RESUMO
Current evidence suggests heterogeneity of amyotrophic lateral sclerosis (ALS) among geographic areas and populations. Lower mortality rates have been reported in admixed populations compared to European origin populations. We aimed to describe and compare ALS mortality rates among ethnic groups using a population-based approach in a multiethnic country. Annual mortality cause registers were searched to determine ALS deaths from the National Institute of Statistics and Censuses in Ecuador (INEC) from 1990 to 2016. Mid-year population was considered for each year. The time trend was assessed using a negative binomial regression. Rate ratio statistics were performed to compare the age and sex standardized rates based on the 2010 US population among ethnic groups. Overall, 570 ALS deaths were identified. ALS mortality showed an age-related profile with a peak between 55 and 70 years. After age-sex standardization on the 2010 US population, mortality rate was 0.33 (CI 0.30-0.36) per 100,000. The time trend showed an increase of ALS mortality (p < 0.001). There was no statistical difference in age-sex standardized mortality rates per 100,000 when admixed was compared to white (p = 0.231) and black (p = 0.125). Differences reached statistical significance between admixed and other ethnics (p = 0.015). Our population-based study supports the hypothesis that ALS occurrence is lower in predominant admixed populations from Latin America compared to European and Northern American populations. Further studies are needed to clarify the role of ancestral origin in ALS susceptibility.
Assuntos
Esclerose Lateral Amiotrófica/etnologia , Esclerose Lateral Amiotrófica/mortalidade , Etnicidade , Vigilância da População , Idoso , Esclerose Lateral Amiotrófica/diagnóstico , Equador/etnologia , Feminino , Humanos , América Latina/etnologia , Masculino , Pessoa de Meia-Idade , Mortalidade/etnologia , Mortalidade/tendências , Vigilância da População/métodosRESUMO
INTRODUCTION: Epilepsy is one of the most common neurological diseases in Latin American Countries (LAC) and epilepsy associated with convulsive seizures is the most frequent type. Therefore, the detection of convulsive seizures is a priority, but a validated Spanish-language screening tool to detect convulsive seizures is not available. We performed a field validation to evaluate the accuracy of a Spanish-language questionnaire to detect convulsive seizures in rural Bolivia using a three-stage design. The questionnaire was also administered face-to-face, using a two-stage design, to evaluate the difference in accuracy. METHODS: The study was carried out in the rural communities of the Gran Chaco region. The questionnaire consists of a single screening question directed toward the householders and a confirmatory section administered face-to-face to the index case. Positive subjects underwent a neurological examination to detect false positive and true positive subjects. To estimate the proportion of false negative, a random sample of about 20% of the screened negative underwent a neurological evaluation. RESULTS: 792 householders have been interviewed representing a population of 3,562 subjects (52.2% men; mean age 24.5 ± 19.7 years). We found a sensitivity of 76.3% (95% CI 59.8-88.6) with a specificity of 99.6% (95% CI 99.4-99.8). The two-stage design showed only a slightly higher sensitivity respect to the three-stage design. CONCLUSION: Our screening tool shows a good accuracy and can be easily used by trained health workers to quickly screen the population of the rural communities of LAC through the householders using a three-stage design.
Assuntos
População Rural , Convulsões/epidemiologia , Inquéritos e Questionários , Adolescente , Adulto , Bolívia/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Convulsões/diagnóstico , Adulto JovemRESUMO
BACKGROUND: Multiple sclerosis (MS) prevalence in Latin America was estimated in some regions and it was found to range from 0.75 to 30/100,000. The reasons for variation in rates of prevalence around the world still are not clear, but there are environmental and genetic explanations to this phenomenon. This study aimed at estimating the MS prevalence in Volta Redonda, Brazil. METHOD: Three sources of cases ascertainment were used and the method of capture-recapture was applied for assessing the corrected prevalence in the city of Volta Redonda in November 2012. The capture-recapture method uses data from incomplete lists and allows calculating the number of unregistered cases. Data were analyzed using a log-linear model. RESULTS: A total of 40 MS cases was found by withdrawing overlaps of sources and it was estimated that a total number of 40 cases (95% CI 13.5-118.8) were not detected by the sources. The corrected prevalence of MS was, then, 30.7/100,000. CONCLUSION: Our study was the first in Brazil to use the capture-recapture method to assess the prevalence of MS, demonstrating the highest prevalence rate so far. It is necessary to perform other similar studies and in other regions of the country using the same method for a better evaluation of the true prevalence of MS our country.
Assuntos
Esclerose Múltipla/epidemiologia , Adolescente , Adulto , Brasil/epidemiologia , Criança , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
AIM: The objective was to analyse and discuss data from three studies of newly-diagnosed epileptic seizures (provoked and unprovoked) conducted in Geneva, Martinique, and the Reunion Island, in which the same methodology was used. METHODS: We extracted data from three studies in which the incidence of seizures was estimated and aetiologies identified. Data was extracted and analysed using STATA. Group comparison was performed firstly for each study as a single group, and secondly by considering Martinique and the Reunion Island as an overseas group, in comparison with Geneva, considered as a mainland group. Uncorrected χ(2)was used and statistical significance (two-sided, p=0.05) was determined for each aetiology per cohort. RESULTSThe incidence of newly-diagnosed epileptic seizures per 100,000 was 71.0, 80.6, and 100.4 in Geneva, Martinique, and the Reunion Island, respectively. A bimodal distribution and predominance of generalised seizures was noted. The male to female ratio was higher in Martinique (â¼2.0) than other populations (â¼1.5). Status epilepticus was noted in Geneva and more so in the Reunion Island. The incidence of provoked seizures per 100,000 was 25.2, 16.4, and 17.7, and for unprovoked seizures was 45.6, 64.1, and 81.2 in Geneva, Martinique, and the Reunion Island, respectively. There was a greater risk of provoked seizures in Geneva relative to the overseas group, which was due to tumours, use of toxic substances, and drug abuse. The risk of unprovoked seizures in Geneva was due to trauma and infections. In Martinique, alcoholism and HIV were foremost factors for provoked and unprovoked seizures, and stroke was an important aetiology in both Martinique (provoked seizures) and the Reunion Island (unprovoked seizures). CONCLUSION: The risk of provoked seizures was greatest in Geneva and risk of unprovoked seizures was greatest in the Reunion Island. Toxic substances, alcohol, infection, and trauma constituted major factors for epileptic seizures in Geneva, while alcoholism, HIV, and stroke were major factors in the overseas group. Relative eradication of tropical infections has paved a way for the emergence of non-communicable aetiologies (stroke, alcoholism). Males from Martinique demonstrated the greatest risk of epileptic seizures, signifying the importance of alcoholism, HIV, etc. Three steps should follow: follow-up studies (mortality), strong mechanisms for prevention (or control) of risk factors, guidelines on whether to treat or not.
Assuntos
Epilepsia/epidemiologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos de Coortes , Epilepsia/terapia , Feminino , França/epidemiologia , Humanos , Lactente , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , População , Estudos Prospectivos , Reunião/epidemiologia , Fatores Sexuais , Suíça/epidemiologia , Adulto JovemRESUMO
Our objective was to compare clinical features and survival in two groups of ALS patients from countries in opposite hemispheres. The study took place at an ALS referral centre in the Limousin region of France (LIM) and in Uruguay (UY). All consecutive patients diagnosed with ALS between 1 January 2002 and 31 December 2004 were enrolled. Data from a total of 187 ALS patients were analysed: 84 from LIM and 103 from UY. Mean ages at onset and diagnosis were significantly higher in LIM (66 vs. 61 years). UY patients demonstrated more advanced disease at the time of diagnosis. The proportions of definite forms were 82% in UY versus 10% in LIM (p<0.001), and median manual muscle testing (MMT) and ALSFRS scores were significantly lower in LIM. This observed difference was not directly explained by a longer diagnostic delay in UY (10 vs. 9 months). Median survival from time of diagnosis was significantly shorter in UY patients (19 vs. 28 months; log-rank test, p=0.030). In conclusion, survival of ALS patients in UY is nine months shorter than in LIM, probably due to the heterogeneity of medical care and the absence of an ALS referral centre.