Trends in the Incidence and Mortality of Stroke in Matão, Brazil: The Matão Preventing Stroke (MAPS) Study.

BACKGROUND: Stroke population-based studies in the same setting comparing time trends of rates are a gold standard method to determine the primary prevention status of stroke. Twelve years ago, we measured the stroke incidence and mortality in Matão city, Southeast of Brazil. OBJECTIVE: This second Matão stroke registry study aimed to determine the time trends in the incidence, mortality, case fatality, and functional status of patients with stroke. METHODS: This was a prospective, population-based study known as the Matão Preventing Stroke (MAPS). We determined all incident stroke events that occurred between August 1, 2015, and July 31, 2016. Between the periods of November 1, 2003, to October 31, 2004, and August 1, 2015, to July 31, 2016, the rates were age adjusted to the Brazilian and world population. Functional status was measured by Barthel scale 1 year after the index event. RESULTS: We registered 81 cases of incident stroke. Demographic and cardiovascular risk factors were similar in both periods. The mean age increased by 9%, from 65.2 (95% CI 62.6-67.8) to 71.0 (95% CI 68.1-73.8) years. Between 2003-2004 and 2015-2016, the age-adjusted incidence decreased by 39% (incidence rate ratio [IRR] 0.61; 95% CI 0.46-0.79) and mortality by 50% (IRR 0.50; 95% CI 0.31-0.94). The 1-year case fatality was 26%; approximately 56% of the patients were functionally independent, while 7% had a recurrent stroke. Compared with the results of our first registry study, these outcomes did not differ significantly. CONCLUSION: Our findings agree with those of previous studies, showing a decline in the incidence and mortality of stroke in Brazil. Improvements in local public health care might explain these declines.

Hypertension Prevalence, Awareness and Blood Pressure Control in Matao, Brazil: A Pilot Study in Partnership With the Brazilian Family Health Strategy Program.

BACKGROUND: Around 30% of Brazilian population is hypertensive. Brazilian's Family Health Strategy (FHS) is a community-based approach to provide primary health care and control chronic disease as hypertension. The aims of this pilot study were to study hypertension prevalence and awareness and to analyze the feasibility of FHS program with community healthy agents (CHA) to collect data about hypertensive subjects in Matao, Brazil. METHODS: A cross-sectional study was conducted in subjects equal or older than 40 years old in a neighborhood belonging to FHS program. CHA were trained to collect data and to assess blood pressure (BP) with an automated device. Hypertension diagnosis was defined if systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg or subject had previous use of hypertensive drug. Chi-square test and univariate logistic regression analysis were applied with significance level of 5% and a confidence interval of 95%. RESULTS: In 625 subjects, hypertension prevalence was 68.8% and women (71.9%) were more hypertensive than men (63.2%) (P = 0.02). Prevalence of hypertension increased with age group, from 46.3% (40 - 49 years) to 82.5% (70 - 79 years) (P < 0.001). The overall prevalence of pre-hypertension was 40.1%: stage 1, 25.7% and stage 2, 17.0%. Hypertension awareness was 81.8% and 79.8% reported use of anti-hypertensive drugs. BP was not controlled in 61.8% and 67.7% of them was using anti-hypertensive drugs. CHA reported no difficulties to collect data and BP assessment with the automated device. CONCLUSION: We observed a high hypertension prevalence rate, awareness, and subjects with uncontrolled hypertension even with use of anti-hypertensive drugs. CHA from FHS program are a feasible option to BP control in future studies involving larger populations.

Mattis dementia rating scale (DRS) normative data for the brazilian middle-age and elderly populations.

OBJECTIVE: To expand norms for the Mattis Dementia Rating Scale (DRS) for the Brazilian middle-age and elderly populations. METHODS: The DRS was administered to 502 individuals without cognitive deficits, 312 women and 190 men, aged 50 years or over and with educational level ranging from 0 to 13 years or more. The sample was composed of subjects who participated in other studies, from Caeté (Minas Gerais state), Ribeirão Preto (São Paulo state) and São Paulo (São Paulo state). Participants were divided into four schooling groups (illiterate, 1 to 4 years, 5 to 12 years and 13 years or more). The subjects were divided into four groups according to age (50 to 60, 61 to 70, 71 to 80, and 80 years or over). RESULTS: Normative data for DRS scores are expressed as percentile values. The group with lowest schooling and subjects older than 80 years had the worst scores. CONCLUSION: As expected, age and education were strongly correlated with DRS scores. Illiterates and older old individuals performed worse than the other groups. These data might help to improve the accuracy of the diagnosis of cognitive impairment and dementia in Brazilian middle-age and elderly populations.

OBJETIVO: Expandir normas para o Mattis Dementia Rating Scale (MDRS) na população brasileira de meia idade e idosa. MÉTODOS: A MDRS foi aplicada em 502 indivíduos, 312 mulheres e 190 homens, com idade de 50 anos ou mais e escolaridade de 0 a 13 anos ou mais anos. A amostra foi composta de sujeitos que participaram de outros estudos: Caeté (Minas Gerais), Ribeirão Preto (São Paulo) e São Paulo (São Paulo). Participantes foram divididos em quatro grupos de escolaridade (analfabetos, 1 a 4 anos, 5 a 12 anos e 13 anos ou mais). Os sujeitos foram divididos em quatro grupos de idade (50 a 60, 61 a 70, 71 a 80 e acima de 80 anos). RESULTADOS: Dados normativos dos escores da MDRS são apresentados em percentis. O grupo com menos escolaridade e sujeitos acima de 80 anos apresentaram escores mais baixos. CONCLUSÃO: Como esperado, idade e escolaridade foram fortemente correlacionados aos escores da MDRS. Analfabetos e indivíduos muito idosos apresentaram pior desempenho que os outros grupos. Os dados podem ajudar a melhorar a acurácia para o diagnóstico de prejuízo cognitivo e demência na população brasileira de meia-idade e idosos.

Social support, socioeconomic and clinical risk: comparison between neighborhoods in a Brazilian upcountry town.

The objective of this study was to compare the perceptions of two families living in two different neighborhoods (rated according to risk levels) regarding social support. A questionnaire was designed to assess social support according to the following dimensions: instrumental, emotional, religious, and support from friends, neighbors and family. The sample was comprised as follows: considering the 114 families living in neighborhood 1, 52 families were interviewed; and among the 162 families living in neighborhood 2, 60 families were interviewed. No significant difference was found related to instrumental, religious and emotional support, including the support from relatives among the families from both neighborhoods. The results disagree with the reviewed literature, which indicated a strong association between social support and families living at socioeconomic risk. In conclusion, social support is important for families, regardless of their risk stratification.

Relation between myelin area and axon diameter in the aortic depressor nerve of spontaneously hypertensive rats.

The hypothesis that the aortic depressor nerve (ADN) from spontaneously hypertensive rats (SHR) does not show the expected correlation between myelin sheath area and the axonal diameter of myelinated fibers detected in normotensive rat myelinated fibers was tested by means of regression analysis. Proximal and distal segments of ADN from 13 normotensive Wistar-Kyoto rats (WKY) and nine SHR were prepared for light microscopy study. With an image analysis system, the area of the myelin sheath and the axonal diameter of all myelinated fibers in each nerve were automatically measured. Regression lines were calculated for all nerve segments from each group. Differences between the regression lines were tested for slope and intercept and differences between the correlation coefficients were also tested. Regression lines for WKY data showed no differences between the proximal and distal segments either for slope or intercept. Proximal and distal SHR regression lines were not coincident between segments or when compared to WKY data. These results agree with previous observations that there are morphological differences between WKY and SHR myelinated fibers of the ADN suggesting that the SHR depressor nerve fibers present characteristics of axonal atrophy and/or remyelination.