Thromboembolic Events With the Woven Endobridge Device: Incidence, Predictive Factors, and Management.

BACKGROUND AND OBJECTIVES: The Woven EndoBridge (WEB) device has been increasingly used to treat wide-neck aneurysms showing a safe and effective profile, but a relatively high number of thromboembolic events (TEEs) have been reported with such treatment. We aimed to evaluate the incidence and management of TEEs and possible predictive factors related to WEB embolization of ruptured and unruptured intracranial aneurysms. METHODS: A single-center database with consecutive aneurysms treated with a WEB device between July 2012 and May 2022 was reviewed for intraoperative and delayed TEEs. Univariate and multivariable analyses were used to determine factors associated with TEEs. RESULTS: A total of 266 independent aneurysms were treated with WEB devices in 245 patients (mean age 55.78 ± 11.64 years, 169 (63.5%) females, 80 (30%) ruptured). The overall rate of TEEs is 13% (35/266), including 8.7% intraoperative. Symptomatic TEEs with clinical sequelae at a 3-month follow-up are reported to be 2.6% (7/266) with no TEE-related mortality. Both the replacement of a WEB device during the procedure (adjusted odds ratio = 2.61, 95% CI 1.24-5.49; P = .01) and ruptured aneurysms (adjusted odds ratio = 2.74, 95% CI 1.31-5.7; P = .007) were independent predictors of TEEs. A case-by-case management of intraprocedural TEE is also presented; tirofiban was successfully used in most cases of this cohort. CONCLUSION: In this study, we demonstrated that ruptured aneurysms and WEB device replacement during the procedure were independent predictive factors for TEEs. As a result, making the correct choice of WEB is crucial for improving treatment outcomes. Moreover, with proper medical management of TEEs, minimal morbidity and no mortality could be achieved, which reinforces the safety of the technique.

Association between frailty and oral health services use in Brazilian older adults.

OBJECTIVES: To assess the association between frailty and oral health services use in Brazilian older adults. METHODS: This cross-sectional study analysed the baseline data from the Longitudinal Study on Brazilian Ageing (ELSI-Brazil) representative of Brazilians aged 50 or over. The outcome was oral health services used in the year prior to the interview. The main exposure variable was Frailty defined by the frailty phenotype. Age, skin colour, wealth, sex, education, type of service, health insurance, number of teeth and self-perceived oral health were included as covariates. Prevalence ratios (PR) with their respective 95% confidence intervals (CI) were estimated using Poisson regression with robust variance. RESULTS: 8405 individuals were included in this study. The prevalence of frailty was 7.5%. Regarding frailty status, the prevalence of dental service use was 47.0%, 48.5% and 4.5% for robust, pre-frail and frail individuals, respectively. Frail individuals had a 7% higher prevalence of not using dental (PR: 1.07; 95% CI: 1.01-1.13) than robust individuals. Frailty was independently associated with not using oral health services. CONCLUSION: Given the complexity of the determinants of dental service use, frailty adds another dimension to be examined in older adults. Public health strategies considering a common risk factor approach should be endorsed.

Pathways Between Religiosity and Tooth Loss in Older Adults in Brazil.

The aim of this cross-sectional study was to evaluate the direct and indirect pathways between religiosity and tooth loss in older adults from Brazil. We analyzed the data of the Brazilian Longitudinal Study of Aging, a nationally representative study of individuals aged 50 years or older. The pathways were analyzed through structural equation modeling. A total of 9073 individuals were evaluated. It was observed that oral hygiene and smoking were mediators of the relationship between religiosity and tooth loss, through spirituality and social support, respectively. Spirituality also directly influenced the tooth loss.

Kinetics of cerebral blood flow velocities during treatment for delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage.

BACKGROUND: In aneurysmal subarachnoid hemorrhage (aSAH), one of the main determinants of prognosis is delayed cerebral ischemia (DCI). Transcranial Doppler (TCD) is used to monitor vasospasm and DCI. We aimed to better understand cerebral hemodynamics response to hypertension induction (HI) with norepinephrine (NE) and inotropic therapy with milrinone so that TCD can be a bedside tool in helping to guide DCI therapies. Our primary objective was to determine TCD blood flow velocity (BFV) kinetics during HI and inotropic therapy for DCI treatment. Secondly, we performed an analysis by treatment subgroups and evaluated clinical response to therapies. METHODS: We performed a prospective observational cohort study in a Brazilian high-volume center for aSAH. Patients with aSAH admitted between 2016 and 2018 who received NE or milrinone for DCI treatment were included. TCDs were performed before therapy initiation (t0) and 45 (t1) and 90 min (t2) from the onset of therapy. For each DCI event, we analyzed the highest mean flow velocity (MFV) and the mean MFV and compared their kinetics over time. The National Institutes of Health Stroke Scale was determined at t0, t1, and t2. RESULTS: Ninety-eight patients with aSAH were admitted during the study period. Twenty-one (21.4%) developed DCI, of whom six had DCI twice, leading to a total of 27 analyzed DCI events (12 treated with HI and 15 with milrinone). Patients treated with NE had their mean arterial pressure raised (85 mm Hg in t0, 112 mm Hg in t2 [p < 0.001]), whereas those treated with milrinone had a significant decrease in mean arterial pressure over treatment (94 mm Hg in t0, 88 mm Hg in t2 [p = 0.004]). Among all treated patients, there was a significant drop from t0 to t2 but not to t1 in the highest MFV and in the highest mean MFV. Among those treated with HI, there were no significant changes from t0 to t1 or t2 (highest MFV in t0 163.2 cm/s, in t1 172.9 cm/s [p = 0.27], and in t2 164 cm/s [p = 0.936]). Conversely, in those treated with milrinone, there was a significant decrease from t0 to t1 and to t2 (highest MFV in t0 197.1 cm/s, in t1 172.8 cm/s [p = 0.012], in t2 159 cm/s [p = 0.002]). Regarding clinical outcomes, we observed a significant improvement in mean National Institutes of Health Stroke Scale scores from 17 to 16 in t1 (p < 0.001) and to 15 in t2 (p = 0.002). CONCLUSIONS: BFV analyzed by TCD in patients with aSAH who developed DCI and were treated with milrinone or NE significantly decreased in a time-dependent way. Milrinone effectively decrease cerebral BFV, whereas NE do not. Clinical improvement was achieved with both treatment strategies.

Prevalência de queixas urinárias e o impacto destas na qualidade de vida de mulheres integrantes de grupos de atividade física / Prevalence of urinary complaints and their impact on the quality of life of women that participate in physical activity groups

Introdução: A Sociedade Internacional de Continência define incontinência urinária como qualquer perda de urina relatada pelo paciente.É uma condição que afeta a população mundial, principalmente feminina, levando a diversas implicações. O objetivo desteestudo foi verificar a prevalência de queixas urinárias e o impacto destas na qualidade de vida das mulheres, integrantes de grupos deatividade física. Métodos: Participaram do estudo 50 mulheres, com idade a partir de 40 anos, participantes de grupos de atividadefísica conduzidos pela Fisioterapia em um Centro de Saúde de Belo Horizonte, Minas Gerais. As voluntárias foram submetidas a umaanamnese uroginecológica, e aquelas que apresentaram queixas urinárias nos últimos meses responderam o questionário ?King?s HealthQuestionnaire? para avaliação da qualidade de vida. Resultados: A prevalência de mulheres com queixas urinárias foi de 42 por cento. Ossintomas mais predominantes foram: urgência (95,24 por cento), freqüência (90,48 por cento), incontinência de esforço (85,71 por cento) e noctúria (80,95 por cento).Quanto à intensidade, os sintomas de urge-incontinência (49 por cento) e urgência (46 por cento) apresentaram os maiores índices. De acordo com a análise dos domínios, o impacto da incontinência (53,96 ± 26,83) sobressalta-se quando comparado a outros resultados, seguido pelodomínio medidas de gravidade (43,78 ± 23,01). Conclusão: A população estudada apresentou elevada prevalência de queixas urinárias e o impacto da qualidade de vida encontrado não descarta a influência negativa do quadro patológico.

Avaliação da qualidade de vida dos agentes comunitários de saúde de Lagoa Santa - MG / Evaluation of the quality of life of the health community agents from Lagoa Santa û MG

O Agente Comunitário de Saúde (ACS) é reconhecido como um importante articulador entre os serviços de saúde e a comunidade. Entretanto, justamente pelo fato de o mesmoresidir e atuar na sua comunidade, passa a sofrer fortepressão, tanto por parte da comunidade como da própriaequipe de saúde da família, o que pode gerar agravos a suasaúde e prejuízos em sua qualidade de vida (QV). Esteestudo avaliou a qualidade de vida dos ACS do municípiode Lagoa Santa/MG. Trata-se de um estudo transversal,descritivo e analítico, com aprovação ética, do qual participaram 60 ACS, utilizando-se o questionário WHOQOLBref e um questionário socioeconômico específico. Osdados foram analisados pelo programa estatístico SPSS,versão 13.0 (2004), tendo sido estabelecida, previamente,uma margem de erro de 5 por cento (p ≤ 0,05) para rejeição da hipótese de nulidade. A análise comparativa foi feita por meio do coeficiente de correlação de Pearson (r > 0,60). Observou-se que 96,7 por cento dos ACS eram mulheres adultas, jovens (média das idades de 33 anos; ± 11 anos), sendo 53,4 por cento delas solteiras. A religião católica foi a mais prevalente (63,3 por cento), 78,3 por cento da população possuía 2º grau completo,78,3 por cento relatou renda familiar de até três salários mínimos por mês e 44 por cento atuavam como ACS no Programa de Saúde da Família (PSF) de Lagoa Santa/MG há menos de um ano. Em relação ao WHOQOL-Bref, o domínio que apresentou melhor pontuação média foi o Físico (82,8), seguidos pelo domínio Relações Sociais (77,0), Psicológico (76,0) e, por último, o domínio do Meio Ambiente (59,5). (AU)

Avaliação da qualidade de vida dos agentes comunitários de saúde de Lagoa Santa - MG / Evaluation of the quality of life of the health community agents from Lagoa Santa – MG

O Agente Comunitário de Saúde (ACS) é reconhecido como um importante articulador entre os serviços de saúde e a comunidade. Entretanto, justamente pelo fato de o mesmo residir e atuar na sua comunidade, passa a sofrer forte pressão, tanto por parte da comunidade como da própria equipe de saúde da família, o que pode gerar agravos a sua saúde e prejuízos em sua qualidade de vida (QV). Este estudo avaliou a qualidade de vida dos ACS do município de Lagoa Santa/MG. Trata-se de um estudo transversal, descritivo e analítico, com aprovação ética, do qual participaram 60 ACS, utilizando-se o questionário WHOQOLBrefe um questionário socioeconômico específico. Os dados foram analisados pelo programa estatístico SPSS®, versão 13.0 (2004), tendo sido estabelecida, previamente, uma margem de erro de 5% (p ≤ 0,05) para rejeição da hipótese de nulidade. A análise comparativa foi feita por meio do coeficiente de correlação de Pearson (r > 0,60). bservou-se que 96,7% dos ACS eram mulheres adultas, jovens (média das idades de 33 anos; ± 11 anos), sendo 53,4% delas solteiras. A religião católica foi a mais prevalente (63,3%), 78,3% da população possuía 2º grau completo, 78,3% relatou renda familiar de até três salários mínimos por mês e 44% atuavam como ACS no Programa de Saúde da Família (PSF) de Lagoa Santa/MG há menos de um ano. Em relação ao WHOQOL-Bref, o domínio que apresentou melhor pontuação média foi o Físico (82,8), seguidos pelo domínio Relações Sociais (77,0), Psicológico (76,0) e, por último, o domínio do Meio Ambiente (59,5).

The Community Health Agent (CHA) is recognised as a managing person of great importance among the health services and the community. However, considering the fact that they dwell in the community where they act; they are targets to many different situations which caused a strong pressure from part of the community and from the family health team itself, conditions able to cause damages to their health and loss of quality of life (QL). This study evaluated the quality of life of the CHA from Lagoa Santa/MG. This is a transversal, descriptive and analytical study, ethically approved, where 60 CHA joined the program, using the instrument WHOQOL-Bref and a social and economical questionnaire for this study. The data were analysed using the statistic program SPSS®, version 13.0 (2004), established previously a 5% margin of error (p ≤ 0,05) to reject the hypothesis of nullity. The comparative analysis was made by Pearson’s coefficient of correlation (r > 0,60). It was observed that 96,7% of CHA were young adult women (average age 33 years old; ± 11 years), 53,4% of them single. The catholic religion prevailed (63,3%), 78,3% have completed high school, 78,3% described a familiar income reaching the maximum of 3 minimum wage per month and 44% has been working as a CHA at the Family Health Program (FHP) of Lagoa Santa/MG for less than a year. Considering the WHOQOL-Bref, the domain which shown the best average score was the Physical (82,8) followed by the Social Relationships (77,0), Psychological (76,0) and the Environment (59,5). The most part of CHA from Lagoa Santa/MG were single young adult women, catholics, with low family income, average level of education and little professional experience regarding the FHP where they were inserted. Concerning their QL, it was detected by the WHOQOL-Bref a positive relation with Physical, Social Relationships and Psychological domains and a negative relation with the Environment domain.