Prediction on the cardio-cerebrovascular death and probability of premature death caused by common risk factors in China in 2030 / 中华预防医学杂志

Objective: Predictive models were used to evaluate the impact of common risk factors on the number of cardio-cerebrovascular deaths and the probability of premature death. Methods: Using the data for China estimated by the Global Burden of Disease study 2015 (GBD 2015), we calculated the population attribution fraction (PAF) of risk factors. The proportional change model was used to estimate the number of unattributable deaths by 2030, and to predict the number of deaths, mortality, standardized mortality and probability of premature death by 2030. Results: According to the natural change trend of risk factors from 1990 to 2015, the number of deaths and mortality would reach 6.12 million and 428.53/100 000 by 2030, with an increase of 59.92% and 52.87%. By 2030, the probability of premature death from cardio-cerebrovascular diseases among Chinese aged 30-70 years old would continue to decline, from 11.43% to 11.28% for men, and from 5.79% to 4.43% for women. If the goals of all included risk factors were reached by 2030, 2 289 200 cardio-cerebrovascular deaths would be avoided. If only the exposure to a single risk factor was achieved by 2030, blood pressure, total cholesterol, and fine particulate matter exposure were the three most important factors affecting cardio-cerebrovascular deaths, which would reduce 1 332 800, 609 100 and 306 800 deaths, respectively. Among the involved risk factors, the control of blood pressure would mostly decrease the number of deaths due to ischemic heart disease and hemorrhagic stroke, about 677 300 and 391 100 deaths, accordingly. Conclusion: The control of risk factors is of great significance in reducing deaths and probability of premature death due to cardio-cerebrovascular diseases. If the control targets of all risk factors could be achieved by 2030, the burden of cardio-cerebrovascular diseases would be reduced greatly.

Elderly Mortality from Cerebrovascular Disease in Alagoas, 2000-2016: Spatial-Temporal Analysis

Abstract Background Cerebrovascular diseases (CVDs) are the second leading cause of death in Brazil. Objective This study aimed to describe the epidemiological profile and to analyze the spatiotemporal dynamics of mortality from cerebrovascular disease in the elderly in Alagoas from 2000-2016. Methods This is a multilevel ecological study of all deaths from CVD in individuals aged 60 years or older. Data were collected from the Mortality Information System. The variables were submitted to descriptive analysis, trend analysis by Joinpoint Regression method and spatial analysis with Global Moran's and local statistics; 95% confidence interval and significance of 5% were considered in the analysis. Results There were 21,440 deaths in the study period, 50.4% (n=10,797) male, 40.5% (n=8,670) aged ≥ 80 years, 44.5% (n=9,465) of "brown" race, 30.1% (n=6,448) married and 36.5% (n=7,828) with less than four years of schooling. Female and male mortality rates were 460.24/100,000 and 602.23 / 100,000, respectively. An annual decreasing trend of -1.4% (p<0.001) in overall and male mortality was observed from 2007 on. The highest mortality rates were concentrated in the eastern region of Alagoas (Moran's I =0.766288; p=0.01). Twenty-two municipalities were in quadrant Q1 of Moran's scattering diagram and considered priorities. Conclusion Death from CVD in Alagoas occurred equally in men and women in the study period, mostly in individuals of mixed race, married, and with low education attainment. The highest rates were observed in the eastern region of the state . The results highlight the need for public policies aimed at healthy aging in the state. (Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0)

Manifestaciones neuroftalmológicas en pacientes con enfermedad cerebrovascular isquémica / Neuro-ophthalmological manifestations in patients with ischemic cerebrovascular disease

La enfermedad cerebrovascular isquémica tiene una elevada incidencia y prevalencia en Cuba, y constituye la tercera causa de muerte en el país. Existen diferencias anatómicas y clínicas entre el infarto de la circulación anterior y la posterior. En ocasiones, los elementos distintivos que ayudan al diagnóstico topográfico de la enfermedad cerebrovascular isquémica son las manifestaciones neuroftalmológicas. Con el objetivo de profundizar en el conocimiento actual sobre las alteraciones neuroftalmológicas que se asocian a la enfermedad cerebrovascular isquémica, se realizó una revisión bibliográfica, donde se consultaron un total de 69 fuentes de información digital de los últimos 5 años. La circulación cerebral se divide de manera general en anterior y posterior. Los síntomas y signos principales del ictus que afecta la circulación anterior son la desviación conjugada de la mirada, la afectación de las sácadas, la hemianopsia homónima, la heminegligencia y la apraxia de la apertura ocular; mientras que las alteraciones asociadas a la afectación de la circulación posterior son el nistagmo, las anormalidades en la alineación y los movimientos oculares, así como la hemianopsia homónima con conservación macular. Se concluye que en la enfermedad cerebrovascular isquémica aparecen síntomas y signos como consecuencia de la afectación, tanto de la vía visual aferente, como de la eferente. La hemianopsia homónima es el signo más frecuente reportado(AU)

Ischemic cerebrovascular disease has a high incidence and prevalence in Cuba, and it is the third cause of death in the country. A number of anatomical and clinical differences distinguish anterior from posterior circulation infarction. On certain occasions the distinguishing elements that aid in the topographic diagnosis of ischemic cerebrovascular disease are its neuro-ophthalmological manifestations. With the purpose of gaining insight into the current knowledge about the neuro-ophthalmological alterations associated to ischemic cerebrovascular disease, a bibliographic review was conducted based on the analysis of 69 digital information sources from the last five years. Cerebral circulation is generally divided into anterior and posterior. The main symptoms and signs of the stroke that affects anterior circulation are conjugate gaze deviation, altered saccades, homonymous hemianopsia, heminegligence and eyelid opening apraxia, whereas the alterations associated to posterior circulation involvement are nystagmus, eye movement and alignment abnormalities, and homonymous hemianopsia with macular preservation. It is concluded that ischemic cerebrovascular disease presents symptoms and signs related to both the afferent and the efferent visual pathways. Homonymous hemianopsia is the most common sign reported(AU)

Comparison of the clinical features and therapeutics of COVID-19 in cardio-cerebrovascular disease (CCVD) and non-CCVD patients / 医学前沿

Cardio-cerebrovascular disease (CCVD) is a major comorbidity of Coronavirus disease 2019 (COVID-19). However, the clinical characteristics and outcomes remain unclear. In this study, 102 cases of COVID-19 from January 22, 2020 to March 26, 2020 in Xixi Hospital of Hangzhou were included. Twenty cases had pre-existing CCVD. Results showed that compared with non-CCVD patients, those with CCVD are more likely to develop severe disease (15% versus 1%), and the proportion of pneumonia severity index grade IV was significantly higher (25% versus 3.6%). Computed tomography images demonstrated that the proportion of multiple lobe lesion involvement was significantly higher in the CCVD group than in the non-CCVD group (90% versus 63.4%). Compared with non-CCVD group, the levels of C-reactive protein, fibrinogen, D-dimer, and serum amyloid-A were higher, whereas the total protein and arterial partial PaO

Tendências das internações por condições cardiovasculares sensíveis à atenção primária à saúde no município de Senador Canedo, Goiás, 2001-2016 / Tendencias de las internaciones por condiciones cardiovasculares sensibles a la atención primaria de salud en el municipio de Senador Canedo, Goiás, Brasil, 2001-2016 / Trends of hospitalizations for ambulatory care-sensitive cardiovascular conditions in the municipality of Senador Canedo, Goiás, Brazil, 2001-2016

Objetivo: analisar a tendência das taxas de internação por condições cardiovasculares sensíveis à atenção primária à saúde (CCSAP). Métodos: estudo ecológico das séries temporais das taxas de internação por CCSAP pelo Sistema Único de Saúde (SUS) no município de Senador Canedo, GO, em 2001-2016; utilizaram-se dados do Sistema de Informações Hospitalares e estimativas populacionais da Rede Interagencial de Informações para a Saúde (RIPSA) e da Fundação IBGE; utilizou-se o método de Prais-Winsten para análise de tendência. Resultados: utilizaram-se dados de 3.244 internações por CCSAP; verificou-se tendência temporal decrescente para a taxa de internações por CCSAP (taxa de incremento anual [TIA] = -8,14 - IC95% -11,78;-4,35) e a taxa de insuficiência cardíaca (TIA = -12,07 - IC95% -14,75;-9,30); as tendências temporais das taxas de internações por hipertensão, angina e doenças cerebrovasculares foram estacionárias. Conclusão: as taxas de internação por CCSAP e insuficiência cardíaca diminuíram; entretanto as taxas por hipertensão, angina e doenças cerebrovasculares permaneceram constantes.

Objetivo: analizar la tendencia de las tasas de internación por condiciones cardiovasculares sensibles a la atención primaria de salud (CCSAP). Métodos: estudio ecológico de las series temporales de tasas de internación por CCSAP en el Sistema Único de Salud (SUS) en el municipio de Senador Canedo, GO, Brasil, en 2001-2016; se utilizaron datos del Sistema de Informaciones Hospitalarias y estimativas de población de la Red Interagencial de Informaciones para Salud (RIPSA) y de la Fundación IBGE; se utilizó el método de Prais-Winsten para el análisis de tendencia. Resultados: se utilizaron datos de 3.244 internaciones por CCSAP; hubo una tendencia temporal decreciente para la tasa de internaciones por CCSAP (tasa de incremento anual [TIA] = -8,14 - IC95% -11,78;-4,35) y de insuficiencia cardíaca (TIA = -12,07 - IC95% -14,75;-9,30); las tendencias temporales de las tasas de internaciones para hipertensión, angina y enfermedades cerebrovasculares (EC) fueron estacionarias. Conclusión: las tasas de internación por CCSAP e insuficiencia cardíaca disminuyeron; sin embargo, las tasas por hipertensión, angina y enfermedades cerebrovasculares permanecieron constantes.

Objective: to analyze trends of hospitalization for ambulatory care-sensitive cardiovascular conditions (ACSCC). Methods: this was an ecological study of time series of rates of hospitalization for ACSCC in the municipality of Senador Canedo, GO, Brazil, 2001-2016; we used data from the Hospital Information System and population estimates provided by the Inter-Agency Health Information Network (RIPSA) and the Brazilian Institute of Geography and Statistics (IBGE); the Prais-Winsten method was used to analyze trends. Results: we used data on 3,244 hospitalizations for ACSCC; there was decreasing trend in the rate of hospitalizations for ACSCC (annual increase rate [AIR] = -8.14 - 95%CI -11.78;-4.35) and in the heart failure rate (AIR = -12.07 - 95%CI -14.75;-9.30); hospitalization rate time trends for hypertension, angina and cerebrovascular diseases were stationary. Conclusion: rates of hospitalization for ACSCC and heart failure decreased, however rates for hypertension, angina and cerebrovascular diseases remained constant.

Capacidade funcional de pacientes com indicação de cuidados paliativos na atenção primária / Functional capacity of patients indicated for palliative care in primary care

INTRODUÇÃO: Pacientes com indicação de cuidados paliativos podem ter perda da capacidade funcional e da qualidade de vida, mas há pouca informação sobre essas condições na atenção primária à saúde. OBJETIVO: Caracterizar os aspectos funcionais e sintomáticos dos indivíduos com indicação de cuidados paliativos na atenção primária. MÉTODOS: Estudo transversal e descritivo com seis equipes de saúde da família de três unidades básicas de saúde de Londrina, Paraná, que indicaram pacientes com necessidade de cuidados paliativos. Os pacientes foram avaliados pela Escala de Performance de Karnofsky (EPK), pela Escala de Avaliação de Sintomas de Edmonton (ESAS) e por questionário sociodemográfico e clínico. RESULTADOS: 73 pacientes (30 homens e 43 mulheres) foram incluídos, com idade média de 77,2 ± 12,1 anos. Demências e doenças cerebrovasculares foram as condições mais frequentes com 20 (27%) e 19 (26%) pacientes, respectivamente. A média na EPK foi de 47,9 ± 13,9 pontos, sendo 44 ± 11,3 pontos para homens e 51 ± 11,3 para mulheres, com diferença significativa entre os sexos (p = 0,023). Pacientes com câncer tiveram um melhor grau de funcionalidade em comparação àqueles com doenças neurológicas. A ESAS indicou que os sintomas mais frequentes foram o comprometimento do bem-estar, dor, cansaço e sonolência, todos com escore médio abaixo de 3 pontos (intensidade leve). Pacientes sem cuidadores tiveram melhor status funcional, mas apresentaram maior intensidade para dor e cansaço. CONCLUSÃO: Todos os pacientes tinham alguma limitação da funcionalidade, sendo aqueles com doença neurológica os mais acometidos. Os sintomas tiveram, no geral, uma intensidade leve. A presença de cuidadores pode ter influência num melhor controle dos sintomas.

INTRODUCTION: Patients indicated for palliative care may have losses in functional capacity and quality of life, but there is little information about these conditions in primary health care. OBJECTIVE: To characterize the functional and symptomatic aspects of individuals indicated for palliative care in primary care. METHODS: This cross-sectional descriptive study involved six family health teams from three basic health units in Londrina, Paraná, Brazil that indicated patients with palliative care needs. The patients were assessed with the Karnofsky Performance Scale (KPS), the Edmonton Symptom Assessment Scale (ESAS) and a sociodemographic and clinical questionnaire. RESULTS: 73 patients (30 men and 43 women) whose mean age was 77.2 ± 12.1 years were included. Dementia and cerebrovascular diseases were the most frequent conditions, with 20 (27%) and 19 (26%) patients, respectively. The mean KPS score was 47.9 ± 13.9 points (44 ± 11.3 points for men and 51 ± 11.3 for women), with a significant difference between the sexes (p = 0.023). Cancer patients had better functionality than those with neurological diseases. The ESAS, whose mean score was below 3 points (mild intensity), indicated that the most frequent symptoms were impaired well-being, pain, fatigue and drowsiness. Patients without caregivers had better functional status, but greater pain and fatigue intensity. CONCLUSION: All patients had some functional limitations, and those with neurological diseases were the most affected. The symptoms were generally mild. The presence of caregivers may positively influence symptom control.

Hypertension and diabetes-related morbidity and mortality trends in a municipality in the countryside of São Paulo / Tendência da morbimortalidade associada à hipertensão e diabetes em município do interior paulista / Propensión a la morbimortalidad asociada a hipertensión y a diabetes en un municipio del interior paulista

Objectives: to identify the main causes for hospital admissions and deaths related to systemic arterial hypertension and diabetes mellitus (DM), and to analyze morbidity and mortality trends, in a municipality in São Paulo's countryside, by comparing two three-years periods, 2002 to 2004 and 2010 to 2012. Methods: cross-sectional study which used secondary data regarding deaths from the Information System on Mortality and concerning hospital admissions from the DataSus Hospital Information System. Univariate and multivariate statistical analyses were conducted. Results: from 2002 to 2012, 325,439 people were admitted to hospitals, 14.7% of them due to circulatory system diseases (CSD) and 0.7% due to DM. The deaths distributed as the following: 29,027 deaths (31.5%) were due to CSD; 8.06% due to cerebrovascular diseases (CVD); and 2.75% due to DM. There was a significant association between admittance and death causes and patients' gender and age in the three-year periods (p<0.001). The highest lethality in hospital admissions was found to be due to CVD (10%). That trend showed that mortality rates dropped, younger patients were admitted due to DM, and older patients were admitted due to CVD - they were more often females. Conclusion: the main causes for hospital admissions were the CSDs; main mortality causes were the CVDs in hypertensive and diabetic women. Those findings can back public policies which prioritize the promotion of health.

Objetivo: identificar o perfil epidemiológico, o conhecimento sobre a doença e a taxa de adesão ao tratamento de pacientes com hipertensão arterial sistêmica, internados no serviço de emergência. Métodos: estudo transversal, realizado com 116 pacientes internados no Serviço de Emergência de um Hospital Universitário, de ambos os gêneros e idade superior a 18 anos, no período de março a junho 2013. As variáveis pesquisadas foram os dados sociodemográficos, comorbidades, atividade física e conhecimento sobre a doença. A adesão do paciente ao tratamento e a identificação das barreiras foi avaliada pelo teste de Morisky e Brief Medical Questionnaire, respectivamente. Resultados: a maioria dos pacientes era de mulheres (55%), cor da pele branca (55%), casados (51%), aposentados ou pensionistas (64%) e com baixa escolaridade (58%). A adesão ao tratamento, na maioria das vezes (55%), foi moderada e a barreira de adesão mais prevalente foi a de recordação (67%). Quando a aquisição de medicamento era integral, houve maior adesão ao tratamento. Conclusão: os pacientes deste estudo apresentaram moderado conhecimento sobre a doença. A alta correlação entre o número de fármacos utilizados e a barreira de recordação sugere que a monoterapia seja uma opção para facilitar a adesão ao tratamento, para diminuir a taxa de esquecimento.

Objetivos: identificar las principales causas de ingresos y mortalidad por hipertensión arterial sistémica y Diabetes Mellitus (DM) y analizar la propensión a la morbimortalidad, comparando los trienios 2002-2004 y 2010-2012, de un municipio del interior paulista, en Brasil. Métodos: estudio transversal que utilizó datos secundarios de defunciones del Sistema de Información sobre Mortalidad y los ingresos del Sistema de Información Hospitalaria del Datasus. El análisis estadístico se realizó de forma univariada y multivariada. Resultados: de 2002 a 2012 ocurrieron 325.439 ingresos, el 14,7% por Enfermedades del Aparato Circulatorio (EAC) y el 0,7% por DM. Las defunciones fueron: 29.027, el 31,5% por EAC, el 8,06% por Enfermedades Cerebrovasculares (ECV) y el 2,75% por DM. Hubo asociación significativa entre las causas del ingreso y de las defunciones con respecto al sexo y a la edad de los pacientes en los trienios (p<0,001). La mayor letalidad en los pacientes ingresados fue por ECV (el 10%). La propensión mostró que hubo disminución de la mortalidad, los pacientes más jóvenes fueron ingresados debido a la DM y los de edad avanzada por ECV, con mayor frecuencia en el sexo femenino. Conclusión: las principales causas de ingresos hospitalarios fueron las EAC y de mortalidad, las ECV en las mujeres hipertensas y diabéticas. Estos hallazgos ofrecen subsidios a las políticas públicas que prioricen a la promoción de la salud.

A Study of Cerebro Vascular Accident Patients.

To find out the proportion of different types of strokes among the CVA patients and to examine the correlation between stroke and various risk factors. Patients and Methods: Sixty CVA patients who attended the department of Medicine of TMC & Dr.BRAM Teaching hospital comprised the material for this study. Detailed history, clinical examination especially CNS examination, different biochemical and radiological investigations including CT Scan were performed to establish the diagnosis of CVA and to confirm the type of CVA. Various risk factors then correlated in causation of CVA. Result: Out of 60 CVA patients 42(70%) had ishaemic and 18(30%) had haemorrhagic stroke. Among the 42 ischaemic stroke patients 12 (20%) had lacunar stroke. 38 patients (63.3%) had hypertension, out of which only 4 (15%) had regular follow up showing that hypertension is a definite risk factor. Serum Cholesterol (213.52 ± 32.97) and Serum Triglyceride (176.25 ± 41.97 ) were statistically significant (p<0.01) along with Serum LDL (117.88 ± 27.18) and VLDL (49.11 ± 13.76),t value 5.096 and 5.128 respectively. In this study 14 (23.3%) patients had diabetes mellitus, 31 (51.6%) smokers, 14 (23.3%) alcoholics and 15 (25%) overweight, but none of them could be established as a statistically significant risk factor.

Cerebrovascular Diseases and Associated Risk Factors in WHO Eastern Mediterranean Countries.

Background: In the WHO Eastern Mediterranean region, nearly one million deaths are caused by cardio-vascular diseases every year. During the last decade, the number of deaths caused by stroke increased by 23%. Most cardiovascular diseases can be prevented by addressing behavioural risk factors such as tobacco use, alcohol, unhealthy diet, physical inactivity, and metabolic risk factors like obesity, high blood pressure, diabetes and raised lipids. Methods: This is a systematic review on cerebrovascular diseases and associated risk factors in WHO Eastern Mediterranean countries. Medline, Science Direct, and other sources were used to get peer reviewed papers dealing with the review theme. The search was limited to publications between 1990 and 2013 (30th June). Results and Discussion: According to the inclusion criteria, 45 papers were included in the present review. The prevalence was found greater than 50% in 38 studies for hypertension, greater than 25% in 36 studies for diabetes, greater than 15% in 26 studies for smoking and greater than 25% in 19 studies for dyslipidemia. It was also indicated that incidence of stroke increases with ageing. The majority of studies found a prevalence of stroke higher in men than in women with a ratio male: female reaching 3.55:1 in one study. Conclusion: Although at different levels of importance, all the studies reveal that hypertension, diabetes, dyslipidemia and smoking are crucial risk factors for stroke. This review also indicates a lack or scarcity of studies in many countries with an uneven contribution by country since 33% of studies are from Pakistan whereas North Africa (Egypt, Morocco, Libya, Tunisia) contributed with only 2 papers.

Cerebrovascular Disease and Stroke in Korean Male Adolescent

PURPOSE: This study aimed to estimate the prevalence and incidence of cerebrovascular disease (CVD) and stroke in Korean male adolescents. MATERIALS AND METHODS: The authors reviewed all medical certificates, medical records, and radiologic images from the examinations of Korean military conscription from January 2008 to May 2011. RESULTS: Of the 101156 examinees, 40 had CVD and stroke during adolescence. The overall prevalence and incidence of CVD and stroke was 39.54 cases per 100000 adolescents and 2.08 cases per 100000 adolescents per year, respectively and these were similar to the worldwide data. There were 3 cases of aneurysm, 3 cases of dural arteriovenous fistula, 11 cases of arteriovenous malformation, 4 cases of cavernous hemangioma, 4 cases of cerebrovascular infarction, 16 cases of Moyamoya disease, and 1 case of missing data. The incidence of arteriovenous malformation (0.57 cases per 100000 adolescents per year) was lower than the incidence for the worldwide general population. The incidence of Moyamoya disease was higher than that in any other country (15.82 cases per 100000 adolescents, vs. 0.83 cases per 100000 adolescents per year). CONCLUSION: We observed ischemic and hemorrhagic stroke, each accounting for approximately half of cases, and high incidence of Moyamoya disease with low incidence of arteriovenous malformation in Korean male adolescents.

Factores de riesgo de la enfermedad cerebrovascular en ancianos pertenecientes al Policlínico Universitario Milanés, Matanzas, 2007-2008 / Risk factors of cerebrovascular disease in elder people belonging to University Policlinic Milanés, Matanzas, 2007-2008

Se realizó un estudio observacional, prospectivo y descriptivo, con el objetivo de caracterizar el comportamiento de la enfermedad cerebrovascular de la población anciana, perteneciente a tres consultorios del Equipo Básico No. 3, del Policlínico Universitario Milanés. Se aplicó la encuesta del grupo de investigación 10/66 —avalada internacionalmente— a 183 ancianos con enfermedad cerebrovascular, pertenecientes a los tres consultorios. Los datos fueron procesados y se expresaron los resultados en tablas y gráficos. Resultó significativo que la enfermedad afectó predominantemente al sexo masculino, en las edades entre 75 y 79 años, y entre los factores de riesgos se destacaron: el consumo de dieta no saludable, la hipertensión arterial y las enfermedades cardiovasculares, entre otras. Las complicaciones post enfermedad cerebrovascular se presentaron en la mayoría de los ancianos estudiados, y entre las más frecuentes se señalaron las infecciones intercurrentes. Se arribó a la conclusión de que la enfermedad cerebrovascular es una de las causas más importantes de morbilidad en la población anciana, con grandes implicaciones económicas y familiares

We carried out an observational, prospective and descriptive study with the objective of characterizing cerebrovascular disease's behaviour in elder population belonging to three family physician's office of the Basic Team No. 3, University Policlinic Milanés. We applied the survey of the investigation group 10/66 —internationally endorsed— to 183 elder people with cerebrovascular disease, belonging to three family physician's office. Data were processed and the results showed in tables and charts. It was significant that the disease affected mainly the male genre, at the ages between 75 and 79 years, and among the risk factors there stood out: non healthy diet consumption, arterial hypertension and cerebrovascular diseases, among others. There were complications after the cerebrovascular disease in most of the studied elder people, and among the most frequent were the intercurrent infections. We arrived to the conclusion that the cerebrovascular disease is one of the most important causes of morbidity in the elder population, with great familiar and economic implications

Impacto de un programa de atención domiciliaria al enfermo crónico en ancianos: calidad de vida y reingresos hospitalarios / Impact of the program home care for the chronically ill for elderly: quality of life and hospital readmissions

OBJETIVO: Evaluar el impacto del programa Atención Domiciliaria al Enfermo Crónico (ADEC) comparado con la atención habitual (AH) a ancianos con dependencia funcional, derechohabientes del Instituto Mexicano del Seguro Social (IMSS). MATERIAL Y MÉTODOS: Cohorte prospectiva a tres meses a partir del egreso hospitalario en dos hospitales de la Ciudad de México. Se ingresaron 130 ancianos con dependencia funcional, 70 insertados al programa ADEC y 60 con atención habitual. Se midió impacto en reingresos hospitalarios y calidad de vida a partir de la escala Perfil de Impacto de la Enfermedad (SIP, por sus siglas en inglés). RESULTADOS: La edad promedio de los ancianos fue de 74 años (61/103) y 60 por ciento fueron mujeres. El principal diagnóstico fue enfermedad vascular cerebral (EVC) (30.77 por ciento). El grupo de ADEC mejoró la calidad de vida en la dimensión psicosocial [46.26 (±13.85) comparado con 29.45 (±16.48) vs. 47.03 (±16.47) a 42.36 (±16.35) p<0.05 en grupo habitual]. No se presentaron diferencias en los reingresos (p>0.05). CONCLUSIONES: El programa mejoró la dimensión psicosocial de calidad de vida.

OBJECTIVE: To evaluate the impact of the ADEC program (acronym in Spanish) as compared with the typical care provided to disabled elderly affiliated with the Mexican Institute of Social Security (IMSS). MATERIAL AND METHODS: Prospective cohort at three months after discharge from two general hospitals in Mexico City. A total of 130 patients with functional dependency were studied, 70 in the ADEC program and 60 with typical care. Impact was measured using hospital readmissions and quality of life based on the Sickness Impact Profile (SIP). RESULTS: Average age was 74 (61/103) years and 60 percent were women. The main diagnosis was cerebrovascular disease (30.77 percent). The quality of life in the psychosocial dimension improved for the ADEC group (from 46.26 (±13.85) to 29.45(±16.48) as compared with 47.03 (±16.47) to 42.36 (±16.35) for those receiving typical care (p<0.05). No differences were found regarding hospital readmissions. (p>0.05). CONCLUSIONS: HC program improved the psychosocial dimension of quality of life.

[Complex variation in the brain arteries in Tehran]

Variations in the cerebral arterial circle [CAC] correlate with incidence of some cerebrovascular diseases and must be considered during surgical operations [1, 2]. It also seems that different distribution of variations of the CAC is related to the race. This issue may partially explain the different incidences of some of the cerebrovascular diseases in different ethnic or racial groups [3-5]. Although there have been some reports of Variations in the cerebral arterial circle in other part of the world, the evidence for Iranian population is poorly reviewed. A 70 year-old female of Tehran population in central Iran is presented here. In this case Subclaivan and Vertebral arteries have abnormal origin and circumflex of Willis isn't complete because posterior cerebral arteries are absent

Comportamiento de la enfermedad cerebrovascular en la unidad de cuidados intensivos del Hospital General de Morón: marzo 2007- marzo 2009 / The cerebrovascular disease behavior in the intensive care unit of Morón General Hospital: March 2007- March 2009

Las enfermedades cerebrovasculares son procesos del sistema nervioso causados por la afección de sus vasos sanguíneos. Clínicamente la expresión del fenómeno varía en dependencia del área lesionada y la severidad del daño. Ocupan el tercer lugar en la morbi mortalidad de los países desarrollados, luego de las cardiopatías y el cáncer, la primera causa de discapacidad en países desarrollados y la segunda causa de demencia después de la enfermedad de Alhzhaimer. Se realizó un estudio observacional, longitudinal, descriptivo, retrospectivo de todos los pacientes con enfermedades cerebrovasculares que ingresaron en la Unidad de Cuidados Intensivos del Hospital General Provincial Docente Capitán Roberto Rodríguez Fernández en el período comprendido de marzo del 2007 a marzo del 2009. Predominaron los pacientes mayores o iguales de 60 años, el sexo masculino y la raza blanca. La enfermedad cerebrovascular hemorrágica fue la modalidad más frecuentemente ingresada en la Unidad de Cuidados Intensivos. Los factores de riesgo más frecuentes presentes en los pacientes ingresados fueron la hipertensión arterial, el hábito de fumar y las enfermedades cardíacas. El mayor porciento de pacientes con enfermedades cerebrovasculares recibieron ventilación mecánica artificial.

Cerebrovascular diseases are nervous system process caused by their blood vessels affection. Clinically the phenomenon expression would vary taking into account the injured area and the severity of the damage. They occupy the third place of morbimortality in developed countries, after cardiopathy and cancer, the first cause of incapacity and the second one of dementia after the Alhzhaimer disease. It was realized an observational, longitudinal, descriptive, retrospective study in patients with cerebrovascular diseases admitted in the Intensive Care Unit of the Provincial General Teaching Hospital Capitán Roberto Rodríguez Fernández in the period of March 2007 to March 2009. Patients greater than or equal to 60 years of age, male sex and white race predominated. The hemorrhagic cerebrovascular disease was the most common modality that entered in the Intensive Care Unit. The more frequent risk factors in entering patients were hypertension, smoke habit and cardiac diseases. Greater percent of patients with cerebrovascular disease received artificial mechanical ventilation.

Evaluación clínico- epidemiológica de la morbimortalidad por enfermedad cerebrovascular: Hospital Militar de Matanzas / Clinico-epidemiologic evaluation of the morbimortality by cerebrovascular disease in the Military Hospital of Matanzas

Las enfermedades cerebrovasculares (ECV) constituyen uno de los problemas de salud más importantes en todos los países desarrollados y en nuestro país. Nos proponemos profundizar en los factores que inciden en la morbiletalidad de estos pacientes en nuestra área, cumpliendo con el objetivo general de profundizar en el estudio de las enfermedades cerebrovasculares para interactuar y lograr disminuir su morbilidad, sus secuelas y la letalidad que las caracterizan. Se realiza un estudio prospectivo descriptivo, se incluyen los pacientes que ingresaron en el hospital Dr Mario Muñoz Monroy de Matanzas con enfermedades cerebrovasculares de Junio del 2000 a Junio del 2003, tenemos que el sexo más frecuente es el masculino y el grupo de edad, el comprendido entre 70-79 años, resultando la Hipertensión Arterial , el factor de riesgo que más incide, presentándose en la mayoría de los pacientes, algún grado de discapacidad. Llegamos a la conclusión que el incremento de la morbilidad y letalidad, a medida que aumenta la edad, asociado a la forma mas frecuente de presentación que lo constituye el infarto cerebral, con afectación de la cerebral media, fundamentalmente, predominando las complicaciones sépticas, existiendo dificultad en cuanto a la correlación clínico patológica.

Cerebrovascular diseases are one of the main health problems in all the developed countries and in our country. Our purpose is to deepen in the factors striking in the morbilethality of these patients in our area, fulfilling the general objective of deepening in the study of the cerebrovascular diseases to interact and achieve a decrease of their morbidity, sequelae and the lethality characterizing them. We carried out a descriptive prospective study, including the patients entering the hospital Dr Mario Muñoz Monroy of Matanzas with cardiovascular diseases from June 2000 to June 2003 obtaining that the most frequent genre is the male one, and the age group, the one between 70-79 years-old, being arterial hypertension the risk fact with higher incidence, most of the patients showing some level of disability. We arrived to the conclusion that morbidity and lethality increase with age, associated to the most frequent presentation, cerebral stroke, affecting mainly the cerebral media. Septic complications are predominant, with difficulties in the clinic-pathologic correlation.

Tempo de adesão à Estratégia de Saúde da Família protege idosos de eventos cardiovasculares e cerebrovasculares em Florianópolis, 2003 a 2007 / Time of adhesion to the Family Health Strategy protects elderly against cardiovascular and cerebrovascular accidents in Florianópolis, 2003 to 2007

A Estratégia de Saúde da Família (ESF) proporciona acompanhamento longitudinal e atenção integral à saúde. Este estudo avaliou a influência do tempo de adesão à ESF sobre a incidência de eventos cardiovasculares e cerebrovasculares entre idosos cadastrados na CASSI-Florianópolis. Os agravos selecionados justificam-se pela alta incidência, boa notificação e associação com fatores de risco modificáveis pela ESF. Quanto maior o tempo de adesão à ESF, menor a incidência de eventos agudos, demonstrando efetividade da mesma. Foi realizado estudo de coorte histórica, com 674 idosos (60 anos ou mais) cadastrados entre novembro de 2003 a março de 2007. Realizou-se análise bivariada e multivariada com regressão logística. Identificaram-se como fatores de risco independentes: idade acima de 80 anos (OR=3,44; IC95 por cento: 1,8-6,2), diabetes (OR=2,62; IC95 por cento: 1,4-4,7), hipertensão (OR=1,68; IC95 por cento: 1,0-2,6) e sedentarismo (OR=2,06; IC95 por cento: 1,2-3,2). Não houve associação significativa com gênero, dislipidemia, obesidade, tabagismo ou alcoolismo. O maior tempo de adesão à ESF demonstrou efeito protetor independente (OR=0,43; IC95 por cento: 0,2-0,8), após ajuste para covariáveis anteriores, sendo eficiente na redução do risco de eventos cardiovasculares e cerebrovasculares entre idosos cadastrados.

The Family Health Strategy (FHS) provides longitudinal follow-up and integrated healthcare. This study evaluated the influence of the time of adhesion to the FHS upon the incidence of cardiovascular and cerebral vascular accidents among the elderly enrolled in the CASSI-Florianópolis. The events were selected because of their high incidence, good notification and association with risk factors the FHS is able to modify. The longer the time of adhesion to the strategy the lower the incidence of these events, demonstrating the effectiveness of the FHS. A historical cohort study was conducted with 674 senior participants (60 or more years), registered between November/2003 and March/2007. The analysis used Student's T test, bivariate and multivariate analysis with logistic regression. The independent risk factors were: age over 80 years, (OR=3,44; CI 95 percent: 1,8-6,2), diabetes (OR=2,62; CI 95 percent: 1,4-4,7), hypertension (OR=1,68; CI 95 percent: 1,0-2,6) and physical inactivity (OR=2,06; CI 95 percent: 1,2-3,2). The study found no significant association between gender, dislipidemia, obesity, smoking, alcoholism and the studied events. The long time of adhesion to the FHS showed independent protective effect (OR=0,43; CI 95 percent: 0,2-0,8) after adjustment to earlier covariates, being effective in reducing the incidence of cardiovascular and cerebral vascular accidents among the enrolled population of elderly.

Mortalidade por doenças do aparelho circulatório na população com 50 anos e mais, município de São Bernardo do Campo, 1980-2001 / Mortality due to diseases of the circulatory system in population with 50 years or more, in the city of São Bernardo do Campo, 1980-2001

Objetivo. Estudar a evolução da tendência da mortalidade por doenças do aparelho circulatório no município de São Bernardo do Campo na população com 50 anos e mais, no período de 1980 a 2000. Verificar possíveis fatores associados com a ocorrência de óbitos em menores de 60 anos, no ano de 2001. Material e métodos. Os dados de mortalidade foram obtidos por meio do Sistema de Informação de Mortalidade do Ministério da Saúde, para o período de 1980 a 2000, e os dados do Sistema de Informação de Mortalidade Municipal, para o ano de 2001.Estudaram-se as tendências dos coeficientes padronizados e específicos, por faixas etárias decenais, segundo sexo, e as tendências dos coeficientes de mortalidade padronizados e específicos, por faixas etárias decenais, devido a óbitos por doenças isquêmicas do coração, doenças cerebrovasculares e demais doenças do aparelho circulatório, utilizando-se modelos de regressão linear. Para os óbitos ocorridos no ano de 2001 realizou-se o estudo de regressão logística para verificar uma possível associação de fatores com os óbitos em menores de 60 anos. Resultados. Observou-se, no período, um declínio nas mortes por doenças do aparelho circulatório, para homens e mulheres. Esta queda foi observada e ocorreu em todas as faixas etárias do estudo. A diminuição dos óbitos foi maior para as doenças cerebrovasculares, seguida por queda nas mortes por doenças isquêmicas do coração e por demais doenças do aparelho circulatório. No ano de 2001 observou-se nos óbitos precoces uma associação positiva para homens, com poucas menções na declaração de óbito e para doenças isquêmicas do coração. Conclusões. Embora apresentem uma queda significativa, os óbitos por doenças do aparelho circulatório ainda representam um dos principais problemas de saúde no município de São Bernardo do Campo.

Cerebrovascular disease in type 2 diabetes mellitus.

Incidence of CVD in diabetic men was reported to be twice as that of non-diabetics and almost three times greater in diabetic women in the Framingham Study. It is postulated that excessive glycation and oxidation, endothelial dysfunction and increased platelet aggregation may be responsible for endothelial proliferation and thickening of plasmatic membrane in small blood vessels ('lipohyalinosis') leading to lacunar infarction. Prothrombotic state may precipitate a stroke, however, platelet aggregability, elevated fibrinopeptide A (FPA) and D-dimer were not significantly related to stroke in diabetic mellitus (DM), whereas suppressed fibrinolytic activity was a common finding. Of many unknown factors in pathogenesis, the deficient insulin secretion, resistance to action of insulin at level of 'insulin receptors', changes in counter regulatory hormones (e.g. glucagon, pancreatic polypetides, growth hormone, catecholamines, etc.) and decrease in the hepatic sensitivity to insulin action in suppressing glucose output have received more attention. Hyperosmolar state can simulate stroke syndromes. Early recognition and treatment of risk factors such as hypertension or better glycemic control, correction of hyperlipidemia or obesity in diabetic population are important. In diabetic subjects already showing recurrent transient cerebral ischemic attacks (TIAs) or minor strokes, the benefit of antiplatelet agents or antithrombotic therapy in prevention of major strokes is well established. Ramipril has been found to be effective in reducing stroke risk by 33% in diabetic patinets in HOPE study.