Cardiovascular Statistics - Brazil 2021.

This is the 2021 edition of the Cardiovascular Statistics – Brazil , a multi-institutional effort to periodically provide updated information on the epidemiology of heart diseases and stroke in Brazil. The report incorporates official statistics provided by the Brazilian Ministry of Health and other government agencies, by the GBD project led by the IHME of the University of Washington, as well as data generated by other sources and scientific studies, such as cohorts and registries, on CVDs and their risk factors. The document is directed to researchers, clinicians, patients, healthcare policy makers, media professionals, the public, and others who seek comprehensive national data available on heart disease and stroke

The effect of multiple adverse childhood experiences on health: a systematic review and meta-analysis

Background A growing body of research identifies the harmful effects that adverse childhood experiences (ACEs; occurring during childhood or adolescence; eg, child maltreatment or exposure to domestic violence) have on health throughout life. Studies have quantified such effects for individual ACEs. However, ACEs frequently co-occur and no synthesis of findings from studies measuring the effect of multiple ACE types has been done. Methods In this systematic review and meta-analysis, we searched five electronic databases for cross-sectional, case-control, or cohort studies published up to May 6, 2016, reporting risks of health outcomes, consisting of substance use, sexual health, mental health, weight and physical exercise, violence, and physical health status and conditions, associated with multiple ACEs. We selected articles that presented risk estimates for individuals with at least four ACEs compared with those with none for outcomes with sufficient data for meta-analysis (at least four populations). Included studies also focused on adults aged at least 18 years with a sample size of at least 100. We excluded studies based on high-risk or clinical populations. We extracted data from published reports. We calculated pooled odds ratios (ORs) using a random-effects model. Findings Of 11 621 references identified by the search, 37 included studies provided risk estimates for 23 outcomes, with a total of 253 719 participants. Individuals with at least four ACEs were at increased risk of all health outcomes compared with individuals with no ACEs. Associations were weak or modest for physical inactivity, overweight or obesity, and diabetes (ORs of less than two); moderate for smoking, heavy alcohol use, poor self-rated health, cancer, heart disease, and respiratory disease (ORs of two to three), strong for sexual risk taking, mental ill health, and problematic alcohol use (ORs of more than three to six), and strongest for problematic drug use and interpersonal and self-directed violence (ORs of more than seven). We identified considerable heterogeneity (I 2 of > 75%) between estimates for almost half of the outcomes. Interpretation To have multiple ACEs is a major risk factor for many health conditions. The outcomes most strongly associated with multiple ACEs represent ACE risks for the next generation (eg, violence, mental illness, and substance use). To sustain improvements in public health requires a shift in focus to include prevention of ACEs, resilience building, and ACE-informed service provision. The Sustainable Development Goals provide a global platform to reduce ACEs and their life-course effect on health. Funding Public Health Wales. © 2017 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licens

Descrição e avaliação dos fatores associados ao término precoce de ensaios clínicos registrados no site clinicaltrialsgov

Background: Early termination of clinical trials represents a major concern for investigators, healthcare providers, patients and funding agencies. In the present study we aimed to determine the prevalence and predictors of early termination of interventional trials registered in a large trial registry database. Results: We identified 119,713 interventional trials registered in ClinicalTrials.gov up to june 2013 where 59,822 (49.9%) were completed and 6,524 (5.4%) were early terminated. Operational reasons represent the major motive why studies are terminated (58.1%), poor recruitment being the most important operational barrier (33%). Regarding predictors for early termination, when compared with studies funded by NIH, studies funded by other sources (such as academic institutions, for example) were more likely to be early discontinued (OR 1.40; 95% CI1.08-1.83), other risk factors for trial termination include: population including adults and seniors (OR 1.61; 95% CI 1.34-1.94), interventions using devices or procedures (OR 1.21; 95%CI 1.01-1.44) intervention models with single groups (OR 1.42 95%; CI 1.23-1.63). Conclusion: In this large and comprehensive analysis of trials registered in the ClinicalTrials.gov, early termination was observed in 5.4% from all clinical trials, with operational reasons, especially poor recruitment, being the most frequently reason leading to premature trial discontinuation. There is a need for better consideration on readiness and organization of the groups willing to develop clinical trials.Introdução: O término precoce de ensaios clínicos constitui uma preocupação importante para investigadores, pacientes e agências de fomento. O presente estudo objetiva determinar a prevalência e preditores de término para ensaios clínicos registrados em uma ampla base de registros. Resultados: Foram identificados 119.713 ensaios clínicos registrados no ClinicalTrials.gov até junho de 2013 dos quais 59.822 (49,9%) estavam completos e 6.524 (5,4%) terminados precocemente. As razões operacionais representam o principal motivo para os estudos serem interrompidos precocemente (58,1%), sendo falha no recrutamento a maior barreira operacional (33,7%). Dentre os fatores preditores para término precoce, quando comparados a estudos financiados pelo NIH, estudos financiados por outras fontes (como instituições acadêmicas, por exemplo) são mais propensos à interrupção precoce (RC 1,40; 95%IC 1,08-1,83), outros fatores de risco encontrados incluem: a faixa etária incluindo adultos e idosos (RC 1,61;95%IC 1,34-1,94), intervenções com dispositivos ou procedimentos (RC 1,21; 95%IC 1,01-1,44) e modelos de intervenção utilizando grupo único (RC 1,42; 95%IC 1,23-1,63). Conclusão: Nessa ampla e compreensiva análise de ensaios clínicos registrados no ClinicalTrials.gov, o término precoce foi observado em 5,4% de todos os ensaios clínicos, sendo as razões operacionais (principalmente a falha de recrutamento) o principal motivo para a descontinuação prematura do estudo. Uma melhor reflexão acerca da preparo e organização das equipes que se propõem a realizar ensaios clínicos é necessária.Dados abertos - Sucupira - Teses e dissertações (2013 a 2016

An?lise da factibilidade e seguran?a do transplante aut?logo de c?lulas tronco de medula ?ssea em pacientes com epilepsia

Made available in DSpace on 2015-04-14T13:35:03Z (GMT). No. of bitstreams: 1 426668.pdf: 3860401 bytes, checksum: cecf8536ffcc30bf313ecd3f32dd76e9 (MD5) Previous issue date: 2010-09-30A Epilepsia do Lobo Temporal (ELT) ? a manifesta??o convulsiva mais comum em adultos e que comumente se apresenta como uma s?ndrome refrat?ria aos tratamentos farmacol?gicos. Altera??es anat?micas e fisiol?gicas est?o geralmente presentes em pacientes com ELT, como a atrofia hipocampal vista em estudos de RM. As c?lulas tronco mostraram ter a habilidade de regenerar estruturas hipocampais em modelos experimentais. O objetivo do presente estudo ? avaliar a seguran?a e factibilidade de uma nova estrat?gia terap?utica - o transplante aut?logo de c?lulas tronco mononucleares da medula ?ssea (CTMMO) no tratamento de pacientes com ELT com esclerose hipocampal unilateral refrat?ria. Foram avaliados 9 pacientes adultos com diagn?stico de ELT confirmado por hist?ria cl?nica, RM com volumetria hipocampal, v?deo EEG prolongado para registro de crises e exames laboratoriais. Ap?s consentimento informado e preenchendo todos os crit?rios de congru?ncia para lateralidade, os pacientes foram submetidos ao transplante de CTMMO. O transplante de c?lulas tronco foi realizado atrav?s de arteriografia seletiva da art?ria cerebral posterior infundindo-se de 1,51 x 108 a 5,51 x 108 c?lulas mononucleares. Nenhum efeito adverso significativo foi registrado durante o procedimento nem durante o tempo de seguimento. Tr?s pacientes (44.5%) permaneceram na Classe IA de Engel, 04 na classe IB e 02 pacientes na classe IIA. Dados os resultados obtidos, conclu?mos que o transplante de CTMMO parece fact?vel e seguro em pacientes com ELT refrat?ria. O controle de crises alcan?ado nessa popula??o nos d? um potencial terap?utico promissor no tratamento dessa popula??

Update on the Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Guideline of the Brazilian Society of Cardiology-2019

sem informação113344966

Primary stroke prevention worldwide: translating evidence into action

Stroke is the second leading cause of death and the third leading cause of disability worldwide and its burden is increasing rapidly in low-income and middle-income countries, many of which are unable to face the challenges it imposes. In this Health Policy paper on primary stroke prevention, we provide an overview of the current situation regarding primary prevention services, estimate the cost of stroke and stroke prevention, and identify deficiencies in existing guidelines and gaps in primary prevention. We also offer a set of pragmatic solutions for implementation of primary stroke prevention, with an emphasis on the role of governments and population-wide strategies, including task-shifting and sharing and health system re-engineering. Implementation of primary stroke prevention involves patients, health professionals, funders, policy makers, implementation partners, and the entire population along the life course