Changes in childhood stroke mortality from 1990 to 2019 in Brazil and its federative units.

This research analyzed the temporal trend of stroke mortality in children aged 0-14 years, from 1990 to 2019, in Brazil and its federative units. This ecological study used data from the Global Burden of Disease, a study led by the Institute for Health Metrics and Evaluation. Stroke definition considered the International Classification of Diseases according to codes G45, G46, and I60-I69. Age-standardized mortality rates and the mean annual percentage change (APC) in mortality rates were estimated. Stroke mortality trends decreased, with an APC of - 3.9% (95% CI - 4.5; - 3.3; p < 0.001). Reducing trends were found in all but two states, where they were stationary. Maranhão (- 6.5%; 95% CI - 7.6; - 5.4; p < 0.001) had the greatest reduction and Rondônia, the smallest (- 1.2%; 95% CI - 2.3; - 0.1, p = 0.027). Decrease was more important in children < 5 (- 5.8%; 95% CI - 6.3; - 5.2; p < 0.001) compared to 5-14 years old (- 2.1%; 95% CI - 2.9; - 1.3; p < 0.001); additionally, it was greater in girls (- 4.1%; 95% CI - 4.6; - 3.5; p < 0.001) than in boys (- 3.8%; 95% IC - 4.5; - 3.1; p < 0.001). Ischemic stroke had the highest APC (- 6.1%; 95% CI - 6.8; - 5.3; p < 0.001), followed by intracranial hemorrhage (- 5.3%; 95% CI - 6.1; - 4.5; p < 0.001) and subarachnoid hemorrhage (- 2.7%; 95% CI - 3.3; - 2.1; p < 0.001). Largest reductions were seen in states with more vulnerable socioeconomic contexts. The stationary trends and lowest APCs were concentrated in the northern region, which had greater impact of diseases and less favorable outcomes.

Temporal Trend of the Prevalence of Modifiable Risk Factors of Stroke: An Ecological Study of Brazilians between 2006 and 2012.

Stroke is one of the leading causes of death worldwide, including in Brazil. This study aimed to analyze the temporal trend of the prevalence of modifiable risk factors of stroke from 2006 to 2012. This ecological study was conducted by secondary analysis in May 2018, using data from the surveillance of risk factors and protection for chronic diseases by telephone inquiry (VIGITEL) available in the Department of Informatics of the Unified Health System (DATASUS). The modifiable risk factors of stroke in Brazilians were systemic arterial hypertension, diabetes mellitus, abusive alcohol consumption, overweight, and obesity. Overall, there was a significant increase in the risk factors of diabetes (ß = 0.30, P = 0.001, r2 = 0.99), overweight (ß = 0.50, P = 0.002, r2 = 0.98), and obesity (ß = 0.88, P < 0.001, r2 = 0.96). However, there was a stability in the prevalence of hypertension (ß = 0.25, P = 0.320, r2 = 0.88) and alcohol abuse (ß = 0.32, P = 0.116, r2 = 0.49). There was an increase in the prevalence of diabetes mellitus, overweight, and obesity, but stability in systemic arterial hypertension and abusive alcohol consumption in the Brazilian population.

Reduction on Proinflammatory Cytokines after Application of Transcutaneous Electrical Nerve Stimulation (TENS) in Patients with a Breast Cancer: A Nonrandomized, Open, and Single-Arm Study Protocol with Paired Analysis.

BACKGROUND: Transcutaneous electrical nerve stimulation (TENS) has been used as analgesic therapy in many diseases. It is already known that studies that have observed the relationship between pain and cytokines have found that patients who report less severe pain have less production of proinflammatory cytokines. However, one another accepted mechanism is that decreasing proinflammatory cytokines results in decreased pain intensity. Analyzing the literature, the authors describe that, in addition to the analgesic effect, TENS has shown systemic effects, and clinically, the reduction of proinflammatory cytokines could be a protective factor against inflammation. To test the inflammatory effect of TENS, we researched the literature for clinical conditions that suggest that proinflammatory cytokines are one of the main mediators of the disease process. Chronic inflammation is one of the risk factors mentioned for the development of a new cancer; at the same time, it is indicated as an indicator of the worst prognosis. Studies also suggest that the worst prognosis of breast cancer, one of the types with the highest incidence in the world, may be related to increased inflammatory activity. Considering that inflammation is increased in breast cancer and that TENS can reduce proinflammatory cytokines even without blocking the pain pathway, our hypothesis is that the anti-inflammatory effect of TENS can bring benefits to these patients. The aim of this study will be to evaluate the effect of TENS on blood reduction of proinflammatory cytokines in breast cancer patients. METHODS: This study will evaluate at least 59 patients, over 18 years of age, diagnosed with breast cancer, but who have not yet started any treatment. All patients will be submitted to TENS intervention (Ibramed, Model Neurodyn III, parameters: VIF-turn on, frequency-2-247 Hz, pulse size-50-500 µs, and intensity (mA)-maximum tolerated by the patient), and the data will be analyzed in the pre- and postintervention of each patient. The application has a total duration of 30 minutes, and 8 ml of blood will be collected before and after the intervention. Proinflammatory (IL-1, IL-2, IL-6, IL-7, and TNF-α) and anti-inflammatory (IL-4, IL-10, IL-13, and FTCß) cytokines will be analyzed. As a primary endpoint, we will analyze the reduction in blood concentration of proinflammatory cytokines, and as secondary endpoints, we will analyze the size of the effect according to each type of proinflammatory cytokine, describe the effect size of the reduction according to the breast cancer immunohistochemistry, and analyze the effect of TENS on anti-inflammatory cytokines. This study is approved by the Research Ethics Committee (Centro Universitário FMABC, Brazil) and registered in the Brazilian Clinical Trials (Search text: RBR-10jbwh47).

Inequalities in Mortality and Access to Hospital Care for Cervical Cancer-An Ecological Study.

Cervical cancer is the second most common form of cancer in the world among women, and it is estimated to be the third most frequent cancer in Brazil, as well as the fourth leading cause of death from cancer. There is a difference in cervical cancer mortality rates among different administrative regions in Brazil along with an inadequate distribution of cancer centers in certain Brazilian regions. Herein, we analyze the trends in hospital admission and mortality rates for CC between 2000 and 2012. This population-based ecological study evaluated the temporal trend in cervical cancer between the years 2000 and 2012, stratifying by Brazilian administrative regions. The North and Northeast regions had no reduction in mortality in all age groups studied (25 to 64 years); when analyzing hospitalization rates, only the age group of 50 to 64 years from the North Region did not present a reduction. During the years studied, in the South Region, the age group ranging from 50 to 54 years had the greatest reduction in mortality rates (ß = -0.59, p = 0.001, r2 = 0.63), and the group ranging from 45 to 49 years had the greatest reduction in hospital admission rates (ß = -8.87, p = 0.025, r2 = 0.37). Between the years 2000 and 2012, the greatest reduction in the incidence of UCC was in the South Region (ß = -1.43, p = 0.236, r2 = 0.12) followed by the Central-West (ß = -1, p < 0.001, r2 = 0.84), the Southeast (ß = -0.95, p < 0.001, r2 = 0.88), the Northeast (ß = -0.67, p = 0.080, r2 = 0.25), and, finally, by the North (ß = -0.42, p = 0.157, r2 = 0.17). There was a greater reduction in mortality rates and global hospitalization rates for CC in Brazil than in the United States during the same period with exceptions only in Brazil's North and Northeast regions.

Correlation between timed up and go, usual gait speed and dizziness handicap inventory in elderly with vestibular disorders: a retrospective and analytical study.

BACKGROUND: This study was done to verify the associations between the usual gait speed (UGS), the Timed Up and Go test (TUG), and the perception of disability in elderly vestibular patients and to identify factors associated with TUG results. METHODS: This was a descriptive, analytical, and retrospective study that used data from the clinical records of vestibular patients aged 65 years or older at a rehabilitation service in Buenos Aires, Argentina. The records were examined for the following information: sex, age, type of vestibular disorder, dizziness handicap inventory (DHI) score and performance in the TUG and UGS tests before treatment. Pearson's or Spearman's correlation coefficient was used depending on the distribution of data. Age and the DHI were factored into multiple linear regression models in order to model the tests. A Receiver Operating Characteristic (ROC) curve was used to analyze the predictive power of age, the DHI total, and the UGS for the sample's TUG results. The level of significance was 5%. RESULTS: We evaluated 118 clinical records, of which 26 were excluded due to incomplete information, leaving data from 92 vestibular patients (73 females; 78.3 ± 5.8 years old). Unilateral vestibular hypofunction and Benign Paroxysmal Positional Vertigo presented the highest prevalence. The total score and the DHI domains showed a significant association with the TUG and UGS values. The age-adjusted DHI had a low predictive power for these same values. CONCLUSIONS: The total score and DHI domains have a significant association with the TUG and UGS values for elderly adults with vestibular disorders. The age-adjusted DHI has a low predictive power for TUG and UGS values.

Clinical aspects and the quality of life among women with endometriosis and infertility: a cross-sectional study.

BACKGROUND: The quality of life (QoL) of patients with endometriosis and infertility was assessed in different stages and correlated with the clinical features of the cases. METHODS: The present study was a cross-sectional study; 106 women were included, divided in two endometriosis groups (Grade I/II, 26 women, and Grade II/IV, 74 women). All participants attended the Endometriosis and Infertility Outpatient Clinic of the Instituto Ideia Fértil de Saúde Reprodutiva, Faculdade de Medicina do ABC, São Paulo, Brazil, were and responded to the Short Form (SF) Health Survey-36. Convenience sampling was used due to the authors' access to the study population; however, the sample number was calculated to be sufficient for 95% power in both groups. RESULTS: Homogeneity was observed between Grade I/II and Grade III/IV staging, with similar mean ages (35.27, ±3.64 years and 34.04, ±3.39 years, respectively, p = 0.133); types of infertility (p = 0.535); infertility time (p = 0.654); degrees of pain (p = 0.849); and symptoms common to endometriosis, namely, dysmenorrhea (p = 0.841), dyspareunia (0.466), chronic pelvic pain (p = 0.295), and intestinal (p = 0.573) or urinary (p = 0.809) diseases. Comparisons of median scores in the QoL domains demonstrated that the distributions of QoL and clinical symptoms were significantly related between the types of dyspareunia and the following domains: physical functioning (p = 0.017), role- emotional (p = 0.013), and general health (p = 0.001). Regarding pain outside of menstruation, there was significance in the pain domain (p = 0.017), and degree of pain was significance in physical functioning (p = 0.005) and role-physical (p = 0.011) domains. CONCLUSIONS: The present study pointed out that it is not the stage of endometriosis that interferes in the quality of life of women with endometriosis and infertility but rather the clinical manifestations, such as dyspareunia and pain. Thus, we can conclude that the patient's perception of the disease should be considered in health care and that the losses are independent of the degree of endometriosis in this population with the aggravating factor of infertility.

Association between pubertal development stages and body adiposity in children and adolescents.

BACKGROUND: The study aimed to analyze the association between pubertal development stages and adiposity in children and adolescents. METHODS: Cross-sectional study conducted in 2007 in Florianópolis, Brazil, with 2339 schoolchildren 32 aged 8 to 14 years old (1107 males). The outcome (adiposity) was evaluated using Z score and 33 percentilee values > = 85 of four skinfolds (triceps, subscapular, suprailiac and calf) and waist 34 circumference. Total body adiposity (Z score of the sum of skinfolds), central adiposity (Z score 35 of waist circumference) and peripheral adiposity (Z scores of triceps and calf skinfolds) were 36 estimated. Pubertal development stages was self-assessed according to Tanner stages of development. Thirty-seven Children and adolescents were classified according to tertiles of age for each pubertal development stages 38 stage - early, normal and late. Statistical analysis was performed using univariate and 39 multivariate Poisson regression models. RESULTS: Children and adolescent from both sexes with early pubertal development stages presented higher prevalence of central adiposity (waist circumference), with adjusted prevalence ratio (CI 95%) of 2.21 (1.12; 4.35) for males and 2.18 (1.04; 4.57) for females (reference group: normal pubertal development stages). Among females, there was a reduction in the prevalence of excess adiposity with decreased occurrence of early pubertal development stages. There was a strong relationship between adiposity and pubertal development stages. CONCLUSIONS: Excess adiposity was higher in both sexes for those with early pubertal development stages.

Decline in Stroke Mortality Between 1997 and 2012 by Sex: Ecological Study in Brazilians Aged 15 to 49 Years.

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 (ß = -0.46, p < 0.001, R2 = 0.95) and women (ß = -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: ß = 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.

Contrasting performance between physically active and sedentary older people playing exergames.

The increase in life expectancy associated with the increase in chronological age and less active people helps in the appearance of chronic and degenerative diseases. The encouragement of physical exercises contributes to older people abandoning sedentarism and preventing such diseases. Exergame is a promising alternative, for making exercise a pleasurable activity.In this study, we compared the performance of physically active older people with sedentary older people in exergames.Participants were 83 older adults over 65 years of age, of both sexes, divided into 2 physically active older people (AG) and sedentary older people (CG) groups. The participants performed a task through an exergame called "MoviLetrando" that uses the score, number of hits, number of omissions, and an average time of hits as an evaluation. A characterization questionnaire was applied, with information about sex, age, marital status, economic class, self-rated health, time of use of electronic games, a questionnaire on the practice of physical activity, and the Brunel Mood Scale.There was a higher exergame score in AG than in CG (P = .003), in the number of correct answers (P = .012). The number of omissions was lower in AG than in CG (P = .023). The mean time of correct answers was lower in AG than in CG (P = .013). The regression analysis revealed a significant finding F (3, 82) = 11.06, P < .001 and showed a prediction ability of 26.9% (r = .269). Three variables remained significantly associated with the score: physical activity was marginally significant (ß = .19, P = .06), age (ß = -.403, P < .001), depression (ß = -.212, P = .028).Physically active older people perform better when compared with the sedentary older people. Age, depression, and physical activity influence the performance in exergame.

Correlation between municipal human development index and stroke mortality: a study of Brazilian capitals.

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.

Regional differences in the temporal evolution of stroke: a population-based study of Brazil according to sex in individuals aged 15-49 years between 1997 and 2012.

OBJECTIVE: The present study analyzed the temporal trend of stroke mortality according to sex in individuals aged 15-49 years in the different regions of Brazil between 1997 and 2012. RESULTS: There was progressive reduction in mortality rate due to stroke in Brazil. The reduction trend was the same for both sexes, although mortality remained slightly higher among men. There was a difference in mortality rates according to the administrative region of the country.

Cardiac autonomic modulation impairments in advanced breast cancer patients.

AIM: To compare cardiac autonomic modulation in early- versus advanced-stage breast cancer patients before any type of cancer treatment and investigate associated factors. METHODS AND RESULTS: This cross-sectional study included women (30-69 years old) with primary diagnosis of breast cancer and women with benign breast tumors. We evaluated cardiac modulation by heart rate variability and assessed factors of anxiety, depression, physical activity, and other relevant medical variables. Patients were divided into three groups based on TNM staging of cancer severity: early-stage cancer (n = 42), advanced-stage cancer (n = 37), or benign breast tumors to serve as a control (n = 37). We analyzed heart rate variability in time and frequency domains. The advanced-stage cancer group had lower vagal modulation than early-stage and benign groups; also, the advance-stage group had lower overall heart rate variability when compared to benign conditions. Heart rate variability was influenced by age, menopausal status, and BMI. CONCLUSIONS: Heart rate variability seems to be a promising, non-invasive tool for early diagnosis of autonomic dysfunction in breast cancer and detection of cardiovascular impairments at cancer diagnosis. Cardiac autonomic modulation is inversely associated with breast cancer staging.

Evaluation of functional rehabilitation physiotherapy protocol in the postoperative patients with anterior cruciate ligament reconstruction through clinical prognosis: an observational prospective study.

BACKGROUND: The aim of the study was to evaluate the evolution of patients subject to physical treatment based on guidelines of functional rehabilitation after surgery anterior cruciate ligament reconstruction. METHODS: This is a prospective study of 177 patients with anterior cruciate ligament injury, who underwent surgery and physical therapy guideline conducted in an orthopedic clinic in São Paulo, southeastern Brazil. The clinical evolution of patients was made according to Lysholm and IKDC questionnaire on the 1st day after surgery with 30, 90 and 180 days of treatment. RESULTS: There was statistically significant increase in the gross values of Lysholm and IKDC questionnaires during the treatment (p < 0.001), which indicates progressive gain of function. According to the scores obtained from the IKDC, it can be observed that in stage 1 the average progress was 53.5 %, falling to 50 % in stage 2, and 26.1 % in stage 3. As to Lysholm score, it started with 87.7 %, falling to 62.6 % in the second stage and 7 % in the third stage, both statistically significant (p < 0.001). The rehabilitation-oriented functional objectives priority is to quickly get the exercises to gain breadth, strength and proprioception, optimizing and improving the integration of the athlete back to sport. CONCLUSION: Synthesizing the gradual gain of function and according to clinical outcomes assessed by IKDC and Lysholm, the functional guideline presented may be considered an alternative for rehabilitation of patients in postoperative anterior cruciate ligament.

Access to health services by lesbian, gay, bisexual, and transgender persons: systematic literature review.

BACKGROUND: The relationship between users and health services is considered essential to strengthen the quality of care. However, the Lesbian, Gay, Bisexual, and Transgender population suffer from prejudice and discrimination in access and use of these services. This study aimed to identify the difficulties associated with homosexuality in access and utilization of health services. METHOD: A systematic review conducted using PubMed, Cochrane, SciELO, and LILACS, considering the period from 2004 to 2014. The studies were evaluated according to predefined inclusion and exclusion criterias. Were included manuscripts written in English or Portuguese, articles examining the Lesbian, Gay, Bisexual, and Transgender population's access to health services and original articles with full text available online. RESULTS: The electronic databases search resulted in 667 studies, of which 14 met all inclusion criteria. Quantitative articles were predominant, showing the country of United States of America to be the largest producer of research on the topic. The studies reveal that the homosexual population have difficulties of access to health services as a result of heteronormative attitudes imposed by health professionals. The discriminatory attendance implies in human rights violations in access to health services. CONCLUSIONS: The non-heterosexual orientation was a determinant factor in the difficulties of accessing health care. A lot must still be achieved to ensure access to health services for sexual minorities, through the adoption of holistic and welcoming attitudes. The results of this study highlight the need for larger discussions about the theme, through new research and debates, with the aim of enhancing professionals and services for the health care of Lesbian, Gay, Bisexual, and Transgender Persons.