RESUMO
OBJECTIVES: Stroke epidemiology varies among different populations. The burden of stroke is high in low- and middle-income countries. Reliable population data is needed to assess the impact of stroke and to develop policies aimed to improve stroke care in our region. EstEPA is a population-based project assessing prevalence, incidence, mortality and burden of stroke in General Villegas Department, Buenos Aires, Argentina (pop=30,864 inhabitants). We determined incidence of stroke (first-ever and recurrent stroke) and stroke case-fatality rate from 2017 to 2020. METHODS: First-ever strokes, recurrent strokes and transient ischemic attacks were ascertained and case-fatality rate was obtained. Diagnoses were based on standard AHA/WHO definitions. Study population included all persons residing in General Villegas during the three-year period. Hospitals, households, nursing homes, death certificates and several overlapping sources were surveyed. RESULTS: We assessed 92,592 person-years. There were 155 cerebrovascular events aged 70 years (SD ± 13 years), of which 115 were first-ever strokes (74%), 21 recurrent strokes (13.5%) and 19 transient ischemic attacks (12.5%). The crude overall incidence rate of first-ever strokes was 124.2 per 100,000 population (86.9 per 100,000 [95% CI 58.5-115.2] when standardized by WHO World population and 109.7 per 100,000 [95% CI 89.7-129.8] when standardized by Argentine population) and 317.0 per 100,000 population in subjects older than 40 years. Case fatality rate at 30 days of first-ever strokes was 27%. CONCLUSION: In this population-based comprehensive stroke epidemiological study in Argentina, first-ever stroke incidence in an urban population was 124.2 per 100,000 population (86.9 per 100,000 adjusted by the WHO World population). This is lower than the incidence in other countries in the region and similar to a recent incidence study in Argentina. It is also comparable to reported incidence in most middle- and high-income countries. Stroke case-fatality rate was comparable to other population-based Latin-American studies.
Assuntos
Ataque Isquêmico Transitório , Acidente Vascular Cerebral , Humanos , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/epidemiologia , Incidência , Argentina/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Casas de SaúdeRESUMO
OBJECTIVES: Stroke knowledge is poor in the general population worldwide. Yet, data from Spanish-Speaking populations, particularly in Latin America, are scant. We aim to evaluate stroke awareness using personal interviews in a population-based study. MATERIALS AND METHODS: A questionnaire of stroke awareness was administered to a randomly selected sample of households. "Good stroke knowledge for action" was defined as recognition of impaired strength, sensation and language plus intention to seek urgent medical attention in a hypothetical stroke situation. Demographics, the term to name stroke, recognition of warning signs and attitude towards seeking medical attention were compared between individuals with and without "good stroke knowledge for action". RESULTS: From 1986 respondents (87%, median age 59 years [IQR 23], 50.7% female), most recognized stroke as ACV (cerebrovascular accident, [63%]). Weakness/decreased sensation were recognized as stroke warning signs by 83.5% of respondents, followed by aphasia (77.9%), incoordination (71.6%) and headache (70.5%). Chest pain was misclassified as stroke warning sign by 25% of subjects. In a hypothetical stroke situation, most respondents would go to the hospital (52.3%), or activate the EMS (39%). Individuals with a good stroke knowledge for action (63.5%) recognized visual symptoms (60.4% vs 43.8, p<0.0001), incoordination (78.8% vs 34.4%, p<0.0001) and headache (70.5% vs. 57.8%, p<0.0001) more frequently, and were less likely to misrecognize chest pain as stroke warning sign (23.8% vs. 28.9%, p=0.015). Neither, age (OR 1 CI 0.99-1.00, p=0.94), gender (OR 0.95, CI 0.79-1.16, p=0.61) or race (OR 1.17, CI 0.97-1.42, p=0.097) predicted good stroke knowledge for action. CONCLUSIONS: Most people recognize stroke as ACV. The recognition of stroke warning signs and the attitude towards seeking emergent medical attention appears acceptable. Yet, most respondents would go directly to the hospital avoiding the EMS.
Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Letramento em Saúde , Acidente Vascular Cerebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Argentina/epidemiologia , Conscientização , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Reconhecimento Psicológico , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Epidemiological data on stroke is scarce in Latin America. Estudio Epidemiológico Poblacional sobre Accidente Cerebrovascular (EstEPA) is a population-based program planned to assess prevalence, incidence, mortality, and burden of disease for stroke in the Department of General Villegas, province of Buenos Aires, Argentina. METHODS AND DESIGN: Prevalence study will consist of a two-phase survey approach in the urban area of General Villegas. First, trained social workers with a structured questionnaire will collect data in 2000 randomly selected housing units. Those subjects screened positive for possible strokes will be interviewed and examined by stroke neurologists to confirm diagnosis. The incidence study will be performed according to the methodology of WHO STEPS stroke surveillance manual and will detect all new strokes in the department during a 5-year period. General and disease-specific mortality rates will be assessed monthly during a 5-year period, using different sources of information. To assess the overall burden of cerebrovascular disease, disability adjusted life years will be calculated. DISCUSSION: EstEPA will assess for the first time all aspects of stroke epidemiology in Argentina. Its results will help to implement population-based interventions and to properly allocate public health resources.
Assuntos
Acidente Vascular Cerebral/epidemiologia , Argentina/epidemiologia , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Humanos , Incidência , Masculino , Prevalência , Projetos de Pesquisa , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The geographic distribution of multiple sclerosis (MS) is classically divided into three zones based on frequency that were established by Kurtzke in the early 1970s. In recent years, an increasing number of epidemiological studies have shown significantly higher MS prevalence and incidence rates. OBJECTIVE: The aim of this study was to review and update the geographic distribution of MS using incidence, prevalence and disease duration from the latest epidemiology surveys. METHODS: We conducted a systematic review of articles on MS epidemiology published between January 1, 1990 and December 31, 2012. RESULTS: MS studies were grouped by continent: the Americas, Europe, Asia, Australia/New Zealand, and Africa. A total of 101 studies were identified according to the inclusion criteria, and 58 reported incidence estimates. Globally, the median estimated incidence of MS was 5.2 (range: 0.5-20.6) per 100,000 p-yrs, the median estimated prevalence of MS was 112.0 (with a range of 5.2-335) per 100,000 p-yrs, and the average disease duration was 20.2 years (range: 7.6-36.2). CONCLUSION: In the past few decades, the global prevalence and incidence patterns of MS have changed dramatically. Regardless of the reason of increasing prevalence and incidence rate, we suggest the need for a novel classification system based on global MS disease burden. Adopting such a system would improve economic efficiency and prioritization in health policy planning for MS.
Assuntos
Saúde Global , Esclerose Múltipla/classificação , Feminino , Humanos , Incidência , Masculino , Esclerose Múltipla/diagnóstico , Esclerose Múltipla/epidemiologia , Prevalência , Estudos RetrospectivosRESUMO
OBJECTIVE: To ascertain the prevalence of epilepsy in Junín, a town of 70,000-80,000 inhabitants from the Province of Buenos Aires, Argentina. BACKGROUND: Some South American communities have reported extremely high prevalences of epilepsy. We investigated whether Junín would also have a high prevalence. DESIGN/METHODS: Systematic sampling was used to select 5,839 households (sampling fraction = 25%). Participating households amounted to 5,648 (97%), with 17,049 persons. A two-phase case-finding strategy was used. Phase 1 was the screening of the 17,049 persons, which was performed by trained but medically unsophisticated interviewers. Phase 2 was the neurological evaluation of the 250 persons who were screened positive for epilepsy. Diagnoses were based on defined diagnostic criteria. RESULTS: As of January 1, 1991 (prevalence day), 106 persons had epilepsy, including 64 (60%) with active epilepsy. Among these, 9 (14%) were epilepsy cases newly diagnosed by survey neurologists, and 50 (78%) were on antiepileptic treatment at the time of the survey. Regarding the same 64 persons, seizures were generalized in 37 (58%) and partial in 24 (38%). Lifetime prevalence of epilepsy was 6.2/1,000 (6.3/1,000, age adjusted to the world standard population). Total point prevalence for active epilepsy was 3.8/1,000 (4.0 for females and 3.5 for males). In addition, prevalence peaked at the ages of 40-59 for females and 0-4 for males. CONCLUSIONS: This is one of the first community-based studies of epilepsy in Argentina, and the prevalence results provide new epidemiological data contributing to our understanding of the different prevalence rates found in Latin America.
Assuntos
Epilepsia/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Anticonvulsivantes/uso terapêutico , Argentina/epidemiologia , Criança , Pré-Escolar , Epilepsia/diagnóstico , Epilepsia/tratamento farmacológico , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Distribuição por Sexo , Saúde da População UrbanaRESUMO
OBJECTIVE: To determine the prevalence of stroke and its distribution by age, sex and clinical type, and to use the outcomes for prevention, care and rehabilitation. DESIGN/METHOD: The survey was conducted in Junín, a town of about 75,000 inhabitants, situated in an agricultural region of the Province of Buenos Aires, Argentina. Systematic sampling was used to select 5,839 dwellings (sampling fraction approximately 25%) and 5,648 (97%) households participated in our study, including 17,049 participants. The initial stage of the study involved a case-finding strategy consisting of a two-stage screening approach in the selected households; household screening was followed by neurological examination. We used a point prevalence with reference date January 1, 1991. Stroke was defined according to the WHO criteria. RESULTS: As of January 1, 1991, 148 subjects were identified as cases of stroke (79.6% ischemic and 20.4% hemorrhagic). Point prevalence ratio was 868.1 cases per 100,000 inhabitants in the total population (473.4/100,000 age adjusted to the worldwide population) and 1,867.4 in those patients of 40 years of age or older (1,534.4/100,000 age adjusted to the worldwide population). In both sexes, prevalence increased with age. However, this increase was more significant and sustained in men of 50 years of age and older. Moderate to severe disability was observed in 52% of patients. CONCLUSION: This is one of the first community-based studies conducted in Argentina about the prevalence of stroke. Final results are similar to those reported in other developed countries.