Stroke prevention and control in Brazil: missed opportunities

Quality of life: predictors and outcomes after stroke in a Brazilian public hospital

BACKGROUND

Some scales are applied after stroke to measure functional independence but qualify of life (QoL) is sometimes neglected in this scenario.

OBJECTIVE

To analyze predictors and outcomes of QoL after stroke using a validated scale in our population.

METHODS

Our study included patients who had their first ischemic stroke and were followed in the outpatient clinic for at least 6 months from stroke index. Disability status was assessed using the modified Rankin scale (mRS), the Barthel index (BI), and the Lawton and Brody scale. Quality of life was assessed by a stroke-specific QoL (SSQoL) scale. Statistical significance was accepted for p < 0.05. The estimated measure of association was the odds ratio (OR) for which 95% confidence intervals (95%Cis) were presented.

RESULTS

Of 196 patients studied, the median age was 60.4 (±13.4) years, and 89 (45.40%) of the patients were female. In a stepwise model considering risk factors, basic activities of daily living scales, satisfaction with life, and outcomes, we found four independent variables related to a poor QoL after stroke, namely hypertension, non-regular rehabilitation, not returning to work, and medical complications. The National Institutes of Health stroke scale (NIHSS) score at admission ≥ 9 was also an independent clinical marker. Approximately 30% of all participants had a negative score under 147 points in the SSQoL.

CONCLUSIONS

Our results showed that QoL after stroke in a developing country did not seem to differ from those of other countries, although there is a gap in rehabilitation programs in our public system. The functional scales are important tools, but they have failed to predict QoL, in some patients, when compared with specific scales.

Hypertension in Latin America: Current perspectives on trends and characteristics

The region of Latin America, which includes Central America, the Caribbean and South America, is one that is rapidly developing. Signified by socio-economic growth, transition and development over the last few decades, living standards in countries like Brazil and Mexico have improved dramatically, including improvements in education and health care. An important marker of socio-economic change has been the epidemiological shift in disease burden. Cardiovascular disease is now the leading cause of death in Latin America, and the drop in prevalence of infectious diseases has been accompanied by a rise in non-communicable diseases. Hypertension is the major risk factor driving the cardiovascular disease continuum. In this article we aim to discuss the epidemiological and management trends and patterns in hypertension that may be specific or more common to Latin-American populations - what we term 'Latin American characteristics' of hypertension - via a review of the recent literature. Recognizing that there may be a specific profile of hypertension for Latin-American patients may help to improve their treatment, with the ultimate goal to reduce their cardiovascular risk. We focus somewhat on the countries of Brazil, Mexico and Venezuela, the experience of which may reflect other Latin American countries that currently have less published data regarding epidemiology and management practices.