Prevalence of stroke survival in rural communities living in northern Peru.

BACKGROUND AND PURPOSE: Stroke is the leading cause of neurological impairment in the South American Andean region. However, the epidemiology of stroke in the region has been poorly characterized. METHODS: We conducted a staged three-phase population-based study applying a validated eight-question neurological survey in 80 rural villages in Tumbes, northern Peru, then confirmed presence or absence of stroke through a neurologist's examination to estimate the prevalence of stroke. RESULTS: Our survey covered 90% of the population (22,278/24,854 individuals, mean age 30±21.28, 48.45% females), and prevalence of stroke was 7.05/1,000 inhabitants. After direct standardization to WHO's world standard population, adjusted prevalence of stroke was 6.94/1,000 inhabitants. Participants aged ≥85 years had higher stroke prevalence (>50/1000 inhabitants) compared to other stratified ages, and some unusual cases of stroke were found among individuals aged 25-34 years. The lowest age reported for a first stroke event was 16.8 years. High blood pressure (aPR 4.2 [2.7-6.4], p>0.001), and sedentary lifestyle (aPR 1.6 [1.0-2.6], p = 0.045) were more prevalent in people with stroke. CONCLUSIONS: The age-standardized prevalence of stroke in this rural coastal Peruvian population was slightly higher than previously reported in studies from surrounding rural South American settings, but lower than in rural African and Asian regions. The death rate from stroke was much higher than in industrialized and middle-income countries.

Implicancias éticas en la atención hospitalaria a personas con discapacidad intelectual: una revisión narrativa

Las personas con discapacidad intelectual (PDI) son propensas a complicaciones durante algunas enfermedades debido a sus comorbilidades, por lo que requieren una atención hospitalaria diferenciada; sin embargo, no suelen recibir un trato idóneo y muchas veces se vulneran sus derechos, sobre todo en el ámbito ético. Los principios de justicia, no maleficencia, beneficencia y autonomía podrían estar transgrediéndose en el ámbito hospitalario no solo por parte del personal de salud, quienes, en oportunidades, brindan un trato deshumanizado y con poco involucramiento del cuidador, sino también por los sistemas de atención hospitalaria que no consideran las limitaciones, inequidades y necesidades prioritarias. Para identificar esta realidad se ha realizado la presente revisión narrativa donde se encontró 484 artículos de bases como Pubmed, Scopus y Lilacs, de los cuales se han incluido 53. Se destaca la escasa información directamente relacionada a la ética en la atención hospitalaria, sin embargo, se analizaron temas relacionados como salud reproductiva, trasplante, manejo de enfermedades crónicas y promoción de la salud, y se resaltó las faltas a la autonomía y justicia, principalmente. Luego de la revisión, se llegó a la conclusión de la importancia de difundir los principios éticos para todo el personal del sector salud, desde el inicio de su formación, así como sensibilizar a los decisores del rubro respecto al trato a las personas con discapacidad intelectual, especialmente en el ámbito hospitalario, donde se requiere un sistema de atención diferenciado y justo que favorezca la integración, el acceso y la comunicación.

People with intellectual disabilities (PID) are prone to complications during some illnesses due to their comorbidities, thus requiring differentiated hospital care. However, they do not usually receive an appropriate treatment and their rights are often violated, especially in the ethical field. The principles of justice, non-maleficence, beneficence and autonomy could be violated in hospital settings not only by health personnel, who sometimes provide dehumanized treatment and with little involvement of the caregiver, but also by hospital care systems, which do not consider PID's limitations, inequalities and priority needs. To identify this reality, the present narrative review was conducted, finding 484 articles in databases such as PubMed, Scopus and LILACS, out of which 53 were included. The scarcity of information directly related to ethics in hospital care stands out; however, related topics such as reproductive health, transplantation, management of chronic diseases and health promotion were analyzed, mainly highlighting the lack of autonomy and justice. After the review, it was concluded that it is important to disseminate ethical principles to all healthcare personnel, from the beginning of their education, as well as to sensitize healthcare decision-makers regarding the treatment of PID, especially in hospital settings, where a differentiated and fair care system that favors integration, access and communication is required.