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.

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.

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.

[Perception on and registration of alcohol abuse and alcohol-related diseases at a university general hospital]

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.