Cardiovascular Diseases Commons^™

Emergency Medical Services Transport Delays For Suspected Stroke And Myocardial Infarction Patients, Ashley Pedigo Golden, Agricola Odoi

Agricola Odoi

Background: Prehospital delays in receiving emergency care for suspected stroke and myocardial infarction (MI) patients have significant impacts on health outcomes. Use of Emergency Medical Services (EMS) has been shown to reduce these delays. However, disparities in EMS transport delays are thought to exist. Therefore the objective of this study was to investigate and identify disparities in EMS transport times for suspected stroke and MI patients. Methods: Over 3,900 records of suspected stroke and MI patients, reported during 2006–2009, were obtained from two EMS agencies (EMS 1 & EMS 2) in Tennessee. Summary statistics of transport time intervals were computed. …

Bystander Performance Using Automated External Defibrillators During Simulated Cardiac Arrest, Richard N. Bradley, Lynda M. Schoenstein, Wesley H. Hamilton, Mark R. Boyle

Richard N Bradley

Objective: Automated external defibrillators (AEDs) are becoming widely available to the public. This study examined the hypothesis that less than 75% of the general population can defibrillate using an AED in less than three minutes.

Methods: This was a survey of the behavior of individuals over age 12 in a major airport on Jan. 2–3, 2003. After obtaining consent, an investigator told the subject that he/she was walking down the concourse and saw a person collapse. The subject demonstrated his/her response, using only a telephone and an AED simulating ventricular fibrillation. Data were analyzed using a one-sample test of proportions. …

Resistant Hypertension: Risk Factors, Subclinical Atherosclerosis, And Comorbidities Among Adults—The Brazilian Longitudinal Study Of Adult Health (Elsa-Brasil), Paulo A. Lotufo

Paulo A Lotufo

The frequency of resistant hypertension—defined as blood

pressure (BP) ≥140/90 mm Hg with proven use of three

antihypertensive medications, or as the use of four antihypertensive drug classes regardless of BP—is unknown in low-middle–income countries. Using data from the Brazilian Longitudinal Study of Adult Health, a cohort of 15,105 civil servants aged 35 to 74 years, the authors identified 4116 patients taking treatment for hypertension, 11% of who had resistant hypertension. These participants were more likely to be older, black, less educated, poorer, and obese. The adjusted prevalence ratios (95% confidence intervals) were diabetes, 1.44 (1.20–1.72); glomerular filtration rate ( …

The Scientific Foundations Of The American Red Cross Cpr Training Standards, Richard N. Bradley

Richard N Bradley

The CPR (cardiopulmonary resuscitation) training and certification standards established by the ARC (American Red Cross) are based on a scientific review of the best available published literature. Minimal difference are present between the ARC and other national training organizations. These differences result from differing organizational opinions on the best way to implement standards from limited scientific evidence.

Cardiopulmonary Resuscitation With Rescue Breathing Is Superior To Hands-Only Cardiopulmonary Resuscitation For Children And Infants: Results Of A Systematic Review, Joseph W. Rossano, Richard N. Bradley

Richard N Bradley

Introduction

Evidence supports teaching hands-only CPR for the initial treatment of cardiac arrest in adults. Unlike adults, however, children and infants with cardiac arrest are more likely to have non-cardiac causes.

Hypothesis: The objective of this project was to conduct a structured literature review to answer the question, “In children and infants with cardiac arrest treated in an out-of-hospital setting, does compression-only CPR, alone or with supplemental oxygen, compared to CPR with rescue breathing lead to improved outcomes?”

Results

Sixty-nine records were identified and screened. Fifty-four of these did not meet inclusion/exclusion criteria, leaving fifteen full-text articles that we assessed …

Arc Sac Advisory Pulse Check For Cardiac Arrest, Sarah Clarke, Richard N. Bradley, Siobán Kennedy

Richard N Bradley

One good quality study (LOE 4) supports omitting a pulse check after defibrillation for patients in cardiac arrest.

One fair quality study (LOE 4) opposes the performance of simultaneous as opposed to sequential pulse and breathing check to determine cardiac arrest.

There is insufficient evidence to support a recommendation on the preferred method for the initial determination of cardiac arrest.

CPR courses should specifically teach the recognition of agonal breathing and the understanding that agonal breathing is not normal breathing and that it indicates the need for CPR.

Brazilian Longitudinal Study Of Adult Health (Elsa-Brasil): Objectives And Design., Paulo A. Lotufo

Paulo A Lotufo

The Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) aims to contribute relevant information with respect to the development and progression of clinical and subclinical chronic diseases, particularly cardiovascular diseases and diabetes. In this report, the authors delineate the study's objectives, principal methodological features, and timeline. At baseline, ELSA-Brasil enrolled 15,105 civil servants from 5 universities and 1 research institute. The baseline examination (2008-2010) included detailed interviews, clinical and anthropometric examinations, an oral glucose tolerance test, overnight urine collection, a 12-lead resting electrocardiogram, measurement of carotid intima-media thickness, echocardiography, measurement of pulse wave velocity, hepatic ultrasonography, retinal fundus photography, and an …

A Reappraisal In São Paulo, Brazil (2008) Of "The Ecology Of Medical Care:" The "One Per Thousand's Rule"., Adriana Roncoletta, Gustavo D. Gusso, Isabela M. Bensenor, Paulo A. Lotufo

Paulo A Lotufo

This paper reassessed in Brazil, the concept of "Medical ecology" i introduced in 1961 to describe the relationship and utilization of health care services by a given population. This was a cross-sectional telephone survey among a random sample of people enrolled in a private HMO. We interviewed a random sample of non-pregnant adults over age 18 using 10 questions about symptoms and health care use during the month prior to interview. The final sample consisted of 1,065 participants (mean age 68 years, 68% female). From this sample, 424 (39.8%) reported the presence of symptoms, 311 (29.2%) had a medical office …

Hypothyroidism In The Elderly, Paulo A. Lotufo

Paulo A Lotufo

An overview adressing observational and randomized clinical trials about hypothyroidism in the elderly.

Chronic Non-Communicable Diseases In Brazil: Priorities For Disease Management And Research, Bruce B. Duncan, Dora Chor, Estela M. Aquino, Isabela M. Bensenor, J.Geraldo Mill, M.Ines Schmidt, Paulo A. Lotufo, Alvaro Vigo, Sandhi M. Barreto

Paulo A Lotufo

Chronic Non-Communicable Diseases are the main source of disease burden in Brazil. In 2011, the Brazilian Ministry of Health launched the Strategic Plan of Action for Management of Chronic Non-Communicable Diseases focusing on population-based interventions to manage cardiovascular diseases, diabetes, cancer, and chronic respiratory diseases mainly through fi ghting tobacco use, unhealthy diets, physical inactivity and the harmful use of alcohol. Although a signifi cant number of scientifi c studies on chronic diseases and their risk factors have been undertaken in Brazil, few are of cohort design. In this context, the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), a cohort …

Elsa-Brasil: Historico [In Portuguese], Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Vigilância Em Doença Cerebrovascular [Portuguese], Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

A Reappraisal Of Stroke Mortality Trends In Brazil (1979 To 2009), Paulo A. Lotufo

Paulo A Lotufo

Background: Brazil has the highest cerebrovascular death rate in the Western Hemisphere. We investigated temporal trends according to gender and stroke subtypes. Methods: We analysed mortality rates between 1979 and 2009 for different stroke subtypes. Data were stratified by sex and age (35–74 y). The annual percent change (APC) and significant changes in the trends were identified with joinpoint Poisson regression. The average annual percent change (AAPC) for 2005-09 was presented because that period had the best quality of information. Results: After excluding deaths due to stroke sequels, for men, the APCs (95% confidence intervals) were: 1979-84: 0.7 (-0.8 to …

Neighborhood Disparities In Stroke And Myocardial Infarction Mortality: A Gis And Spatial Scan Statistics Approach, Agricola Odoi

Agricola Odoi

Background: Stroke and myocardial infarction (MI) are serious public health burdens in the US. These burdens vary by geographic location with the highest mortality risks reported in the southeastern US. While these disparities have been investigated at state and county levels, little is known regarding disparities in risk at lower levels of geography, such as neighborhoods. Therefore, the objective of this study was to investigate spatial patterns of stroke and MI mortality risks in the East Tennessee Appalachian Region so as to identify neighborhoods with the highest risks. Methods: Stroke and MI mortality data for the period 1999-2007, obtained free …

Prevalence Of Thyroid Disorders Among Older People: Results From The São Paulo Ageing & Health Study, Paulo A. Lotufo

Paulo A Lotufo

This study aimed to estimate prevalence of thyroid disorders in the São Paulo Ageing & Health Study, an epidemiological study addressing several health-adverse outcomes among elderly people living in a poor area of São Paulo, Brazil. All participants answered a questionnaire and had a blood sample collected to assess levels of tireotropic hormone and free-thyroxine. Among 1,373 people (60.8% women), prevalence rates (95% confidence interval) for thyroid dysfunction (%) were: overt hyperthyroidism, 0.7% (0.2-1.1) [women: 0.8% (0.2-1.5); men: 0.4% (0.01-0.9)]; overt hypothyroidism, 5.7% (4.5-6.9) [women: 5.9% (4.3-7.5); men: 5.4% (3.5-7.3)]; subclinical hyperthyroidism, 2.4% (1.6-3.2) [women: 2.8% (1.6-3.9); men: 1.9% (0.7-3.0)]; …

Pufa And Vitamin D And Type 2 Diabetes Inflammatory Markers, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

A Stepwise Approach To Stroke Surveillance In Brazil: The Emma (Estudo De Mortalidade E Morbidade Do Acidente Vascular Cerebral) Study, Paulo A. Lotufo

Paulo A Lotufo

Background: Stroke mortality rates in Brazil are the highest in the Americas. Deaths from cerebrovascular disease surpass coronary heart disease. Aim: To verify stroke mortality rates and morbidity in an area of Sa˜o Paulo, Brazil, using the World Health Organization Stepwise Approach to Stroke Surveillance. Methods: We used the World Health Organization Stepwise Approach to Stroke Surveillance structure of stroke surveillance. The hospital-based data comprised fatal and nonfatal stroke (Step 1). We gathered stroke-related mortality data in the community using World Health Organization questionnaires (Step 2). The questionnaire determining stroke prevalence was activated door to door in a family-healthprogramme neighbourhood …

Validation Of A Stroke Symptom Questionnaire For Epidemiological Surveys., Paulo A. Lotufo

Paulo A Lotufo

CONTEXT AND OBJECTIVE:Stroke is a relevant issue within public health and requires epidemiological surveillance tools. The aim here was to validate a questionnaire for evaluating individuals with stroke symptoms in the Stroke Morbidity and Mortality Study (Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral, EMMA), São Paulo, Brazil.DESIGN AND SETTING:This was a cross-sectional study performed among a sample of the inhabitants of Butantã, an area in the western zone of the city of São Paulo.METHODS:For all households in the coverage area of a primary healthcare unit, household members over the age of 35 years answered a stroke symptom questionnaire …

Socioeconomic Status And Coronary Heart Disease Mortality In The City Of Sao Paulo, Brazil (1996 To 2007), Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Non-Inferiority Trials [In Portuguese], Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Cardiovascular And Cancer Mortality In Brazil, Paulo A. Lotufo

Paulo A Lotufo

Cancer are not surpassing Cardiovascular Diseases. Here you have an evaluation of mortality in Brazil. The debate was ignited by paper from IARC (International Agency for Research on Cancer) that forecasts cancer deaths surpassing heart diseases rates during de 2020’s. There is no dispute about the fact that - at least in the US and other countries - the decline of mortality deaths for heart diseases presenting a faster pace compared to cancer death rates. It is an epidemiological evidence that must be analyzed and some headline fueling hype as “heart diseases as an old agenda of public health and …

Gender Differences Of Case-Fatality Rate In A Brazilian Stroke Registry, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Characteristics Of Small Areas With A Higher Stroke Mortality, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Higher Frequency Of Stroke Deaths On Monday And Saturday, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Social Inequalities And The Decline Of Stroke Mortality In The City Of Sao Paulo, Brazil, Paulo A. Lotufo

Paulo A Lotufo

No abstract provided.

Subclinical Hyperthyroidism And Dementia: The Sao Paulo Ageing & Health Study (Spah), Paulo A. Lotufo

Paulo A Lotufo

Background: Several epidemiologic studies have shown a possible association between thyroid function and cognitive decline. Our aim was to evaluate the association of subclinical hyperthyroidism and dementia in a population sample of older people. Methods: A cross-sectional study - São Paulo Ageing & Health Study (SPAH) - in a population sample of low-income elderly people ≥ 65 years-old to evaluate presence of subclinical thyroid disease as a risk factor for dementia. Thyroid function was assessed using thyrotropic hormone and free-thyroxine as well as routine use of thyroid hormones or antithyroid medications. Cases of dementia were assessed using a harmonized one-phase …

Nutritional Evaluation Of The Patients With Head And Neck Squamous Cell Carcinoma [Portuguese], Paulo A. Lotufo

Paulo A Lotufo

Patients with head and neck squamous cell carcinoma (HNSCC) usually present nutritional disorders, secondary to the upper aerodigestive tract involvement or due to the treatment sequels. Objective: To assess the nutritional status of patients with HNSCC in different phases of the disease treatment. Methods: Cross-sectional study with 155 patients divided in 4 groups: 103 patients with HNSCC (29 before treatment, 47 post-treatment with no recurrence and 27 post treatment with recurrent disease) and 52 controls without HNSCC. Clinical and epidemiological data were collected and a nutrition assessment was performed from anthropometric parameters (weight, height and Body Mass Index – BMI), …

Patterns Of Viral Load In Chronic Hepatitis B Patients In Brazil And Their Association Withalt Levels And Hbeag Status, Paulo A. Lotufo

Paulo A Lotufo

Serum hepatitis B virus (HBV) DNA level is a predictor of the development of cirrhosis and hepatocellular carcinoma in chronic hepatitis B patients. Nevertheless, the distribution of viral load levels in chronic HBV patients in Brazil has yet to be described. This cross-sectional study included 564 participants selected in nine Brazilian cities located in four of the five regions of the country using the database of a medical diagnostics company. Admission criteria included hepatitis B surface antigen seropositivity, availability of HBV viral load samples and age >or=18 years. Males comprised 64.5% of the study population. Mean age was 43.7 years. …

Estudo Longitudinal De Saúde Do Adulto -Elsa-Brasil [English], Paulo A. Lotufo

Paulo A Lotufo

Presentation update on September, 2011.

Framingham Score For Cardiovascular Diseases [Portuguese], Paulo A. Lotufo

Paulo A Lotufo

Review about cardiovascular risk factors.