Challenges in adapting a stroke unit in a middle-income country: warning about costs and underfunding to achieve the Brazilian Ministry of Health’s benchmark

BackgroundSince the implementation of the stroke care line in Brazil, the relationship (adequacy) of costs spent during hospitalization with the Brazilian Ministry of Health indicators for a stroke unit have not yet been analyzed.AimsThis study aimed to assess the adequacy of a comprehensive stroke center for key performance indicators and analyze the costs involved in hospitalization. We verified the association between stroke severity at admission and care costs during hospitalization.MethodsA retrospective medical chart review of 451 patients was performed using semiautomatic electronic data from a single comprehensive stroke center in Brazil between July 2018 and January 2020. Clinical and resource utilization data were collected, and the mean acute treatment cost per person was calculated. The Kruskal–Wallis test with Dunn’s post-test was used to compare the total costs between stroke types and reperfusion therapies. A robust linear regression test was used to verify the association between stroke severity at hospital admission and the total hospitalization costs. Good adequacy rates were observed for several indicators.ResultsData from 451 patients were analyzed. The stroke unit had good adaptation to key performance indicators, but some critical points needed revision and improvement to adapt to the requirements of the Ministry of Health. The average total cost of the patient’s stay was the USD 2,637.3, with the daily hospitalization, procedure, operating room, and materials/medication costs equating to USD 2,011.1, USD 220.7, USD 234.1, and USD 98.8, respectively. There was a positive association between the total cost and length of hospital stay (p < 0.001).ConclusionThe stroke unit complied with most of the main performance indicators proposed by the Brazilian Ministry of Health. Underfunding of the costs involved in the hospitalization of patients was verified, and high costs were associated with the length of stay, stroke severity, and mechanical thrombectomy

Estudo SABE: Sintomas depressivos em idosos do município de São Paulo

Sintomas depressivos são prevalentes entre idosos acarretando importante problema de saúde pública, por sua freqüência e associação com doenças físicas, mortalidade, incapacidade funcional, prejuízo na qualidade de vida e sobrecarga para a família e para serviços de saúde. Estimar a prevalência de sintomas depressivos em idosos do município de São Paulo – Estudo SABE - em 2006; identificar os fatores a eles associados em 2006 e os fatores de risco já presentes no momento de inclusão dos idosos na coorte (ano 2000), e ainda identificar possíveis fatores de proteção para sintomas depressivos entre os idosos que não os apresentaram na avaliação realizada em 2000 e nem na de 2006. Num estudo de corte transversal, foram estudados 972 idosos, por meio de inquérito domiciliar, sobre condições vida e saúde (Estudo SABE) que responderam à Escala de Depressão Geriátrica (GDS) para detectar sintomas depressivos tanto no momento da inclusão na coorte (2000), como em 2006. O questionário utilizado em 2000 foi mantido com acréscimo de instrumentos para os novos objetivos propostos em 2006. A amostra deste estudo foi composta por pessoas com 60 anos ou mais, no momento da inclusão, derivada de setores censitários e obtida em dois estágios, com reposição e probabilidade proporcional à população, para idosos de 75 anos ou mais. Em 2000 foram entrevistados 2.143 idosos e em 2006 foram novamente entrevistadas 1.115 pessoas, registrando-se entre as duas avaliações: 649 óbitos, 11 institucionalizações, 52 mudanças para outros municípios, 139 pessoas não foram localizados e 177 pessoas que recusaram a nova avaliação. A prevalência de sintomas depressivos em 2006 foi de 14,2% (IC 95% 11,8 – 16,7). A partir dos resultados (p<0,10) da análise univariada, realizada com o teste de Rao-Scott para amostras...Depressive symptoms are prevalent among the elderly, causing a major public health problem due to their frequency and association with physical illness, mortality, disability, impaired quality of life and burden on the family and healthcare services. Estimate the prevalence of depressive symptoms in the elderly in São Paulo, SABE Study (Health, Well-Being and Aging), in 2006; identify the factors associated with these in 2006 and risk factors already present at the inclusion of these individuals in the cohort (2000); and identify other possible protective factors against depression among the elderly than those presented in the evaluation performed in 2000 or 2006. This cross-sectional study evaluated 972 elderly individuals through a household survey on health status and living conditions (SABE Study) who responded to the Geriatric Depression Scale (GDS) to detect depressive symptoms both at inclusion in the cohort (2000) and in 2006. The questionnaire used in 2000 was maintained with additional tools for new goals proposed in 2006. The study sample consisted of individuals aged 60 years-old or over at the time of inclusion, derived from census sectors and conducted in two stages, with replacement and probability proportional to the population of individuals aged 75 years-old or over. In 2000, 2,143 elderly were interviewed and in 2006, 1,115 were re-interviewed. Between the two evaluations, the following events occurred: 649 individuals died, 11 were institutionalizations, 52 moved to other cities, 139 individuals were not located and 177 refused reassessment. The prevalence of depressive symptoms in 2006 was 14.2% (95%CI: 11.8-16.7). From the results (p <0.10) of the univariate analysis, performed using the Rao-Scott test for complex samples, logistic regression models were constructed for the different groups of... (Complete abstract click electronic access below)Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES

Atitudes distintas de profssionais de diferentes especialidades médicas relacionadas à autonomia e aspectos jurídicos no cuidado de pacientes com demência

The evaluation of competence of Alzheimer's disease (AD) patients to assume personal or collective responsibilities and the resulting legal implications is a relevant issue. Objectives: The aim of this study was to evaluate the attitudes of different medical specialists towards the disability of patients with Alzheimer's disease and practitioners' competence to interfere with decision-making autonomy. Methods: Professionals from different areas (Neurology, Psychiatry, Geriatrics, and General Practice) were interviewed by one of the authors, after being presented a fictitious clinical case which raised several topics, namely: [1] Critical judgment and capacity of the patient to take decisions related to daily activities; [2] The role of family physicians in nominating trustees and caregivers. Results: Answers to the first question did not differ regarding degree of preservation of awareness but at least 25% stressed that the patient must be carefully listened to, independent of caregiver or legal representative opinion. There were significant knowledge gaps in responses to the second question. Half of the physicians interviewed did not have adequate information about the legal aspects of caring for patients with Alzheimer's disease. Conclusions: Legal aspects is a topic that must be incorporated into professional training in order to improve attitudes toward the long-term management of patients with dementia

Distinct attitudes of professionals from different medical specialties toward autonomy and legal instruments in the assessment of patients with Alzheimer's disease

Abstract The evaluation of competence of Alzheimer's disease (AD) patients to assume personal or collective responsibilities and the resulting legal implications is a relevant issue. Objectives: The aim of this study was to evaluate the attitudes of different medical specialists towards the disability of patients with Alzheimer's disease and practitioners' competence to interfere with decision-making autonomy. Methods: Professionals from different areas (Neurology, Psychiatry, Geriatrics, and General Practice) were interviewed by one of the authors, after being presented a fictitious clinical case which raised several topics, namely: [1] Critical judgment and capacity of the patient to take decisions related to daily activities; [2] The role of family physicians in nominating trustees and caregivers. Results: Answers to the first question did not differ regarding degree of preservation of awareness but at least 25% stressed that the patient must be carefully listened to, independent of caregiver or legal representative opinion. There were significant knowledge gaps in responses to the second question. Half of the physicians interviewed did not have adequate information about the legal aspects of caring for patients with Alzheimer's disease. Conclusions: Legal aspects is a topic that must be incorporated into professional training in order to improve attitudes toward the long-term management of patients with dementia

Depressive symptoms among elderly inpatients of a Brazilian university hospital: prevalence and associated factors

Background: This study aims to evaluate the prevalence of depressive symptoms and associated factors among elderly hospital inpatients.Methods: A cross-sectional study evaluated 189 participants using the Geriatric Depression Scale, the Mini-mental State Examination and the Katz and Lawton Index, to assess dependence regarding activities of daily living (ADL).Results: Most of the participants were women, aged between 60 and 92 years, with low levels of educational attainment and personal income, and non-qualified occupations. The prevalence of depressive symptoms was 56%, but only 3% had a psychiatric diagnosis registered in their medical records. Univariate analysis showed significant associations between depressive symptoms and low educational level and income, marital status, number of hospitalizations in the previous year, cognitive decline, dependence regarding basic and instrumental ADL, and death. After logistic regression, the only variables that remained significantly associated with depression were low educational level, dependence regarding basic ADL, and death.Conclusions: Depressive symptoms were independently associated with low educational level and dependence regarding basic ADL. Hospitalized elderly people with depressive symptoms were more likely to die. It is essential to diagnose and treat depression properly in this population to minimize its negative impacts

Public awareness of dementia: A study in Botucatu, a medium-sized city in the State of São Paulo, Brazil

Abstract Dementia is a progressive and debilitating disease affecting an increasing number of people worldwide. Despite its importance, only a few studies have examined public awareness of dementia. We present a study of the public awareness of dementia in Botucatu, São Paulo, Brazil. Methods: A sample of 73 individuals answered a questionnaire approved by the Medical Ethics Research Committee inquiring about the characteristics of healthy old-aged and demented individuals. Results: Those interviewed believed that dementia is characterized by prevalent memory impairment (41%) and behavioral changes (32.9%) with onset in the 60's or older (42.5%) and upon suspecting dementia, only a few would seek specialized medical help. Discussion: Better understanding of public awareness of dementia provides the clue to more effective health and social policies in order to achieve a higher rate of early diagnosis and thereby possibly decreasing patient, family and caregiver distress

Delayed recall memory impairment in patients with Parkinson's disease

ABSTRACT Age is one of the risk factors for dementia in patients with Parkinson's disease (PDD). Distinct cognitive syndromes of Parkinson's disease (PD) have been identified in previous studies. Questions about the role of such cognitive disorders in PD outcomes, especially memory dysfunction, in patients with PD remain unanswered. Objective: To establish possible correlations between delayed recall memory (episodic memory), age, and other demographic variables in patients with PD. Methods: A two-stage protocol was applied. Patients with delayed recall memory compromise, selected based on a brief battery of tests (BBRC-Edu), were classified as dementia cases and submitted to the Mattis Dementia Rating Scale (MDRS). Data from patients with memory disturbances were compared against individuals without episodic memory impairment, and correlated with age and demographic variables. Results: Except for identification and naming, all subtests in the screening battery showed a significant difference (p≤0.0001) between the memory-compromised group (case) and the group without memory impairment (no case). The results also correlated negatively with age (p≤0.0001) and positively with level of education (p=0.0874) in patients with PD. Conclusion: The analysis showed a significant relationship between age and dementia characterized by impaired episodic memory. The findings support reports of a wide spectrum of neuropsychological performance impairment in PD with age, particularly dementia associated with memory deterioration. No correlations between disease duration and cognitive dysfunction were evident