TIOTREFIS GOMES FERNANDES
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- Stroke in the Rain Forest: Prevalence in a Ribeirinha Community and an Urban Population in the Brazilian Amazon(2014) FERNANDES, Tiotrefis Gomes; BENSENOR, Isabela Martins; GOULART, Alessandra Carvalho; TAVARES, Bruno Mendes; ALENCAR, Airlane Pereira; SANTOS, Itamar Souza; LOTUFO, Paulo AndradeBackground: Our objective was to determine the cerebrovascular prevalence in a town in the Brazilian Amazon basin and compare the ribeirinhos (riparians) to the urban population in the same municipality. Methods:From May to October 2011, 6,216 residents over 35 years of age in the town of Coari were interviewed using a screening questionnaire, the Stroke Symptom Questionnaire. Cerebrovascular prevalence rates (PRs) from the door-to-door surveillance were calculated according to the location of the home. Results: Respondent totals were 4,897 in the urban area and 1,028 in the rural area. The crude prevalence of stroke was 6.3% in rural and 3.7% in urban areas with differences maintained after sex and age adjustment. Among stroke cases, the ribeirinhos were those with less access to medical care in comparison to the urban area (32.1 vs. 52.5%, p = 0.01), and a positive association between rural area and no medical care for stroke remained (PR, 1.33; 95% confidence interval, 1.03-1.71), independently of age, sex, education and functional impairment. Conclusions: This study provides the first population-based cerebrovascular prevalence comparison between an urban and a rural population in the Amazon rain forest. The PRs were higher in the ribeirinha compared to the urban population in the same municipality. (C) 2014 S. Karger AG, Basel
article 11 Citação(ões) na Scopus Chronic obstructive pulmonary disease in Brazil: mortality and hospitalization trends and rates, 1996-2008(2011) BENSENOR, I. M.; FERNANDES, T. G.; LATUFO, P. A.SETTING: Chronic obstructive pulmonary disease (COPD) is the third leading cause of death among adults in Brazil. OBJECTIVE: To evaluate the mortality and hospitalisation trends in Brazil caused by COPD during the period 1996-2008. DESIGN: We used the health official statistics system to obtain data about mortality (1996-2008) and morbidity (1998-2008) due to COPD and all respiratory diseases (tuberculosis: codes A15-16; lung cancer: code C34, and all diseases coded from J40 to 47 in the 10th Revision of the International Classification of Diseases) as the underlying cause, in persons aged 45-74 years. We used the Joinpoint Regression Program log-linear model using Poisson regression that creates a Monte Carlo permutation test to identify points where trend lines change significantly in magnitude/direction to verify peaks and trends. RESULTS: The annual per cent change in age-adjusted death rates due to COPD declined by 2.7% in men (95%CI -3.6 to -1.8) and -2.0% (95%CI -2.9 to -1.0) in women; and due to all respiratory causes it declined by -1.7% (95%CI 2.4 to -1.0) in men and -1.1% (95%CI -1.8 to -0.3) in women. Although hospitalisation rates for COPD are declining, the hospital admission fatality rate increased in both sexes. CONCLUSION: COPD is still a leading cause of mortality in Brazil despite the observed decline in the mortality/hospitalisation rates for both sexes.- Educational levels and the functional dependence of ischemic stroke survivors(2012) FERNANDES, Tiotrefis G.; GOULART, Alessandra C.; SANTOS-JUNIOR, Waldyr R.; ALENCAR, Airlane P.; BENSENOR, Isabela M.; LOTUFO, Paulo A.We evaluated the functional dependence of stroke survivors from the Study of Stroke Mortality and Morbidity, using the Rankin Scale. Out of 355 ischemic stroke survivors (with a mean age of 67.9 years), 40% had some functional dependence at 28 days and 34.4% had some functional dependence at 6 months. Most predictors of physical dependence were identified at 28 days. These predictors were: low levels of education [illiterate vs. >= 8 years of education, multivariate odds ratio (OR) = 3.7; 95% confidence interval (95%CI): 1.60-8.54] and anatomical stroke location (total anterior circulation infarct, OR = 16.9; 95%CI: 2.93-97.49). Low levels of education and ischemic brain injury influenced functional dependence in these stroke survivors. Our findings reinforce the necessity of developing strategies for the rehabilitation of stroke patients, more especially in formulating specific strategies for care and treatment of stroke survivors with low socioeconomic status.
- Early and One-Year Stroke Case Fatality in Sao Paulo, Brazil: Applying the World Health Organization's Stroke STEPS(2012) GOULART, Alessandra C.; BENSENOR, Isabela M.; FERNANDES, Tiotrefis G.; ALENCAR, Airlane P.; FEDELI, Ligia M.; LOTUFO, Paulo A.Case fatality rate is considered a main determinant of stroke mortality trends. We applied the World Health Organization's Stroke STEPS to identify case fatality rates in a community hospital in Brazil. We evaluated all patients with first-ever stroke seeking acute care at the hospital's emergency ward between April 2006 and December 2008 to verify early and late case fatality according to stroke subtype. We used years of formal education as a surrogate for socioeconomic status. Of 430 first-ever stroke events, 365 (84.9%) were ischemic and 65 (15.1%) were intracerebral hemorrhage. After 1 year, we adjudicated 108 deaths (86 ischemic; 22 hemorrhagic). Age-adjusted case fatality rates for ischemic stroke and intracerebral hemorrhage were 6.0% v 19.8% at 10 days, 10.6% v 22.1% at 28 days, 17.6% v 29.1% at 6 months, and 21.0% v 31.5% at 1 year. Illiteracy or no formal education was a predictor of death at 6 months (odds ratio [OR], 4.31; 95% confidence interval [CI] 1.34-13.91) and 1 year (OR, 4.21; 95% CI, 1.45-12.28) in patients with ischemic stroke, as well as at 6 months (OR, 3.19; 95% CI, 1.17-8.70) and 1 year (OR, 3.30; 95% CI, 1.30-8.45) for all stroke patients. Other variables, including previous cardiovascular risk factors and acute medical care, did not change this association to a statistically significant degree. In conclusion, case fatality, particularly up to 6 months, was higher in hemorrhagic stroke, and lack of formal education was associated with increased stroke mortality.
- A reappraisal of stroke mortality trends in Brazil (1979-2009)(2013) LOTUFO, Paulo A.; GOULART, Alessandra C.; FERNANDES, Tiotrefis G.; BENSENOR, Isabela M.Background Brazil has one of the highest cerebrovascular death rates in the Western Hemisphere. We investigated temporal trends according to gender and stroke subtypes. Methods We analyzed mortality rates between 1979 and 2009 for different stroke subtypes. Data were stratified by gender and age (3574years). The annual percent change and significant changes in the trends were identified with Poisson regression. Results After excluding deaths due to sequel from stroke for men, the annual percent changes (95% confidence intervals) were as follows: 19791984, 0 center dot 7 (0 center dot 8 to 2 center dot 1); 19841994, 1 center dot 8 (2 center dot 4 to 1 center dot 2); 19942007, 5 center dot 0 (5 center dot 4 to 4 center dot 7); and 20072009, 0 center dot 8 (7 center dot 0 to 5 center dot 8). For women, the annual percent changes were as follows: 19791994, 1 center dot 9 (2 center dot 2 to 1 center dot 6); 19941997, 7 center dot 5 (14 center dot 0 to 0 center dot 6); 19972007, 4 center dot 0 (4 center dot 6 to 3 center dot 3); and 20072009, 1 center dot 6 (5 center dot 5 to 9 center dot 2). For the 20062009 period, the average annual percent change (95% confidence interval) for all strokes was 3 center dot 1 (3 center dot 3 to 2 center dot 9) for men and 2 center dot 9 (3 center dot 1 to 2 center dot 8) for women. For the same period, the average annual percent change of death rates for stroke subtypes were, for men and women, respectively: intracerebral hemorrhage, 4 center dot 0 (4 center dot 9 to 3 center dot 1) and 2 center dot 9 (3 center dot 4 to 2 center dot 3); and ischemic stroke, 3 center dot 2 (3 center dot 3 to 3 center dot 0) and 1 center dot 4 (2 center dot 0 to 0 center dot 9). Conclusion Stroke mortality rates are declining in Brazil for all stroke subtypes.