This article describes the development and operation of the Integrated Regional STEMI Network in Salvador, Bahia, Brazil, and defines its basic components. Moreover, we present a preliminary STEMI registry, including patients' demographics, clinical, interval times, and primary reperfusion © 2012 American Heart Association, Inc. Background-Regionalized integrated networks for ST-segment-elevation myocardial infarction (STEMI) care have been proposed as a step forward in overcoming real-world obstacles, but data are lacking on its performance in developing countries. We describe an integrated regional STEMI network in Salvador, Bahia, Brazil.Methods and Results-The network was created in 2009. It was coordinated by the prehospital emergency medical service and encompassed the public emergency system (prehospital mobile units, community-based emergency units, general hospitals, and cardiology reference centers). The 12-lead ECGs are interpreted via telemedicine. This network operates as follows: The Telemedicine Center sends each ECG suggestive of STEMI to a Regional STEMI Alert Team, which, together with emergency medical services, offers support for thrombolysis or immediate transfer for primary percutaneous coronary intervention. In 14 months, there were 433 suspected victims, of which in 287 (76.5%) the STEMI could be confirmed (age, 62.1±12.5 years; 63.4% men). Most of them were self-transported. The median pain-to-admission time was 180 minutes (interquartile range, 90-473 minutes), and the median admission-to-ECG time was 159.5 minutes (interquartile range, 83.5-340 minutes). The median interval time between the ECG and the telemedicine report was 31 minutes (interquartile range, 21-44 minutes). For those who sought medical attention and had an ECG performed within 12 hours after symptoms onset (n=119), the reperfusion rate was 75.6% (34.4% by thrombolysis and 65.6% by primary percutaneous coronary intervention).Conclusions-Regional STEMI networks may be feasible in developing countries. Preliminary results showed this network to be effective, achieving primary reperfusion rates comparable with those reported internationally despite the obstacles faced.(Circ Cardiovasc Qual Outcomes. 2013;6:9-17.)

BackgroundFew data exist on regional systems of care for the treatment of ST‐segment–elevation myocardial infarction (STEMI) in developing countries. Our objective was to describe temporal trends in 30‐day mortality and identify predictors of mortality among STEMI patients enrolled in a prospective registry in Brazil.Methods and ResultsFrom January 2011 to June 2013, 520 patients who received initial STEMI care at 23 nonspecialized public health units or hospitals, some of whom were transferred to a public cardiology referral center, were identified through a regional STEMI network supported by telemedicine and the local prehospital emergency medical service. We stratified patients into five 6‐month periods based on presentation date. Mean age (±SD) of patients was 62.0 (±12.2) years, and 55.6% were men. The mean Global Registry of Acute Coronary Events (GRACE) score was 145 (±34). Overall mortality at 30 days was 15.0%. Use of dual antiplatelet therapy and statins increased significantly from baseline (January 2011) to period 5 (June 2013): 61.8% to 93.6% (P<0.001) and 60.4% to 79.7% (P<0.001), respectively. Rates of primary reperfusion also increased (29.1%–53.8%; P<0.001), and more patients were transferred to the referral center (44.7%–76.3%; P=0.001). Thirty‐day mortality rates decreased from 19.8% to 5.1% (P<0.001). In multivariable analysis, factors independently associated with 30‐day mortality were higher GRACE score, history of previous stroke, lack of transfer to the referral center, and lack of use of optimized medical therapy.ConclusionsImplementation of a regional STEMI system was associated with lower mortality and higher use of evidence‐based therapies.

Doenças transmitidas por alimentos (DTA) oferecem riscos à saúde. No Brasil em 2016 foram notificadas 9.935 pessoas com DTA, reforçando a importância de conhecer os fatores associados para prevenção e planejamento da redução de incidentes. Crianças estão expostas às DTA, principalmente no carnaval. O objetivo deste artigo é descrever as características clínicas e fatores associados às DTA em crianças durante o carnaval de Salvador. Este é um estudo transversal, com análise das fichas de atendimento de crianças de 0 a 12 anos, durante o carnaval de Salvador/2016. Para análise dos dados foi utilizada a estatística descritiva, aplicou-se o teste qui-quadrado de Pearson para medidas de associação (p < 0,05). A amostra foi constituída de 127 crianças, sendo que 37,8% foram diagnosticadas com DTA. Dentre as crianças com DTA, houve o predomínio da faixa etária de 1 a 9 anos (70,8%) e sexo masculino (54,2%), folião de rua (95,8%), atendidos no circuito Osmar (52,1%), no período da tarde (31,3%). Na análise bivariada identificou-se associação de DTA  com: náuseas/vômitos (p < 0,001) e dor abdominal (p = 0,001). Prevaleceu o número de crianças de 1 a 9 anos, sexo masculino e a maioria sendo folião de rua, atendidos no turno da tarde. As DTA foram associadas com náuseas/vômitos e dor abdominal. Palavras-chave: Aglomeração. Saúde da criança. Saúde pública. Doenças transmitidas por alimentos.