Stroke prevention and control in Brazil: missed opportunities
Notice bibliographique
Résumé
everal studies have shown that stroke has a huge global impact with a considerable financial cost both to health and care services and to patients and their families.Stroke is one of the leading causes of mortality and disability in Latin America and the Caribbean 1 .Brazil presents the fourth worst stroke mortality rate among these countries with an early in-hospital stroke mortality rate of 34.3% which is high when compared to the rates in Canada (6.9%) or the Netherlands (17.3%) 2 .Stroke mortality varies considerably according to social and economic development and about 85% of strokes occur in low-and middle-income countries (LMIC) with one third affecting the economically active population 3,4 .A recent publication from the Global Burden of Disease Collaborators has shown that stroke is among the three main causes of years of life lost in Brazil 5 .The demographic transition occurring in most developing countries towards an increase of the older population will amplify the impact of stroke.Understanding the epidemiology and risk factors for stroke is important to be able to identify people at risk and implement preventative interventions.Hypertension is probably the most important and well-documented risk factor 6 and there is overwhelming evidence that its control reduces the absolute and relative risk of stroke 7,8 .Population-based surveys are crucial for quantifying the disease burden, contributing to evidence-based healthcare planning, and evaluating the effectiveness and relative contribution of various primary and secondary/tertiary preventative measures for reducing the burden of diseases such as stroke 9 .In this issue of Arquivos de Neuropsiquiatria, Bensenor et al. 10 publish an important study which assesses the self-declared prevalence of stroke in the Brazilian population using the National Health Survey (Pesquisa Nacional de Saúde -PNS) undertaken in 2013 that covered both urban and rural areas and included information on gender, race/self-reported skin color, education level and occupation.This study estimated that there were 2.231.000people who had suffered a stroke and 568.000 stroke cases with severe disabilities and showed high stroke prevalence rates especially in older individuals without formal education and urban dwellers.The findings of this survey reveal the scale of the challenges in terms of stroke prevention and control in Brazil.Primary care offers the best opportunity for preventive interventions in people at risk of stroke.Evidence-based guidelines 11 for primary stroke prevention are easily available in many countries.Despite this, patients who present at hospital with first stroke have been found to have multiple untreated or undertreated risk factors 12 illustrating missed opportunities.Studies of the use and adherence to stroke prevention guidelines are few and limited.Cost-effective interventions are available for secondary prevention of stroke, and the potential gains associated with the consistent use of such interventions are very large.Making these interventions accessible to all patients with stroke could lead to substantial individual and public health benefits.Phase 1 of the WHO-PREMISE study 13 is aimed at assessing current practice patterns related to secondary prevention of cardio and cerebrovascular disease (CVD) and identifying barriers and opportunities for scaling up secondary prevention.It was conducted in areas of ten LMIC including Brazil (Porto Alegre).This study showed that several measures of well established secondary prevention interventions were far behind what would
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,018 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,003 | 0,002 |
| Communication savante | 0,003 | 0,003 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,012 | 0,011 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».