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Cagna-Castillo D, Salcedo-Carrillo AL, Carrillo-Larco RM, Bernabé-Ortiz A. Prevalence and incidence of stroke in Latin America and the Caribbean: a systematic review and meta-analysis. Sci Rep 2023; 13:6809. [PMID: 37100856 PMCID: PMC10133252 DOI: 10.1038/s41598-023-33182-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 04/08/2023] [Indexed: 04/28/2023] Open
Abstract
Stroke is a recurrent and well-known cardiovascular event and a leading cause of death worldwide. We identified reliable epidemiological evidence of stroke in Latin America and the Caribbean (LAC) and estimated the prevalence and incidence of stroke, overall and by sex, in that region. A systematic search in OVID (Medline, Embase and Global Health) and in the Latin America and Caribbean Health Sciences Literature (LILACS) until the end of 2020 was made for all cross-sectional or longitudinal studies estimating (or allowing the estimation of) the prevalence or incidence of stroke among individuals of the general population ≥ 18 years from LAC countries. No language restriction was applied. Studies were assessed for methodological quality and risk of bias. Pooled estimates were calculated using random effect meta-analysis as high heterogeneity was expected. A total of 31 papers for prevalence and 11 papers for incidence were included in the review for analysis. The overall pooled stroke prevalence was 32 (95% CI 26-38) per 1000 subjects and were similar among men (21; 95% CI 17-25) and women (20; 95% CI 16-23) per 1000 subjects. The overall pooled stroke incidence was 255 (95% CI 217-293) per 100 000 person-years, being higher in men (261; 95% CI 221-301) compared to women (217; 95% CI 184-250) per 100 000 person-years. Our results highlight the relevance of the prevalence and incidence of stroke in the LAC region. The estimates were similar in stroke prevalence by sex, but with higher incidence rates among males than females. Subgroup analyses highlight the need for standardized methodologies to obtain appropriate prevalence and incidence estimates at the population level in a region with a great burden of cardiovascular events.
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Affiliation(s)
| | | | - Rodrigo M Carrillo-Larco
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Antonio Bernabé-Ortiz
- Universidad Cientifica del Sur, Lima, Peru
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
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2
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Prevalence of Stroke in the Elderly: A Systematic Review and Meta-Analysis. INTERDISCIPLINARY NEUROSURGERY 2023. [DOI: 10.1016/j.inat.2023.101746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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3
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Choudhuri S, Garg NJ. Platelets, Macrophages, and Thromboinflammation in Chagas Disease. J Inflamm Res 2022; 15:5689-5706. [PMID: 36217453 PMCID: PMC9547606 DOI: 10.2147/jir.s380896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 08/24/2022] [Indexed: 11/23/2022] Open
Abstract
Chagas disease (CD) is a major health problem in the Americas and an emerging health problem in Europe and other nonendemic countries. Several studies have documented persistence of the protozoan parasite Trypanosoma cruzi, and oxidative and inflammatory stress are major pathogenic factor. Mural and cardiac thrombi, cardiac arrhythmias, and cardiomyopathy are major clinical features of CD. During T. cruzi infection, parasite-released factors induce endothelial dysfunction along with platelet (PLT) and immune-cell activation. PLTs have a fundamental role in maintaining hemostasis and preventing bleeding after vascular injury. Excessive activation of PLTs and coagulation cascade can result in thrombosis and thromboembolic events, which are recognized to occur in seropositive individuals in early stages of CD when clinically symptomatic heart disease is not apparent. Several host and parasite factors have been identified to signal hypercoagulability and increase the risk of ischemic stroke in early phases of CD. Further, PLT interaction with immune cells and their role in host defense against pathogens and inflammatory processes have only recently been recognized and evolving. In the context of parasitic diseases, PLTs function in directly responding to T. cruzi infection, and PLT interactions with immune cells in shaping the proinflammatory or immunoregulatory function of monocytes, macrophages, and neutrophils remains elusive. How T. cruzi infection alters systemic microenvironment conditions to influence PLT and immune-cell interactions is not understood. In this review, we discuss the current literature, and extrapolate the mechanistic situations to explain how PLT and innate immune cell (especially monocytes and macrophages) interactions might be sustaining hypercoagulability and thromboinflammation in chronic CD.
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Affiliation(s)
- Subhadip Choudhuri
- Department of Microbiology and Immunology, Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, USA
| | - Nisha J Garg
- Department of Microbiology and Immunology, Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX, USA
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4
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Oliveira GMMD, Brant LCC, Polanczyk CA, Biolo A, Nascimento BR, Malta DC, Souza MDFMD, Soares GP, Xavier Junior GF, Machline-Carrion MJ, Bittencourt MS, Pontes Neto OM, Silvestre OM, Teixeira RA, Sampaio RO, Gaziano TA, Roth GA, Ribeiro ALP. Cardiovascular Statistics - Brazil 2020. Arq Bras Cardiol 2020; 115:308-439. [PMID: 33027364 PMCID: PMC9363085 DOI: 10.36660/abc.20200812] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023] Open
Affiliation(s)
- Gláucia Maria Moraes de Oliveira
- Instituto do Coração Edson Saad da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro , RJ - Brasil.,Disciplina de Cardiologia, Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro , RJ - Brasil
| | - Luisa Campos Caldeira Brant
- Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil.,Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil
| | - Carisi Anne Polanczyk
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre , RS - Brasil.,Serviço de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS - Brasil.,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre , RS - Brasil
| | - Andreia Biolo
- Faculdade de Medicina da Universidade Federal do Rio Grande do Sul (UFRS), Porto Alegre , RS - Brasil.,Serviço de Cardiologia do Hospital Moinhos de Vento , Porto Alegre , RS - Brasil.,Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre , RS - Brasil
| | - Bruno Ramos Nascimento
- Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil.,Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil
| | - Deborah Carvalho Malta
- Programa de Pós-Graduação em Saúde Pública da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil
| | - Maria de Fatima Marinho de Souza
- Programa de Pós-Graduação em Saúde Pública da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil.,Organização Vital Strategies , Nova York - EUA
| | - Gabriel Porto Soares
- Instituto do Coração Edson Saad da Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro , RJ - Brasil.,Curso de Medicina da Universidade de Vassouras , Vassouras , RJ - Brasil
| | | | | | - Marcio Sommer Bittencourt
- Divisão de Clínica Médica do Hospital Universitário da Universidade de São Paulo , São Paulo , SP - Brasil.,Faculdade Israelita de Ciências da Saúde Albert Einstein , São Paulo , SP - Brasil
| | - Octavio M Pontes Neto
- Serviço de Neurologia Vascular e Emergências Neurológicas, Divisão de Neurologia, Departamento de Neurociências e Ciências do Comportamento , Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (USP), São Paulo , SP - Brasil
| | | | - Renato Azeredo Teixeira
- Programa de Pós-Graduação em Saúde Pública da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil
| | - Roney Orismar Sampaio
- Departamento de Cardiopneumologia da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo , SP - Brasil.,Programa de Pós-Graduação da Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo , SP - Brasil.,Unidade Clínica de Cardiopatias Valvares do Instituto do Coração (Incor) do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP), São Paulo , SP - Brasil
| | - Thomaz A Gaziano
- Brigham and Women's Hospital , Boston - EUA.,Department of Medicine , Cardiovascular, Harvard Medical School , Boston - EUA
| | - Gregory A Roth
- Global Health and Health Metrics Sciences at the Institute for Health Metrics and Evaluation (IHME), Washington - EUA.,Division of Cardiology at the University of Washington School of Medicine , Washington - EUA
| | - Antonio Luiz Pinho Ribeiro
- Departamento de Clínica Médica da Faculdade de Medicina da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil.,Serviço de Cardiologia e Cirurgia Cardiovascular e Centro de Telessaúde do Hospital das Clínicas da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte , MG - Brasil
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Hospitalization of the aged due to stroke: An ecological perspective. PLoS One 2019; 14:e0220833. [PMID: 31390380 PMCID: PMC6685616 DOI: 10.1371/journal.pone.0220833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 07/24/2019] [Indexed: 12/05/2022] Open
Abstract
Contextual variables have been associated with the incidence of stroke, but their association with hospitalization of older persons remains unclear. This study evaluated the association between social context variables and hospitalization of 60 years old and older patients due to stroke in Rio de Janeiro, Brazil. An ecological cross-sectional study was conducted, with secondary data from the Brazilian Hospital Information System from 2006 to 2014. Hospitalization rates were calculated and categorized by tertiles. For subsequent analyzes, the polar extremes method was used to select the groups with extremes values. After that, Student t or Mann-Whitney tests were used to compare the contextual variables and the hospitalization rates clusters. Then, a Binary Logistic Regression analysis was used to assess the association between hospitalization rates clusters and the contextual variables. The total number of hospitalizations was 82 796; the hospitalization rate varied in extremes groups from the lowest (3.49) to the highest (11.95) (p<0.001). The highest rates group was positively associated with the proportion of elderly (p<0.001), the illiteracy rate of the aged (p = 0.01), primary care coverage (p<0.001) and ambulatory care for hypertension and diabetes, while the income ratio showed negative association with the highest rates of hospitalization (p = 0.01). In the multivariate analysis, only the proportion of elderly (OR = 1.55; 95%CI 1.07–2.25), primary care coverage (OR = 1.05; 95%CI 1.01–1.11) and income ratio (OR = 0.82; 95%CI 0.67–0.99) maintained the association. In conclusion, contextual variables in the three dimensions studied were associated with the rate of hospitalization of aged due to stroke in the municipalities in Rio de Janeiro State. Transitional care and other improvements in both the health care and social services are demanded.
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Mandy A, Chesani F, Mezadri T. An exploration of the experiences of Brazilian hemiplegic manual wheelchair users. Disabil Rehabil Assist Technol 2019; 15:637-642. [PMID: 31232116 DOI: 10.1080/17483107.2019.1604825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose: The objective of this research was to explore the experiences of 11 hemiplegic users with their manual wheelchairs.Method: The phenomenological approach explored the subjective experiences of Brazilian hemiplegic manual wheelchair users in order to identify and describe the factors that affected their relationship with their wheelchair. Using in depth semistructured interviews. The data were analysed using thematic analysis. The health records from the physiotherapy service of the Health Department of Itajaí were reviewed to identify hemiplegic wheelchair users.Results: The results identified 4 key themes: heteronomy, inadequate/inappropriateness of wheelchair design, poor state of the pavements and roads prohibiting wheelchair use and lack of suitable wheelchair provision.Conclusion: The findings confirm that current manual wheelchair provision, both new and secondhand, for this group of users is inadequate and they highlighted the issues and problems arising from the current provision. A novel finding was the identification of heteronomy that resulted from the provision of unsuitable equipment.Implication for rehabilitationAdding into physiotherapy and occupational therapy education, the importance of matching technology to the user in their environment.The importance of involving the user in decisions made about wheelchair provision.Sharing findings with wheelchair manufacturers to improve manual wheelchair design for hemiplegic users.
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Affiliation(s)
- Anne Mandy
- Health and Labor Management, University of Brighton, Brighton, UK
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Sousa LVDA, Paiva LDS, Figueiredo FWDS, Almeida TCDC, Oliveira FR, Adami F. Trends in Stroke-Related Mortality in the ABC Region, São Paulo, Brazil: An Ecological Study Between 1997 and 2012. Open Cardiovasc Med J 2017; 11:111-119. [PMID: 29290833 PMCID: PMC5721306 DOI: 10.2174/1874192401711010111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 08/29/2017] [Accepted: 10/12/2017] [Indexed: 11/29/2022] Open
Abstract
Background: Stroke is the second leading cause of death and the third leading cause of physical disability in the world, with a high burden of morbidity and mortality, but it has been shown a reduction in mortality worldwide over the past two decades, especially in regions with higher income. Objective: The study analyzed the temporal trend and the factors associated with stroke-related mortality in the cities that make up the ABC region of São Paulo (Santo André, São Bernardo do Campo, São Caetano do Sul, Diadema, Mauá, Ribeirão Pires, and Rio Grande da Serra), in comparison to data from the capital city of São Paulo, in the state of São Paulo, Brazil. Method: This was an ecological study conducted in 2017 using data from 1997 to 2012. Data were collected in 2017 from the Department of Informatics of the Brazilian Unified National Health System (DATASUS), where the Mortality Information System (SIM/SUS) was accessed. Linear regression analysis was used to estimate the temporal trend of stroke-related mortality according to sex, stroke subtypes, and regions. The confidence level adopted was 95%. Results: There was a reduction in the mortality rates stratified according to sex, age groups above 15 years, and subtypes of stroke. Mortality from hemorrhagic and non-specified stroke decreased in all regions. However, a significant reduction in ischemic stroke-related mortality was observed only in the ABC region and in Brazil. Conclusion: The ABC region showed greater mortality due to stroke in males, the age group above 49 years, and non-specified stroke between 1997 and 2012.
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Affiliation(s)
- Luiz Vinicius de Alcantara Sousa
- Faculty of Medicine of ABC. Laboratory of Epidemiology and Data Analysis, Department of Collective Health, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, Brazil
| | - Laércio da Silva Paiva
- Faculty of Medicine of ABC. Laboratory of Epidemiology and Data Analysis, Department of Collective Health, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, Brazil
| | - Francisco Winter Dos Santos Figueiredo
- Faculty of Medicine of ABC. Laboratory of Epidemiology and Data Analysis, Department of Collective Health, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, Brazil
| | - Tabata Cristina do Carmo Almeida
- Faculty of Medicine of ABC. Laboratory of Epidemiology and Data Analysis, Department of Collective Health, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, Brazil
| | - Fernando Rocha Oliveira
- Faculty of Public Health, University of São Paulo, Department of Epidemiology. Av. Dr. Arnaldo, 715, São Paulo, SP, Brazil
| | - Fernando Adami
- Faculty of Medicine of ABC. Laboratory of Epidemiology and Data Analysis, Department of Collective Health, Av. Lauro Gomes, 2000, Vila Sacadura Cabral, Santo André, SP, Brazil
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8
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Santana MTM, Chun RYS. Language and functionality of post-stroke adults: evaluation based on International Classification of Functioning, Disability and Health (ICF). Codas 2017; 29:e20150284. [PMID: 28300953 DOI: 10.1590/2317-1782/20172015284] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 08/04/2016] [Indexed: 11/22/2022] Open
Abstract
Purpose Cerebrovascular accident is an important Public Health problem because of the high rates of mortality and sequelae such as language disorders. The conceptual health changes have led to the incorporation of functional and social aspects in the assessments as proposed by the World Health Organization in the International Classification of Functioning, Disability and Health. The purpose was to evaluate and classify language aspects, functionality and participation of post-stroke individuals based on the concepts of the International Classification of Functioning, Disability and Health and characterize the sociodemographic profile of participants. Methods Data collection was carried out through the application of a clinical instrument to evaluate language, participation and functionality in fifty individuals based on the International Classification of Functioning, Disability and Health. Results The age of the participants varied between 32 and 88 years, and the majority were elderly men. Among body functions, the participants reported more difficulties in "memory functions". As for activity and participation, more difficulties were reported in "recreation and leisure". As for environmental factors, the component "healthcare professionals" was indicated as a facilitator by the majority of participants. Conclusion The results show the impact of language difficulties in the lives of post-stroke adults and reinforce the applicability of the International Classification of Functioning, Disability and Health as an important complementary tool for assessing language, functionality and participation in a comprehensive and humane approach, towards the improvement of health assistance in ambulatory care.
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Lima MJMR, Moreira TMM, Florêncio RS, Braga P. Factors associated with young adults' knowledge regarding family history of Stroke. Rev Lat Am Enfermagem 2016; 24:e2814. [PMID: 27878217 PMCID: PMC5173298 DOI: 10.1590/1518-8345.1285.2814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 07/05/2016] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE: to analyze the factors associated with young adults' knowledge regarding family history of stroke. METHOD: an analytical transversal study, with 579 young adults from state schools, with collection of sociodemographic, clinical and risk factor-related variables, analyzed using logistic regression (backward elimination). RESULTS: a statistical association was detected between age, civil status, and classification of arterial blood pressure and abdominal circumference with knowledge of family history of stroke. In the final logistic regression model, a statistical association was observed between knowledge regarding family history of stroke and the civil status of having a partner (ORa=1.61[1.07-2.42]; p=0.023), abdominal circumference (ORa=0.98[0.96-0.99]; p=0.012) and normal arterial blood pressure (ORa=2.56[1.19-5.52]; p=0.016). CONCLUSION: an association was observed between socioeconomic factors and risk factors for stroke and knowledge of family history of stroke, suggesting the need for health education or even educational programs on this topic for the clientele in question. OBJETIVO: analisar os fatores associados ao conhecimento dos adultos jovens sobre histórico familiar de Acidente Vascular Cerebral (AVC). MÉTODO: estudo transversal analítico, com 579 adultos jovens de escolas públicas, com coleta de variáveis sociodemográficas, clínicas e de fatores de risco em formulário, analisados utilizando-se regressão logística (backward elimination). RESULTADOS: detectou-se associação estatística de idade, situação conjugal, classificação da pressão arterial e circunferência abdominal com conhecimento do histórico familiar de AVC. No modelo final de regressão logística, observou-se associação estatística do conhecimento sobre histórico familiar de AVC com situação conjugal com companheiro (ORa=1,61[1,07-2,42]; p=0,023), circunferência abdominal (ORa=0,98[0,96-0,99]; p=0,012) e pressão arterial normal (ORa=2,56[1,19-5,52]; p=0,016). CONCLUSÃO: foi constatada associação de fatores socioeconômicos e de risco para AVC com o conhecimento do histórico familiar de AVC, sugerindo a necessidade de educação em saúde ou mesmo de programas educacionais sobre o tema junto à clientela em estudo. OBJETIVO: analizar los factores asociados al conocimiento de los adultos jóvenes sobre el histórico familiar de Accidente Vascular Cerebral (AVC). MÉTODO: estudio transversal analítico en 579 adultos jóvenes de escuelas públicas, con recolección de variables sociodemográficas, clínicas y de factores de riesgo en formulario, los datos fueron analizados utilizando la regresión logística (backward elimination). RESULTADOS: se detectó asociación estadística de edad, situación conyugal, clasificación de la presión arterial y circunferencia abdominal con el conocimiento del histórico familiar de AVC. En el modelo final de regresión logística, se observó una asociación estadística del conocimiento sobre el histórico familiar de AVC con: situación conyugal con compañero (ORa=1,61[1,07-2,42] p=0,023); circunferencia abdominal (ORa=0,98[0,96-0,99] p=0,012); y presión arterial normal (ORa=2,56[1,19-5,52] p=0,016). CONCLUSIÓN: fue constatada asociación de factores socioeconómicos y de riesgo para AVC con el conocimiento del histórico familiar de AVC; se sugiere la necesidad de realizar acciones de educación en salud o inclusive de preparar programas educacionales sobre el tema para la población estudiada.
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Affiliation(s)
| | | | - Raquel Sampaio Florêncio
- Doctoral student, Universidade Estadual do Ceará, Fortaleza, CE, Brazil. Scholarship holder from Coordenação de Aperfeiçoamento de Pessoal em Nível Superior (CAPES), Brazil
| | - Predro Braga
- PhD, Adjunct Professor, Universidade Estadual do Ceará, Fortaleza, CE, Brazil
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Carmo JFD, Oliveira ERA, Morelato RL. Functional disability and associated factors in elderly stroke survivors in Vitória, Brazil. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2016. [DOI: 10.1590/1809-98232016019.150215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: The aim of the present study was to estimate the prevalence of disability and associated factors in elderly stroke survivors. Methods: A cross-sectional study of 230 elderly persons was conducted in the 22 territories of the Estratégia de Saúde da Família (the Family Health Strategy) of Vitória, in the state of Espirito Santo. Patients were assessed using the modified Rankin Scale. Poisson regression with robust variance in crude and adjusted analyses was employed. Results: The majority of subjects were men (52.1%) aged between 60 to 98 years, with a mean age of 75.8 (sd±9.2). The prevalence of disability was 66%. Age ≥80 years, self-perceived limitations in bodily function, considering the physical structure of the street to be a barrier to leaving home and believing street lighting to be insufficient were positively associated with functional disability. Possessing 12 or more years of schooling was inversely associated with the outcome. Conclusions: The high prevalence of disability and associated factors in elderly stroke survivors reinforce the need for a health system that operates continuously and proactively, promoting active aging.
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Lopes JM, Sanchis GJB, Medeiros JLAD, Dantas FG. Hospitalização por acidente vascular encefálico isquêmico no Brasil: estudo ecológico sobre possível impacto do Hiperdia. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2016; 19:122-34. [DOI: 10.1590/1980-5497201600010011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 07/14/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Objetivo: O estudo avaliou a tendência de hospitalização por acidente vascular encefálico isquêmico (HAVEI) e a sua mortalidade hospitalar no Brasil nos últimos 15 anos, assim como o impacto do programa Hiperdia nesse cenário. Métodos: Delineou-se um estudo ecológico com abordagem analítica e dados coletados no Sistema de Internação Hospitalar sobre episódios de AVEI, referentes aos anos de 1998 a 2012. Todos os dados foram estratificados por sexo e faixa etária, criando-se um indicador para HAVEI e proporção de mortalidade hospitalar. A fim de estimar a tendência dos dados criou-se uma curva polinomial de melhor aderência e para a averiguar o impacto do Hiperdia aplicou-se o Modelo Linear Generalizado tomados como desfecho a HAVEI e a mortalidade hospitalar. Adotou-se um nível de significância de 5% para minimizar um erro tipo I. Resultados: Foi evidenciada redução das HAVEI de 37,57/105 habitantes em 1998 a 2001 para 10,33/105 habitantes em 2002 a 2005, declinando 73,64%. A redução aconteceu em ambos os sexos, assim como para todas as faixas etárias. A mortalidade hospitalar por AVEI também declinou no Brasil a partir de 2002, tanto em homens como em mulheres, porém em menos de 3% e apenas nas faixas entre 0 e 14 anos e acima de 80 anos não detectamos tendência. Conclusão: Portanto, o declínio das HAVEI coincidiu temporalmente com a implementação do Hiperdia no ano de 2002 e essa tendência se mantém até hoje.
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Gaspar MDRDF, Pinto GDS, Gomes RHS, Santos RS, Leonor VD. Avaliação da qualidade de vida em pacientes com disfagia neurogênica. REVISTA CEFAC 2015. [DOI: 10.1590/1982-0216201517619114] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO: Objetivo: avaliar a qualidade de vida de pacientes com Acidente Vascular Encefálico e disfagia neurogênica. Métodos: estudo quantitativo, do tipo transversal, descritivo, realizado no Setor de Neurologia de um Hospital de Ensino, em Curitiba- Paraná. A amostra foi constituída de 35 indivíduos com Acidente Vascular Encefálico e queixa de disfagia. Os dados foram coletados por meio de questionário para avaliação da qualidade de vida em disfagia. Resultados: nas variáveis sociodemográficas houve predomínio de homens, idosos, brancos, casados e primeiro grau incompleto. A avaliação de qualidade de vida demonstrou que os domínios que apresentaram alterações foram os que investigam como a alteração da deglutição tem afetado o aspecto social dos participantes. A correlação de Mann-Whitney evidenciou significância estatística (p < 5) quando relacionou a deglutição como um fardo com o tempo de se alimentar (p 0,002), frequência dos sintomas (p <0,001), saúde mental (p <0,001) e fadiga (p <0,001). Conclusão: o levantamento estatístico comprovou o impacto causado pela disfagia neurogênica na qualidade de vida dos pacientes acometidos por Acidente Vascular Encefálico, representado pelas alterações encontradas nos resultados de avalição da qualidade de vida. Na correlação de Mann-Whitney, ao se realizar os cruzamentos entre os domínios do instrumento, os dados evidenciaram significância estatística quanto ao tempo de alimentação, medo de se alimentar, saúde mental, social e fadiga, que causam prejuízo na qualidade de vida dos pacientes com disfagia neurogênica.
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Costa VDSP, Guimarães PSR, Fernandes KBP, Probst VS, Marquez ADS, Fujisawa DS. Prevalence of risk factors for the occurrence of strokes in the elderly. FISIOTERAPIA EM MOVIMENTO 2014. [DOI: 10.1590/0103-5150.027.004.ao07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction Stroke (CVA) is a multifactorial disease, where the combination of risk factors may be associated with and contribute to its development. Objectives The objective of this study was to evaluate the prevalence of risk factors for stroke in the physically independent elderly in the city of Londrina, Brazil. Materials and methods This study was composed of the elderly individuals participating in the EELO project (Age and Ageing Study, Londrina, State of Paraná, Brazil). In order to identify the risk factors for stroke, one used a structured questionnaire with information about socio-demographic and anthropometric data as well as lifestyle variables, such as physical inactivity and smoking, presence of comorbidities, and laboratory tests for diagnosis of diabetes and dyslipidemia. Results The study included 454 elderly with mean age of 69.7 years. There was a significant relationship between the number of risk factors and gender (p = 0.01), with higher prevalence among women. In separate analysis, the elderly between 60 and 69 years had a higher incidence of obesity (p = 0.03) and dyslipidemia (p = 0.04). Regarding gender, obesity (p = 0.01), smoking (p = 0.0001), vascular disease (p = 0.0001) and heart disease in the family (p = 0.01) higher incidence was shown in females, according toChi Square’s test. Conclusions It is concluded that elderly people aged less than 70 years and older women were those with the highest number of risk factors for CVA. Therefore, it may be suggested the development of primary care programs in order to promote information on the prevention of these risk factors and thus reduce the occurrence of stroke.
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Silveira RED, Santos ADS, Sousa MCD, Monteiro TSA. Expenses related to hospital admissions for the elderly in Brazil: perspectives of a decade. EINSTEIN-SAO PAULO 2014; 11:514-20. [PMID: 24488394 PMCID: PMC4880392 DOI: 10.1590/s1679-45082013000400019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 10/09/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To describe the profile of morbidities and expenses related to hospitalization of the elderly compared to the adult population (20 to 59 years). METHODS A descriptive, cross-sectional investigation of hospitalizations of the elderly (60 years or older) in Brazil during the period from 2002 to 2011, with data from DATASUS and based on ICD-10. RESULTS Although the highest number of hospitalizations were in the adult age range, the expenses were greater with the elderly, and in this case especially with mental and behavioral disorders, musculoskeletal and connective tissue diseases, followed by circulatory diseases and external causes. CONCLUSION The results suggest the adoption of more comprehensive policies and increased investment in health promotion, disease prevention, and appropriate and suitable treatment for the most prevalent diseases in the elderly, particularly in primary care.
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Fernandes TG, Benseñor IM, Goulart AC, Tavares BM, Alencar AP, Santos IS, Lotufo PA. Stroke in the rain forest: prevalence in a ribeirinha community and an urban population in the Brazilian Amazon. Neuroepidemiology 2014; 42:235-42. [PMID: 24903570 DOI: 10.1159/000362210] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/14/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND 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.
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Drummond A, Alves ED. Perfil socioeconômico e demográfico e a capacidade funcional de idosos atendidos pela Estratégia Saúde da Família de Paranoá, Distrito Federal. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2013. [DOI: 10.1590/s1809-98232013000400007] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJETIVOS: Estabelecer o perfil socioeconômico, demográfico e funcional de idosos atendidos pela Estratégia Saúde da Família (ESF) em Paranoá, Distrito Federal, Brasil, e observar as possíveis associações entre os fatores encontrados com o nível de capacidade funcional desta população. MÉTODOS: Trata-se de pesquisa descritiva, com aplicação de questionário socioeconômico e demográfico, escala de Lawton e índice de Katz, para obtenção dos dados sobre funcionalidade em 93 idosos. Para a análise estatística, utilizaram-se o teste exato de Fisher e o qui-quadrado, adotando nível de significância de 0,05. RESULTADOS: Não houve associação entre os elementos de saúde (considerando a autopercepção da saúde, doenças como hipertensão arterial, diabetes, reumatismo, asma, bronquite, varizes, insônia, infarto agudo do miocárdio e acidente vascular encefálico), ou aspectos sociodemográficos e econômicos com funcionalidade, exceto para os fatores histórico de quedas e visita aos amigos (p<0,05). CONCLUSÃO: Houve manutenção principalmente das atividades básicas de vida diária, com pequeno percentual de comprometimento das atividades instrumentais de vida diária.
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Pires MRGM, Duarte EC, Göttems LBD, Figueiredo NVF, Spagnol CA. Fatores associados à atenção domiciliária: subsídios à gestão do cuidado no âmbito do SUS. Rev Esc Enferm USP 2013; 47:648-56. [DOI: 10.1590/s0080-623420130000300018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
A identificação de variáveis associadas ao tipo de atenção domiciliária (AD) dos usuários do Sistema Único de Saúde (SUS) contribui para a gestão do cuidado na Rede de Atenção à Saúde (RAS). Objetiva-se identificar variáveis associadas ao tipo de AD dos usuários em Unidades Básicas de Saúde (UBS) selecionadas de Belo Horizonte. Estudo transversal em duas UBS com todos os usuários (n=114) em AD da área de abrangência. Utilizou-se a análise de regressão logística múltipla para seleção (stepwise) de variáveis significativas. Obteve-se maior comprometimento clínico dos usuários (OR=27,47), estado emocional triste (OR=24,36), risco para úlcera por pressão pela escala de Braden (OR=7,6) e a semidependência para as AVD pelo índice de Katz (OR=63,8) como fortemente associadas ao tipo de AD (p < 0,05). As variáveis fundadas no contexto social, familiar e clínico dos sujeitos subsidiam a abordagem integral e a tomada de decisão da equipe de saúde.
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Gonçalves DF, Tinoco ALA, Ribeiro RDCL, Martinho KO, de Mendonça ET, Benfica DT. Nutritional status and epidemiological profile of elderly people. Arch Gerontol Geriatr 2011; 55:1-4. [PMID: 21737152 DOI: 10.1016/j.archger.2011.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2010] [Revised: 05/10/2011] [Accepted: 05/11/2011] [Indexed: 11/13/2022]
Abstract
We intended to identify and evaluate the association between the socio-demographic and epidemiological characteristics of elderly people with their nutritional characteristics. This is a transversal study PMTI (from the Portuguese name of "Programa Municipal da Terceira Idade"), conducted at Viçosa, MG, Brazil. We analyzed 93 records of elderly people registered since 2006 and who underwent nutritional care. After having analyzed the questionnaire, we performed the descriptive and association analyses in the Epi Info (version 6.04) and Minitab softwares. Of the 93 analyzed records, most elderly people were women (80.4%), with an average of 72 years of age, of which 13.0% were long-lived people. The mean body mass index (BMI) was 27.4 kg/m(2), and 50.5% were overweight. We have found 26.8% elderly patients with hypertension, and 31.6% took antihypertensives. Elderly patients who were overweight are 4.54 times more likely to have arterial hypertension (odds ratio (OR)=4.54; 95% confidence interval (CI)=1.2-2.45). Only 7.5% smoked, 30.1% were alcoholics and 60.2% made physical activities. Inadequacies were found regarding the servings of fruits, dairy products, vegetables and sugars consumed. However, the servings of cereals, leguminous, meat and fat consumed were appropriate. This study showed that the nutritional diagnosis and the epidemiological and socio-demographic studies are critical tools to understand this population group, in addition to being important to the planning of health actions.
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Affiliation(s)
- Déborah Franco Gonçalves
- Department of Nutrition and Health, Federal University of Viçosa, Av. P.H Rolfs, s/n, CCB-2 - CEP: 36570-000 Viçosa, MG, Brazil.
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Abe IM, Lotufo PA, Goulart AC, Benseñor IM. Stroke Prevalence in a Poor Neighbourhood of SãO Paulo, Brazil: Applying a Stroke Symptom Questionnaire. Int J Stroke 2011; 6:33-9. [DOI: 10.1111/j.1747-4949.2010.00538.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Background Brazil has one of the highest stroke mortality rates in the world, these rates are most endemic in the poor. We verified the prevalence of stroke in a deprived neighbourhood in the city of São Paulo, Brazil and compared it with other surveys worldwide. Methods A questionnaire with six questions concerning limb and facial weakness, articulation, sensory disturbances, impaired vision, and past diagnosis of stroke was completed door-to-door in a well-defined area of 15 000 people. Questionnaires were considered positive when a participant answered two or more questions about stroke symptoms or the presence of stroke being confirmed by a physician, or at least three questions in the positive, even if not confirmed by a doctor. Results Of the 4496 individuals over 35-years old living in the area, 243 initially screened positive for stroke. The age-adjusted prevalence rate for men was 4·6% (95% confidence interval 3·5–5·7). For women, the prevalence rate was 6·5% (95% confidence interval 5·5–7·5); when considering only one question, the rate was 4·8% (95% confidence interval 3·9–5·7). The most commonly reported symptoms were limb weakness and sensory disturbances. Hypertension and heart disease were the conditions most commonly associated with previous stroke. Conclusion Stroke prevalence rates were higher in this poor neighbourhood compared with other surveys.
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Affiliation(s)
- Ivana M. Abe
- School of Medicine, University of São Paulo, Sao Paulo, Brazil
| | - Paulo A. Lotufo
- School of Medicine, University of São Paulo, Sao Paulo, Brazil
- Hospital Universitário, University of São Paulo, Sao Paulo, Brazil
| | - Alessandra C. Goulart
- Hospital Universitário, University of São Paulo, Sao Paulo, Brazil
- Hospital das Clínicas, University of São Paulo, Sao Paulo, Brazil
| | - Isabela M. Benseñor
- School of Medicine, University of São Paulo, Sao Paulo, Brazil
- Hospital Universitário, University of São Paulo, Sao Paulo, Brazil
- Hospital das Clínicas, University of São Paulo, Sao Paulo, Brazil
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Abe IM, Goulart AC, Santos WR, Lotufo PA, Benseñor IM. Validation of a stroke symptom questionnaire for epidemiological surveys. SAO PAULO MED J 2010; 128:225-31. [PMID: 21120435 PMCID: PMC10938991 DOI: 10.1590/s1516-31802010000400010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Revised: 06/11/2010] [Accepted: 06/18/2010] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Stroke is a relevant issue within public health and requires epidemiological surveillance tools. The aim here was to validate a questionnaire for evaluating individuals with stroke symptoms in the Stroke Morbidity and Mortality Study (Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral, EMMA), São Paulo, Brazil. DESIGN AND SETTING This was a cross-sectional study performed among a sample of the inhabitants of Butantã, an area in the western zone of the city of São Paulo. METHODS For all households in the coverage area of a primary healthcare unit, household members over the age of 35 years answered a stroke symptom questionnaire addressing limb weakness, facial weakness, speech problems, sensory disorders and impaired vision. Thirty-six participants were randomly selected for a complete neurological examination (gold standard). RESULTS Considering all the questions in the questionnaire, the sensitivity was 72.2%, specificity was 94.4%, positive predictive value was 92.9% and negative predictive value was 77.3%. The positive likelihood ratio was 12.9, the negative likelihood ratio was 0.29 and the kappa coefficient was 0.67. Limb weakness was the most sensitive symptom, and speech problems were the most specific. CONCLUSIONS The stroke symptom questionnaire is a useful tool and can be applied by trained interviewers with the aim of identifying community-dwelling stroke patients, through the structure of the Family Health Program.
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Affiliation(s)
- Ivana Makita Abe
- PhD. Attending physician, Hospital Universitário (HU), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Alessandra Carvalho Goulart
- PhD. Epidemiologist, Hospital Universitário (HU), Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Waldyr Rodrigues Santos
- MD. Neurologist, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Paulo Andrade Lotufo
- PhD. Professor of Clinical Medicine and Epidemiology, Faculdade de Medicina da Universidade de São Paulo (FMUSP), and Superintendent of Hospital Universitário (HU), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
| | - Isabela Martins Benseñor
- PhD. Attending physician, Hospital das Clínicas (HC), Faculdade de Medicina da Universidade de São Paulo (FMUSP), and Hospital Universitário (HU), Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil.
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Abstract
Chagas disease is a neglected infectious disease in the tropics and an emerging health problem in Europe and the USA. In the past decade, a link has been recorded between ischaemic stroke and Trypanosoma cruzi infection in several epidemiological studies, and an increase in stroke prevalence is expected with the ageing of the population infected with T cruzi in Latin America. Heart failure, mural thrombus, left ventricular apical aneurysm, and several types of cardiac arrhythmias are associated with stroke in Chagas disease. Stroke could also be the first sign of Chagas disease in asymptomatic patients and those with mild systolic dysfunction, so patients with stroke who are from endemic regions should be screened for T cruzi infection. The most frequent stroke syndrome seen in patients with Chagas disease is partial anterior circulation infarction. Stroke recurrence has been estimated to occur in 20% of patients, and secondary prevention measures include chronic anticoagulation in cardioembolic chagasic stroke. So far, no studies have been done to assess the effect of chagasic stroke on vascular dementia.
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