The impact of the strategic action plan to combat chronic non-communicable diseases on hospital admissions and deaths from cardiovascular diseases in Brazil.

Chronic Non-Communicable Diseases (NCDs) are the main causes of death worldwide, responsible for millions of hospital admissions per year, especially cardiovascular diseases (CVD). Several strategies for controlling and coping with these diseases have been developed in several countries. The aim of the study was to evaluate the impact of the Strategic Action Plan to Combat NCDs (2011-2022) on hospital admissions, deaths and mortality rate in Brazil, classified by CVD. This is a descriptive study, with secondary data from the Hospital Information System of the Unified Health System (SIH/SUS). Hospital admissions, deaths and mortality rate due to CVD in the Brazilian population aged over 20 years were analyzed, according to region, sex and age group. Statistical analysis was performed using the GraphPad Prism program. Data normality was assessed using the Komogorov Smirnov test and the comparison between groups and year periods was performed using the two-way ANOVA test with Tukey's post hoc test. A value of p<0.05 was considered significant. In this study, in most analyses, a reduction in the hospitalization rates of the adult population was observed after the implementation of the plan, however, there was no improvement in relation to the number of deaths and mortality rate from CVD. This shows that there is still a long way to go to reduce the impact of these diseases in Brazil, and they reaffirm the need for and importance of maintaining the prevention of their risk factors, the social determinants of health and the reorganization of care in the face of to population aging. Such findings contribute with information that allow better control and monitoring of CVD and should be considered when implementing new strategies for prevention, care and control of risk factors.

Time trend of Brazilian hospital admissions and deaths due to asthma among children and teenagers, 1998-2019.

BACKGROUND: Asthma is one of the most prevalent non-communicable diseases worldwide. The aim of this study was to characterize the distribution of Brazilian hospital admissions due to asthma among children and teenagers between 1998 and 2019, as well as to analyze hospital admission incidence and mortality rate during the period according to the geographic region, age group and gender. METHODS: This is a descriptive time trend study using secondary data regarding hospital admissions and lethality registered in the Brazilian System of Hospital Information of the Brazilian Public Health System (SIH/SUS) due to asthma (ICD-10) in subjects aged from 0 to 19 years old between 1998 and 2019. The following variables were collected: number and place of hospital admissions classified by the ICD-10, absolute values and frequency by age group, gender and lethality. Statistical analysis was performed by GraphPad Prism version 5.0 software. RESULTS: The total number of hospital admissions due to asthma was 3,138,064. It was observed that children aged between 1 to 4 years, living in the Northeast region and males showed the highest number of hospitalizations. A 74.37% reduction over a 21-year period was found. The lethality rate found in the study was 0.06, with the highest rates being from the Northeast region, males and < 1-year-old. CONCLUSION: Hospital admissions were more prevalent in young children, male gender and in the Northeast region. A decrease of hospital admissions and lethality rate was observed in all groups over time. This profile is important for implementing government strategies to lower hospital admissions and decrease costs.

Diabetes mellitus hospitalization and mortality rate according to a national database in Brazil: a longitudinal study.

BACKGROUND: Diabetes mellitus (DM) is an important public health problem worldwide. In addition to the impairment in functionality, the large number of complications which lead to hospitalizations results in high treatment costs. The aim of this study was to analyze the incidence of hospitalizations, mortality rate and hospital costs, as well as to observe the temporal trend of hospitalizations and length of hospital stay due to DM between 2008 and 2019 in Brazil. METHODS: This is a longitudinal descriptive study in which all data regarding hospital admissions registered in the Brazilian system of Hospital Information of "Sistema Único de Saúde" (SIH/SUS; http://datasus.saude.gov.br ) due to DM (ICD-10) were included. Comparisons among the groups were performed by an unpaired Student's t-test, two-way ANOVA with a Tukey post hoc test (p < 0.05). RESULTS: An increased hospitalization of 1.83% due to DM was observed between 2008 and 2019 in Brazil. The Southeastern region had the highest incidence (34.6%) and mortality rate when compared to the other regions (p < 0.05). We also found that females were more likely to be hospitalized in comparison to males, without a statistically significant difference. Finally, a progressive increase of hospitalizations and mortality rate were observed according to age groups, as well as increased spending due to DM hospitalizations over the years. CONCLUSION: Hospitalizations due to DM in Brazil showed an expressive increase over the last 12 years, and there is a need for primary healthcare interventions to help reduce this situation.

Sleep quality is associated with Disability and Quality of life in breast cancer survivors: a cross-sectional pilot study.

PURPOSE: To evaluate the sleep quality and its association with disability, fatigue and quality of life of breast cancer survivors. METHODS: This is a cross-sectional pilot study developed with breast cancer survivors. The data collection instruments consisted of general and clinical information on the disease and the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0); Pittsburgh Sleep Quality Index (PSQI); Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F); and Disabilities of the arm and Shoulder (DASH). Descriptive statistical analysis, correlation tests, tests for means comparison and linear regression were performed. Cohen's d analysed the effect size. The significance was set at p < 0.05. RESULTS: 71,9% of women had poor sleep quality. Subjective poor sleep quality was a predictor of worse scores for fatigue (p = 0.007), quality of life by FACT-G (p = 0.010) and FACIT-F (p = 0.004), the functional performance of upper limbs (p = 0.001) and disability (p = 0.003). CONCLUSIONS: Breast cancer survivors with subjective poor sleep quality had more fatigue, less upper limb-related functional performance, more disability and worse quality of life.

Characterization of Brazilian hospital admissions due to cardiovascular diseases: a longitudinal study.

BACKGROUND: Cardiovascular diseases (CVD) are the main cause of death and comorbidities worldwide. It is estimated that three quarters of all deaths related to CVD occur in low and middle income countries such as Brazil. Furthermore, it is estimated that emerging countries will present the highest worldwide prevalence of such diseases by 2050. In view of the above, this study aims to characterize Brazilian hospital admission distribution classified by the ICD-10 in adults between 2008 and 2017 in Brazil. METHODS: This is a longitudinal descriptive study in which all data regarding hospital admissions registered in the Brazilian Hospital Information System of "Sistema Único de Saúde" (SIH/SUS) due to cardiovascular diseases (ICD-10) were included. All admissions from private or public services linked to the SUS from 2008 and 2017 were evaluated. The following variables were collected: number of hospital admissions, place of hospitalization classified by the ICD-10 and mortality rate at the federal level and according to regions. Absolute values and frequency of hospital admissions were grouped according to sex, age and living region as well as the number of deaths. The extracted data was stored in a Microsoft Excel 2013 program spreadsheet. Statistical analysis was performed by GraphPad Prism version 5.0 software. RESULTS: There was a total of 11,345,821 hospital admissions due to CVD registered between 2008 and 2017. Individuals from 50 to 79 years old were the most affected. Heart failure (21.3%), other ischemic heart diseases (13.3%) and stroke (11.4%) were responsible for almost half of the hospital admissions associated to CVD. The number of registered deaths caused by any CVD was 867,838 and the national mortality rate was 7.82. CONCLUSION: CVD were responsible for around 10% of all hospital admissions in Brazil between 2008 and 2017. Moreover, it was possible to observe a decrease in hospital admissions as well as mortality rate over time after implementing governmental strategies to prevent cardiovascular diseases.

After-Effects of Thixotropic Maneuvers on Chest Wall and Compartmental Operational Volumes of Healthy Subjects Using Optoelectronic Plethysmography.

The volumes assessed by optoelectronic plethysmography (OEP) and based on a three-compartmental model provide an accurate breath-by-breath index of expiratory and inspiratory (ribcage muscles and diaphragm) muscle length. Thus, after performing thixotropic maneuvers, OEP may also provide evidence regarding the history-dependent properties of these muscles. We studied the after-effects of different thixotropic conditionings on chest wall (CW) and compartmental operational volumes of 28 healthy subjects (25.5 ± 2.2 years, FVC%pred 94.8 ± 5.5, and FEV1 %pred 95.5 ± 8.9) using OEP. Conditionings were composed of inspiratory or expiratory contractions performed from total lung capacity (TLC) or residual volume (RV). The study protocol was composed of three consecutive contractions of the same maneuver, with 60 s of spontaneous breathing in between, and after-effects were studied in the first seven respiratory cycles of each contraction. Cumulative effects were also assessed by comparing the after-effects of each thixotropic maneuver. Inspiratory contractions performed from both TLC and RV acutely increased end-inspiratory (EIV) CW volumes (all p < 0.0001), mainly on both upper and lower ribcage compartments (i.e., non-diaphragmatic inspiratory muscles and diaphragm, respectively); while, expiratory contractions from RV decreased CW volumes (p < 0.0001) by reducing the upper ribcage and abdominal volumes (all p < 0.0001). The response of the thixotropic maneuvers did not present a cumulative effect. In healthy, the use of the three-compartmental model through OEP allows a detailed assessment of the diaphragm, inspiratory and expiratory muscle thixotropy. Furthermore, specific conditioning maneuvers led to thixotropy of the inspiratory ribcage, diaphragm, and expiratory muscles.

Chest wall volume and asynchrony in stroke and Parkinson's disease subjects: A case-control study.

BACKGROUND: The expansion of the rib cage and abdomen occurs in a synchronic way during a coordinated contraction of the diaphragm and the abdominal and intercostal muscles under normal conditions and healthy. The presence of restrictive respiratory disease may lead to uncoordinated action of the respiratory muscles which affects breathing pattern and chest wall volumes. The aim of this study was to evaluate chest wall volumes, chest wall asynchrony and inspiratory paradoxical movement of breathing, as well as the influence of the time of disease diagnosis in subjects with Parkinson's disease and post-Stroke in comparison to healthy individuals. METHODS: Total and compartmental chest wall volumes, chest wall asynchrony and paradoxical movement were measured at rest in a seated position by Optoelectronic Plethysmography in 76 individuals (29 healthy individuals, 20 post-Stroke and 27 Parkinson's disease subjects). Post-stroke and Parkinson's disease subjects were also grouped according to the length of diagnosis. RESULTS: In both groups with restrictive respiratory disease we observed that pulmonary rib cage compartment (VRCp) volume is reduced when compared to healthy subjects (p <0.05). This same pattern was observed when analyzing post-stroke subjects with more than three years of diagnosis and Parkinson's subjects with less than three years of diagnosis (p<0.05). Furthermore, post-stroke subjects with inspiratory paradoxical movement showed decreased total and compartmental chest wall volumes (p<0.05), while individuals with Parkinson's disease with inspiratory paradoxical movement only presented a decrease in pulmonary rib cage compartment volume (p<0.05). CONCLUSION: Our study presents new findings for better understanding of chest wall volumes and chest wall asynchrony in post-stroke and Parkinson's disease individuals. Half of the subjects with post-Stroke and Parkinson's disease presented inspiratory paradox movement, but changes in breathing pattern was especially observed in post-stroke subjects with more than three years of diagnosis.

Sensory deficits in ipsilesional upper-extremity in chronic stroke patients / Déficit sensorial na extremidade superior ipsilateral em pacientes com ave crônico

Objective To investigate somatosensory deficits in the ipsilesional wrist and hand in chronic stroke patients and correlate these deficits with contralesional sensorimotor dysfunctions, functional testing, laterality and handedness.Methods Fifty subjects (twenty-two healthy volunteers and twenty-eight stroke patients) underwent evaluation with Semmes-Weinstein monofilaments, the sensory and motor Fugl-Meyer Assessment, the Nottingham Sensory Assessment in both wrists and hands and functional tests.Results Twenty-five patients had sensory changes in the wrist and hand contralateral to the stroke, and eighteen patients (64%) had sensory deficits in the ipsilesional wrist and hand. The most significant ipsilesional sensory loss was observed in the left-handed patients. We found that the patients with brain damage in the right hemisphere had better scores for ipsilesional tactile sensation.Conclusions A reduction in ipsilesional conscious proprioception, tactile or thermal sensation was found in stroke subjects. Right hemisphere damage and right-handed subjects had better scores in ipsilesional tactile sensation.

Objetivo Investigar déficits somatossensoriais no punho e mão ipsilesional em pacientes com acidente vascular encefálico (AVE) crônico e correlacionar esses déficits com disfunções sensório-motoras contralesional, testes funcionais, lateralidade e preferência manual.Métodos Cinquenta indivíduos (vinte e dois voluntários saudáveis e vinte e oito pacientes com AVE) foram submetidos à avaliação com monofilamentos de Semmes-Weinstein, Avaliação Fugl-Meyer (sensorial e motora), Avaliação Sensorial Nottingham em punhos e mãos, e testes funcionais.Resultados Vinte e cinco pacientes apresentaram alterações sensoriais no punho e mão contralateral ao AVE, e dezoito pacientes (64%) apresentaram déficits sensoriais no punho e mão ipsilesional. A perda sensorial ipsilesional mais significativa foi observada nos pacientes canhotos. Pacientes com lesão cerebral no hemisfério direito tiveram melhores pontuações para sensação tátil ipsilesional.Conclusões A redução da propriocepção consciente ipsilesional, da sensibilidade tátil e térmica foi encontrada em indivíduos com AVE. Lesão no hemisfério direito e indivíduos destros apresentaram melhores pontuações na sensação tátil ipsilesional.

Sensory deficits in ipsilesional upper-extremity in chronic stroke patients.

Objective To investigate somatosensory deficits in the ipsilesional wrist and hand in chronic stroke patients and correlate these deficits with contralesional sensorimotor dysfunctions, functional testing, laterality and handedness.Methods Fifty subjects (twenty-two healthy volunteers and twenty-eight stroke patients) underwent evaluation with Semmes-Weinstein monofilaments, the sensory and motor Fugl-Meyer Assessment, the Nottingham Sensory Assessment in both wrists and hands and functional tests.Results Twenty-five patients had sensory changes in the wrist and hand contralateral to the stroke, and eighteen patients (64%) had sensory deficits in the ipsilesional wrist and hand. The most significant ipsilesional sensory loss was observed in the left-handed patients. We found that the patients with brain damage in the right hemisphere had better scores for ipsilesional tactile sensation.Conclusions A reduction in ipsilesional conscious proprioception, tactile or thermal sensation was found in stroke subjects. Right hemisphere damage and right-handed subjects had better scores in ipsilesional tactile sensation.

Desempenho sensório-motor na paresia aferente em paciente após acidente vascular encefálico crônico: relato de caso / Sensorimotor performance in afferent paresis in chronic stroke patient: case report

Introdução: Lesões no giro cerebral pós-central podem causar o fenômeno de paresia aferente. Objetivo: Descrever o desempenho sensório-motor de uma paciente com paresia aferente pós-acidente vascular encefálico (AVE) crônico. Métodos: Paciente do sexo feminino, 39 anos, com diagnóstico de hemorragia subaracnoide aguda por rompimento de aneurisma em artéria cerebral média direita foi submetida a protocolo de desempenho físico de Fugl-Meyer, avaliação sensorial de Nottingham, teste dos sinos, testes de sequência motora e dez testes funcionais, sendo os dois últimos executados com e sem privação visual. Resultados: A paciente apresentou comprometimento motor leve, hipoestesia tátil e ausência de propriocepção em punho e mão, astereognosia e dificuldade na resolução de tarefas motoras durante a privação visual. Conclusão: A paciente com sequelas crônicas pós-AVE apresentou déficits sensoriais e lentidão ou incapacidade de realização das tarefas motoras manuais na ausência da orientação visual, caracterizando, assim, a paresia aferente.

Introduction: Lesions on the postcentral gyrus may cause the phenomenon denominated afferent paresis. Objective: To describe sensorimotor performance of a patient with afferent paresis after chronic stroke. Methods: Female patient, 39 years with a diagnosis of acute subarachnoid hemorrhage caused by rupture of an aneurysm in the right middle cerebral artery underwent physiotherapy assessment. She was subjected to the Fugl-Meyer assessment, Nottingham sensory assessment, the bells test, the motor sequences and ten functional tests, the last two were performed with and without visual deprivation. Results: The patient had mild motor dysfunction, tactile hypoesthesia and absence of proprioception in the wrist and hand, astereognosis and difficulty in resolving motor tasks during visual deprivation. Conclusion: The chronic post-stroke patient exhibited significant sensory deficits in the contralesional upper extremity and slowness or inability to perform motor tasks only in the absence of visual guidance, thus characterizing the afferent paresis.