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Muniz LS, Moraes MDA, Sales RS, Ribeiro LS, Cunha BS, de Jesus PAP, Sampaio EES, Baccin CRA, Teles CADS, Mussi FC. Factors associated with decision time to seek care in the face of ischemic stroke. Rev Esc Enferm USP 2023; 57:e20230075. [PMID: 37624382 PMCID: PMC10461728 DOI: 10.1590/1980-220x-reeusp-2023-0075en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 06/29/2023] [Indexed: 08/26/2023] Open
Abstract
OBJECTIVE To verify the association between sociodemographic, clinical, environmental, cognitive, and emotional factors and the decision time of people with ischemic stroke to seek a health service after the onset of symptoms or wake up stroke. METHOD Cross-sectional study carried out from March to October 2019, with 304 patients, in a public hospital, a reference in neurology. Data obtained through interview and from medical records. Decision time was analyzed as a geometric mean. In the bivariate and multivariate analyses, linear regression was used and the Akaike Information Criterion was used to select the best model. Statistical significance of 5% was adopted. RESULTS The geometric mean of decision time was 0.30h (95% CI 0.23-0.39). The final model explained this time in 41%, showing an increase of 0.5 min for people with arterial hypertension; 10.8 min for those who waited for symptoms to improve; 1.4 min for those who were alone at the onset of symptoms; 3.9 min for those at home; 3.2 min for the ones at work; and 2.1 for those on the street/public space. CONCLUSION The mean decision time for seeking a health service was high and influenced by clinical, environmental, cognitive, and emotional variables. The results guide nurses regarding health education.
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Affiliation(s)
- Ludimila Santos Muniz
- Empresa Brasileira de Serviços Hospitalares, Hospital Universitário Professor Edgard Santos, Salvador, BA, Brazil
| | | | - Rilary Silva Sales
- Universidade Federal da Bahia, Faculdade de Enfermagem, Salvador, BA, Brazil
| | - Laís Silva Ribeiro
- Universidade Federal da Bahia, Faculdade de Enfermagem, Salvador, BA, Brazil
| | - Brenda Silva Cunha
- Universidade Federal da Bahia, Faculdade de Enfermagem, Salvador, BA, Brazil
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Moraes MDA, Jesus PAPD, Muniz LS, Costa GA, Pereira LV, Nascimento LM, Teles CADS, Baccin CA, Mussi FC. Ischemic stroke mortality and time for hospital arrival: analysis of the first 90 days. Rev Esc Enferm USP 2023; 57:e20220309. [PMID: 37058593 PMCID: PMC10112237 DOI: 10.1590/1980-220x-reeusp-2022-0309en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/30/2023] [Indexed: 04/16/2023] Open
Abstract
OBJECTIVE To analyze the association between time of arrival at a reference hospital and mortality of people with ischemic stroke. METHOD Descriptive and inferential statistics were used. Modifying and confounding variables between time of arrival and mortality were observed in the multivariate analysis. The Akaike Information Criterion was used to choose the model. Statistical significance of 5% and risk correction using the Poisson Model were adopted. RESULTS Most participants arrived within 4.5 hours of symptom onset or wake up stroke to the referral hospital and 19.4% died. The score of the National Institute of Health Stroke Scale was a modifier. In the multivariate model stratified by scale score ≥14, arrival time >4.5h was associated with lower mortality; and age ≥60 years and having Atrial Fibrillation, to higher mortality. In the model stratified by score ≤13, previous Rankin ≥3, and presence of atrial fibrillation were predictors of mortality. CONCLUSION The relationship between time of arrival and mortality up to 90 days was modified by the National Institute of Health Stroke Scale. Prior Rankin ≥3, atrial fibrillation, time to arrival ≤4.5h, and age ≥60 years contributed to higher mortality.
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Affiliation(s)
| | | | | | - Greice Alves Costa
- Universidade Federal da Bahia, Escola de Enfermagem, Salvador, BA, Brazil
| | | | | | - Carlos Antônio de Souza Teles
- Fiocruz, Instituto Gonçalo Muniz, Salvador, BA, Brazil
- Universidade Estadual de Feira de Santana, Feira de Santana, BA, Brazil
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Moraes MDA, Jesus PAD, Muniz LS, Baccin CA, Barreto ABM, Sales RS, Pires CGDS, Teles CADS, Mussi FC. Arrival time at a referral hospital and functional disability of people with stroke: a cohort study. SAO PAULO MED J 2023; 141:e2022510. [PMID: 37194766 DOI: 10.1590/1516-3180.2022.0510.r1.27022023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/27/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Stroke is a major cause of death and functional disability worldwide. Knowledge of the associated factors is essential for defining education, management, and healthcare strategies. OBJECTIVE To analyze the association between arrival time at a neurology referral hospital (ATRH) and functional disability in patients with ischemic stroke 90 days after the event. DESIGN AND SETTING Prospective cohort study conducted at a public institution of higher education in Brazil. METHODS This study included 241 people aged ≥ 18 years who presented ischemic stroke. The exclusion criteria were death, inability to communicate without companions who could answer the research questions, and > 10 days since ictus. Disability was assessed using the Rankin score (mR). Variables for which associations showed a P value ≤ 0.20 in bivariate analysis were tested as modifiers between ATRH and disability. Significant interaction terms were used for multivariate analysis. Multivariate logistic regression analysis was performed with all variables, arriving at the complete model and adjusted beta measures. The confounding variables were included in the robust logistic regression model, and Akaike's Information Criterion was adopted to choose the final model. The Poisson model assumes a statistical significance of 5% and risk correction. RESULTS Most participants (56.0%) arrived at the hospital within 4.5 hours of symptom onset, and 51.7% presented with mRs of 3 to 5 after 90 days of ictus. In the multivariate model, ATRH ≥ 4.5 hours and females were associated with more significant disability. CONCLUSIONS Arrival at the referral hospital 4.5 hours after the onset of symptoms or wake-up stroke was an independent predictor of a high degree of functional disability.
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Affiliation(s)
- Mariana de Almeida Moraes
- MSc, PhD. Nurse and Adjunct Professor, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Pedro Antônio de Jesus
- MD, MSc, PhD. Adjunct Professor, Institute of Health Science, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Ludimila Santos Muniz
- MSc. Nurse, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Camila Antunes Baccin
- MSc, PhD. Nurse, Laboratório de Produção, Inovação e Pesquisa em Tecnologias e Informática em Saúde e Enfermagem (LAPETEC/GIATE), Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil
| | | | - Rilary Silva Sales
- Graduate Student, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | | | | | - Fernanda Carneiro Mussi
- MSc, PhD. Nurse and Full Professor, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
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Demétrio F, Teles CADS, Santos DBD, Pereira M. Food insecurity in pregnant women is associated with social determinants and nutritional outcomes: a systematic review and meta-analysis. Cien Saude Colet 2021; 25:2663-2676. [PMID: 32667549 DOI: 10.1590/1413-81232020257.24202018] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 11/15/2018] [Indexed: 12/22/2022] Open
Abstract
The association between FI, social determinants, and nutritional outcomes for pregnant women are analyzed. A systematic review was conducted through a search of articles in five electronic databases. Social determinants (race, education, participation in social programs) and nutritional status (pre-gestational BMI, gestational weight gain, anemia) were analyzed in relation to the FI situation. For each article, the frequency of food insecurity was collected in order to calculate the summary measure, prevalence ratio (PR). 26 articles were selected. An elevated occurrence of FI was associated with black pregnant women (PR: 1.83, 95% CI 1.08-3.10), participation in social protection programs (PR = 1.43, 1.02-2.01), and with low education levels on the part of pregnant women (PR = 2.73, 1.68-4.43). FI increased the chances of being overweight (PR = 1.57, 95% CI = 1.29-1.91) and obese (PR = 1.47, 95% CI = 1.15-1.87) in pregnant women, as well as excessive weight gain (PR = 1.42, 95% CI = 1.10-1.82) and inadequate weight gain (PR = 1.47; 95% CI = 1.09-1.97) during pregnancy. Anemia was not associated with FI. Social inequities are associated with food and nutritional insecurity in pregnant women.
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Affiliation(s)
- Fran Demétrio
- Cento de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia. R. Carlos Amaral 1.015, Cajueiro. 44574-490 Santo Antônio de Jesus BA Brasil.
| | | | - Djanilson Barbosa Dos Santos
- Cento de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia. R. Carlos Amaral 1.015, Cajueiro. 44574-490 Santo Antônio de Jesus BA Brasil.
| | - Marcos Pereira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia. Salvador BA Brasil
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Mussi FC, Mendes AS, Damasceno CA, Gibaut MDAM, Guimarães AC, Teles CADS. [Environmental factors associated with the decision time for seeking care in myocardial infarction]. Rev Bras Enferm 2014; 67:722-9. [PMID: 25517665 DOI: 10.1590/0034-7167.2014670508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Accepted: 08/24/2014] [Indexed: 11/22/2022] Open
Abstract
The purpose was to estimate the decision time (DT) for searching for attendance for men and women suffering from acute myocardial infarction (AMI); and to analyze the influence of surrounding variables in the DT. Transversal study, involving one hundred patients interviewed in hospitals of Salvador-BA, Brazil. For data analysis, it was used the chi-squared or Fisher's exact test, and the Robust Linear Regression Model. AMI at the home predominated, with family members and patients receiving mistaken actions. A high DT was observed both, for women (0.9h) and men (1.4h). Those at home during the initial symptoms had higher DT, compared to those at work; and lower in relation to those in public spaces (p=0.047). Statistically significant interaction occurred among gender and the fact of living with company; and among gender and having a companion and children, for the outcome of the DT. Nursing care focused on the specificity of surrounding factors and gender can optimize early attendance.
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