, human development, clinical manifestations and predictors of mortality - a retrospective study with data from 59 695 individuals.

Brazil ranks second in the number of confirmed cases of COVID-19 worldwide. In spite of this, coping measures differ throughout the national territory, as does the disease's impact on the population. This cross-sectional observational study, with 59 695 cases of COVID-19 registered in the state of Alagoas between March and August 2020, analysed clinical-epidemiological variables, incidence rate, mortality rate, case fatality rate (CFR) and the social indicators municipal human development index (MHDI) and social vulnerability index (SVI). Moran statistics and regression models were applied. Logistic regression analysis was applied to determine the predictors of death. The incidence rate was 1788.7/100 000 inhabitants; mortality rate was 48.0/100 000 and CFR was 2.7%. The highest incidence rates were observed in municipalities with better human development (overall MHDI (I = 0.1668; p = 0.002), education MHDI (I = 0.1649; p = 0.002) and income MHDI (I = 0.1880; p = 0.005)) and higher social vulnerability (overall SVI (I = 0.0599; p = 0.033)). CFR was associated with higher social vulnerability (SVI human capital (I = 0.0858; p = 0.004) and SVI urban infrastructure (I = 0.0985; p = 0.040)). Of the analysed cases, 55.4% were female; 2/3 were Black or Brown and the median age was 41 years. Among deaths, most were male (919; 57.4%) and elderly (1171; 73.1%). The predictors of death were male sex, advanced age and the presence of comorbidities. In Alagoas, Brazil, the disease has undergone a process of interiorisation and caused more deaths in poorer municipalities. The presence of comorbidities and advanced age were predictors of death.

Functional outcomes among stroke patients in Alagoas, Brazil: observational study

ABSTRACT BACKGROUND: Stroke is the principal cause of disability around the world and the ensuing functional dependence (FD) can be correlated with different factors. OBJECTIVE: To determine how demographic factors and clinical characteristics after stroke distinguish patients who achieve functional independence from those who do not. DESIGN AND SETTING: Observational study at specialized neurovascular clinic in Alagoas, Brazil. METHODS: FD was classified according to the modified Rankin scale (mRs): 0 to 2 points were classified as independent (FD-), and 3 to 5 points were classified as dependent (FD+). Logistic regression analysis included age, sedentary lifestyle, the Center for Epidemiological Studies - Depression Scale (CES-D) and the National Institutes of Health Stroke Scale (NIHSS). The Mann-Whitney test and χ2 test were used to compare groups. RESULTS: We included 190 stroke patients with a mean age of 60.02 ± 14.22 years. We found that 34.8% of the patients were classified as FD+. Lower NIHSS and CES-D scores were more associated with achieving functional independence. Most of the patients had access to physical therapy, and the mean duration of rehabilitation therapy was 65.2 minutes per week. Females had higher prevalence of depressive symptoms (P = 0.005) and rehabilitation time was shorter for hemorrhagic stroke (P = 0.02). CONCLUSION: We found a FD rate four times greater than in another Brazilian study. Lower stroke severity and fewer depressive symptoms were associated with achieving functional independence. Less than half of the patients were referred to a rehabilitation service at hospital discharge and few had access to multidisciplinary treatment.