Comprehensive portrait of stroke fellowship training in Brazil: A national survey study.

BACKGROUND AND OBJECTIVES: The field of vascular neurology has undergone significant advances over the last decade, and care has become more complex. However, vascular neurology training programs remain underdeveloped in many countries, despite stroke impact on health care. There are efforts towards building a nationally regulated curricula in some countries. Still, comprehensive planning and implementation of these programs may be needed on a global scale, especially in countries where stroke treatment is not fully implemented. We aim to comprehensively analyze vascular neurology trainees' profiles in Brazil to describe training program contents from trainees and program directors' perspectives. METHODS: We performed an observational, cross-sectional, web-based survey study to describe trainee and program-specific characteristics at vascular neurology fellowship training programs in Brazil. The study was conducted from June to September 2023 using a secure web-based survey sent to active fellows and program directors from all known vascular neurology fellowship programs in the country. All respondents were required to provide informed consent. RESULTS: We obtained a 100 % response rate of a total of 12 programs distributed in 7 federal states. Notably, 57 % of the 28 surveyed fellows were women, 60 % were aged 25-30, and 70 % self-identified as White. All fellows had prior neurology training, and 60 % engaged in the program just following residency. Exposure to various training experiences was favorable, except for simulation-based learning and telestroke training. Program directors perceived exposure to be sufficient for most components but similarly found deficiencies in telestroke and simulation-based learning. Scientific productivity was low, with about two-thirds of fellows having no publications or abstracts. Most fellows (92.6 %) reported performing non-fellowship medical activities to supplement their incomes. DISCUSSION: In conclusion, the number of vascular neurology training programs and trainees in Brazil is currently insufficient and exhibits an uneven geographic distribution. Despite this, the clinical training provided is extensive, and there is generally some funding available for fellows. These insights highlight the need for strategic improvements in Brazil's stroke education and could inform similar developments in other nations.

HAND HYGIENE PRACTICES POST EBOLA VIRUS DISEASE OUTBREAK IN A NIGERIAN TEACHING HOSPITAL.

INTRODUCTION: Ebola virus disease (EVD) is a highly contagious viral infection that requires a high risk perception and practice of good hand hygiene by regular hand washing or use of hand sanitizers for infection control at all time. The declaration of Nigeria as an Ebola-free country by the World Health Organization on the 20th of October, 2014 has prompted many Nigerians, including healthcare workers, to discontinue the regular practice of good hand hygiene which was commonplace during the EVD outbreak. OBJECTIVE: The study assessed hand hygiene practices for infection control after the West African Ebola virus disease outbreak in a Nigerian teaching hospital. METHOD: This study was cross-sectional in design. A total of 450 staff of the University College Hospital, Ibadan participated in the survey. Data was collected using a structured, self-administered questionnaire. Chi-square test and multivariate logistic regression were used to determine associations between predictors of good hand hygiene practice at 5% level of significance. RESULTS: The mean age was 42.2 ± 8.6 years. A higher proportion of respondents in this study had a good knowledge of the risk factors of EVD; good knowledge of the precautionary measures against EVD and a good risk perception towards EVD. However, the majority of respondents, 359 (80.0%), had a poor practice of hand hygiene for infection control. Having good knowledge of risk factors and precautionary measures against EVD was associated with practice of good hand hygiene. Respondents with good risk perception of EVD were 1.63 times more likely to practice good hand hygiene (OR= 1.63; 95% CI= 1.20 - 4.38; p= 0.019). CONCLUSION: There was a good knowledge of risk factors and precautionary measures of EVD among staff of the University College Hospital, Ibadan. However, the majority of respondents had a poor practice of hand hygiene for infection control, Post EVD. Sensitization workshops to promote the regular practice of good hand hygiene is recommended for healthcare workers to control infection from EVD.

PREVALENCE AND PREDICTORS OF PREDIABETES AMONG ADMINISTRATIVE STAFF OF A TERTIARY HEALTH CENTRE, SOUTHWESTERN NIGERIA.

INTRODUCTION: Prediabetes is a condition in which individuals have blood glucose levels higher than normal but not high enough to be classified as diabetes mellitus. Inadequate moderate-intensity physical activity, amidst other risk factors, is a well-documented risk factor for prediabetes. Hospital administrative staff can be particularly vulnerable to prediabetes because of the greater number of hours spent in a sitting or sedentary position during administrative duties. The aim of this study was to find the prevalence of prediabetes and to determine its predictors among administrative staff of a tertiary health centre in southwestern Nigeria. METHOD: This was a descriptive cross-sectional study carried out among 300 administrative staff of the University College Hospital, Ibadan over a period of three months. Data was collected using a semi-structured questionnaire that was adapted from the generic WHO-STEPs instrument approach to surveillance of chronic non-communicable diseases risk factors. Data was analyzed using the Statistical Package for Social Sciences (SPSS) version 17. Descriptive analyses were performed to estimate the prevalence of prediabetes while the independent predictors of prediabetes were investigated using multinomial logistic regression model. The level of statistical significance was set at p < 0.05. RESULTS: The mean age of participants was 51.2 ± 5.3 years. There were 164 (54.7%) males and 136 (45.3%) females that participated in the study. The prevalence of prediabetes was 22.3%. Based on the final multivariable multinomial model, the independent predictors of prediabetes included; male sex (OR= 1.24; 95% CI= 1.082 - 2.460), positive family history of diabetes mellitus (OR= 1.57; 95% CI= 1.088 - 2.611), alcohol intake (OR= 1.13; 95% CI= 0.688 - 1.543) and inadequate moderate-intensity physical activity (OR= 1.49; 95% CI= 1.027 - 2.936). CONCLUSION: There was a high prevalence of prediabetes among the administrative staff of University College Hospital, Ibadan. Regular screening of hospital employees for prediabetes is highly recommended. Work-place exercise should be advocated to improve moderate-intensity physical activity among hospital employees.

Evolutionary processes involved in the diversification of chelonian and mammal polystomatid parasites (Platyhelminthes, Monogenea, Polystomatidae) revealed by palaeoecology of their hosts.

Polystomatid flatworms (Platyhelminthes) are monogenean parasites that infect exclusively aquatic or semi-aquatic sarcopterygians such as the Australian lungfish, amphibians, freshwater turtles and the African common hippopotamus. Previous studies on the phylogenetic relationships of these parasites, excluding Oculotrema hippopotami infecting common hippos, showed a global coevolution between hosts and their parasites at a macroevolutionary scale. These studies also demonstrated a strong correlation between the diversification of early neobatrachian polystomes and Gondwana breakup in the Mesozoic period. However the origin of chelonian polystomes is still in question as a switch from presumably primitive aquatic amniotes to turtles at the time of their first appearance, or soon after during their radiation, was assumed. In order to resolve this sticking point, we extended the phylogeny of polystomes with broader parasite sampling, i.e. 55 polystome species including Nanopolystoma tinsleyi a polystome infecting caecilians and O. hippopotami, and larger set of sequence data covering two nuclear and two mitochondrial genes coding for the ribosomal RNA 18S and 28S, the Cytochrome c Oxidase I and the ribosomal RNA 12S, respectively. The secondary structure of nuclear rRNAs genes (stems and loops) was taken into account for sequence alignments and Bayesian analyses were performed based on the appropriate models of evolution selected independently for the four designed partitions. Molecular calibrations were also conducted for dating the main speciation events in the polystome tree. The phylogenetic position of chelonian parasites that are phylogenetically closer to N. tinsleyi than all other amphibian polystomes and molecular time estimates suggest that these parasites originated following a switch from caecilians, at a geological period when primitive turtles may already have adapted to an aquatic life style, i.e. at about 178Million years ago, or a little later when the crown group of extant turtles have already diversified, i.e. at about 152Mya. Similarly, because O. hippopotami constitutes the sister group of chelonian parasites, proposing that an African caecilian could be the ancestral host for this polystome species seems at this stage the most likely hypothesis to explain its occurrence within the common hippo. Regardless of the scenario that may be predicted to explain the origin of polystomes within aquatic or semi-aquatic amniotes, their presence and evolution are indicative of early aquatic ecological habits within ancestral lineages.

Parasitic infections of the African dwarf crocodile (Osteolaemus tetraspis) and the ornate Nile monitor (Varanus ornatus) from Nigeria.

The parasitic infections of market derived Osteolaemus tetraspis from the rainforest and Varanus ornatus from locations in the savanna-mosaic and the rainforest of southern Nigeria were investigated. Parasites recovered from O. tetraspis included members of the Pentastomida, Trematoda and Nematoda. An undescribed pentastomid belonging to the family Sebekidae was recovered from O. tetraspis. The same parasite was also found to parasitize V. ornatus from the rainforest. Other parasites found in O. tetraspis were Pseudoneodiplostomum thomasi, Dujardinascaris sp. and larva of a Camallanus sp. Varanus ornatus from the rainforest and the derived savanna had some parasites including Duthiersia fimbriata, an unidentified pseudophyllidean cestode and Tanqua tiara in common. Cosmocerca ornata and Oswaldocruzia hoepplii were restricted to hosts from the derived savanna while the unidentified trematode occurred only in lizards from the rainforest. The unidentified pseudophyllidean cestode bears a close resemblance to Probothriocephalus, a cestode previously reported only from deep water teleosts. Pseudoneodiplostomum thomasi and Duthiersia fimbriata are new locality records for Nigeria.

[Perception on and registration of alcohol abuse and alcohol-related diseases at a university general hospital]. / Percepção e registro de abuso de álcool e de doenças relacionadas num hospital geral universitário.

BACKGROUND: The high frequency of alcohol related problems highlights the importance of its approach. The association of both the alcohol-abuse and alcohol related diseases has been pointed in the literature and are often the main reason for hospitalization. Physicians use different tools to detect abusive drinkers, and one of them is the CAGE-test, validated by Mayfield et al. in 1974. OBJECTIVES: To study the association between the result of the CAGE-test and the perception and registration of alcohol abuse by the medical staff and the nurses in charge of inpatients of Hospital de Clínicas de Porto Alegre, southern Brazil. MATERIAL AND METHOD: The design involved three phases. First, the application of the CAGE-test to the 385 eligible patients. Second, review of all 51 CAGE-positive patients' records as well the controlled evaluation of 51 randomized CAGE-negative patients, to seek alcoholic habits and alcohol-related diseases. Third, interview with the medical staff to find out their perception about these subjects. RESULTS: We found 51 patients CAGE-positive (prevalence = 13%). When evaluated through the registration and through a standardized interview, medical staff and nurses were not aware of more than half of CAGE-positive patients. No significant differences were found between medical staff registration and perception; the prevalence of alcohol related diseases was the same for both: 26 and 27% (p = .861). The prevalence of alcohol related diseases was higher among CAGE-positive patients (p = .0003). CONCLUSIONS: In spite of the high prevalence among our patients, alcohol abuse is not pursued by our health teams as it should be. As for the future, there is reason to envision a continuing alcoholism rapprochement.

Percepçäo e registro de abuso de álcool e de doenças relacionadas num hospital geral universitário / Perception and registration of alcohol abuse and alcohol related diseases by nurses and medical staff of an university general hospital

Objetivo. Avaliar a associaçao entre o resultado do teste CAGE aplicado em pacientes internados num hospital geral universitário (Hospital de Clínicas de Porto ALegre - HCPA) e a percepçao e registro de abuso de álcool e de doenças relacionadas pelas equipes de saúde. Pacientes e Métodos. O delineamento envolveu três fases: a) aplicaçao do teste CAGE aos 385 pacientes adultos e adolescentes internados considerados elegíveis para o estudo; b) revisao dos prontuários dos pacientes CAGE-positivo e de um número igual de pacientes CAGE-negativo, estratificados por área de internaçao e sorteados, para identificar hábitos alcoólicos e a presença de doenças relacionadas ao uso de álcool; c) entevista com os membros das equipes médicas responsáveis para avaliar sua percepçao sobre o hábito alcoólico em seu paciente. As diferenças encontradas foram analisadas através do teste Qui-quadrado e do teste t de Student, com significância estatística em nível de 5 por cento bicaudal. Resultados. Foram encontrados 51 pacientes CAGE-positivo (13 por cento). A equipe médica registrou abuso de álcool no prontuário de 51 por cento dos pacientes CAGE-positivo e 10 por cento dos CAGE-negativo, e a equipe de enfermagem fez este registro no prontuário de 31 por cento dos pacientes CAGE-positivo e 8 por cento dos CAGE-negativo (p=.724). Nao houve diferença entre o registro e a percepçao da equipe médica (p=.184). A prevalência de doenças relacionadas ao abuso de álcool foi 27 por cento quando se examinou os prontuários médicos e 26 por cento quando se entrevistou a equipe médica (p=.861), sendo maior entre os pacientes CAGE-poistivo (43 por cento) do que entre os CAGE-negativo (10 por cento) (p=.0003). Conclusoes. O abuso de bebidas alcoólicas e a presença de doenças associadas ao mesmo sao condiçoes prevalentes nos pacientes admitidos ao HCPA. Entretanto, mais de metade dos casos nao foram detectados pela equipe de saúde, havendo correspondência entre os registros de prontuário e a entrevista.