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Objective and reliable measurements to investigate daily behavior patterns in people with stroke could help therapeutic interventions after a stroke. To evaluate whether the Activity Monitoring for Rehabilitation (AMoR) platform has adequate concurrent validity and reliability for step counting and time spent sitting/lying in people post-stroke and to investigate its percentage accuracy for step counting at different walking speeds. Cross-sectional observational study. Fifty chronic post-stroke subjects used the AMoR platform and SAM simultaneously while a Video camera recorded the same activities during clinical trials. Spearman's correlation coefficient, the mean absolute percentage error, the intraclass correlation coefficient and Bland-Altman plot analyses were used to estimate the validity and reliability of the AMoR platform and StepWatchTM Activity Monitor (SAM). The accuracy percentage was calculated for each device and plotted as a function of the walking speed during the 10-meter walk test (10MWT). There was a very high correlation for step counting in all tests and a high correlation for time spent sitting/lying. The mean absolute percentage error values remained below 4% for step counting and time sitting/lying. The AMoR platform also showed excellent reliability for step counting and sitting/lying time, with values within the limit of agreement in the Bland-Altman plots. A high percentage of accuracy for step counting in the AMoR platform was observed during the 10MWT. The AMoR platform is valid and reliable for step counting and time spent sitting/lying, with a high percentage of accuracy at different walking speeds in the post-stroke population. [ABSTRACT FROM AUTHOR]

Nurses play an important role in healthcare, and the Nursing Outcomes Classification is a key tool for the standardization of care. This study aims to validate the nursing outcome "Neurological Status" for patients with cerebrovascular diseases. A methodological study was performed in four phases. In Phase 1, the relevance of the indicators was evaluated by seven specialists and the modified kappa coefficient and content validity index were calculated. In Phase 2, conceptual and operational definitions were formulated. In addition, their content was validated with a focus group in Phase 3. In Phase 4, the results were applied in clinical practice and convergence with the National Institute of Health Stroke Scale was verified. The reliability was measured by Cronbach's alpha. Of the 22 initial indicators, 6 were excluded. The focus group suggested changes in the definitions and the exclusion of two indicators. In Phase 4, only 13 indicators were validated due to the impossibility of measuring intracranial pressure. A strong correlation between the two scales and agreement among all the indicators were observed. Following the specialists' review, the nursing outcome was reliable and clinically validated with 13 indicators: consciousness, orientation, language, central motor control, cranial sensory and motor function, spinal sensory and motor function, body temperature, blood pressure, heart rate, eye movement pattern, pupil size, pupil reactivity, and breathing pattern. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Introduction: The objective was to analyze whether socioeconomic factors related to the context and those related to the model of care—specifically the coverage of primary care by the Family Health Strategy (ESF)—had an impact on hospitalizations due to heart failure (HF) and stroke, in the State of São Paulo/Brazil between 1998 and 2013. Methods: A longitudinal ecological study involving 645 municipalities was conducted in the state of São Paulo/Brazil from 1998 to 2013, using the Hospital Information System (SIH–DataSUS database). The hospitalizations for primary care sensitive conditions: Stroke and heart failure (HF) that correspond to the International Classification of Diseases (ICD 10): I50, I63 to I67; I69, G45 to G46 were analyzed longitudinally during the period indicated regarding the percentage of people covered by the Family Health Program (PSF) adjusted for confounders (population size, gross domestic product -GDP and human development index- HDI). Results: There was a significant decrease in the number of hospitalizations for heart failure and stroke per 10000 (inhabitants) in the period (p <0.0001), with a significant relationship with increased proportion of ESF (p <0.0001), and this remained significant even when possible confounders (population size, GDP and HDI) were included in the model (p <0.0001). Conclusions: GDP per capita was close to or higher than that if many European countries, which shows the relevance of the study. The health care model based on the Family Health Strategy positively impacted hospitalization indicators for heart failure and stroke, indicating that this model is effective in the prevention of primary care sensitive conditions. [ABSTRACT FROM AUTHOR]

Background: Clinicopathological studies are important in determining the brain lesions underlying dementia. Although almost 60% of individuals with dementia live in developing countries, few clinicopathological studies focus on these individuals. We investigated the frequency of neurodegenerative and vascular-related neuropathological lesions in 1,092 Brazilian admixed older adults, their correlation with cognitive and neuropsychiatric symptoms, and the accuracy of dementia subtype diagnosis.Methods and Findings: In this cross-sectional study, we describe clinical and neuropathological variables related to cognitive impairment in 1,092 participants (mean age = 74 y, 49% male, 69% white, and mean education = 4 y). Cognitive function was investigated using the Clinical Dementia Rating (CDR) and the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE); neuropsychiatric symptoms were evaluated using the Neuropsychiatric Inventory (NPI). Associations between neuropathological lesions and cognitive impairment were investigated using ordinal logistic regression. We developed a neuropathological comorbidity (NPC) score and compared it to CDR, IQCODE, and NPI scores. We also described and compared the frequency of neuropathological diagnosis to clinical diagnosis of dementia subtype. Forty-four percent of the sample met criteria for neuropathological diagnosis. Among these participants, 50% had neuropathological diagnoses of Alzheimer disease (AD), and 35% of vascular dementia (VaD). Neurofibrillary tangles (NFTs), hippocampal sclerosis, lacunar infarcts, hyaline atherosclerosis, siderocalcinosis, and Lewy body disease were independently associated with cognitive impairment. Higher NPC scores were associated with worse scores in the CDR sum of boxes (β = 1.33, 95% CI 1.20-1.46), IQCODE (β = 0.14, 95% CI 0.13-0.16), and NPI (β = 1.74, 95% CI = 1.33-2.16). Compared to neuropathological diagnoses, clinical diagnosis had high sensitivity to AD and high specificity to dementia with Lewy body/Parkinson dementia. The major limitation of our study is the lack of clinical follow-up of participants during life.Conclusions: NFT deposition, vascular lesions, and high NPC scorewere associated with cognitive impairment in a unique Brazilian sample with low education. Our results confirm the high prevalence of neuropathological diagnosis in older adults and the mismatch between clinical and neuropathological diagnoses. [ABSTRACT FROM AUTHOR]

Background: Trends in food availability and metabolic risk factors in Brazil suggest a shift toward unhealthy dietary patterns and increased cardiometabolic disease risk, yet little is known about the impact of dietary and metabolic risk factors on cardiometabolic mortality in Brazil. Methods: Based on data from Global Burden of Disease (GBD) Study, we used comparative risk assessment to estimate the burden of 11 dietary and 4 metabolic risk factors on mortality due to cardiovascular diseases and diabetes in Brazil in 2010. Information on national diets and metabolic risks were obtained from the Brazilian Household Budget Survey, the Food and Agriculture Organization database, and large observational studies including Brazilian adults. Relative risks for each risk factor were obtained from meta-analyses of randomized trials or prospective cohort studies; and disease-specific mortality from the GBD 2010 database. We quantified uncertainty using probabilistic simulation analyses, incorporating uncertainty in dietary and metabolic data and relative risks by age and sex. Robustness of findings was evaluated by sensitivity to varying feasible optimal levels of each risk factor. Results: In 2010, high systolic blood pressure (SBP) and suboptimal diet were the largest contributors to cardiometabolic deaths in Brazil, responsible for 214,263 deaths (95% uncertainty interval [UI]: 195,073 to 233,936) and 202,949 deaths (95% UI: 194,322 to 211,747), respectively. Among individual dietary factors, low intakes of fruits and whole grains and high intakes of sodium were the largest contributors to cardiometabolic deaths. For premature cardiometabolic deaths (before age 70 years, representing 40% of cardiometabolic deaths), the leading risk factors were suboptimal diet (104,169 deaths; 95% UI: 99,964 to 108,002), high SBP (98,923 deaths; 95%UI: 92,912 to 104,609) and high body-mass index (BMI) (42,643 deaths; 95%UI: 40,161 to 45,111). Conclusion: suboptimal diet, high SBP, and high BMI are major causes of cardiometabolic death in Brazil, informing priorities for policy initiatives. [ABSTRACT FROM AUTHOR]

The aim of this study was to relate the presence of a temporal acoustic window (TAW) to the variables sex, age and race. This observational study was conducted in patients under etiologic investigation after stroke, sickle-cell anemia and hospitalization in an intensive therapy neurologic unit. TAW presence was confirmed by bilateral assessment by two neurologists via transcranial Doppler (TCD). Multiple logistic regression was performed to explain the presence of the window as a function of sex, age and race. In 20% of the 262 patients evaluated, a TAW was not present. The incidence of TAW presence was greater in men (odds ratio [OR] = 5.4, 95% confidence interval [CI] = 2.5–11.7, p < 0.01); lower with increased age (OR = 0.9, 95% CI = 0.92–0.97, p < 0.01); and lower among those of African and Asian descent (OR = 0.32, 95% CI = 0.14–0.70, p = 0.005). On the basis of the results, more men than women had TAWs, and the decrease in TAWs was associated with increased age and African or Asian descent. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 epidemic overloaded the São Paulo metropolitan area (SPMA) health system in 2020. The leading hospitals directed their attention to patients with COVID-19. At the same time, the SPMA Health Secretary decreed social isolation (SI), which compromised the care for cardiovascular diseases (CVD), even though higher cardiovascular events were expected., Methods: This study analyzed mortality from CVD, ischemic heart disease (IHD), and stroke, along with hospital admissions for CVD, IHD, stroke, and SI in the SPMA in 2020. Data regarding hospitalization and mortality from CVD were obtained from the SPMA Health Department, and data regarding SI was obtained from the São Paulo Intelligent Monitoring System. Time-series trends were analyzed by linear regression, as well as comparisons between these trends., Results: there was an inverse correlation between SI and hospitalizations for CVD (R 2 = 0.70; p < 0.001), IHD (R 2 = 0.70; p < 0.001), and stroke (R 2 = 0.39; p < 0.001). The most significant hospitalization reduction was from March to May, when the SI increased from 43.07% to 50.71%. The increase in SI was also associated with a reduction in CVD deaths (R 2 = 0.49; p < 0.001), IHD (R 2 = 0.50; p < 0.001), and stroke (R 2 = 0.26; p < 0.001)., Conclusions: Increased social isolation was associated with reduced hospitalizations and deaths from CVD, IHD, and stroke.