1
|
Bichara JL, Bastos LA, Villela PB, de Oliveira GMM. Socioeconomic Indicators and Mortality from Ischemic Heart Disease and Cerebrovascular Disease in Brazil from 2000 to 2019. Arq Bras Cardiol 2023; 120:e20220832. [PMID: 37971046 PMCID: PMC10519229 DOI: 10.36660/abc.20220832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/10/2023] [Accepted: 06/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND Previous studies have identified inequalities in the variation of mortality rates from ischemic heart disease (IHD) and cerebrovascular disease (CBVD) when comparing regions with different levels of socioeconomic development indicators. OBJECTIVE To analyze the variation in IHD and CBVD mortality rates and economic development, evaluated by the sociodemographic index (SDI) and social vulnerability index (SVI) in Brazil over a period of 20 years. METHODS Ecological study of time series of crude and standardized mortality rates (direct method, based on the Brazilian population in year 2000) from IHD and CBVD by sex and Federative Unit (FU) between 2000 and 2019, compared using the SDI and SVI. RESULTS There was an improvement in SDI and SVI concomitantly to a reduction in age-standardized mortality rate from IHD and CBVD in the country; however, this occurred unevenly across the FUs. The FUs with the best socioeconomic indicators had the greatest reduction in mortality rates. DISCUSSION The variations in mortality rates from IHD and CBVD, compared using variations in socioeconomic development, are aligned with those from previous studies, but the present study goes further by including the indicators SDI and SVI in the comparison. The limitations include the observational nature of the study, the use of databases, and the vulnerability to ecological bias. CONCLUSION The observed data raise the hypothesis that the improvement in socioeconomic conditions is one of the factors responsible for the reduction in mortality rates from IHD and CBVD.
Collapse
Affiliation(s)
- José Lucas Bichara
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro, Rio de Janeiro, RJ – Brasil
| | - Luiz Antônio Bastos
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro, Rio de Janeiro, RJ – Brasil
| | - Paolo Blanco Villela
- Universidade Federal do Rio de JaneiroRio de JaneiroRJBrasilUniversidade Federal do Rio de Janeiro, Rio de Janeiro, RJ – Brasil
| | | |
Collapse
|
2
|
Rosário CFD, Fernandes Neto WG, Pessotti AL, Rodrigues BC, Baptista JD, Segatto M, Nunes VS, Barbosa LDA, Pereira AFA, Mota CL, Fiorot Júnior JA. Epidemiological analysis of stroke patients with emphasis on access to acute-phase therapies. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:117-124. [PMID: 35195222 DOI: 10.1590/0004-282x-anp-2020-0466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/13/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Stroke is a public health problem. For patients with ischemic stroke, venous thrombolysis and mechanical thrombectomy are effective therapeutic options. However, even after the National Stroke Treatment Guidelines were published in 2012, the number of cases treated is still lower than expected. OBJECTIVE To identify the determining factors for obtaining access to acute-phase therapies in the state of Espírito Santo (ES) and investigate the profile of stroke patients treated at the Central State Hospital (HEC). METHODS Retrospective data from the medical records of 1078 patients from May 2018 to December 2019 were analyzed. RESULTS Among the 1,078 patients, 54.9% were men and the most prevalent age group was 60 to 79 years. Systemic arterial hypertension was the main single risk factor. Regarding treatment modality among the patients who arrived at the HEC within the therapeutic window, 47% received some type of acute-phase therapy. Waking up with the deficit was the main contraindication for venous thrombolysis in these cases. CONCLUSIONS Application of the flowchart established by SESA-ES seemed to be effective for enabling responsiveness of care for stroke victims. Public emergency transport services had a fundamental role in this process. In addition, the care provided by the tertiary stroke center provided excellent access to acute-phase therapies. However, despite the efficiency of the service provided at the HEC, it only reached a maximum of 50% of the ES population. This service model therefore needs to be expanded throughout the state.
Collapse
|
3
|
Moreira PVL, de Arruda Neta ADCP, Ferreira SS, Ferreira FELL, de Lima RLFC, de Toledo Vianna RP, de Araújo JM, de Alencar Rodrigues RE, da Silva Neto JM, O’Flaherty M. Coronary heart disease and stroke mortality trends in Brazil 2000-2018. PLoS One 2021; 16:e0253639. [PMID: 34473712 PMCID: PMC8412280 DOI: 10.1371/journal.pone.0253639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/09/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To analyse the mortality rate trend due to coronary heart disease (CHD) and stroke in the adult population in Brazil. METHODS From 2000 to 2018, a time trend study with joinpoint regression was conducted among Brazilian men and women aged 35 years and over. Age-adjusted and age, sex specific CHD and stroke trend rate mortality were measured. RESULTS Crude mortality rates from CHD decreased in both sexes and in all age groups, except for males over 85 years old with an increase of 1.78%. The most accentuated declining occurred for age range 35 to 44 years for both men (52.1%) and women (53.2%) due to stroke and in men (33%) due to CHD, and among women (32%) aged 65 to 74 years due to CHD. Age-adjusted mortality rates for CHD and stroke decreased in both sexes, in the period from 2000 to 2018. The average annual rate for CHD went from 97.09 during 2000-2008 to 78.75 during 2016-2018, whereas the highest percentage of change was observed during 2008 to 2013 (APC -2.5%; 95% CI). The average annual rate for stroke decreased from 104.96 to 69.93, between 2000-2008 and 2016-2018, and the highest percentage of change occurred during the periods from 2008 to 2013 and 2016 to 2018 (APC 4.7%; 95% CI). CONCLUSION The downward trend CHD and stroke mortality rates is continuing. Policy intervention directed to strengthen care provision and improve population diets and lifestyles might explain the continued progress, but there is no room for complacency.
Collapse
Affiliation(s)
| | | | - Sara Silva Ferreira
- Department of Nutrition, Federal University of Paraiba, João Pessoa, Paraíba, Brazil
| | | | | | | | | | | | | | - Martin O’Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, Merseyside, United Kingdom
| |
Collapse
|
4
|
de Souza CDF, de Oliveira DJ, da Silva LF, dos Santos CD, Pereira MC, de Paiva JPS, Leal TC, Mariano RDS, de Araújo AKBF, Baggio JADO. Cerebrovascular Disease Mortality Trend in Brazil (1996 To 2015) and Association with Human Development Index and Social Vulnerability. Arq Bras Cardiol 2021; 116:89-99. [PMID: 33566971 PMCID: PMC8159516 DOI: 10.36660/abc.20190532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 11/05/2020] [Accepted: 12/27/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Cerebrovascular diseases (CBVD) are the second major cause of death in the world. OBJECTIVE To analyze the mortality trend of CBVD in Brazil (1996 to 2015) and its association with Human Development Index (HDI) and the Social Vulnerability Index (SVI). METHODS This is an ecological study. We analyzed the mortality rate standardized by CBVD. Death data were obtained from the Mortality Information System (SIM) and populational data from the Brazilian Institute of Geography and Statistics (IBGE). The model of regression by inflection points (Joinpoint regression) was used to perform the temporal analysis, calculating the Annual Percent Change (APC) and Average Annual Percent Change (AAPC), with 95% of confidence interval and a significance of 5%. Trends were classified as increasing, decreasing or stationary. A multivariate regression model was used to analyze the association between mortality by CBVD, HDI and SVI. RESULTS During this period, 1,850,811 deaths by CBVD were recorded. We observed a reduction in the national mortality rate (APC -2.4; p = 0.001). Twenty federation units showed a significant trend, of which 13 showed reduction, including all states in the Midwest (n=4), Southeast (n=4) and South (n=3). The HDI was positively associated and the SVI was negatively associated with mortality (p = 0.046 and p = 0.026, respectively). CONCLUSION An unequal epidemiological course of mortality was observed between the regions, being higher in the Southeast and South states, with a significative tendency of reduction, and lower in the North and Northeast states, but with a significative tendency of increase. HDI and SVI showed an association with mortality. (Arq Bras Cardiol. 2021; 116(1):89-99).
Collapse
Affiliation(s)
- Carlos Dornels Freire de Souza
- Universidade Federal de AlagoasArapiracaALBrasilUniversidade Federal de Alagoas - Campus Arapiraca, Arapiraca, AL - Brasil
| | - Denilson José de Oliveira
- Faculdade São Francisco de JuazeiroJuazeiroBABrasilFaculdade São Francisco de Juazeiro, Juazeiro, BA - Brasil
| | - Leonardo Feitosa da Silva
- Universidade Federal de AlagoasArapiracaALBrasilUniversidade Federal de Alagoas - Campus Arapiraca, Arapiraca, AL - Brasil
| | - Camila Damasceno dos Santos
- Faculdade São Francisco de JuazeiroJuazeiroBABrasilFaculdade São Francisco de Juazeiro, Juazeiro, BA - Brasil
| | - Monaliza Coelho Pereira
- Faculdade São Francisco de JuazeiroJuazeiroBABrasilFaculdade São Francisco de Juazeiro, Juazeiro, BA - Brasil
| | - João Paulo Silva de Paiva
- Universidade Federal de AlagoasArapiracaALBrasilUniversidade Federal de Alagoas - Campus Arapiraca, Arapiraca, AL - Brasil
| | - Thiago Cavalcanti Leal
- Universidade Federal de AlagoasArapiracaALBrasilUniversidade Federal de Alagoas - Campus Arapiraca, Arapiraca, AL - Brasil
| | - Renato de Souza Mariano
- Instituto de Medicina Integral Professor Fernando FigueiraUPAEPetrolinaREBrasilInstituto de Medicina Integral Professor Fernando Figueira – UPAE, Petrolina, RE - Brasil
| | | | | |
Collapse
|
5
|
Furlan NE, Souza JTD, Bazan SGZ, Franco RJDS, Luvizutto GJ, Gut AL, Modolo GP, Winckler FC, Martin LC, Bazan R. Association between statin use and mortality risks during the acute phase of ischemic stroke in patients admitted to an intensive care unit. ARQUIVOS DE NEURO-PSIQUIATRIA 2020; 78:158-162. [PMID: 32215458 DOI: 10.1590/0004-282x20190172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 10/08/2019] [Indexed: 11/21/2022]
Abstract
Ischemic stroke is a common cause of death. The role of statins in the secondary prevention of the chronic ischemic stroke phase has been established. However, evidence regarding their efficacy in this phase is limited and contradictory. OBJECTIVE To evaluate the association between statin use and mortality risk during the acute phase of ischemic stroke in patients admitted to an intensive care unit. METHODS This was an observational and prospective study of ischemic stroke patients aged ≥18, admitted to an intensive care unit. Medications used during the first 7 days after the ictus, as well as medications used previously, were recorded. The primary outcome was all-cause mortality during the first 7 days. RESULTS We screened 212 patients and included 97 patients with ischemic stroke in the study period. The mortality rate among patients who used statins during the acute IS phase [14% (9/63)] was significantly lower than that among patients who did not use statins [41% (14/34); p=0.007]. This was confirmed in logistical regression with an 0.19 Odds Ratio - OR [p=0.018; 95% confidence interval - 95%CI 0.05-0.75]. Patients who died were older, had a higher incidence of acute myocardial infarction, higher scores on the NIHSS and lower systolic blood pressure. Statins and angiotensin converting enzyme inhibitors were used more frequently among survivors. These associations persisted even after adjustment for confounding variables. CONCLUSION Statins and angiotensin converting enzyme inhibitors use during hospitalization were independently associated to a lower rate of all-cause mortality in the first 7 days of intensive care unit admission.
Collapse
Affiliation(s)
- Natalia Eduarda Furlan
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade do Estado de São Paulo, Botucatu, SP, Brazil
| | - Juli Thomaz de Souza
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade do Estado de São Paulo, Botucatu, SP, Brazil
| | - Silméia Garcia Zanati Bazan
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade do Estado de São Paulo, Botucatu, SP, Brazil
| | | | - Gustavo José Luvizutto
- Departamento de Fisioterapia Aplicada, Universidade Federal do Triângulo Mineiro, Uberaba, MG, Brazil
| | - Ana Lúcia Gut
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade do Estado de São Paulo, Botucatu, SP, Brazil
| | - Gabriel Pinheiro Modolo
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina, Universidade do Estado de São Paulo, Botucatu, SP, Brazil
| | - Fernanda Cristina Winckler
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade do Estado de São Paulo, Botucatu, SP, Brazil
| | - Luis Cuadrado Martin
- Departamento de Medicina Interna, Faculdade de Medicina, Universidade do Estado de São Paulo, Botucatu, SP, Brazil
| | - Rodrigo Bazan
- Departamento de Neurologia, Psicologia e Psiquiatria, Faculdade de Medicina, Universidade do Estado de São Paulo, Botucatu, SP, Brazil
| |
Collapse
|
6
|
Barberato SH, Romano MMD, Beck ALDS, Rodrigues ACT, Almeida ALCD, Assunção BMBL, Gripp EDA, Guimarães Filho FV, Abensur H, Castillo JMD, Miglioranza MH, Vieira MLC, Barros MVLD, Nunes MDCP, Otto MEB, Hortegal RDA, Barretto RBDM, Campos TH, Siqueira VND, Morhy SS. Position Statement on Indications of Echocardiography in Adults - 2019. Arq Bras Cardiol 2019; 113:135-181. [PMID: 31411301 PMCID: PMC6684182 DOI: 10.5935/abc.20190129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Silvio Henrique Barberato
- CardioEco-Centro de Diagnóstico Cardiovascular, Curitiba, PR - Brazil.,Quanta Diagnóstico e Terapia, Curitiba, PR - Brazil
| | - Minna Moreira Dias Romano
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP-USP), Ribeirão Preto, SP - Brazil
| | - Adenalva Lima de Souza Beck
- Instituto de Cardiologia do Distrito Federal, Brasília, DF - Brazil.,Fundação Universitária de Cardiologia (ICDF/FUC), Brasília, DF - Brazil
| | - Ana Clara Tude Rodrigues
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HC-FMUSP), São Paulo, SP - Brazil
| | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardíaco, Rio de Janeiro, RJ - Brazil.,Hospital Universitário Antônio Pedro, Niterói, RJ - Brazil.,DASA, São Paulo, SP - Brazil
| | | | - Henry Abensur
- Hospital Beneficência Portuguesa de São Paulo, São Paulo, SP - Brazil
| | | | - Marcelo Haertel Miglioranza
- Fundação Universitária de Cardiologia (ICDF/FUC), Brasília, DF - Brazil.,Instituto de Cardiologia de Porto Alegre, Porto Alegre, RS - Brazil
| | - Marcelo Luiz Campos Vieira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brazil.,Hospital Israelita Albert Einstein, São Paulo, SP - Brazil
| | - Márcio Vinicius Lins de Barros
- Faculdade de Saúde e Ecologia Humana (FASEH), Vespasiano, MG - Brazil.,Rede Materdei de Saúde, Belo Horizonte, MG - Brazil.,Hospital Vera Cruz, Belo Horizonte, MG - Brazil
| | | | | | | | | | - Thais Harada Campos
- Diagnoson-Fleury, Salvador, BA - Brazil.,Hospital Ana Nery, Salvador, BA - Brazil
| | | | | |
Collapse
|
7
|
Dantas LF, Marchesi JF, Peres IT, Hamacher S, Bozza FA, Quintano Neira RA. Public hospitalizations for stroke in Brazil from 2009 to 2016. PLoS One 2019; 14:e0213837. [PMID: 30889198 PMCID: PMC6424448 DOI: 10.1371/journal.pone.0213837] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 03/01/2019] [Indexed: 12/22/2022] Open
Abstract
Background Stroke is the third major cause of death in the world and the second in Brazil. The purpose of this work was to assess the stroke-related hospitalization, in-hospital mortality, and case fatality rates under the Brazilian Unified Health System (SUS) from 2009 to 2016. Methods We evaluated the hospital admissions for stroke and their associated outcomes using data from the Hospital Information available at the Informatics Department of SUS. We selected hospitalization registries according to stroke diagnosis codes from the International Statistical Classification of Diseases and Related Health Problems (ICD-10). We identified the association of age and sex with patient death through multiple logistic regression and calculated the rates of hospitalization, mortality and case-fatality per 100,000 inhabitants using age-adjustment methodology. Results We analyzed 1,113,599 stroke hospitalizations. From 2009 to 2016, the number of admissions increased from 131,122 to 146,950 and the absolute number of in-hospital deaths increased from 28,731 to 31,937. Younger age and male sex were significantly associated with patient survival. Our results showed that the annual age-adjusted hospitalization and in-hospital mortality rates decreased by 11.8% and 12.6%, respectively, but the case fatality rate increased for patients older than 70 years. Conclusions Although the age-adjusted hospitalization and in-hospital mortality rates declined, the total number of hospitalization and deaths have increased. It is expected a continuous increase over the next years of stroke admissions with the rapid aging of the Brazilian population. Efforts should be renewed targeting risk factors, access to hospital and rehabilitation in particular for the elderly population.
Collapse
Affiliation(s)
- Leila F. Dantas
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Janaina F. Marchesi
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Igor T. Peres
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Silvio Hamacher
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Fernando A. Bozza
- Evandro Chagas National Institute of Infectious Disease, Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, RJ, Brazil
- IDOR, D’Or Institute for Research and Education, Rio de Janeiro, RJ, Brazil
- * E-mail:
| | - Ricardo A. Quintano Neira
- Department of Industrial Engineering, Pontifical Catholic University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
8
|
Decline in Stroke Mortality Between 1997 and 2012 by Sex: Ecological Study in Brazilians Aged 15 to 49 Years. Sci Rep 2019; 9:2962. [PMID: 30814591 PMCID: PMC6393459 DOI: 10.1038/s41598-019-39566-8] [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: 06/21/2017] [Accepted: 01/22/2019] [Indexed: 11/16/2022] Open
Abstract
This study aimed to analyse the time trends of stroke mortality between 1997 and 2012 according to sex in Brazilians aged 15 to 49 years. This ecological study used data obtained from the Mortality Information System, which is available from the National Health System Department of Informatics - DATASUS and maintained by the Brazilian Ministry of Health. Stroke definition included International Classification of Disease version 10 (ICD-10) codes I60, I61, I63, and I64. Crude and age-standardized mortality rates and respective 95% confidence intervals were estimated per 100,000 inhabitants and stratified by age, region, year, and sex. Linear regression models were used to analyse the time trends with a confidence level of 95%. The statistical program used was Stata 11.0. Between 1997 and 2012, there were 124,866 deaths due to stroke in Brazilians aged 15 to 49 years. There was a decreasing linear trend in stroke mortality among men (β = −0.46, p < 0.001, R2 = 0.95) and women (β = −0.40, p < 0.001, R2 = 0.98) during this period. Overall there was no significant difference in stroke mortality trends by sex, except with respect to the age group of 40 to 49 years where there was a difference in the decrease of stroke mortality between men and women (interaction sex * year: β = 0.238, p = 0.012, R² = 0.96). Mortality rates decrease significantly over time in men and women in the age group 15 to 49 years old, but there is only significant difference in the decrease of rates by sex only in the age group from 40 to 49 years old.
Collapse
|
9
|
de Santana NM, Dos Santos Figueiredo FW, de Melo Lucena DM, Soares FM, Adami F, de Carvalho Pádua Cardoso L, Correa JA. The burden of stroke in Brazil in 2016: an analysis of the Global Burden of Disease study findings. BMC Res Notes 2018; 11:735. [PMID: 30326942 PMCID: PMC6192154 DOI: 10.1186/s13104-018-3842-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023] Open
Abstract
Objective To analyze the epidemiological stroke data of Brazil according to the Global Burden of Disease (GBD) study in 2016 and secondary data from the GBD database. Results The highest percentage of deaths due to stroke in general occurred in individuals aged 70 years or over (60.2%; 95% confidence interval [CI] 59.9–60.5%) followed by that in men (52.9%; 95% CI 52.6–53.2%). Ischemic stroke was the most common type, accounting for 61.8% (95% CI 61.5–62.1%) of deaths due to stroke in 2016. Most of the epidemiological indicators (incidence, prevalence, mortality-to-incidence ratio, mortality, disability-adjusted life years, years lost due to disability, and years of life lost) of stroke in general or either type of stroke were higher in men and those aged 70 years or over. Stroke data in Brazil are a major concern and represent a real health challenge for the coming decades. Men and individuals aged 70 years or older appear to represent the groups with the highest epidemiological parameters and risk for the various stroke outcomes. However, this does not mean the female data are irrelevant, which, although representing a lower risk than the male data, also raise the need for policies aimed at prevention and improvement in the treatment of stroke and its sequelae.
Collapse
Affiliation(s)
| | | | | | - Fernando Mayo Soares
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | - Fernando Adami
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| | | | - João Antonio Correa
- Disciplina de Angiologia e Cirurgia Vascular, Faculdade de Medicina do ABC, Santo André, SP, Brazil
| |
Collapse
|
10
|
de Melo Lucena DM, Dos Santos Figueiredo FW, de Alcantara Sousa LV, da Silva Paiva L, do Carmo Almeida TC, Galego SJ, Correa JA, da Silva Maciel E, Adami F. Correlation between municipal human development index and stroke mortality: a study of Brazilian capitals. BMC Res Notes 2018; 11:540. [PMID: 30068387 PMCID: PMC6071391 DOI: 10.1186/s13104-018-3626-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/20/2018] [Indexed: 12/18/2022] Open
Abstract
Objective To analyze the correlation between municipal human development indices (MHDIs) and stroke mortality in residents of Brazilian state capitals in 2010. A secondary data analysis was conducted in 2015 using data for the MHDI and the following dimensions: income, longevity and education which were obtained from the United Nations Development Program. Additionally, we analyzed age-standardized stroke mortality data from the Department of System Information Unified Health of Brazil. Results We observed a correlation between stroke mortality and MHDIs overall (Pearson r = − 0.563; p = 0.002) and within the following dimensions: income (Spearman’s ρ = − 0.479; p = 0.011), longevity (Pearson r = − 0.510; p = 0.006) and education (Pearson r = − 0.592; p = 0.001). We identified moderate but significant negative correlations between MHDI overall and in its individual dimensions (income, longevity, and age) and stroke mortality in Brazilian capitals. Stroke is the second leading cause of death in industrialized countries and the leading cause of death in Brazil. Therefore, the discovery of factors that may influence the epidemiology of stroke is important for the construction of adequate policies considering to the socioeconomic status in these places and with an emphasis in lower socioeconomic status places.
Collapse
Affiliation(s)
| | | | | | - Laércio da Silva Paiva
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| | | | - Sidnei José Galego
- Disciplina de Angiologia e Cirurgia Vascular, Faculdade de Medicina do ABC, Santo André, Brazil
| | - João Antônio Correa
- Disciplina de Angiologia e Cirurgia Vascular, Faculdade de Medicina do ABC, Santo André, Brazil
| | | | - Fernando Adami
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
| |
Collapse
|
11
|
Bezerra PCDL, Monteiro GTR. Trends in overall mortality and from diseases of the circulatory system in elderly individuals in Rio Branco, Acre, 1980-2012. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2018. [DOI: 10.1590/1981-22562018021.170128] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Abstract Objective: To analyze trends in general mortality and circulatory system disease mortality among elderly persons living in the city of Rio Branco, Acre, Brazil, from 1980 to 2012. Method: A study of the cause of death of elderly people was carried out from the data available in the Brazilian Mortality Information System. Crude and age-based overall and circulatory system mortality rates were calculated. The trend analyses of these rates were performed using the JoinPoint Regression program. Results: Despite the reductions in mortality rates, diseases of the circulatory system remained the main cause of death of the elderly in Rio Branco. The decrease in overall mortality rates was higher among elderly women and those aged 70 years or older. There was a tendency for death rates due to diseases of the circulatory system to decline among elderly men and grow among elderly women. Conclusion: The mortality rate among the elderly in Rio Branco revealed a declining trend. Deaths from diseases of the circulatory system were the leading cause of death, suggesting that research should be carried out to assess the need for investment to ensure that increased longevity is accompanied by good quality of life.
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Cantú-Brito C, Silva GS, Ameriso SF. Use of Guidelines for Reducing Stroke Risk in Patients With Nonvalvular Atrial Fibrillation: A Review From a Latin American Perspective. Clin Appl Thromb Hemost 2017; 24:22-32. [PMID: 28992764 PMCID: PMC5726608 DOI: 10.1177/1076029617734309] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Atrial fibrillation (AF) is a prominent risk factor for stroke and a leading cause of death and disability throughout Latin America. Contemporary evidence-based guidelines for the management of AF and stroke incorporate the use of practical and relatively simple scoring methods to estimate both stroke and bleeding risk, in order to assist in matching patients with appropriate interventions. This review examines consistencies and differences among guidelines for reducing stroke risk in patients with AF, assessing the role of user-friendly scoring methods to determine appropriate patients for anticoagulation and other treatment options. Current options include warfarin and direct oral anticoagulants such as dabigatran, rivaroxaban, apixaban, and edoxaban. These agents have been found to be superior or noninferior to standard vitamin K antagonist anticoagulation in large randomized trials. Potential benefits of these agents mainly include lower ischemic stroke rates, reduced intracranial bleeding, no need for regular monitoring, and fewer drug-drug and drug-food interactions. Expert opinions regarding clinical situations for which data are presently lacking, such as emergency bleeding and stroke in anticoagulated patients, are also provided. Enhanced attention and adherence to evidence-based guidelines are essential components for a strategy to reduce stroke morbidity and mortality across Latin America.
Collapse
Affiliation(s)
- Carlos Cantú-Brito
- 1 Department of Neurology, National Institute of Medical Science and Nutrition Salvador Zubirán, Mexico City, Mexico
| | - Gisele Sampaio Silva
- 2 Hospital Israelita Albert Einstein/UNIFESP (Universidade Federal de São Paulo), São Paulo, Brazil
| | | |
Collapse
|
14
|
Gama GL, de Lucena LC, Brasileiro ACDAL, Silva EMGDS, Galvão ÉRVP, Maciel ÁC, Lindquist ARR. Post-stroke hemiparesis: Does chronicity, etiology, and lesion side are associated with gait pattern? Top Stroke Rehabil 2017; 24:388-393. [PMID: 28399777 DOI: 10.1080/10749357.2017.1304865] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Studies that evaluate gait rehabilitation programs for individuals with stroke often consider time since stroke of more than six months. In addition, most of these studies do not use lesion etiology or affected cerebral hemisphere as study factors. However, it is unknown whether these factors are associated with post-stroke motor performance after the spontaneous recovery period. OBJECTIVE To investigate whether time since stroke onset, etiology, and lesion side is associated with spatiotemporal and angular gait parameters of individuals with chronic stroke. METHODS Fifty individuals with chronic hemiparesis (20 women) were evaluated. The sample was stratified according to time since stroke (between 6 and 12 months, between 13 and 36 months, and over 36 months), affected cerebral hemisphere (left or right) and lesion etiology (ischemic and hemorrhagic). The participants were evaluated during overground walking at self-selected gait speed, and spatiotemporal and angular gait parameters were calculated. Results Differences between gait speed, stride length, hip flexion, and knee flexion were observed in subgroups stratified based on lesion etiology. Survivors of a hemorrhagic stroke exhibited more severe gait impairment. Subgroups stratified based on time since stroke only showed intergroup differences for stride length, and subgroups stratified based on affected cerebral hemisphere displayed between-group differences for swing time symmetry ratio. CONCLUSION In order to recruit a more homogeneous sample, more accurate results were obtained and an appropriate rehabilitation program was offered, researchers and clinicians should consider that gait pattern might be associated with time since stroke, affected cerebral hemisphere and lesion etiology.
Collapse
Affiliation(s)
- Gabriela Lopes Gama
- a Institute of Physical Activity and Sport Sciences , Cruzeiro do Sul University , São Paulo , Brazil
| | | | | | | | | | | | | |
Collapse
|
15
|
Luz FED, Santos BRMD, Sabino W. Estudo comparativo de mortalidade por doenças cardiovasculares em São Caetano do Sul (SP), Brasil, no período de 1980 a 2010. CIENCIA & SAUDE COLETIVA 2017; 22:161-168. [DOI: 10.1590/1413-81232017221.18362015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/29/2015] [Indexed: 11/21/2022] Open
Abstract
Resumo A análise do comportamento da mortalidade por doenças cardiovasculares (DCV) pode subsidiar medidas de prevenção e controle quanto à sua ocorrência. O objetivo deste artigo foi comparar taxas de mortalidade por DCV no município de São Caetano do Sul, no estado de São Paulo e no Brasil. Foram calculadas as taxas padronizadas de mortalidade e mortalidade proporcional por DCV de 1980 a 2010. Observou-se redução importante da mortalidade cardiovascular no período de 1980 a 2010 nas três unidades de estudo, sendo que a redução maior foi em São Caetano do Sul. O estado de São Paulo foi a unidade que apresentou maior taxa de mortalidade. Já São Caetano do Sul apresentou a maior média de mortalidade por DCV. Por outro lado, em São Caetano do Sul, a taxa de mortalidade por DCV foi três vezes maior em homens, em comparação às mulheres na faixa etária dos 30 aos 59 anos, e maior em mulheres em relação aos homens com idade superior a 60 anos. A redução dos índices é resultado da implementação de diferentes políticas de saúde pública. Todavia, são necessárias intervenções específicas voltadas a mudanças no estilo de vida, principalmente dos homens adultos e dos idosos.
Collapse
|
16
|
Lentsck MH, Latorre MDRDDO, Mathias TADF. Trends in hospitalization due to cardiovascular conditions sensitive to primary health care. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2016; 18:372-84. [PMID: 26083509 DOI: 10.1590/1980-5497201500020007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 11/07/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze the trend in hospitalizations for primary care-sensitive cardiovascular conditions for residents of the state of Paraná, Brazil, from 2000 to 2011. METHODS Ecological, time series study of the rates of hospitalization for cardiovascular diseases in residents aged 35-74 years old by sex, age and main diagnosis for hospitalization. Data from the Hospital Information System of the Unified Health System (SIH-SUS) and polynomial regression models for trend analyses were used. RESULTS Hospitalization rates for cardiovascular conditions decreased during the period (r2 = 0.96; p < 0.001), with similar decreasing patterns for males and females, in all age ranges, although always higher for males. Although hospitalization trends for hypertension, heart failure and cerebrovascular disease decreased, angina remained stable for males and females. CONCLUSION A downward trend in hospital admissions due to primary care-sensitive cardiovascular conditions in the state of Paraná between 2000 and 2011 may have resulted from the expansion of the health network of and the access to primary health attention, as well as other factors that influence this set of diseases, such as improved socioeconomic conditions of the population, organization of primary care services for higher age ranges and women and decrease in risk factors.
Collapse
|
17
|
Villela PB, Klein CH, Oliveira GMMD. Trends in Mortality from Cerebrovascular and Hypertensive Diseases in Brazil Between 1980 and 2012. Arq Bras Cardiol 2016; 107:26-32. [PMID: 27355586 PMCID: PMC4976953 DOI: 10.5935/abc.20160092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 02/06/2016] [Indexed: 11/20/2022] Open
Abstract
Background Cerebrovascular and hypertensive diseases are among the main causes of death
worldwide. However, there are limited data about the trends of these
diseases over the years. Objective To evaluate the temporal trends in mortality rates and proportional mortality
from cerebrovascular and hypertensive diseases according to sex and age in
Brazil between 1980 and 2012. Methods We evaluated the underlying causes of death between 1980 and 2012 in both
sexes and by age groups for circulatory diseases (CD), cerebrovascular
diseases (CBVD), and hypertensive diseases (HD). We also evaluated death due
to all causes (AC), external causes (EC), and ill-defined causes of death
(IDCD). Data on deaths and population were obtained from the Department of
Information Technology of the Unified Health System (Departamento de
Informática do Sistema Único de Saúde, DATASUS/MS). We
estimated crude and standardized annual mortality rates per 100,000
inhabitants and percentages of proportional mortality rates. Results With the exception of EC, the mortality rates per 100,000 inhabitants of all
other diseases increased with age. The proportional mortality of CD, CBVD,
and HD increased up to the age range of 60-69 years in men and 70-79 years
in women, and reached a plateau in both sexes after that. The standardized
rates of CD and CBVD declined in both sexes. However, the HD rates showed
the opposite trend and increased mildly during the study period. Conclusion Despite the decline in standardized mortality rates due to CD and CBVD, there
was an increase in deaths due to HD, which could be related to factors
associated with the completion of the death certificates, decline in IDCD
rates, and increase in the prevalence of hypertension.
Collapse
|
18
|
Adami F, Figueiredo FWDS, Paiva LDS, de Sá TH, Santos EFDS, Martins BL, Valenti VE, de Abreu LC. Mortality and Incidence of Hospital Admissions for Stroke among Brazilians Aged 15 to 49 Years between 2008 and 2012. PLoS One 2016; 11:e0152739. [PMID: 27332892 PMCID: PMC4917086 DOI: 10.1371/journal.pone.0152739] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 03/18/2016] [Indexed: 12/14/2022] Open
Abstract
Introduction The objective was to analyze rates of stroke-related mortality and incidence of hospital admissions in Brazilians aged 15 to 49 years according to region and age group between 2008 and 2012. Methods Secondary analysis was performed in 2014 using data from the Hospital and Mortality Information Systems and the Brazilian Institute of Geography and Statistics. Stroke was defined by ICD, 10th revision (I60–I64). Crude and standardized mortality (WHO reference) and incidence of hospital admissions per 100,000 inhabitants, stratified by region and age group, were estimated. Absolute and relative frequencies; and linear regression were also used. The software used was Stata 11.0. Results There were 35,005 deaths and 131,344 hospital admissions for stroke in Brazilians aged 15–49 years old between 2008 and 2012. Mortality decreased from 7.54 (95% CI 7.53; 7.54) in 2008 to 6.32 (95% CI 6.31; 6.32) in 2012 (β = -0.27, p = 0.013, r2 = 0.90). During the same time, incidence of hospital admissions stabilized: 24.67 (95% CI 24.66; 24.67) in 2008 and 25.11 (95% CI 25.10; 25.11) in 2012 (β = 0.09, p = 0.692, r2 = 0.05). There was a reduction in mortality in all Brazilian regions and in the age group between 30 and 49 years. Incidence of hospitalizations decreased in the South, but no significant decrease was observed in any age group. Conclusion We observed a decrease in stroke-related mortality, particularly in individuals over 30 years old, and stability of the incidence of hospitalizations; and also regional variation in stroke-related hospital admission incidence and mortality among Brazilian young adults.
Collapse
Affiliation(s)
- Fernando Adami
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- Departamento de Saúde da Coletividade, Laboratório de Delineamento de Estudos e Escrita Científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- * E-mail:
| | - Francisco Winter dos Santos Figueiredo
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- Departamento de Saúde da Coletividade, Laboratório de Delineamento de Estudos e Escrita Científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
| | - Laércio da Silva Paiva
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- Departamento de Saúde da Coletividade, Laboratório de Delineamento de Estudos e Escrita Científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
| | - Thiago Hérick de Sá
- Departamento de Nutrição da Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, São Paulo, Brasil
| | - Edige Felipe de Sousa Santos
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- Departamento de Saúde da Coletividade, Laboratório de Delineamento de Estudos e Escrita Científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- Departamento de Epidemiologia, Faculdade de Saúde Pública da Universidade de São Paulo, São Paulo, São Paulo, Brasil
- Unidade Saúde, Faculdade Leão Sampaio, Juazeiro do Norte, Ceará, Brasil
| | - Bruno Luis Martins
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
| | - Vitor Engrácia Valenti
- Departamento de Fonoaudiologia, Faculdade de Filosofia e Ciências da Universidade Estadual Paulista Júlio de Mesquita Filho, Marília, São Paulo, Brasil
| | - Luiz Carlos de Abreu
- Departamento de Saúde da Coletividade, Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
- Departamento de Saúde da Coletividade, Laboratório de Delineamento de Estudos e Escrita Científica, Faculdade de Medicina do ABC, Santo André, São Paulo, Brasil
| |
Collapse
|
19
|
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.
Collapse
|
20
|
Avezum Á, Costa-Filho FF, Pieri A, Martins SO, Marin-Neto JA. Stroke in Latin America: Burden of Disease and Opportunities for Prevention. Glob Heart 2015; 10:323-31. [DOI: 10.1016/j.gheart.2014.01.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 12/21/2013] [Accepted: 01/27/2014] [Indexed: 10/24/2022] Open
|
21
|
Malta DC, Stopa SR, Szwarcwald CL, Gomes NL, Silva Júnior JB, Reis AACD. A vigilância e o monitoramento das principais doenças crônicas não transmissíveis no Brasil - Pesquisa Nacional de Saúde, 2013. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 18 Suppl 2:3-16. [DOI: 10.1590/1980-5497201500060002] [Citation(s) in RCA: 56] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 06/11/2015] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Objetivo: Descrever as principais doenças crônicas não transmissíveis (DCNT) no país segundo as informações coletadas em indivíduos de 18 anos ou mais de idade. Métodos: Foram utilizados dados da Pesquisa Nacional de Saúde (PNS), 2013, estudo transversal de base populacional. As proporções de cada DCNT foram calculadas e apresentadas segundo sexo, com intervalo de confiança de 95% (IC95%), com os valores absolutos. Resultados: Do total de entrevistados, 45,1% referiram ter pelo menos uma DCNT. A Região com maior prevalência de DCNT foi a Sul (52,1%). A hipertensão arterial apresentou a maior prevalência dentre as DCNT, com 21,4%, seguida por problema crônico de coluna (18,5%), depressão (7,6%), artrite (6,4%) e diabetes (6,2%). O grau de limitação intenso/muito intenso apresentou maiores prevalências para outra doença mental (37,6%) e acidente vascular cerebral (AVC) (25,5%). Conclusão: A melhoria dos serviços de saúde é indispensável para uma resposta efetiva à dupla carga de adoecimento de países de média e baixa renda.
Collapse
|
22
|
Onoue SS, Ortiz KZ, Minett TSC, Borges ACLDC. Audiological findings in aphasic patients after stroke. ACTA ACUST UNITED AC 2015; 12:433-9. [PMID: 25628193 PMCID: PMC4879908 DOI: 10.1590/s1679-45082014ao3119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 08/29/2014] [Indexed: 12/04/2022]
Abstract
Objective To outline the audiological findings of aphasic patients after cerebrovascular accidents. Methods This is a cross-sectional study performed between March 2011 and August 2012 in the Speech, Language, and Hearing Pathology Department of the Universidade Federal de São Paulo. A total of 43 aphasic subjects (27 men) were referred for audiological evaluation after stroke, with mean age of 54.48 years. Basic audiological evaluation tests were performed, including pure tone audiometry, speech audiometry (speech recognition threshold and word recognition score), immittance measures (tympanometry and contralateral acoustic reflex), and transient otoacoustic emissions. Results Sensorineural hearing loss was prevalent (78.6%). Speech recognition threshold and word recognition score were not obtained in some patients because they were unable to perform the task. Hearing loss was a common finding in this population. Conclusion Comprehension and/or oral emission disruptions in aphasic patients after stroke compromised conventional speech audiometry, resulting in the need for changes in the evaluation procedures for these patients.
Collapse
|
23
|
Outcome determinants of stroke in a brazilian primary stroke center. Stroke Res Treat 2014; 2014:194768. [PMID: 25580352 PMCID: PMC4279148 DOI: 10.1155/2014/194768] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 11/26/2014] [Indexed: 11/30/2022] Open
Abstract
Background. Stroke mortality in Brazil is one of the highest among Western countries. Nonetheless, stroke outcome determinants are still poorly known in this country. In this study we evaluate outcome determinants of stroke in a primary stroke center in São Paulo, Brazil. Methods. We evaluated demographic, clinical, and outcome data of patients with ischemic stroke (IS), transient ischemic attack (TIA), and intracerebral hemorrhage (ICH) admitted at “Hospital Paulistano,” São Paulo, Brazil. In-hospital mortality and functional outcome determinants were assessed. Univariate and binary logistic regression analysis were performed. Results. Three hundred forty-one patients were included in the study, 52.2% being male with 66.8 ± 15.7 years. The stroke type distribution was IS: 59.2%, TIA: 29.6%, and ICH: 11.1%. ICH was associated with greater severity and poorer functional outcome. The determinants of poorer functional outcome were higher NIHSS, lower Glasgow score, and lower oxygen saturation level. The most important mortality determinant was the presence of visual symptoms. Conclusions. The stroke mortality and stroke outcome determinants found in the present study do not remarkably differ from studies carried out in developed countries. Stroke prognosis studies are crucial to better understand the high burden of stroke in Brazil.
Collapse
|