O Brasil é um país em que o número de idosos tem crescido vertiginosamente e com isso ocorrem mudanças no perfil demográfico, socioeconômico e epidemiológico. As doenças crônicas assumem posição de destaque, dentre elas o Acidente Vascular Cerebral - AVC. O objetivo foi determinar a incidência de sintomas depressivos em idosos que foram hospitalizados por AVC, após a alta hospitalar. Trata-se de um estudo observacional e prospectivo com abordagem quantitativa. Foram entrevistados 48 idosos (60 anos ou mais) residentes na comunidade de cidades do interior paulista, que sofreram AVC e foram internados em um hospital terciário. A coleta dos dados foi realizada através de visitas domiciliares em duas etapas (após três e seis meses do AVC), no período de maio de 2010 a março de 2011. O instrumento de coleta de dados foi composto por dados demográficos e socioeconômicos, Mini-Exame do Estado Mental (MEEM), Atividades Instrumentais da Vida Diária (AIVD), Medida de Independência Funcional (MIF), presença de comorbidades e Escala de Depressão Geriátrica (GDS). A média de idade foi de 72,4 (±7,5) anos, com predominância do sexo masculino (56,2%). A maioria era composta por idosos casados, com média de 3,4 anos de estudo, 75% tinham renda familiar maior que um salário mínimo, 89,6% moravam acompanhados e 56,3% possuíam cinco ou mais morbidades. O tipo de AVC mais prevalente foi o isquêmico (81,2%), com maior comprometimento do lado esquerdo do cérebro. Com relação à Capacidade Funcional (CF), houve um aumento da média da MIF do terceiro para o sexto mês, ou seja, os idosos se tornaram mais independentes nesse quesito. Com as AIVD ocorre o contrário, os idosos se tornam mais dependentes na segunda avaliação. Os idosos do sexo masculino se tornaram menos depressivos, enquanto as idosas sofreram mais desses sintomas após seis meses do AVC. Embora o AVC seja a primeira causa de morte no país e também o grande responsável pelas incapacidades (físicas e emocionais) e internações hospitalares, estudos sobre a morbidade ainda é escasso. O intuito desse trabalho é o de apresentar essas consequências e os sintomas depressivos, os quais podem ser prevenidos com avaliação e intervenção de equipe interdisciplinar. / Brazil is a country in which the number of elderly people has displayed a steep growth, entailing changes in the demographic, socioeconomic and epidemiological profile. Chronic conditions stand out, including Cerebrovascular Accident - CVA. The aim was to determine the incidence of depressive symptoms in elderly people hospitalized due to CVA, after discharge from hospital. An observational and prospective study with a quantitative approach was carried out. Forty-eight elderly people (aged 60 years or older) were interviewed who lived in the community in interior cities in São Paulo State, had been victims of a CVA and were hospitalized at a tertiary-care hospital. Data were collected through home visits in two phases (three and six months after the CVA), between May 2010 and March 2011. The data collection instrument comprises demographic and socioeconomic data, the Mini-Mental State Examination (MMSE), Instrumental Activities of Daily Living (IADL), Functional Independent Measure (FIM), presence of co-morbidities and the Geriatric Depression Scale (GDS). The mean age was 72.4 (±7.5) years and the male gender predominated (56.2%). Most elderly were married, the mean education time was 3.4 years, 75% gained a family income of more than one minimum wage, 89.6% lived with another person and 56.3% suffered from five or more co-morbidities. The most prevalent type of CVA was ischemic (81,2%), which more strongly affects the left side of the brain. Regarding Functional Capacity (FC), the mean FIM score increased between the third and sixth month, that is, the elderly became more independent in this regard. The opposite occurred with the IADL, as the elderly become increasingly dependent on the second assessment. Male elderly became less depressed, while these symptoms were more present among female elderly six months after the CVA. Although CVA is the first cause of death in the country and also the main responsible for (physical and emotional) disabilities and hospitalizations, studies on this morbidity remain scarce. This research aims to present these consequences and depressive symptoms, which can be prevented through multidisciplinary team assessment and intervention.

Seat belts save lives; however, unintentional injuries are still the leading cause of death for those between 1 and 44 years in the United States. Seat belts also cause injuries during motor vehicle crashes (MVCs) and obesity changes how seat belts fit. The purpose of this retrospective causal inference quantitative study was to reduce the knowledge gap in scholarly research on seat belt fit in relation to blunt cerebrovascular injuries (BCVI) during MVCs and seat belt compliance. The theoretical framework used was based on H.W. Heinrich's domino theory. The research questions focused on the following dependent variables: BCVI, compliance, and seat belt fit; and independent variables: the size of the individual and seat belt fit. Secondary and primary data were used and analyzed using Spearman's Rank-Order Correlation. The results yielded no relationship between seat belt fit and BCVI in the secondary data (n = 97). In the primary data (n = 138), there was significance found between seatbelt fit and a) seat belt use, and b) BMI. The study contributed to positive social change by enhancing the awareness of the knowledge deficit regarding seat belt fit, and BCVIs sustained during MVCs, and that comfort was influenced by seat belt fit and had a role in compliance. Seat belts were not used by 5.3% and 9.5% or used incorrectly by 3.2% and 2.9% of the people in the primary data and secondary data sets. This knowledge may contribute to a) future seat belt testing to ensure it is done in such a manner that seat belts fit everyone; b) new seat belt laws to ensure that they are consistent across all states, and c) medical care focusing on seat belt fit as a mechanism of injury (blunt) to ensure screenings are done with the appropriate diagnostic tools.

The present study evaluated genetic and metabolic factors influencing the risk of acute cerebrovascular disease (CVD) and internal carotid artery stenosis (ICA stenosis) in a Swedish community. The threonine (T) containing protein of the FABP2 A54T gene polymorphism has a greater affinity for long chain fatty acids (FFAs) than the alanine (A) containing protein. This altered affinity for FFAs has been shown to affect the intestinal absorption of fatty acids and consequently the fatty acid composition of serum lipids, in particularly postprandially. Endothelium derived NO is a potent vasodilator and antiatherogenic agent. Asymmetric dimethyl arginine (ADMA) is an endogenous competitive inhibitor of endothelial nitric oxide synthase (eNOS). ADMA has been shown to be involved in the pathogenesis of atherosclerotic disease, and ADMA inhibits eNOS by displacement of L-arginine from the enzyme, which in turn is believed to affect the amount of NO available within the endothelium. The FABP2 A54T gene polymorphism was analyzed in 407 patients with acute CVD and also in a subset of these patients whose carotids had been evaluated with ultrasound. Both the FABP2 polymorphism and a common polymorphism of the eNOS gene, Glu298Asp, were analyzed in a different population consisting of 54 matched pairs of patients with ICA stenosis and controls. ADMA levels were measured in both study populations. We found that the T54 allele was more frequent in patients with transient ischaemic attacks (TIA), and that the TT genotype was more prevalent in young, non-smoking patients with CVD than in controls. Increased concentrations of ADMA were observed in cardio-embolic infarction and TIA, but not significantly in non-cardio-embolic infarction nor in haemorrhagic stroke. In multivariate logistic regression models, CVD increased across quartiles of ADMA in all subgroups, but this association was only significant in the TIA group. A decreased arginine/ADMA ratio, a measure of NO availability was associated with CVD in the entire study population. Patients with severe carotid stenosis had significantly higher ADMA levels than the controls. Allele and genotype frequencies of the FABP2 and eNOS polymorphisms did not differ between patients with ICA stenosis and controls. Our results indicate that ADMA is a strong marker for TIA and severe ICA stenosis, and that relative defiency of arginine, measured as L-arginine/ADMA, is present in acute CVD. We also conclude that a common polymorphism of the FABP2 gene increases susceptibility to ischaemic stroke and TIA. / Figure 4 on page 17 is publshed with kind permisson from The Journal of Physiology (http://jp.physoc.org/).

The "International Classification of Functioning, Disability and Health" (ICF) is a model that classifies health and health-related function. Of the ICF domains, least is known about participation. Although a few measures have been developed in English that tap the construct "Participation", none exist in Spanish. The Reintegration to Normal Living (RNL)-Index is the measure of reference to evaluate participation. The general objective of the present study was to translate, culturally adapt, and assess the psychometric properties the RNL-Index in Spanish for use in Spain. The translation and the cultural adaptation of the RNL-Index consisted of a five-step process, leading to the Spanish version of the RNL-Index (SRNL-Index). Psychometric evaluation consisted of a cross-sectional study design, with a longitudinal design used for test-retest evaluation. Thirty-two subjects with stroke and 36 with total knee arthroplasty completed the SRNL-Index twice, as well as the Six Minute Walk Test (6MWT), the Short-Form 36 Health Survey (SF-36), and for stroke subjects, the Barthel Index (BI). Descriptive statistics, one-way analysis of variance and post-hoc t tests were calculated, as well as Cronbach's alpha, Pearson's, and Intraclass correlation coefficients. The SRNL-Index was found to be internally consistent. Test-retest reliability was quite poor, being moderately low for the TKA sample and moderate for the stroke sample. Discriminant validity was demonstrated by the correlations between the SRNL-Index's Perception of Self and Daily Activity subscales with the Mental and Physical Component Summary scores of the SF-36. The SRNL-Index has convergent validity as shown by the high correlations between of the SRNL-Index and the 6MWT. Known-groups validity was shown in people with stroke grouped by Barthel Index scores, and in both samples when grouped according to gait speed. The SRNL-Index demonstrated acceptable validity and internal reliability for subjects with stroke and total knee arthroplasty. However, further studies are needed to reassess external validity, reliability, and responsiveness in other populations and other Spanish-speaking countries.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Univ., 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Diss. (sammanfattning) Linköping : Linköpings universitet, 2006. / Härtill 4 uppsatser.

This diploma thesis is a part of the GAJU project entitled "Coordinated rehabilitation of patients with brain injury (reg. number GAJU 128/2016/S)". At the time when the thesis was elaborated, only the patients who suffered the cerebrovascular accident were engaged in the project, since in the hospital, no suitable patient after brain injury who would need a multidisciplinary team in home care had ever been sought. The selection of the patients was based on the communicative skills criteria e.g. if the skills to participate in the directed conversation based on the Functional Independence Measure Questionnaire (FIM), WHO Disability Assessment Schedule 2.0 and the follow-up questions concerning social issues, physiotherapeutic methods and techniques were preserved. Within the framework of the project, the research has not been finished yet. Given the above mentioned reasons, this thesis is therefore mainly focused on the identification of patients' needs after the cerebrovascular accident (CVA), on the period starting from its first incidence during the first three months period after the discharge from the hospital to home care. The complex results will be presented as a part of the publication activity of the project. The thesis comprises a theoretical and a practical part. The theoretical part presents a comprehensive view on the care for the patients who suffered the cerebrovascular accident. I addressed both the basic characteristics of the cerebrovascular accident and the organisation of the care for the patients in the Czech Republic; furthermore, the coordinated rehabilitation team, the role of a social worker, possibilities of social help provided by the welfare system to patients and their families, and the psychical condition of the patient. In the last chapter, I outline the general concept of human needs according to A. Maslow and describe important needs of the sick people. As far as the research part is concerned, my goal is to identify the needs of patients in home care after the brain injury. In connection with the aim of the thesis, two research questions were defined. The first question is: "What are the needs of the patients after brain injury?". The second question is: "What is the role of a social worker in meeting the needs of a patient with brain injury?" The qualitative research strategy was used; the instructional dialogue technique with patients after brain injury in the South Bohemia Region within the project. When analyzing the data collected from the patients during the first three months after the discharge from the hospital to the home care, seven major patient needs emerged need of help, need of psychical equilibrium, need of self-reliance, need of being without paint, need of recovering to the condition before CVA incidence, and need of establishing a new system of activities. Two of these needs, the need of recovering to the condition before CVA incidence and the need of establishing a new system of activities could be considered as principal, because the other needs are in general heading towards them. Furthermore, the analysis of the results showed the role of a social worker by means of which these needs can be saturated The results of the present thesis are used as a partial part from which the complex results of coordinated rehabilitation of patients after brain injury of the GAJU project are complied. The needs analysis of patients brought the proposals of dealing with/saturation of these needs and therefore had a direct impact on the lives of the respondents. The results of the research will become a part of the publication outputs of the above-mentioned projects.