Incidence, risk factors, prognosis, and health-related quality of life after stroke in a low-resource community in Chile (ÑANDU): a prospective population-based study.

BACKGROUND: Stroke is a leading cause of disability and death worldwide. The best estimates of local, national, and global burden of stroke are derived from prospective population-based studies. We aimed to investigate the incidence, risk factors, long-term prognosis, care, and quality of life after stroke in the Ñuble region of Chile. METHODS: We did a prospective community-based study with use of multiple overlapping sources of hospitalised, ambulatory, and deceased cases. Standardised diagnostic criteria were used to identify and follow up all cases occurring in the resident population of the Ñuble region, Chile (in a low-income rural-urban population including predominantly people of Indigenous-European heritage), for 1 year. Participants were included if they had a clinical diagnosis of stroke confirmed according to the study criteria. All cases were adjudicated by vascular neurologists. Incidence rates of first-ever stroke were calculated from the population of Ñuble according to the 2017 national census. FINDINGS: From April 1, 2015, to March 31, 2016, we ascertained 1103 stroke cases, of which 890 (80·7%) were first-ever incident cases. The mean age of patients with first-ever stroke was 70·3 years (SD 14·1) and 443 (49·8%) were women. A CT scan was obtained in 801 (90%) of 890 patients (mean time from symptom onset to scan of 13·4 h (SD 29·8). The incidence of first-ever stroke age-adjusted to the world population was 121·7 (95% CI 113·7-130·1) per 100 000. The age-adjusted incidence rates, per 100 000 inhabitants, by main pathological subtypes were as follows: ischaemic stroke (101·5 [95% CI 90·9-113·0]); intracerebral haemorrhage (17·9 [13·5-23·4]), and subarachnoid haemorrhage (4·2 [2·1-7·3]). The 30-day case-fatality rate was 24·6% (21·9-27·6). At 6 months after the stroke, 55·9% (432 of 773) of cases had died or were disabled, which increased to 61·0% (456 of 747) at 12 months. Health-related quality of life in survivors was low at 6 months, improving slightly at 12 months after the stroke. INTERPRETATION: The incidence of stroke in this low-resource population was higher than our previous finding in northern Chile and within the mid-range of most population-based stroke studies. This result was due mainly to a higher incidence of ischaemic stroke, probably associated with increasing age and a high prevalence of cardiometabolic risk factors in the population studied. Our findings suggest that more should be done for the prevention and care of stroke in communities like the Ñuble population. FUNDING: The National Agency for Research and Development and the Technology-Health Research Fund, Clínica Alemana de Santiago, Boehringer Ingelheim, Bristol Meyers Squibb, The Herminda Martin Clinical Hospital of Chillán, Universidad Mayor, and Universidad de Concepción.

Dolor del recién nacido expuesto a procedimientos de enfermería en la unidad de neonatología de un hospital clínico chileno / Pain in the newborn in a neonatology unit of a clinical chilean hospital

El objetivo de este estudio fue valorar la intensidad del dolor en los recién nacidos frente a procedimientos de enfermería, que les fueron realizados con ocasión de los cuidados y tratamiento. Se sustentó desde la visión humanista del cuidado de Jean Watson. Metodología: Estudio descriptivo-correlacional, de corte transversal, cuya población estuvo constituida por recién nacidos hospitalizados en la Unidad de Neonatología del Hospital Clínico Herminda Martín de Chillán, en el período de junio a septiembre del año 2015. Para Valorar el dolor se aplicó la escala de valoración del dolor de Susan Givens Bell y un cuestionario semiestructurado de variables sociodemográficas. Resultados: La muestra estuvo conformada por 52 Recién Nacidos en un porcentaje igual de hombres y mujeres. El mayor número de procedimientos realizados fueron instalación de sonda orogástrica, punción venosa y arterial, siendo esta última la causante de dolor moderado en el R.N. El nivel de dolor presentado por la muestra, fue en un 42,3% dolor intenso, el 23,1% dolor moderado y en un 34,6 % no presentó dolor. El Instrumento presentó una confiabilidad con un alfa de Crombach de 0,802. Conclusiones: Los prematuros menores de 37 semanas sintieron mayor dolor que los RN de término.El peso de nacimiento se observó que a mayor peso mayor es el dolor. El APGAR de nacimiento en el estudio se observó que hay una relación directa, pero débil, que a mayor APGAR al nacer, mayor es dolor (AU)

This study was aimed to assess the intensity of pain in newborns against nursing treatments, which were performed during care and treatment. This was sustained from the humanist view of Jean Watson. Method: A cross-sectional descriptive-correlational study, whose population consisted of newborns hospitalized at the Neonatology Unit of the Herminda Martin Clinical Hospital of Chillán, Chile, in the period between June and September, 2015. In order to assess pain, Susan Givens Bell Assessment Scale was applied, as well as a semi-structured Questionnaire of sociodemographic variables. Results: The sample consisted of 52 newborns in an equal percentage of men and women. The greatest number of procedures was the nasogastric tube insetion, venipuncture and arterial puncture, being the latter the cause of moderate pain in newborns. The level of pain presented by the sample was 42.3% intense pain, 23.1% moderate pain and in 34.6% no pain was presented. The instrument presented reliability with a Cronbach’s alpha of 0.802. Conclusions: Premature infants under 37 weeks felt greater pain than full-term newborns. Regarding Barth weight, it was observed that the greater the weight, the grater the pain. Birth APGAR in the study indicated that there is a direct but weak relation and the higher APGAR at birth, the greater the pain (AU)

Rendimiento masticatorio y nivel de satisfacción de pacientes tratados con prótesis totales en la Universidad Mayor / Masticatory performance and satisfaction level in patients treated with complete dentures

Se realizó un estudio para medir y comparar el rendimiento masticatorio empleando el Test de Manly en 2 grupos de 18 individuos cada uno. El primer grupo estaba conformado por pacientes desdentados totales tratados en la Universidad Mayor en el año 2012 con prótesis totales removibles, y el segundo grupo, por pacientes con dentadura natural completa. Además, al grupo de pacientes rehabilitados con prótesis totales se le aplicó la encuesta GOHAI para conocer el nivel de satisfacción con el uso de sus prótesis. Los resultados muestran que el rendimiento masticatorio es muy superior en los individuos dentados naturales con respecto a los portadores de prótesis totales, y esta diferencia es estadísticamente significativa. Los pacientes portadores de prótesis totales señalan un bajo nivel de satisfacción con el uso de sus dentaduras completas, en especial durante la función masticatoria.

This study was conducted in order to measure and compare the masticatory performance using the Manly Test in 2 groups of 18 people. The first group was formed by edentulous patients treated in the Universidad Mayor of Santiago, Chile, in 2012 with removable dentures, and the second group consisted of patients with complete natural dentition. In addition, the GOHAI questionnaire was also applied to determinate the level of satisfaction of the group of patients rehabilitated with complete dentures. The results showed that masticatory performance is much higher in individuals with complete natural dentition than in patients rehabilitated with complete dentures, with the difference being statistically significant. Patients with dentures indicated a low level of satisfaction with the use of their complete dentures, especially during masticatory function.