Stroke epidemiology in southern Brazil: Investigating the relationship between stroke severity, hospitalization costs, and health-related quality of life.

We aimed with the present study to fill the gap on the performance and safety of stroke management and the costs related to hospitalizations, the relevant comorbidities associated with stroke patients, and the stroke patient outcomes health-related quality of life (HRQOL) progress. Our study investigated the clinical, neurological, and social impact of stroke in 220 patients in a tertiary hospital located in the countryside of the state of Santa Catarina, Brazil. Description of clinical and neurological characteristics of stroke patients between 2015 to 2020 was analyzed using electronic medical records. The most affected age group was 61-80 years, being female the most affected sex. Almost 89.5% of the patients had some risk factor, with a higher prevalence of ischemic stroke. This type of stroke was the expensive, in terms of hospitalization, with an average cost of $74.10. Considering the stroke-specific quality of life scale (SSQOL) score, 88.3% of patients who demonstrated some comorbidity and 47.6% of women had lower quality of life levels post-stroke. Our data could be useful to substantiate a data-base with epidemiology statistics characterization of stroke hospitalizations, indicating the severity of stroke for the patient.

Built environment, contextual income, and obesity in older adults: evidence from a population-based study. / Ambiente construído, renda contextual e obesidade em idosos: evidências de um estudo de base populacional.

The objective was to verify the association between built environment, contextual income, and obesity in older adults in Florianópolis, Santa Catarina State, Brazil. This was a cross-sectional study in a sample of 1,197 older people (≥ 60 years) evaluated in the EpiFloripa Older Adults Cohort in 2013/2014. The outcomes were overall obesity, abdominal obesity, waist circumference (WC), and body mass index (BMI). Contextual income in the census tract and characteristics of the built environment were analyzed using data from the Florianópolis Institute of Urban Planning (IPUF) and the 2010 Population Census. Logistic and multilevel linear regression models were used. For older women, intermediate mean income was associated with lower odds of abdominal and overall obesity, while higher percentage of paved streets in the census tract was associated with lower odds of abdominal obesity; one percentage point increment in local commerce decreased WC by 0.20cm, and a one percentage point increase in paved streets decreased WC by 0.43cm and BMI by 0.22kg/m2. For older men, better street connectivity and intermediate percentage of local commerce were associated with lower odds of overall obesity; the increment in street density decreased WC by 0.34cm and BMI by 10kg/m2; a one-point increment in lighting increased WC by 0.51cm and BMI by 0.11kg/m2. The results showed different associations according to sex and target outcome, highlighting the need for further studies to explore additional relevant contextual variables for these outcomes in older adults.

O objetivo foi verificar a associação entre o ambiente construído, a renda contextual e a obesidade em idosos de Florianópolis, Santa Catarina, Brasil. Estudo transversal com amostra de 1.197 idosos (≥ 60 anos), avaliados na coorte EpiFloripa Idoso em 2013/2014. Os desfechos foram a obesidade geral, a obesidade abdominal, a circunferência da cintura (CC) e o índice de massa corporal (IMC). A renda contextual do setor censitário e as características do ambiente construído foram analisadas por meio dos dados do Instituto de Planejamento Urbano de Florianópolis (IPUF) e do Censo Demográfico de 2010. Utilizou-se modelos de regressão logística e linear multinível. Para as mulheres, a renda média intermediária foi associada às menores chances de obesidade abdominal e geral, e o maior percentual de ruas pavimentadas às menores chances de obesidade abdominal; o incremento de cada ponto percentual de comércio diminuiu 0,20cm a CC, e no de ruas pavimentadas diminuiu 0,43cm a CC e 0,22kg/m2 o IMC. Para os homens, a maior conectividade das ruas e o percentual de comércio intermediário foram associados às menores chances de obesidade geral; o incremento na densidade de ruas diminuiu 0,34cm na CC e 0,10kg/m2 no IMC; já no percentual de iluminação aumentou 0,51cm a CC e 0,11kg/m2 o IMC. Verificaram-se associações distintas de acordo com o sexo e o desfecho analisado, fazendo-se necessárias novas pesquisas que explorem variáveis contextuais adicionais e relevantes a esses desfechos entre os idosos.

El objetivo fue verificar la asociación entre el ambiente construido, la renta contextual y la obesidad en ancianos de Florianópolis, Santa Catarina, Brasil. Estudio transversal con una muestra de 1.197 ancianos (≥ 60 años), evaluados en la cohorte EpiFloripa Idoso en 2013/2014. Los desenlaces fueron: obesidad general, obesidad abdominal, circunferencia de la cintura (CC) e índice de masa corporal (IMC). La renta contextual del sector censal y las características del ambiente construido se analizaron mediante los datos del Instituto de Planificación Urbana de Florianópolis (IPUF) y del Censo de 2010. Se utilizaron modelos de regresión logística y lineal multinivel. En el caso de las mujeres, una renta media intermedia se asoció a unas menores oportunidades de obesidad abdominal y general, y el mayor porcentaje de calles pavimentadas a unas menores oportunidades de obesidad abdominal; el incremento de cada punto porcentual de comercio disminuyó 0,20cm la CC, y en el de calles pavimentadas disminuyó a 0,43cm la CC y 0,22kg/m2 el IMC. Para los hombres, la mayor conectividad de las calles y el porcentaje de comercio medio estuvieron asociados a unas menores oportunidades de obesidad general; el incremento en la densidad de calles disminuyó 0,34cm en la CC y 0,10kg/m2 en el IMC; en el caso del porcentaje de iluminación aumentó 0,51cm la CC y 0,11kg/m2 el IMC. Se verificaron asociaciones distintas, de acuerdo con el sexo y el desenlace analizado, haciéndose necesarias nuevas investigaciones que exploren variables contextuales adicionales y relevantes a estos desenlaces entre los ancianos.

Ambiente construído, renda contextual e obesidade em idosos: evidências de um estudo de base populacional / Ambiente construido, renta contextual y obesidad en ancianos: evidencias de un estudio de base poblacional / Built environment, contextual income, and obesity in older adults: evidence from a population-based study

O objetivo foi verificar a associação entre o ambiente construído, a renda contextual e a obesidade em idosos de Florianópolis, Santa Catarina, Brasil. Estudo transversal com amostra de 1.197 idosos (≥ 60 anos), avaliados na coorte EpiFloripa Idoso em 2013/2014. Os desfechos foram a obesidade geral, a obesidade abdominal, a circunferência da cintura (CC) e o índice de massa corporal (IMC). A renda contextual do setor censitário e as características do ambiente construído foram analisadas por meio dos dados do Instituto de Planejamento Urbano de Florianópolis (IPUF) e do Censo Demográfico de 2010. Utilizou-se modelos de regressão logística e linear multinível. Para as mulheres, a renda média intermediária foi associada às menores chances de obesidade abdominal e geral, e o maior percentual de ruas pavimentadas às menores chances de obesidade abdominal; o incremento de cada ponto percentual de comércio diminuiu 0,20cm a CC, e no de ruas pavimentadas diminuiu 0,43cm a CC e 0,22kg/m2 o IMC. Para os homens, a maior conectividade das ruas e o percentual de comércio intermediário foram associados às menores chances de obesidade geral; o incremento na densidade de ruas diminuiu 0,34cm na CC e 0,10kg/m2 no IMC; já no percentual de iluminação aumentou 0,51cm a CC e 0,11kg/m2 o IMC. Verificaram-se associações distintas de acordo com o sexo e o desfecho analisado, fazendo-se necessárias novas pesquisas que explorem variáveis contextuais adicionais e relevantes a esses desfechos entre os idosos.

El objetivo fue verificar la asociación entre el ambiente construido, la renta contextual y la obesidad en ancianos de Florianópolis, Santa Catarina, Brasil. Estudio transversal con una muestra de 1.197 ancianos (≥ 60 años), evaluados en la cohorte EpiFloripa Idoso en 2013/2014. Los desenlaces fueron: obesidad general, obesidad abdominal, circunferencia de la cintura (CC) e índice de masa corporal (IMC). La renta contextual del sector censal y las características del ambiente construido se analizaron mediante los datos del Instituto de Planificación Urbana de Florianópolis (IPUF) y del Censo de 2010. Se utilizaron modelos de regresión logística y lineal multinivel. En el caso de las mujeres, una renta media intermedia se asoció a unas menores oportunidades de obesidad abdominal y general, y el mayor porcentaje de calles pavimentadas a unas menores oportunidades de obesidad abdominal; el incremento de cada punto porcentual de comercio disminuyó 0,20cm la CC, y en el de calles pavimentadas disminuyó a 0,43cm la CC y 0,22kg/m2 el IMC. Para los hombres, la mayor conectividad de las calles y el porcentaje de comercio medio estuvieron asociados a unas menores oportunidades de obesidad general; el incremento en la densidad de calles disminuyó 0,34cm en la CC y 0,10kg/m2 en el IMC; en el caso del porcentaje de iluminación aumentó 0,51cm la CC y 0,11kg/m2 el IMC. Se verificaron asociaciones distintas, de acuerdo con el sexo y el desenlace analizado, haciéndose necesarias nuevas investigaciones que exploren variables contextuales adicionales y relevantes a estos desenlaces entre los ancianos.

The objective was to verify the association between built environment, contextual income, and obesity in older adults in Florianópolis, Santa Catarina State, Brazil. This was a cross-sectional study in a sample of 1,197 older people (≥ 60 years) evaluated in the EpiFloripa Older Adults Cohort in 2013/2014. The outcomes were overall obesity, abdominal obesity, waist circumference (WC), and body mass index (BMI). Contextual income in the census tract and characteristics of the built environment were analyzed using data from the Florianópolis Institute of Urban Planning (IPUF) and the 2010 Population Census. Logistic and multilevel linear regression models were used. For older women, intermediate mean income was associated with lower odds of abdominal and overall obesity, while higher percentage of paved streets in the census tract was associated with lower odds of abdominal obesity; one percentage point increment in local commerce decreased WC by 0.20cm, and a one percentage point increase in paved streets decreased WC by 0.43cm and BMI by 0.22kg/m2. For older men, better street connectivity and intermediate percentage of local commerce were associated with lower odds of overall obesity; the increment in street density decreased WC by 0.34cm and BMI by 10kg/m2; a one-point increment in lighting increased WC by 0.51cm and BMI by 0.11kg/m2. The results showed different associations according to sex and target outcome, highlighting the need for further studies to explore additional relevant contextual variables for these outcomes in older adults.

Exploring Associations Between Perceived Measures of the Environment and Walking Among Brazilian Older Adults.

OBJECTIVE: To investigate the associations between perceived environment features and walking in older adults. METHOD: A cross-sectional population-based study was performed in Florianopolis, Brazil, including 1,705 older adults (60+ years). Walking was measured by the International Physical Activity Questionnaire (IPAQ), and perceived environment was assessed through the Neighborhood Environment Walkability Scale. We conducted a multinomial logistic regression to examine the association between perceived environment and walking. RESULTS: The presence of sidewalks was related to both walking for transportation and for leisure. Existence of crosswalks in the neighborhood, safety during the day, presence of street lighting, recreational facilities, and having dog were significant predictors of walking for transportation. Safety during the day and social support were significantly associated with walking for leisure. DISCUSSION: The perceived environment may affect walking for specific purposes among older adults. Investments in the environment may increase physical activity levels of older adults in Brazil.

Correlates of walking for transportation and use of public transportation among adults in St Louis, Missouri, 2012.

INTRODUCTION: Attributes of the built environment can influence active transportation, including use of public transportation. However, the relationship between perceptions of the built environment and use of public transportation deserves further attention. The objectives of this study were 1) to assess the relationship between personal characteristics and public transportation use with meeting national recommendations for moderate physical activity through walking for transportation and 2) to examine associations between personal and perceived environmental factors and frequency of public transportation use. METHODS: In 2012, we administered a mail-based survey to 772 adults in St Louis, Missouri, to assess perceptions of the built environment, physical activity, and transportation behaviors. The abbreviated International Physical Activity Questionnaire was used to assess walking for transportation and use of public transportation. The Neighborhood Environment Walkability Scale was used to examine perceptions of the built environment. Associations were assessed by using multinomial logistic regression. RESULTS: People who used public transportation at least once in the previous week were more likely to meet moderate physical activity recommendations by walking for transportation. Age and employment were significantly associated with public transportation use. Perceptions of high traffic speed and high crime were negatively associated with public transportation use. CONCLUSION: Our results were consistent with previous research suggesting that public transportation use is related to walking for transportation. More importantly, our study suggests that perceptions of traffic speed and crime are related to frequency of public transportation use. Future interventions to encourage public transportation use should consider policy and planning decisions that reduce traffic speed and improve safety.

Perception of environmental obstacles to commuting physical activity in Brazilian elderly.

OBJECTIVE: To evaluate the association between perceived environmental attributes and commuting physical activity (PA) in a population-based sample of elderly persons. METHODS: Cross-sectional study was performed in 2009/2010, including 1652 elderly individuals aged 60 years or greater living in Florianopolis-SC, Brazil. Physical activity was measured using the long version of the International Physical Activity Questionnaire. Perceived environmental variables were assessed using a modified version of the Neighborhood Environment Walkability Scale. Multinomial logistic regression was used and a 5% significance level was taken into account. RESULTS: 36.8% and 35.2% of the subjects were inactive or did not reach 150 min/week on transport-related physical activity, respectively. Physical and social environmental characteristics, such as the absence of parks and athletic courts (OR(Inactive):1.75; 95% CI:1.22-2.51); presence of garbage (OR(Low-active):1.55; 1.04-2.30); street lighting (OR(Low-active):2.51; 95% CI:1.36-4.64; OR(Low-active):2.43; 95% CI:1.43-4.15); not walking with the dog (OR(Inactive): 3.08; 95% CI:1.42-6.69) and don't have a dog (OR(Inactive):2.45; 95% CI:1.06-5.66) were associated with lower levels of commuting PA. CONCLUSIONS: Results showed that poor physical and social environmental characteristics were related to lower commuting. Building public facilities and promoting physical activity in groups are likely to impact in active commuting among the elderly in Brazil.

Familial frontotemporal dementia and parkinsonism with a novel N296H mutation in exon 10 of the tau gene and a widespread tau accumulation in the glial cells.

We report a 62-year-old Japanese man with familial frontotemporal dementia and a novel missense mutation (N296H) in exon 10 of the tau gene. The patient presented with frontal signs followed by temporal signs and parkinsonism. The brain showed localized frontotemporal lobe atrophy including the precentral gyrus and discoloration of the substantia nigra, and revealed severe neuronal loss with proliferation of tau-positive protoplasmic astroglia in the affected cerebral cortex, tau-positive coiled bodies and threads in the subcortical white matter, and tau-positive pretangle neurons in the subcortical and brain stem nuclei. There were no tau-positive neurofibrillary tangles, Pick bodies, tuft-shaped astrocytes or astrocytic plaques in the cerebral cortex. Immunoelectron microscopically, phosphorylated tau accumulated in both neurons and glial cells in different modalities, such as glial filaments in protoplasmic astroglia, straight tubules in coiled bodies, and free ribosomes in pretangle neurons. These findings suggest that tau proteins are not always assembled in abnormal filaments such as twisted ribbons, paired helical filaments and straight tubules in neurons and glial cells, which have been shown in previous cases with frontotemporal dementia and parkinsonism linked to chromosome 17. Immunoblotting of sarkosyl-insoluble tau exhibited accumulation of four-repeat tau isoforms in the brain. The N296H mutation may interfere with the ability of mutated tau to bind with microtubules and lead to tau aggregation. Further study is necessary to determine whether this mutation can account for the characteristic tau pathology of this case.

A neuropathological study of the disturbance of the nigro-amygdaloid connections in brains from patients with dementia with Lewy bodies.

We neuropathologically and immunohistochemically investigated characteristics of the central amygdaloid nucleus lesion and its relationship with the substantia nigra lesion in dementia with Lewy bodies (DLB) brains. Nine DLB, four Parkinson's disease (PD) and four Alzheimer-type dementia (ATD) cases were examined. The degree of neuronal loss in the substantia nigra was (+)-(+++) in DLB cases, (+++) in PD cases and (+) in ATD cases. All DLB cases showed spongy change and ubiquitin-positive spheroids in the central nucleus. The degree of spongy change was (+)-(+++) in DLB cases, (+) in PD cases and (-)-(+) in ATD cases, which was correlated with the degree of neuronal loss in the substantia nigra in DLB cases. The number of ubiquitin-positive spheroids was parallel to the degree of spongy change. The central nucleus receives dense dopaminergic fibers from the substantia nigra. Many ubiquitin-positive spheroids were also positive to alpha-synuclein and tyrosine-hydroxylase, suggesting that they derive from the degeneration of terminal or distal axons of Lewy body-bearing dopaminergic neurons in the substantia nigra. The disturbance of the dopaminergic connections from the substantia nigra to the central nucleus may be responsible for psychotic symptoms in DLB patients.

Glial involvement in the degeneration process of Lewy body-bearing neurons and the degradation process of Lewy bodies in brains of dementia with Lewy bodies.

Glial involvement in the degeneration process of Lewy body (LB)-bearing neurons and the degradation process of LBs in the cerebral cortex and amygdala in brains of dementia with Lewy bodies was investigated immunohistochemically. HLA-DR-positive microglia frequently extended their processes to degenerated neurons with alpha-synuclein-positive LBs, while some GFAP-positive astroglial processes attached to weakly alpha-synuclein-positive extracellular LBs. Some intracellular LBs were immunoreactive to anti-C4d antibody, and these LB-bearing neurons were involved by activated microglia. About half of the intracellular LBs were immunoreactive to anti-chromogranin-A (CGA) antibody, and most of CGA-positive LB-bearing neurons were surrounded by microglia. Although we could find no evident participation of TNF-alpha, a candidate cytokine that is up-regulated by microglia following CGA stimulation, in the degeneration process of LB-bearing neurons, some intracellular LBs were immunoreactive to the antibody to NF-kappaB, a transcriptional factor activated by cytokines. These findings suggest that microglia participate in the degeneration process of LB-bearing neurons via varying immunogenic elements including complement proteins, CGA and probably some cytokines, and that astroglia participate in the degradation process of LBs.

Accumulation of human alpha-synuclein in different cytoskeletons in Lewy bodies in brains of dementia with Lewy bodies.

We investigated the origin of alpha-synuclein-immunoreactive components in Lewy bodies (LB) in brains of dementia with Lewy bodies (DLB) using immunohistochemistry and immunoelectron microscopy with anti-alpha-synuclein antibodies and anti-cytoskeleton antibodies. alpha-Synuclein-positive LB light microscopically consisted of phosphorylated neurofilament (PN)-positive LB, tubulin-positive LB and LB that were negative for both stains. Immunoelectron microscopically, PN-positive LB were composed of PN-positive and alpha-synuclein-positive filamentous components, suggesting that these filamentous components originate from neurofilaments with partially reduced immunoreactivity and alpha-synuclein accumulation. However, tubulin-positive LB were composed of tubulin-positive and alpha-synuclein-positive tubular components, suggesting that these tubular components originate from microtubules with diffusely reduced immunoreactivity and alpha-synuclein accumulation. The results of the present study suggest that alpha-synuclein accumulates in different cytoskeletons in the LB in DLB brains presumably due to a blockage of axonal transport.

Degeneration process of Lewy bodies in the brains of patients with dementia with Lewy bodies using alpha-synuclein-immunohistochemistry.

We investigated the degeneration process of Lewy bodies (LB) in the brains of dementia with Lewy bodies, using alpha-synuclein-immunohistochemistry. Intracellular LB, LB-related neurites and some extracellular LB were positively immunostained with anti-alpha-synuclein antibodies. Concentric LB-bearing neurons had no microglial involvement, while degenerated neurons with ill-defined LB displayed intense microglial involvement. The late stage of extracellular LB were immunoelectron-microscopically composed of loose aggregates of filamentous components with lost alpha-synuclein-immunoreactivity and penetrated astroglial processes. These findings suggest that microglias are involved during the stages from degenerated LB-bearing neurons to extracellular LB, while astroglias are involved during the stage of extracellular LB. Some intracellular LB were positive for anti-C3d and -C4d antibodies, suggesting that the classical complement pathway is activated in degenerated LB-bearing neurons, inducing microglial activation and neuronal death.

Occurrence of human alpha-synuclein immunoreactive neurons with neurofibrillary tangle formation in the limbic areas of patients with Alzheimer's disease.

We examined alpha-synuclein immunoreactivity in the brains from 23 patients with Alzheimer's disease (AD) and two patients with Down's syndrome. In ten of the 23 AD cases and both the two Down's syndrome cases, alpha-synuclein immunoreactivities were observed in the neurons of the limbic areas, predominantly of the amygdala. Nearly all alpha-synuclein-positive neurons had tau-positive neurofibrillary tangles (NFT) in the same neurons, and these consisted of intermingled-type and superimposed-type. By immunoelectron microscopy, the intermingled-type revealed aggregations of alpha-synuclein-positive filamentous components, which were in continuity with paired helical filaments (PHF), while the superimposed-type revealed accumulations of alpha-synuclein-positive non-filamentous components in PHF bundles. These findings suggest that alpha-synuclein can accumulate in PHF and form filamentous aggregations in neurons of the limbic areas in AD cases.

Frequent coexistence of Lewy bodies and neurofibrillary tangles in the same neurons of patients with diffuse Lewy body disease.

We examined the frequency of neurons with coexistent Lewy bodies (LB) and neurofibrillary tangles (NFT) in diffuse Lewy body disease brains, by a double-immunostaining method using MDV2 and Human tau. Double-positive neurons were frequently observed in the limbic areas. These neurons mostly revealed the feature of intermingled MDV2- and Human tau-positive substances. Immunoelectron microscopically, the MDV2-positive components were not in continuity with the MDV2-negative paired helical filaments (PHF). The MDV2-positive LB were surrounded by the small PHF bundles, frequently accompanied by the randomly oriented PHF within LB. In the intermingled neurons, MDV2-positive non-filamentous components without LB were found among the large PHF bundles. These non-filamentous components may represent the early stage of LB formation.

Degenerative terminals of the perforant pathway are human alpha-synuclein-immunoreactive in the hippocampus of patients with diffuse Lewy body disease.

We investigated the hippocampal pathology in diffuse Lewy body disease (DLBD) using alpha-synuclein immunohistochemistry. Ubiquitin-positive intrahippocampal structures caused by the degeneration of terminal axons of the perforant pathway were observed to be alpha-synuclein immunoreactive. These alpha-synuclein-positive degenerative terminals contained granulo-filamentous or vesiculo-tubular components similar to those of Lewy bodies (LB) immunoelectron microscopically, suggesting that alpha-synuclein may abnormally aggregate into filamentous or membranous cytoskeletal components including neurofilaments and synaptic vesicles in DLBD. A 'dying back' degenerating process due to a blockage of axonal transport may explain why the degenerative terminals and LB share similar alpha-synuclein-positive components, but the origin cells of the perforant pathway contain only a few LB.