Quality of Life in Patients After Acute ST-Segment Elevation Myocardial Infarction

Abstract Background: ST-segment elevation myocardial infarction (STEMI) is the acute coronary syndrome with the highest severity and mortality. It can affect physical health and well-being of patients, and consequently their quality of life (QoL). Objective: To describe the QoL of patients at 30 days and 180 days after STEMI, focusing on sex differences and repercussions on physical and mental dimensions. Methods: Observational study with 174 STEMI patients included in the study on STEMI conducted in the city of Salvador, Brazil (PERSISST). The QoL of patients at 30 days (D30) and 180 days (D180) after the coronary event was assessed using the 12-item short form health survey (SF-12). Physical and mental components of QoL were calculated using the SF-12 OrthoToolKit. Descriptive analysis of data was made using the IBM SPSS software, version 25.0. Results: Mean age of participants at D30 and D180 was 57.1±11.4 years and 60.5±10.9 years, respectively, with a higher prevalence of men (55.8% and 56.8%). In general, patients had a poor QoL at both time points (scores 49.1±8.9 and 49.9±8.4, respectively). Analysis by sex, however, showed that men had a good QoL at both 30D (score 51.8±7.4) and 180 D (score 51.3±7.7), whereas a poor QoL was found among women at these time points (45.7±9.6 and 48.1±9.0, respectively). Men showed higher physical and mental health scale scores than women at both D30 and D180, and there was a greater impairment of the physical component in both sexes. Conclusion: Patients had poor QoL at 30 days and 180 days after STEMI, with a greater impairment of the physical component and a worse QoL perception among women than men at both time points.

Bridging Learning in Medicine and Citizenship During the COVID-19 Pandemic: A Telehealth-Based Case Study.

BACKGROUND: COVID-19 presented great challenges for not only those in the field of health care but also those undergoing medical training. The burden on health care services worldwide has limited the educational opportunities available for medical students due to social distancing requirements. OBJECTIVE: In this paper, we describe a strategy that combines telehealth and medical training to mitigate the adverse effects of the COVID-19 pandemic. METHODS: A toll-free telescreening service, Telecoronavirus, began operations in March 2020. This service was operated remotely by supervised medical students and was offered across all 417 municipalities (14.8 million inhabitants) in the Brazilian state of Bahia. Students recorded clinical and sociodemographic data by using a web-based application that was simultaneously accessed by medical volunteers for supervision purposes, as well as by state health authorities who conducted epidemiological surveillance and health management efforts. In parallel, students received up-to-date scientific information about COVID-19 via short educational videos prepared by professors. A continuously updated triage algorithm was conceived to provide consistent service. RESULTS: The program operated for approximately 4 months, engaging 1396 medical students and 133 physicians. In total, 111,965 individuals residing in 343 municipalities used this service. Almost 70,000 individuals were advised to stay at home, and they received guidance to avoid disease transmission, potentially contributing to localized reductions in the spread of COVID-19. Additionally, the program promoted citizenship education for medical students, who were engaged in a real-life opportunity to fight the pandemic within their own communities. The objectives of the education, organization, and assistance domains of the Telecoronavirus program were successfully achieved according to the results of a web-based post-project survey that assessed physicians' and students' perceptions. CONCLUSIONS: In a prolonged pandemic scenario, a combination of remote tools and medical supervision via telehealth services may constitute a useful strategy for maintaining social distancing measures while preserving some practical aspects of medical education. A low-cost tool such as the Telecoronavirus program could be especially valuable in resource-limited health care scenarios, in addition to offering support for epidemiological surveillance actions.

Fatores associados às doenças transmitidas por alimentos em crianças durante o carnaval de Salvador / Factors associated with foodborne diseases in children during carnaval in Salvador / Los factores asociados a las enfermedades transmitidas por alimentos a los niños durante el carnaval de Salvador

Doenças transmitidas por alimentos (DTA) oferecem riscos à saúde. No Brasil em 2016 foram notificadas 9.935 pessoas com DTA, reforçando a importância de conhecer os fatores associados para prevenção e planejamento da redução de incidentes. Crianças estão expostas às DTA, principalmente no carnaval. O objetivo deste artigo é descrever as características clínicas e fatores associados às DTA em crianças durante o carnaval de Salvador. Este é um estudo transversal, com análise das fichas de atendimento de crianças de 0 a 12 anos, durante o carnaval de Salvador/2016. Para análise dos dados foi utilizada a estatística descritiva, aplicou-se o teste qui-quadrado de Pearson para medidas de associação (p < 0,05). A amostra foi constituída de 127 crianças, sendo que 37,8% foram diagnosticadas com DTA. Dentre as crianças com DTA, houve o predomínio da faixa etária de 1 a 9 anos (70,8%) e sexo masculino (54,2%), folião de rua (95,8%), atendidos no circuito Osmar (52,1%), no período da tarde (31,3%). Na análise bivariada identificou-se associação de DTA com: náuseas/vômitos (p < 0,001) e dor abdominal (p = 0,001). Prevaleceu o número de crianças de 1 a 9 anos, sexo masculino e a maioria sendo folião de rua, atendidos no turno da tarde. As DTA foram associadas com náuseas/vômitos e dor abdominal.

Foodborne diseases pose a health risk, regardless of age groups. In Brazil, in 2016, 9,935 people with foodborne diseases were notified, reinforcing the importance of knowing the associated factors to prevention and planning to reduce incidents. This paper describes the clinical characteristics and factors associated with foodborne diseases in children during Carnival in Salvador. This is a cross-sectional study with a retrospective analysis of the medical charts of children from 0 to 12 years old, during the Carnival in Salvador/2016. For data analysis, descriptive statistics was used, and Pearson's Chi-Square test was applied for association measures (p<0.05). The sample consisted of 127 children, and 37.8% were diagnosed with foodborne diseases. Among children with foodborne diseases, there was a predominance of: age group 1-9 years old (70.8%), male (54.2%), street carnival revelers (95.8%), having attended the Osmar circuit (52.1%), in the afternoon (31.3%). Bivariate analysis showed an association of foodborne diseases with: nausea/vomiting (p<0.001) and abdominal pain (p=0.001). Children from 1 to 9 years old, male, and most of them being street carnival revelers, having attended during the afternoon shift. Foodborne diseases were associated with nausea/vomiting and abdominal pain.

Las enfermedades transmitidas por alimentos (ETA) ofrecen riesgos a la salud humana. En Brasil en 2016 se notificaron 9.935 personas con ETA, lo que refuerza la importancia de conocer los factores asociados para la prevención y planificación de la reducción de incidentes. Los niños están expuestos a las ETA, principalmente durante el carnaval. El presente artículo objetivó describir las características clínicas y los factores asociados a las ETA en los niños durante el carnaval de Salvador. Es un estudio transversal, con análisis de las fichas de atención de los niños de 0 a 12 años, durante el carnaval de Salvador en 2016. Para el análisis de datos, se utilizó la estadística descriptiva, se aplicó el test chi-cuadrado de Pearson para medidas de asociación (p < 0,05). La muestra constó de 127 niños, de los cuales un 37,8% tuvieron diagnóstico de ETA. En el caso de los niños con ETA, hubo un predominio del grupo de edad de 1 a 9 años (70,8%), del sexo masculino (54,2%), rumberos del carnaval (95,8%), atendidos en el circuito Osmar (52,1%), en el turno de la tarde (31,3%). En el análisis bivariado se identificó asociación de ETA con: náuseas/vómitos (p < 0,001) y dolor abdominal (p = 0,001). Han prevalecido niños de 1 a 9 años, del sexo masculino y la mayoría rumberos del carnaval, atendidos en el período de la tarde. Las ETA se asociaron con náuseas/vómitos y dolor abdominal.

Implementation of a Regional Network for ST-Segment-Elevation Myocardial Infarction (STEMI) Care and 30-Day Mortality in a Low- to Middle-Income City in Brazil: Findings From Salvador's STEMI Registry (RESISST).

BACKGROUND: Few data exist on regional systems of care for the treatment of ST-segment-elevation myocardial infarction (STEMI) in developing countries. Our objective was to describe temporal trends in 30-day mortality and identify predictors of mortality among STEMI patients enrolled in a prospective registry in Brazil. METHODS AND RESULTS: From January 2011 to June 2013, 520 patients who received initial STEMI care at 23 nonspecialized public health units or hospitals, some of whom were transferred to a public cardiology referral center, were identified through a regional STEMI network supported by telemedicine and the local prehospital emergency medical service. We stratified patients into five 6-month periods based on presentation date. Mean age (±SD) of patients was 62.0 (±12.2) years, and 55.6% were men. The mean Global Registry of Acute Coronary Events (GRACE) score was 145 (±34). Overall mortality at 30 days was 15.0%. Use of dual antiplatelet therapy and statins increased significantly from baseline (January 2011) to period 5 (June 2013): 61.8% to 93.6% (P<0.001) and 60.4% to 79.7% (P<0.001), respectively. Rates of primary reperfusion also increased (29.1%-53.8%; P<0.001), and more patients were transferred to the referral center (44.7%-76.3%; P=0.001). Thirty-day mortality rates decreased from 19.8% to 5.1% (P<0.001). In multivariable analysis, factors independently associated with 30-day mortality were higher GRACE score, history of previous stroke, lack of transfer to the referral center, and lack of use of optimized medical therapy. CONCLUSIONS: Implementation of a regional STEMI system was associated with lower mortality and higher use of evidence-based therapies.

Integrated regional networks for ST-segment-elevation myocardial infarction care in developing countries: the experience of Salvador, Bahia, Brazil.

BACKGROUND: Regionalized integrated networks for ST-segment-elevation myocardial infarction (STEMI) care have been proposed as a step forward in overcoming real-world obstacles, but data are lacking on its performance in developing countries. We describe an integrated regional STEMI network in Salvador, Bahia, Brazil. METHODS AND RESULTS: The network was created in 2009. It was coordinated by the prehospital emergency medical service and encompassed the public emergency system (prehospital mobile units, community-based emergency units, general hospitals, and cardiology reference centers). The 12-lead ECGs are interpreted via telemedicine. This network operates as follows: The Telemedicine Center sends each ECG suggestive of STEMI to a Regional STEMI Alert Team, which, together with emergency medical services, offers support for thrombolysis or immediate transfer for primary percutaneous coronary intervention. In 14 months, there were 433 suspected victims, of which in 287 (76.5%) the STEMI could be confirmed (age, 62.1±12.5 years; 63.4% men). Most of them were self-transported. The median pain-to-admission time was 180 minutes (interquartile range, 90-473 minutes), and the median admission-to-ECG time was 159.5 minutes (interquartile range, 83.5-340 minutes). The median interval time between the ECG and the telemedicine report was 31 minutes (interquartile range, 21-44 minutes). For those who sought medical attention and had an ECG performed within 12 hours after symptoms onset (n=119), the reperfusion rate was 75.6% (34.4% by thrombolysis and 65.6% by primary percutaneous coronary intervention). CONCLUSIONS: Regional STEMI networks may be feasible in developing countries. Preliminary results showed this network to be effective, achieving primary reperfusion rtes comparable with those reported internationally despite the obstacles faced.