Predictors of congruency between clinical and radiographic Oxfordshire Community Stroke Project Classification subtypes.

BACKGROUND: The Oxfordshire Community Stroke Project (OCSP) classification has been widely used to assess ischemic stroke patients based on clinical characteristics alone. However, the correlation between the clinical presentation evaluated using OCSP and imaging findings is yet to be determined. Our study aimed to describe the baseline characteristics of the OCSP subtypes of patients admitted with ischemic stroke and evaluate the predictors of the relationship between clinical and neuroimaging findings. METHODS: Patients with a confirmed diagnosis of ischemic stroke admitted to a comprehensive stroke center in Brazil between February 2015 and October 2017 were eligible for the study. All participants underwent computed tomography (CT) at admission and follow-up neuroimaging within seven days, per the institutional protocol. Trained staff classified patients according to the OCSP at hospital admission. The radiographic OCSP classification was retrospectively assessed based on the last follow-up neuroimaging by investigators unaware of the clinical classification. RESULTS: The overall agreement rates ranged from 65.5% to 88.7%. Lower NIHSS scores, absent hyperdense MCA sign, higher ASPECTS, and absent brainstem symptoms were related to a higher risk of misclassification. Treatment with intravenous tPA was associated with reclassification in patients with total anterior circulation syndrome. For predicting radiographic posterior circulation involvement, vertigo (OR 2.9, 95% CI 1.7-5.1, p < 0.001) and brainstem symptoms (OR 35, 95% CI 20.5-60.2, p < 0.001) were directly associated with correct classification, but motor and higher cerebral function were not correlated. CONCLUSION: The clinical OCSP classification presented good congruency rates with the neuroimaging findings. However, patients with lacunar syndromes are often misclassified when radiological criteria are considered.

Atividade física como fator protetor para o extremo baixo peso em idosos assistidos por uma operadora de saúde / Physical activity as a protective factor for extreme low weight in elderly assisted by a health care operator

Objetivo: Investigar a influência de fatores relacionados aos aspectos multidimensionais do envelhecimento em um grupo de idosos com baixo peso assistidos pelo setor privado de saúde. Métodos: Estudo transversal conduzido com 243 idosos com índice de massa corpórea <23 kg/m², todos assistidos por uma operadora de planos de saúde, no município de São Paulo, SP, Brasil, alocados em dois grupos: baixo peso e extremo baixo peso. Para a coleta dos dados empregou-se inquérito contendo informações relacionadas aos aspectos multidimensionais do envelhecimento. Os dados obtidos foram submetidos a análise descritiva das variáveis, com posterior análise comparativa através dos testes t Student e Qui-Quadrado ou exato de Fisher, quando necessário. Para variáveis com significância estatística, aplicou-se regressão logística e calculou-se as Odds Ratio, com intervalo de confiança de 95%. Resultados: Observou-se que, a idade avançada (p=0,044), dificuldade de mobilidade (p=0,011) e baixos níveis de atividade física (p=0.021) influenciam significativamente os idosos em estado nutricional de extremo baixo peso. Por meio do modelo de regressão logística, verificou-se que para cada uma hora de atividade física praticada pelos idosos deste grupo, os riscos de evolução para extremo baixo peso diminuem em até 14%. Conclusão: A pratica regular e orientada de atividade física praticada por idosos com algum grau de déficit nutricional é capaz de prevenir e/ou retardar desfechos indesejados em grupos susceptíveis.

Objective: Investigate the influence of factors related to multidimensional aspects of aging in a group of elderly assisted by the private health sector. Methods: Cross-sectional study conducted with 243 elders with a body mass index <23 kg/m² assisted by a health plan in the city of São Paulo, SP, Brazil, with them being allocated into two groups: low weight and extreme low weight. For data collection, a survey developed by the researchers themselves containing information related to multidimensional aspects of aging was employed. The obtained data were submitted to a descriptive analysis of the variables and a subsequent comparative analysis through Student's t-distribution, Chi-squared or Fisher's exact tests, when necessary. For variables with statistical significance, logistic regression was applied and the odds ratio, with a 95% confidence interval, was calculated. Results: It was observed that advanced age (p=0.044), mobility difficulty (p=0.011) and low levels of physical activity (p=0.021) significantly influence the elderly in extremely low weight nutritional status. Moreover, through the logistic regression model, it was found that, for this group, every hour of physical activity practiced by underweight elders, the risks of evolution to an extreme low weight status decrease by up to 14%. Conclusion: The regular and oriented practice of physical activity by the elderly with some degree of nutritional deficit is able to prevent and/or delay unwanted outcomes in susceptible groups.