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1.
Lancet Public Health ; 5(1): e42-e50, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31837974

RESUMO

BACKGROUND: Social inequalities in mortality persist in high-income countries with universal health care, and the mechanisms by which these inequalities are generated remain unclear. We aimed to examine whether social inequalities were present before or after the onset of adverse health conditions (multimorbidity, frailty, and disability). METHODS: Our analysis was based on data from the ongoing Whitehall II cohort study, which enrolled British civil servants aged 35-55 years in 1985-88. Participants were assessed for three indicators of socioeconomic status (education, occupational position, and literacy) at age 50 years. Participants underwent clinical examinations (in 2002-04, 2007-09, 2012-13, and 2015-16) for assessment of frailty (two or more of low physical activity, slow walking speed, poor grip strength, weight loss, and exhaustion) and disability (two or more difficulties in bathing, dressing, going to the toilet, transferring, feeding, and walking). In addition, electronic health records were used to assess the incidence of multimorbidity (two or more of diabetes, coronary heart disease, stroke, chronic obstructive pulmonary disease, depression, arthritis, cancer, dementia, and Parkinson's disease) and mortality. In analyses adjusted for sociodemographic factors, we used multistate models to examine social inequalities in transitions from healthy state to adverse health conditions and subsequently to mortality. FINDINGS: Of 10 308 individuals in the Whitehall II study cohort, 6425 had relevant data available at 50 years and to the end of follow-up on Aug 31, 2017, and were included in our analysis. Participants were followed up for a median of 23·6 years (IQR 19·6-28·9). 1694 (26·4%) of 6425 participants developed multimorbidity, 1733 (27·0%) became frail, 692 (10·8%) had a disability, and 611 (9·5%) died. Multimorbidity (hazard ratio [HR] 4·12 [95% CI 3·41-4·98]), frailty (HR 2·38 [95% CI 1·93-2·93]), and disability (HR 1·73 [95% CI 1·34-2·22]) were associated with increased risk of mortality; these associations were not modified by socioeconomic status. In multistate models, occupation was the socioeconomic status indicator that was most strongly associated with inequalities in the transition from healthy state to multimorbidity (HR 1·54 [95% CI 1·37-1·73]), to frailty (HR 2·08 [95% CI 1·85-2·33]), and to disability (HR 1·44 [95% CI 1·18-1·74]). Socioeconomic status indicators did not affect transitions to mortality in those with multimorbidity, frailty, or disability. INTERPRETATION: Socioeconomic status affects the risk of multimorbidity, frailty, and disability, but does not affect the risk of mortality after the onset of these adverse health conditions. Therefore, primary prevention is key to reducing social inequalities in mortality. Of the three adverse health conditions, multimorbidity had the strongest association with mortality, making it a central target for improving population health. FUNDING: UK Medical Research Council; National Institute on Aging, National Institutes of Health; British Heart Foundation.

2.
BMJ ; 366: l4414, 2019 08 07.
Artigo em Inglês | MEDLINE | ID: mdl-31391187

RESUMO

OBJECTIVES: To examine the association between the Life Simple 7 cardiovascular health score at age 50 and incidence of dementia. DESIGN: Prospective cohort study. SETTING: Civil service departments in London (Whitehall II study; study inception 1985-88). PARTICIPANTS: 7899 participants with data on the cardiovascular health score at age 50. EXPOSURES: The cardiovascular health score included four behavioural (smoking, diet, physical activity, body mass index) and three biological (fasting glucose, blood cholesterol, blood pressure) metrics, coded on a three point scale (0, 1, 2). The cardiovascular health score was the sum of seven metrics (score range 0-14) and was categorised into poor (scores 0-6), intermediate (7-11), and optimal (12-14) cardiovascular health. MAIN OUTCOME MEASURE: Incident dementia, identified through linkage to hospital, mental health services, and mortality registers until 2017. RESULTS: 347 incident cases of dementia were recorded over a median follow-up of 24.7 years. Compared with an incidence rate of dementia of 3.2 (95% confidence interval 2.5 to 4.0) per 1000 person years among the group with poor cardiovascular health, the absolute rate differences per 1000 person years were -1.5 (95% confidence interval -2.3 to -0.7) for the group with intermediate cardiovascular health and -1.9 (-2.8 to -1.1) for the group with optimal cardiovascular health. Higher cardiovascular health score was associated with a lower risk of dementia (hazard ratio 0.89 (0.85 to 0.95) per 1 point increment in the cardiovascular health score). Similar associations with dementia were observed for the behavioural and biological subscales (hazard ratios per 1 point increment in the subscores 0.87 (0.81 to 0.93) and 0.91 (0.83 to 1.00), respectively). The association between cardiovascular health at age 50 and dementia was also seen in people who remained free of cardiovascular disease over the follow-up (hazard ratio 0.89 (0.84 to 0.95) per 1 point increment in the cardiovascular health score). CONCLUSION: Adherence to the Life Simple 7 ideal cardiovascular health recommendations in midlife was associated with a lower risk of dementia later in life.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Demência/epidemiologia , Nível de Saúde , Estilo de Vida Saudável , Adulto , Idoso , Doenças Cardiovasculares/sangue , Demência/prevenção & controle , Feminino , Seguimentos , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco
3.
Ann Phys Rehabil Med ; 62(5): 351-355, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31096014

RESUMO

BACKGROUND: Stroke is a common and debilitating neurological disorder having a negative impact on quality of life. OBJECTIVES: We aimed to compare differences in participation in work and leisure activities between patients with and without a self-reported stroke at the national level in France. METHODS: This study used cross-sectional data from the Disability Health Survey that was administered in people's homes (DHH) in 2008 and in institutions (DHI) in 2009. Stroke history and levels of participation in work and leisure activities were collected by interviews. The levels of participation in these activities were compared between participants with and without a history of stroke. RESULTS: Among the 33,785 interviewed participants, 1725 reported a history of stroke. After weighting, this represented a mean (SD) of 766,641 (36,650) people among 49 million adults living in France. After adjustment, as compared with people without stroke, those with stroke were less likely to work (odds ratio 0.19 [95% confidence interval 0.13-0.27]), use the telephone (0.21 [0.17-0.25]) and drive (0.25 [0.21-0.32]). In the age group 19-59 years, as compared with people without stroke, those with stroke less frequently worked (35.9% vs. 72.2%), drove (54.3% vs. 81.3%) and participated in sports (26.6% vs. 55.8%). CONCLUSIONS: Overall, our study indicates that people with a history of stroke report more difficulties in participating in work and leisure activities than those without a history of stroke.

5.
J Stroke Cerebrovasc Dis ; 27(12): 3443-3450, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30190227

RESUMO

GOAL: We studied time trends of admission in neurological rehabilitation units (NRU) among patients hospitalised for stroke from 2010 to 2014 and compared prognostic factors of functional gain, home return and inpatient survival. METHODS: Patients hospitalized for Stroke from 2010 to 2014 were selected from the French national hospital databases. Admission in rehabilitation was searched till 3 months. Predictive factors of functional gain, home return, in-patient survival, and the corresponding trends were studied using logistic regression. RESULTS: In 2014, global rehabilitation rate was 36.3% with 15.8 discharged in a NRU. The rate of patients managed in NRU rose between 2010 and 2014. An increase in the proportion of home return (+4%) and inpatient survival rate (+7%) were observed between 2010 and 2014. Almost 40% of patients with severe functional deficits benefited of a partial or complete recovery after their rehabilitation stay. NRU admission was associated with higher probability of functional gain (OR [odds ratio] =1.76 [confidence interval {CI} 95% 1.67-1.85]), home return (OR = 1.38 [CI 95% 1.29-1.47]) and inpatient survival (OR = 3.15 [CI 95% 2.83-3.52]). CONCLUSIONS: A greater proportion of patients were admitted in NRU along with an increase of home return and in-patient survival, but too many patients remained excluded.


Assuntos
Admissão do Paciente , Centros de Reabilitação , Reabilitação do Acidente Vascular Cerebral , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/reabilitação , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/reabilitação , Feminino , Seguimentos , França/epidemiologia , Mortalidade Hospitalar , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Prognóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/epidemiologia
6.
Am J Phys Med Rehabil ; 97(5): 323-331, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29016402

RESUMO

OBJECTIVE: The aim of the study was to measure the prevalence of traumatic brain injury (TBI)-related disability and health status in the general population. DESIGN: The French National Survey, conducted in households and institutions, assessed 33,896 adults. Data included sequelae from TBI, impairments, current health conditions, and uses of health services. Analyses, adjusted for age and sex, compared subjects who declared sequelae from TBI (n = 479) with the remaining survey population (n = 33,287). Use of weighting factors ensured that results were representative of the national population. RESULTS: Prevalence of persistent sequelae from TBI in France was 704/100,000. Median time since injury was 14 yrs. For all Core Set items of the International Classification of Functioning, subjects with TBI reported more impairments than the control population: adjusted odds ratios from 1.7 (behavioral difficulties) to 8.6 (motor difficulties). Rates of cardiovascular, respiratory, musculoskeletal, digestive, urological, neurological, and psychiatric conditions were higher in the TBI population. Use of health services was greater, and women with TBI had higher rates of unmet health needs. CONCLUSIONS: Persistent sequelae from TBI significantly affect health in the general population. Planning of post-TBI care should address the chronic needs of these persons.


Assuntos
Lesões Encefálicas Traumáticas/epidemiologia , Adulto , Lesões Encefálicas Traumáticas/fisiopatologia , Estudos Transversais , Avaliação da Deficiência , Feminino , França/epidemiologia , Inquéritos Epidemiológicos , Humanos , Classificação Internacional de Funcionalidade, Incapacidade e Saúde , Masculino , Pessoa de Meia-Idade , Prevalência
7.
PLoS One ; 12(11): e0182062, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29112966

RESUMO

BACKGROUND: Knee flexion contractures occur frequently in non-ambulatory, aged persons and persons with central nervous system lesions, rendering positioning and nursing care difficult. There are often risks associated with surgical interventions. OBJECTIVE: To evaluate the effectiveness of percutaneous needle tenotomy to lengthen the knee flexor muscles and improve passive function. METHODS: This was a retrospective study of all patients who underwent percutaneous needle tenotomy between 2012 and 2014. Tenotomy was carried out in the semi-tendinosus, biceps femoris and gracillis muscles under local anesthesia. The procedure took no more than 40 minutes. Range of motion (ROM) was evaluated immediately post-operatively and 3 months later. RESULTS: Thirty-four needle tenotomies were carried out. Mean lack of knee extension was 94.2° (range 35-120°) pre-op, (range 15-90°; p<0.05) immediately post-op and 50.1° (range 10-90°; p<0.05) three months later, thus a mean increase of 44.1° knee extension (range 0-90°). All care and positioning objectives were achieved. There were no complications and procedure-related pain was rated as 3-4/ 10. CONCLUSIONS: Needle tenotomy was well tolerated and yielded a significant increase in ROM with no unwanted effects. All objectives were achieved. This technique could be used in an ambulatory care setting or within institutions for severely disabled individuals.


Assuntos
Articulação do Joelho , Músculo Esquelético/cirurgia , Agulhas , Tenotomia/métodos , Idoso , Feminino , Humanos , Masculino , Estudos Retrospectivos
8.
J Hand Surg Am ; 42(12): 1035.e1-1035.e7, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28935338

RESUMO

PURPOSE: Soft tissue surgery for upper extremity contractures can improve hygiene, pain, and appearance in adults with central nervous system lesions. The goal of such interventions is highly individual; thus, goal attainment scaling (GAS; a method of scoring the extent to which patient's individual goals are achieved [5 levels] in the course of intervention and using T score values) is pertinent to evaluate outcome. The objective of this study was to assess the effect of soft tissue surgery for upper extremity muscle contractures in patients with central nervous system lesions using GAS. METHODS: Retrospective data from 70 interventions were included (63 patients; 23 women). The mean age was 51.3 ± 16.2 years (range, 24.2-87.0 years). The primary goal was to improve hygiene (n = 58), pain (n = 10), or appearance (n = 2). The etiologies were stroke (n = 35), traumatic brain injury (n = 16), cerebral anoxia (n = 4), neurodegenerative disease (n = 6), and cerebral palsy (n = 2). The GAS score was calculated before surgery and 3 months after surgery. RESULTS: The T score (which took into account the weight of each goal) was 52.3 at 3 months (38.5 before surgery), corresponding to a "better than expected" outcome. The mean of the differences of the GAS score for each goal before and after surgery increased by 1.27 for hygiene, 1.06 for pain, and 1.00 for appearance. CONCLUSIONS: Soft tissue surgery can safely and effectively improve hygiene, pain, and appearance in adults with cerebral damage. The preoperative evaluation should be multidisciplinary. The GAS is a useful tool to assess the effectiveness of orthopedic surgery for these patients. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.


Assuntos
Encefalopatias/complicações , Tecido Conjuntivo/cirurgia , Contratura/cirurgia , Mãos , Espasticidade Muscular/cirurgia , Tenotomia , Atividades Cotidianas , Adulto , Idoso , Idoso de 80 Anos ou mais , Contratura/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Espasticidade Muscular/etiologia , Pronação , Amplitude de Movimento Articular , Estudos Retrospectivos , Supinação , Resultado do Tratamento , Adulto Jovem
9.
Ann Phys Rehabil Med ; 59(4): 263-9, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27173174

RESUMO

OBJECTIVE: A systematic review of the literature to determine whether in patients with neurological heterotopic ossification (NHO) after traumatic brain injury, the extent of the neurological sequelae, the timing of surgery and the extent of the initial NHO affect the risk of NHO recurrence. DATA SOURCES: We searched MEDLINE via PubMed and Cochrane library for articles published up to June 2015. Results were compared with epidemiological studies using data from the BANKHO database of 357 patients with central nervous system (CNS) lesions who underwent 539 interventions for troublesome HO. RESULTS: A large number of studies were published in the 1980s and 1990s, most showing poor quality despite being performed by experienced surgical teams. Accordingly, results were contradictory and practices heterogeneous. Results with the BANKHO data showed troublesome NHO recurrence not associated with aetiology, sex, age at time of CNS lesion, multisite HO, or "early" surgery (before 6months). Equally, recurrence was not associated with neurological sequelae or disease extent around the joint. CONCLUSIONS: The recurrence of NHO is not affected by delayed surgery, neurological sequelae or disease extent around the joint. Surgical excision of NHO should be performed as soon as comorbid factors are under control and the NHO is sufficiently constituted for excision.


Assuntos
Lesões Encefálicas Traumáticas/complicações , Procedimentos Neurocirúrgicos , Ossificação Heterotópica/cirurgia , Complicações Pós-Operatórias , Adulto , Lesões Encefálicas Traumáticas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/etiologia , Ossificação Heterotópica/patologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/patologia , Recidiva
10.
Eur J Public Health ; 26(5): 799-804, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27107426

RESUMO

BACKGROUND: Overall decreased socioeconomic status (SES) has been linked to increased stroke incidence and mortality. Questions remain regarding whether these relationships persist into older age and apply to stroke sequelae. It is also unknown whether the influence of SES on absolute risk-the metric of most importance for population health-differs by age. METHODS: A nationally representative cross-sectional survey conducted in 2009 in France involved 26 000 participants, 1653 of whom declared previous stroke. We identified stroke with sequelae and stroke with dependency. SES was characterized as low, medium or high education. We compared the prevalence of stroke outcome across education within age groups (40-59, 60-79 and 80+). RESULTS: Prevalence of stroke was 23.8 per thousand. 65.1% of patients had sequelae and 19.6% were dependent. Variations in the prevalence of stroke and of stroke sequelae were statistically significant only in the youngest generations. A significant education gradient for stroke with dependency was apparent in all three generations, although the prevalence ratio (PR) was highest in the 40-59 (low to high education PR = 8.4, P < 10-3) compared with that in the 80+ (PR = 2.5; P < 10-3); conversely, the absolute difference was of much greater magnitude in the oldest vs. youngest generation (prevalence differences, respectively, 22.8 vs. 1.3 per thousand). CONCLUSIONS: SES disparities in the older age group were significant and large in absolute terms when considering more severe outcomes such as stroke dependency. These findings question the ability of universal health care systems to answer equitably the need of the aging population.


Assuntos
Causas de Morte/tendências , Mortalidade/tendências , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/mortalidade , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Previsões , França , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Medição de Risco , Classe Social
11.
Brain Inj ; 30(1): 95-103, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26735867

RESUMO

OBJECTIVES: (1) To evaluate cognitive and emotional impairments, disability and quality-of-life for adults with cerebral anoxia institutionalized in residential care facilities. (2) To evaluate the efficacy of medication, psychotherapy, support group and therapeutic activities. METHODS: Twenty-seven persons with cerebral anoxia were recruited, on average 8 years post-injury. Only 20 went through the whole study. Over three consecutive 2-month periods, they were assessed four times to evaluate: baseline observations (T1-T2), adjustment of their medication (T2-T3); and the effect of psychotherapy, support group and therapeutic activities such as physical and artistic or cultural activities usually proposed in the facilities involved (T3-T4). Examined variables at all time points were cognitive status, anxiety and depression, anosognosia, alexithymia, disability and quality-of-life. RESULTS: All participants exhibited cognitive and emotional impairments comparable to those reported in the literature. Statistical analyses revealed good baseline stability of their condition and no significant effects of changes in medication (between T2 and T3). Conversely, following implementation of psychotherapy, support group and therapeutic activities (between T3 and T4), quality-of-life and social participation were significantly improved. CONCLUSION: Social participation and quality-of-life for persons instutionalized several years after cerebral anoxia were improved by psychotherapeutic and therapeutic activities.


Assuntos
Hipóxia Encefálica/reabilitação , Adaptação Psicológica , Adulto , Estudos de Casos e Controles , Transtornos Cognitivos/etiologia , Transtornos Cognitivos/psicologia , Terapia Cognitivo-Comportamental , Avaliação da Deficiência , Pessoas com Deficiência , Emoções/fisiologia , Feminino , Humanos , Hipóxia Encefálica/diagnóstico , Hipóxia Encefálica/psicologia , Masculino , Pessoa de Meia-Idade , Psicoterapia , Qualidade de Vida , Estudos Retrospectivos
12.
Ann Phys Rehabil Med ; 59(2): 83-6, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26797076

RESUMO

BACKGROUND: Almost 10% of older adults in nursing homes have a fixed flexion deformity of the fingers (claw hand). Such contractures have important functional consequences, often leading to hygiene difficulties. Medical treatment (such as botulinum toxin injections, physiotherapy or positioning) is not always effective and surgery is often not possible in such fragile patients. Microinvasive tenotomy with a large needle could be a useful alternative because it can be carried out in an ambulatory setting under local anaesthesia. METHODS: A single center, retrospective study involving the 2012-2014 database from the day-hospital unit of a neuro-orthopaedic department in France. All patients who underwent percutaneous needle tenotomy of the finger or thumb flexors were included. Outcomes included Goal Attainment Scaling (GAS) and the distance in centimeters between the palm and the pulp of the most flexed digit (PPD). RESULTS: Eighteen patients underwent tenotomy (13 women; mean age: 76±14 years); all patients lived in a nursing home. The limb to be treated was nonfunctional in all patients. The principal goal was determined by consensus with the patients and their health-care teams and was most often to facilitate hand hygiene. Eight patients had at least one secondary goal. In total, 10 patients underwent microinvasive tenotomy for 4 fingers, 5 patients 1 to 4 fingers and 3 patients only the thumb. At 3 months after treatment, goals were achieved for 11 patients, 5 patients progressed toward the goal without attaining it, and for 2 patients, scores were worse. The T-scores of the GAS and the PPD were significantly increased at 3 months (P=0.0326 and P=0.0002, respectively). No serious adverse events occurred. CONCLUSION: Large-needle tenotomy seems safe and effective for treating claw hand in fragile older patients.


Assuntos
Contratura/cirurgia , Dedos/cirurgia , Tenotomia/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Casas de Saúde , Planejamento de Assistência ao Paciente , Estudos Retrospectivos , Tenotomia/efeitos adversos , Polegar/cirurgia
13.
PLoS One ; 10(12): e0143495, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26624990

RESUMO

BACKGROUND: Twenty-two percent of institutionalised elderly persons have muscle contractures. Contractures have important functional consequences, rendering hygiene and positioning in bed or in a chair difficult. Medical treatment (such as botulinum toxin injections, physiotherapy or positioning) is not very effective and surgery may be required. Surgery is carried out in the operating theatre, under local or general anaesthesia but is often not possible in fragile patients. Mini-invasive tenotomy could be a useful alternative as it can be carried out in ambulatory care, under local anaesthesia. OBJECTIVE: To evaluate the effectiveness of percutaneous needle tenotomy and the risks of damage to adjacent structures in cadavers. METHOD: Thirty two doctors who had never practiced the technique (physical medicine and rehabilitation specialists, geriatricians and orthopaedic surgeons) carried out 401 tenotomies on the upper and lower limbs of 8 fresh cadavers. A 16G needle was used percutaneous following location of the tendons. After each tenotomy, a neuro-orthopaedic surgeon and an anatomist dissected the area in order to evaluate the success of the tenotomy and any adjacent lesions which had occurred. RESULTS: Of the 401 tenotomies, 72% were complete, 24.9% partial and 2.7% failed. Eight adjacent lesions occurred (2%): 4 (1%) in tendons or muscles, 3 (0.7%) in nerves and 1 (0.2%) in a vessel. CONCLUSION: This percutaneous needle technique effectively ruptured the desired tendons, with few injuries to adjacent structures. Although this study was carried out on cadavers, the results suggest it is safe to carry out on patients.


Assuntos
Contratura/cirurgia , Agulhas , Complicações Pós-Operatórias/etiologia , Tenotomia/efeitos adversos , Tenotomia/instrumentação , Cadáver , Humanos , Segurança
14.
Brain Inj ; 29(7-8): 866-71, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25915823

RESUMO

PRIMARY OBJECTIVE: To determine the features of stroke-related HO in a large sample of patients and to assess if HO risk is increased by haemorrhagic stroke. RESEARCH DESIGN: A case control study (risk factor of a rare event using retrospective analysis). METHODS AND PROCEDURES: Sixty-one patients with stroke-81 troublesome HOs-were included, each was matched with four controls, i.e. 244 patients with no HO after stroke. Matching criteria were age (±3.5 years) and sex. Data recorded were time from stroke to surgery, ischaemic or haemorrhagic stroke and presence of HO risk factors. MAIN OUTCOMES AND RESULTS: Mean age at time of stroke = 46.02 ± 11.4 years (15.9-76.3) for the case sub-group. Time from stroke to surgery = 23.4 ± 27.8 months (3.6-150.0). There was a significant relationship between haemorrhagic stroke and HO development (OR = 3.01; 95% CI = 1.14-7.98; p < 0.05), but not for ischaemic stroke. This became non-significant when all matching and risk factors were included in the model (adjusted OR = 1.98; 95% CI = 0.60-6.54; p = 0.26). CONCLUSION: Haemorrhagic stroke appears to increase the risk of HO development. Further studies are required to determine if this risk factor is independent from other comorbid factors.


Assuntos
Ossificação Heterotópica/etiologia , Acidente Vascular Cerebral/complicações , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ossificação Heterotópica/fisiopatologia , Ossificação Heterotópica/cirurgia , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/fisiopatologia , Fatores de Tempo
15.
Arch Phys Med Rehabil ; 96(6): 1103-9, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25620718

RESUMO

OBJECTIVE: To characterize electromyographic abnormalities according to symptoms (asymptomatic, fatigue, pseudobotulism) reported 1 month after botulinum toxin injection. DESIGN: Retrospective, single-center study comparing single-fiber electromyography (SFEMG) in the extensor digitorum communis (EDC) or orbicularis oculi (OO) muscles. SETTING: Hospital. PARTICIPANTS: Four groups of adults treated for spasticity or neurologic bladder hyperactivity (N=55): control group (asymptomatic patients: n=17), fatigue group (unusual fatigue with no weakness: n=15), pseudobotulism group (muscle weakness and/or visual disturbance: n=20), and botulism group (from intensive care unit of the same hospital: n=3). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Mean jitter, percentage of pathologic fibers, and percentage of blocked fibers were compared between groups. RESULTS: SFEMG was abnormal for 17.6% of control patients and 75% of patients in the pseudobotulism group. There were no differences between the control and fatigue groups. Mean jitter, percentage of pathologic fibers, and percentage of blocked fibers of the EDC muscle were significantly higher in the pseudobotulism group than in the fatigue and control groups. There were no differences between groups for the OO muscle. The SFEMG results in the botulism group were qualitatively similar to those of the pseudobotulism group. CONCLUSIONS: SFEMG of the EDC muscle confirmed diffusion of the toxin into muscles distant from the injection site in the pseudobotulism group. SFEMG in the OO muscle is not useful for the diagnosis of diffusion. No major signs of diffusion of botulinum toxin type A were found away from the injection site in patients with fatigue but no motor weakness. Such fatigue may be related to other mechanisms.


Assuntos
Toxinas Botulínicas Tipo A/farmacocinética , Fadiga/induzido quimicamente , Fibras Musculares Esqueléticas/fisiologia , Debilidade Muscular/induzido quimicamente , Fármacos Neuromusculares/farmacocinética , Transtornos da Visão/induzido quimicamente , Adulto , Toxinas Botulínicas Tipo A/administração & dosagem , Botulismo/epidemiologia , Eletromiografia , Feminino , Humanos , Injeções Intramusculares , Masculino , Pessoa de Meia-Idade , Hipertonia Muscular/tratamento farmacológico , Espasticidade Muscular/tratamento farmacológico , Fármacos Neuromusculares/administração & dosagem , Estudos Retrospectivos , Bexiga Urinaria Neurogênica/tratamento farmacológico
16.
PLoS One ; 9(12): e115375, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25521057

RESUMO

In France, the prevalence of stroke and the level of disability of stroke survivors are little known. The aim of this study was to evaluate functional limitations in adults at home and in institutions, with and without self-reported stroke. A survey named "the Disability Health survey" was carried out in people's homes (DHH) and in institutions (DHI). Medical history and functional level (activities-of-daily-living, ADL and instrumented-activities-of-daily-living IADL) were collected through interviews. The modified Rankin score (mRS) and the level of dependence and disability were compared between participants with and without stroke. 33896 subjects responded. The overall prevalence of stroke was 1.6% (CI95% [1.4%-1.7%]). The mRS was over 2 for 34.4% of participants with stroke (28.7% of participants at home and 87.8% of participants in institutions) versus respectively 3.9%, 3.1% and 71.6% without stroke. Difficulty washing was the most frequently reported ADL for those with stroke (30.6% versus 3% for those without stroke). Difficulty with ADL and IADL increased with age but the relative risk was higher below the age of 60 (17 to 25) than over 85 years (1.5 to 2.2), depending on the ADL. In the overall population, 22.6% of those confined to bed or chair reported a history of stroke. These results thus demonstrate a high national prevalence of stroke. Older people are highly dependent, irrespective of stroke history and the relative risk of dependence in young subjects with a history of stroke is high compared with those without.


Assuntos
Atividades Cotidianas , Autorrelato , Acidente Vascular Cerebral/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Acidente Vascular Cerebral/psicologia , Reabilitação do Acidente Vascular Cerebral
18.
Neurorehabil Neural Repair ; 28(1): 36-44, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-23897907

RESUMO

BACKGROUND: In France in 2009, patients admitted to Multidisciplinary Inpatient Rehabilitation for stroke were sent to a neurological rehabilitation center (NRC) or a general or geriatric rehabilitation (GRC) service. OBJECTIVE: To describe the functional outcome of stroke patients admitted for rehabilitation in France in 2009, both globally and as a function of the rehabilitation setting (GRC or NRC). METHODS: Data from the French Hospital Discharge Diagnosis databases for 2009 were included. Two logistic regression models were used to analyze factors related to improvement in dependence score and discharge home. Odds ratios (ORs) were also calculated. RESULTS: Among the 83 505 survivors of acute stroke in 2009, 28 201 were admitted for rehabilitation (33.8%). Of these, 19 553 went to GRC (69%) and 8648 to NRC (31%). On average, patients admitted to GRC were older (78.6 years vs 66.4 years), P < .001). At the start of rehabilitation, 50% of NRC patients and 56% of GRC patients were heavily dependent, but level of dependence was similar within each age-group. Rehabilitation in NRC lead to a greater probability of functional improvement (OR = 1.75, P < .001) and home discharge (OR = 1.61, P < .001) after adjustment for gender, age, Charlson's comorbidity index, initial level of dependence, type of stroke, and total length of stay. CONCLUSION: This study confirms, on a national level, the functional benefit of specialized rehabilitation in NRC. These results should be useful in the improvement of care pathways, organization of rehabilitation, and discharge planning.


Assuntos
Pacientes Internados , Recuperação de Função Fisiológica/fisiologia , Centros de Reabilitação , Reabilitação do Acidente Vascular Cerebral , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , França , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
19.
J Bone Joint Surg Am ; 95(5): 446-53, 2013 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-23467868

RESUMO

BACKGROUND: Contracture of the wrist and extrinsic finger flexor and pronator muscles is a common consequence of central nervous system disorders. The proximal release of the extrinsic flexor and pronator muscles was first described by Page and Scaglietti for a Volkmann contracture. The aim of the present study was to assess the amount of increase in extension and the improvements in global hand function that can be expected following this lengthening procedure in patients with central nervous system disorders. METHOD: A single-center retrospective review of patients with central nervous system lesions and contractures of the wrist and extrinsic finger flexor and forearm pronator muscles, causing aesthetic, hygienic, or functional impairment, was carried out. The Page-Scaglietti technique was used for all interventions. Before the operation, motor nerve blocks were used to distinguish between spasticity and contractures with surgical intervention only for contractures. The Zancolli and House classifications were used to evaluate improvements. RESULTS: Data from fifty-four hands and fifty patients (thirty-five men and fifteen women) were evaluated. The mean duration of follow-up (and standard deviation) was 26 ± 21 months (range, three to 124 months). The mean gain (and standard deviation) in wrist extension with fingers extended was 67° ± 25° (range, -10° to 110°). Preoperatively, no hands were classified as Zancolli Group 1, whereas twenty-five hands were classified as Zancolli Group 1 at the latest follow-up review. Ten nonfunctional hands (rated as House Group 0 or Group 1) became functional as a supporting hand postoperatively. Zancolli and House classifications increased significantly (p < 0.01) postoperatively. In twelve cases, a partial recurrence of the deformity occurred. In seven of these cases, surgery unmasked spasticity or contracture of the intrinsic muscles, which required further intervention. CONCLUSION: The Page-Scaglietti technique appears to improve range of motion and function in people with wrist and finger contractures due to central nervous system disorders.


Assuntos
Contratura/cirurgia , Dedos , Antebraço/cirurgia , Espasticidade Muscular/complicações , Procedimentos Ortopédicos/métodos , Punho , Adolescente , Adulto , Idoso , Encefalopatias/complicações , Contratura/etiologia , Feminino , Articulações dos Dedos/fisiologia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Articulação do Punho/fisiologia , Adulto Jovem
20.
J Shoulder Elbow Surg ; 22(6): 767-74, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23246198

RESUMO

BACKGROUND: Heterotopic ossification (HO) of the shoulder after central nervous system damage has seldom been studied. MATERIALS AND METHODS: We performed a single-center retrospective study from 1993 to 2009 including patients who underwent surgery for troublesome shoulder HO. Demographic data, HO location, surgical approach, preoperative and postoperative shoulder range of motion, etiologies, and postoperative complications were collected from patients' files. RESULTS: We found 19 shoulder HOs in 16 patients (traumatic brain injury in 11, spinal cord injury in 2, stroke in 1, and cerebral anoxia in 2). The data in 2 files were incomplete and were therefore not used. HO locations around the joint were anteroinferomedial in 4 (21.1%), posteroinferomedial in 5 (26.3%), encircling in 3 (15.8%), superior in 1 (5.3%), and mixed (2 associated HOs that are not encircling) in 6 (31.6%). The surgical approaches were as follows: deltopectoral, 5 (26.3%); Neer, 3 (15.8%); posterior, 5 (26.3%); axillary, 1 (5.3%); Martini, 2 (10.5%); posterior associated with deltopectoral, 2 (10.5%); and Neer (superolateral) associated with deltopectoral, 1 (5.3%). The mean range of motion increased significantly (gain at follow-up of 69°, 60°, and 13° in forward elevation, abduction, and lateral rotation, respectively). Regarding postoperative complications, there was 1 case of capsulitis and 1 reoperation for insufficient excision (because of hemorrhage during surgery). There were no other side effects. CONCLUSION: Anatomic relations with nerves and vessels, as well as limited range of motion, require a case-by-case surgical approach, a preoperative scan (looking for a gutter), and sometimes, electromyography. Surgical indications depend on the degree of loss of function or hygiene, control of comorbid factors, and discussion with the patient and his or her family.


Assuntos
Axila/inervação , Lesões Encefálicas/complicações , Ombro/patologia , Traumatismos da Medula Espinal/complicações , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/diagnóstico por imagem , Procedimentos Ortopédicos , Ossificação Heterotópica , Cuidados Pós-Operatórios , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulação do Ombro/patologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
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