Papers by Cristiane Mendes-Chiloff
Frontiers in public health, Feb 1, 2024
Background: Since the implementation of the stroke care line in Brazil, the relationship (adequac... more Background: Since 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. Aims: This 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. Methods: A 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. Results: Data 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). Conclusion: The stroke unit complied with most of the main performance indicators proposed by the Brazilian Ministry of Health. Underfunding of the
Dementia and Geriatric Cognitive Disorders, 2009
To estimate the prevalence and correlates of cognitive impairment (CI) among the elderly in a gen... more To estimate the prevalence and correlates of cognitive impairment (CI) among the elderly in a general hospital. Methods: A cross-sectional study, including 200 Brazilian inpatients aged 60 years or over, using the Mini Mental State Examination to evaluate CI (dependent variable), and the Geriatric Depression Scale and the Katz and Lawton Index to evaluate basic (BADL) and instrumental activities of daily living (IADL). Results: 56% were women, 29% were dependent for BADL and 77.5% for IADL. The prevalence of CI was 29% and, in the logistic regression, it remained associated with higher age (1 74 years old), number of previous hospitalizations (1 3) and dependency for BADL (being dependent raised the odds of being cognitively impaired). Conclusions: It is essential to train the hospital staff to properly assist these patients, and to orient and support their caregivers.
Transtorno Depressivo No Idoso
Dementia & Neuropsychologia, 2008
Dementia is a progressive and debilitating disease affecting an increasing number of people world... more 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.
UNIVERSIDADE ESTADUAL PAULISTA "JÚLIO DE MESQUITA FILHO" FACULDADE DE MEDICINA DE BOTUCATU Estudo SABE - Sintomas depressivos em idosos do município de São Paulo
Jornal Brasileiro de Nefrologia, 2017
Estudo SABE: Sintomas depressivos em idosos do município de São Paulo
Dementia is a progressive and debilitating disease affecting an increasing number of people world... more Dementia is a progressive and debilitating disease affecting an increasing number of people world- wide. 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, Sao 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.
Clinical Nutrition ESPEN, 2017
Background: The risk of cognitive impairment associated with Parkinson's disease (PD) is related ... more Background: The risk of cognitive impairment associated with Parkinson's disease (PD) is related to ageing. The role of body compartmentalization and associated metabolic dysfunctions, as a risk factor for dementia in PD is still not clear. Objective: To investigate body mass distribution, insulin resistance, and other parameters in patients without dementia, and those with dementia classified as compromised delayed memory. Subjects and Methods: We recorded body composition, basal levels of insulin resistance, and other data from 135 patients, who were followed for at least two years. The patients completed a Brief Cognitive Battery test. Patients with delayed recall memory impairment were assessed using the Mattis dementia rating scale. Results: There was a correlation between age and the patient's scores. Age was negatively correlated with scores on all of the screening battery subtests (p 0.001), while formal education was positively correlated with the test scores. Insulin resistance was higher in non-demented patients compared to patients with impaired memory (p ¼ 0.0027). There was no association between body composition and cognitive dysfunction in patients with PD. Conclusions: The results of this study indicate an apparent decrease in insulin resistance associated with cognitive impairment in PD. We found no correlations between body composition and memory dysfunction associated with PD.
Dementia & Neuropsychologia, 2016
Age is one of the risk factors for dementia in patients with Parkinson's disease (PDD). Disti... more 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 d...
Dementia & Neuropsychologia, 2010
The evaluation of competence of Alzheimer's disease (AD) patients to assume personal or colle... more 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, independ...
Archives of Health Investigation, Aug 22, 2014
Disturbios neuropsicológicos e Síndrome da Apneia do Sono em crianças Neuropsychological disorder... more Disturbios neuropsicológicos e Síndrome da Apneia do Sono em crianças Neuropsychological disorders and sleep apnea syndrome in children Trastornos neuropsicológicos y el síndrome de apnea del sueño en niños
… attitudes of professionals from different medical specialties toward autonomy and legal instruments in the assessment of patients with Alzheimer's disease
ABSTRACT
Arquivos de Neuro-Psiquiatria, 2012
OBJECTIVE: To determine correlations between age and metabolic disorders in Parkinson's disea... more OBJECTIVE: To determine correlations between age and metabolic disorders in Parkinson's disease (PD) patients. METHODS: This observational cross-sectional study included brief tests for dementia and the Mattis test. Signals of metabolic syndrome were evaluated. RESULTS: There was no significant effect from the presence of hypertension (OR=2.36 for patients under 65 years old and OR=0.64 for patients over 65), diabetes or hypercholesterolemia regarding occurrences of dementia associated with PD (24% of the patients). The study demonstrated that each year of age increased the estimated risk of dementia in PD patients by 9% (OR=1.09; 95%CI: 1.01-1.17). CONCLUSION: There was no evidence to correlate the presence of metabolic syndrome with the risk of dementia that was associated with PD. The study confirmed that dementia in PD is age dependent and not related to disease duration.
Cognitive learning function in OSA children
European Respiratory Journal, 2011
Introduction: Obstructive Sleep Apnea (OSA) in children is associated with learning problems, as ... more Introduction: Obstructive Sleep Apnea (OSA) in children is associated with learning problems, as attention and memory. Aim: To assess learning, memory and attention function in OSA children. Methods: OSA children (IAH>4 or IA>1), both genders, aged 6 to 12 years, were submitted to psychological learning test (symbol, digits and code – WISC III Wechsler Intelligence Scale for Children). Test result were pondered for age, 10 points were considered normal, Results: 30 children, 9 girls, median age 8.5 years, were enrolled. Median IAH was 11.9 (4 to 65) and mean IDO 12.8 (3.4 to 71). 14 (46%) children, 10 boys, were considered suspicious, 9 (30%), 8 boys, were considered as having learning disturbance (LD). 67% werde diagnosed LD in 2 or more subareas, showing global learning dysfunction as discrimination, velocity and attention. There was no correlation of learning disturbance to IAH or IDO (OSA severity), but it was correlated to male gender and to older age, 50% of children age...
Revista Brasileira de Epidemiologia
RESUMO: Objetivo: Estimar a prevalência de sintomas depressivos em idosos do município de São Pau... more RESUMO: Objetivo: Estimar a prevalência de sintomas depressivos em idosos do município de São Paulo, Brasil (Estudo SABE), em 2006 e identificar fatores de risco associados a essa prevalência em 2006 e fatores de proteção entre os idosos que não apresentaram sintomas depressivos nas avaliações realizadas em 2000 e 2006. Métodos: Estudo transversal e longitudinal que utilizou a Escala de Depressão Geriátrica na inclusão da coorte em 2000 e em 2006. Resultados: A prevalência de sintomas depressivos em 2006 foi de 14,2% (IC95% 11,8 - 16,7) e 74,8% dos participantes não apresentaram sintomas depressivos em 2000 nem em 2006. Foram construídos modelos de regressão logística, tendo como exposição diferentes grupos de variáveis (sociodemográficas; condições e percepção de saúde e memória) ajustando-se para sexo e idade. No modelo final da regressão logística, associaram-se a sintomas depressivos: autoavaliação da visão, da saúde bucal, da memória e da saúde geral como ruins, dependência par...
Depressive symptoms among elderly inpatients of a Brazilian university hospital: prevalence and associated factors
International Psychogeriatrics, 2008
This study aims to evaluate the prevalence of depressive symptoms and associated factors among el... more This study aims to evaluate the prevalence of depressive symptoms and associated factors among elderly hospital inpatients. 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). 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. 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.
Dementia and Geriatric Cognitive Disorders, 2009
Aging ؒ Cognitive reserve ؒ Daily functioning in dementia and mild cognitive impairment ؒ Early d... more Aging ؒ Cognitive reserve ؒ Daily functioning in dementia and mild cognitive impairment ؒ Early detection of mild cognitive impairment and dementia Abstract Ai ms: To e xamine the prevalence and correlates of cognitive impairment (CI) in adults over 50 years old attending primary care centres with complaints of memory failure. Methods: A sample of 580 individuals aged 50+ years with no previous diagnosis of dementia was assessed by use of the Mini Mental State Examination, the Cambridge Cognitive Assessment-Revised and the California Verbal Learning Test -to evaluate CI-dependent variables -and administration of a questionnaire on memory complaints and other instruments -to measure correlates. Results: The prevalence of CI was 46.20% and positive associations were found for age, gender, level of education, subjective memory complaints, instrumental activities of daily living, reading habits and frequency of leisure activities. In the logistic regression, modelled CI was associated with older age, gender (49.12% women, 39.66% men), instrumental activities of daily living, and reading habits. Conclusion: Almost half of the adults aged 50+ years attending primary care centres with subjective memory complaints were affected by CI. Early evaluation of cognitive functioning is essential to establish adequate preventive and intervention strategies.
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Papers by Cristiane Mendes-Chiloff