Lifestyle factors and stroke risk: exercise, alcohol, diet, obesity, smoking, drug use, and stress

Soccer and Vocational Training are Ineffective Delivery Strategies to Prevent HIV and Substance Abuse by Young, South African Men: A Cluster Randomized Controlled Trial

HIV and substance abuse are common among young men, associated with a cluster of risk behaviors. Yet, most services addressing these challenges are delivered in setting underutilized by men and are often inconsistent with male identity. This cluster randomized controlled trial aimed to reduce multiple risk behaviors found among young men township areas on the outskirts of Cape Town, South Africa. Young men aged 18-29 years (N = 1193) across 27 neighborhoods were randomized by area to receive HIV-related skills training during either: (1) a 12-month soccer league (SL) intervention; (2) 6-month SL followed by 6 months of vocational training (VT) intervention (SL/VT, n = 9); or 3) a control condition (CC). Bayesian longitudinal mixture models were used to evaluate behaviors over time. Because we targeted multiple outcomes as our primary outcome, we analyzed if the number of significantly different outcomes between conditions exceeded chance for 13 measures over 18 months (with 83%, 76%, and 61% follow-up). Only if there were three significant benefits favoring the SL/VT over the SL would benefits be significant. Outcome measures included substance use, HIV-testing, protective sexual behaviors, violence, community engagement and mental health. Consistent participation in the SL was typically around 45% over time across conditions, however, only 17% of men completed SL/VT. There were no significant differences between conditions over time based on the number of study outcomes. These structural interventions were ineffective in addressing young men's substance abuse and risk for HIV.Clinical Trial Registration: This trial was prospectively registered on 24 November 2014 with ClinicalTrials.gov (NCT02358226).

Risk and time preferences in individuals with lifestyle-related and non-lifestyle-related cardiovascular diseases: a pilot study

OBJECTIVES

To (1) pilot a study of behavioural characterisation based on risk and time preferences in clinically well-characterised individuals, (2) assess the distribution of preferences in this population and (3) explore differences in preferences between individuals with 'lifestyle-related' (LS) and 'non-lifestyle-related' (NLS) cardiovascular diseases.

DESIGN

Cross-sectional study with an economic online experiment to collect risk and time preferences, a detailed clinical characterisation and a sociodemographic and lifestyle survey. A definition of LS and NLS groups was developed.

SETTING

Specialist outpatient clinics of the clinic for cardiology and pneumology of the University Hospital Düsseldorf and patients from a cardiology practice in Düsseldorf.

PARTICIPANTS

A total of 74 individuals with cardiovascular diseases.

OUTCOMES

Risk and time preferences.

RESULTS

The implementation of the study process, including participant recruitment and data collection, ran smoothly. The medical checklist, the survey and the time preference instrument were well received. However, the conceptual understanding of the risk preference instrument resulted in inconsistent choices for many participants (47%). The remaining individuals were more risk averse (27%) than risk seeking (16%) and risk neutral (10%). Individuals in our sample were also more impatient (49%) than patient (42%). The participant classification showed that 65% belonged to the LS group, 19% to the NLS group and 16% could not be assigned (unclear allocation to lifestyle (ULS) group). Excluding the ULS group, we show that individuals in the LS group were more risk seeking, and unexpectedly, more patient than those in the NLS group.

CONCLUSIONS

The process of the pilot study and its results can be used as a basis for the design of the main study. The differences in risk and time preferences between the LS and NLS groups provide us with a novel hypothesis for unhealthy behaviours: individuals never give up a bad habit, they simply postpone the latter, which can be tested alongside other additional research questions.

Stroke risk in rheumatoid arthritis patients: exploring connections and implications for patient care

Rheumatoid arthritis (RA) can independently increase the risk of stroke, affecting both young and adult RA patients. Recent attention has been drawn to the association between stroke and RA, supported by mounting evidence. Given that stroke is a significant and an urgent public health concern, this review aims to highlight the relationship between stroke and RA, covering mechanisms, underlying risk factors, early detection tools, and treatment implications. By uncovering the connection that links RA to stroke, we can pave the way for targeted healthcare practices and the development of preventive strategies for individuals with RA. Therefore, further research is imperative to deepen our understanding of this association and, ideally, guide treatment decisions for individuals at risk of both RA and stroke.

Bacterial Pneumonia and Stroke Risk: A Nationwide Longitudinal Followup Study

BACKGROUND

Pneumonia causes significant morbidity and mortality and has been associated with cardiovascular complications. Our study aimed to investigate the incidence of ischemic and hemorrhagic strokes following bacterial pneumonia.

METHODS

Between 1997 and 2012, 10,931 subjects with bacterial pneumonia and 109,310 controls were enrolled from the Taiwan National Health Insurance Research Database, and were followed up to the end of 2013. The risk of stroke was estimated in Cox regression analyses with hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS

When compared to the control group, subjects in the bacterial pneumonia group had a higher incidence of developing ischemic stroke (2.7% versus 0.4%, p <0.001) and hemorrhagic stroke (0.7% versus 0.1%, p <0.001). The risk of stroke increases with repeated hospitalizations due to bacterial pneumonia. Across bacterial etiologies, bacterial pneumonia was a significant risk factor among 775 subjects who developed ischemic stroke (HR, 5.72; 95% CI, 4.92-6.65) and 193 subjects who developed hemorrhagic stroke (HR, 5.33; 95% CI, 3.91-7.26).

CONCLUSION

The risks of developing ischemic stroke and hemorrhagic stroke are significant following bacterial pneumonia infection. The risk factors, clinical outcomes, and the disease course should also be profiled to better inform the monitoring of stroke development and the clinical management of bacterial pneumonia patients.

The Effect of Cardiorespiratory Exercise in the Prevention and Treatment of Hypertension among HIV-Infected Individuals on Antiretroviral Therapy in Mthatha, South Africa

The prevalence of hypertension among people living with HIV (PLHIV) on antiretroviral therapy (ART) is concerning. Physical activity is a proposed approach for managing and avoiding hypertension in this population. While cardiorespiratory exercises (CET) have been efficacious in the general population, its effectiveness in PLHIV on ART, especially in the study setting, in Mthatha is unknown. Consequently, the purpose of this study was to see if CET improves cardiorespiratory fitness in HAART-treated PLHIV with blood flow restriction (BFR) in Mthatha, South Africa. A quasi-experimental study with 98 participants (49 of whom were cases) was carried out. Cases were participants assigned to the CET intervention group that comprised of concurrent training as it included both aerobic and resistance exercise, matched on age and gender. The relationship between CET and hypertension was assessed using logistic regression after adjusting for possible confounding variables. At baseline, there was no significant difference between the physical characteristics of the two groups, and after the intervention, there was a significant difference. Obesity and central adiposity were identified as strong risk factors for hypertension. The findings also indicated that a reduction in waist circumference and body mass index had a significant positive association with hypertension treatment amongst the intervention group (p < 0.05). According to the results of the study, CET has the potential to be an efficient and economical non-pharmacological intervention for the management and control of hypertension in PLHIV. However, further study is required to establish how long, how intense, and what kind of exercise is best for this population.

Modifiable risk factors that mediate the effect of educational attainment on the risk of stroke: a network Mendelian randomization study

BACKGROUND

Stroke is a common cerebrovascular disease with great danger to public health. Educational inequality is a universal issue that influences populations' stroke risk. This study aimed to investigate the causal relationship between education and stroke risk and the contributions of effects mediated by four modifiable factors.

MATERIALS AND METHODS

Public large-scale genome-wide association study (GWAS) summary data associated with educational attainment, hypertensive diseases, body mass index (BMI), smoking behavior, time spent on watching the television (TV), and stroke were obtained from European ancestry. The data were used to investigate the causal relationship among educational attainment, hypertensive disease, BMI, smoking, watching TV, and stroke risk. Inverse variance weighted (IVW) method was used as a primary algorithm for estimating causal direction and effect size in univariable and multivariable Mendelian randomization (MR) analyses.

RESULTS

Higher educational attainment was a causal protective factor, while hypertensive diseases, higher BMI, smoking, and longer time spent on watching the TV were all causal risk factors for the risk of stroke. Hypertensive disease, BMI, smoking, and watching TV were all mediators for linking the causal relationship between educational attainment and stroke risk. Hypertensive disease, BMI, smoking, and watching TV explained 47.35%, 24.74%, 15.72%, and 2.29% of the variance in educational attainment's effect on stroke risk, respectively. The explained proportion reached 69.32% after integrating the four factors.

CONCLUSIONS

These findings support the causal effect of educational attainment on the risk of stroke, with a substantial proportion mediated by modifiable risk factors. Interventions on these modifiable factors would lead to substantial reductions in stroke cases attributable to educational inequality.

Prevalence of Hypercholesterolemia and Awareness of Risk Factors, Prevention and Management Among Adults Visiting Referral Hospital in Ethiopia

Background

Unhealthy lifestyles and physical inactivity are among the contributing factors of hypercholesterolemia. This study assessed the prevalence, awareness of risk factors, and prevention and treatment of hypercholesterolemia among adults who visited Woldia referral hospital, Northeast Ethiopia.

Methods

A cross-sectional survey was conducted among adults who visited Woldia referral hospital from May to August 2022. Data was collected using a structured questionnaire through a face-to-face interview and patient medical record review. Logistic regression analysis was employed to determine the association between hypercholesterolemia and other variables. A p-value at a 95% confidence level was statistically significant.

Results

A total of 1180 eligible adults were included in the study. The magnitude of hypercholesterolemia was 26.4%. The majority of the respondents were aware of some risk factors, such as higher fat intake (82.3%), obesity (67.2%), and lack of adequate exercise (56.1%). However, the majority of the respondents were not aware that smoking, alcohol consumption, and age (86.8% for all) had cardiovascular risk. The majority of the respondents were aware that eating a limited amount of saturated fat (56.5%), maintaining a healthy weight (67.2%), and taking prescribed medications properly (86.8%) can prevent the risk of hypercholesterolemia. However, a larger proportion of respondents were unaware that smoking cessation (86.8%), exercise (55.3%), alcohol restriction (86.8%), and stress avoidance (75.3%) can prevent cardiovascular risks. Age (p = 0.036), smoking (p = 0.007), alcohol use (p = 0.013), fruit consumption (p = 0.019), saturated oil use (p = 0.031), level of physical activity (p < 0.001), and body mass index (p = 0.03) were significantly associated with hypercholesterolemia.

Conclusion

This study concluded that more than one-fourth of adults had hypercholesterolemia. The majority of the respondents did not have an awareness of common cardiovascular risk factors and prevention and treatment techniques regarding unhealthy lifestyles and physical inactivity.

Association between childhood maltreatment and adult cortisol concentrations mediated through subjective health complaints

Background

Lower cortisol concentrations in adulthood were repeatedly associated with more severe childhood maltreatment. Additionally, childhood maltreatment was reported to promote health risk behavior, such as smoking or alcohol consumption, and to increase the risk of mental and somatic diseases during adulthood, such as major depressive disorders or obesity. The present study investigated if health risk behavior and disease symptoms in adults mediate the associations between past childhood maltreatment and present basal serum cortisol concentrations.

Methods

Data from two independent adult cohorts of the general population-based Study of Health in Pomerania (SHIP-TREND-0: N = 3,517; SHIP-START-2: N = 1,640) was used. Childhood maltreatment was assessed via the Childhood Trauma Questionnaire (CTQ). Cortisol concentrations were measured in single-point serum samples. Health risk behavior and mental and physical symptoms were used as mediators. Mediation analyses were calculated separately for both cohorts; results were integrated via meta-analyses.

Results

In mediator-separated analyses, associations between childhood maltreatment and basal serum cortisol concentrations were partly mediated by depressive symptoms (BDI-II: βindirect effect = -.011, pFDR = .017, 21.0% mediated) and subjective somatic health complaints (somatic complaints: βindirect effect = -.010, pFDR = .005, 19.4% mediated). In the second step, both mediators were simultaneously integrated into one mediation model. The model replicated the mediation effects of the subjective somatic health complaints (whole model: βindirect effect = -.014, p = .001, 27.6% mediated; BDI-II: βindirect effect = -.006, p = .163, 11.4% mediated, somatic complaints: βindirect effect = -.020, p = .020, 15.5% mediated).

Conclusion

The results support the hypothesis that the long-lasting effects of childhood maltreatment on the stress response system are partly mediated through self-perceived disease symptoms. However, no mediation was found for health risk behavior or physically measured mediators. Mediation models with multiple simultaneous mediators pointed to a relevant overlap between the potential mediators. This overlap should be focused on in future studies.

Eating Behaviors, Lifestyle, and Ischemic Stroke: A Lebanese Case-Control Study

BACKGROUND

Stroke is the second leading cause of death and the third leading cause of disability on a global scale. Most clinicians tend to underestimate the importance of diet and inadequate or dysfunctional eating attitudes in patients with a complicated relationship with food. Concerned about the potential of an independent Lebanese approach, and also because prior international research has revealed a link between eating intake or choice and ischemic stroke risk, it was considered vital to broaden the scope of the literature and evaluate further the association of disordered eating attitudes and focus on the distinct relationship with food in the case of orthorexia nervosa (ON) in the Lebanese community. Consequently, the purpose of the present study is to investigate the potential association between pre-existing disordered eating attitudes, specifically ON, and ischemic stroke risk, with an emphasis on the evidence supporting a Mediterranean-style diet.

METHODS

This research is a case-control survey study involving 113 Lebanese individuals with ischemic stroke and 451 age-(within 5 years) and sex-matched controls recruited from several hospitals in Lebanon (April 2020-April 2021).

RESULTS

According to the findings of our first regression model, living 100 m from a crowded road (adjusted odds ratio [aOR]: 3.421, 95% confidence interval [CI]: 1.585-7.387), living 100 m from an electricity generator (aOR: 3.686, 95% CI: 1.681-8.085), higher waterpipe dependence (aOR: 1.204, 95% CI: 1.117-1.297), higher exposure to passive smoking (aOR: 2.651, 95% CI: 2.051-3.426), being married (aOR: 3.545, 95% CI: 1.297-9.689), having a low educational attainment (aOR: 0.239, 95% CI: 0.084-0.679), vigorous physical activity (aOR: 1.003, 95% CI: 1.001-1.006), and having more inappropriate eating (aOR: 1.040, 95% CI: 1.006-1.074) were all associated with higher odds of having ischemic stroke. Furthermore, atrial fibrillation (aOR: 2.945, 95% CI: 1.010-8.585), diabetes (aOR: 2.550, 95% CI: 1.169-5.561), heart diseases (aOR: 6.193, 95% CI: 2.196-17.463), and hypertension (aOR: 2.744, 95% CI: 1.049-7.180) were also linked to an increased risk of stroke. Moreover, having more orthorexia nervosa tendencies (aOR: 1.123, 95% CI: 1.021-1.235) was related to a higher odds of having an ischemic stroke, whereas better adherence to the MeD was significantly linked (aOR: 0.691, 95% CI: 0.583-0.819) to lower odds of ischemic stroke.

CONCLUSIONS

Ischemic stroke patients were more likely to have disordered eating attitudes and orthorexic behaviors. Furthermore, the MeD has been found to be beneficial in reducing ischemic stroke risk. Despite the study's focus, outdoor pollution, waterpipe dependence, and passive smoking were linked to ischemic stroke. In summary, this review suggests that improving one's nutritional status and making a few lifestyle changes are key stroke prevention and treatment methods.

Sex and Gender Determinants of Vascular Disease in the Global Context

Globally, vascular diseases are a leading cause of morbidity and mortality. Many of the most significant risk factors for vascular disease have a gendered dimension, and sex differences in vascular diseases incidence are apparent, worldwide. In this narrative review, we provide a contemporary picture of sex- and gender-related determinants of vascular disease. We illustrate key factors underlying sex-specific risk stratification, consider similarities and sex differences in vascular disease risk and outcomes with comparisons of data from the global North (ie, developed high-income countries in the Northern hemisphere and Australia) and the global South (ie, regions outside Europe and North America), and explore the relationship between country-level gendered inequities in vascular disease risk and the United Nation's gender inequality index. Review findings suggest that the rising incidence of vascular disease in women is partly explained by an increase in the prevalence of traditional risk factors linked to gender-related determinants such as shifting roles and relations related to the double burden of employment and caregiving responsibilities, lower educational attainment, lower socioeconomic status, and higher psychosocial stress. Social isolation partly explained the higher incidence of vascular disease in men. These patterns were apparent across the global North and South. Study findings emphasize the necessity of taking into account sex differences and gender-related factors in the determination of the vascular disease risk profiles and management strategies. As we move toward the era of precision medicine, future research is needed that identifies, validates, and measures gender-related determinants and risk factors in the global South.

Lifestyle Assessment in Young Adults with Ischemic Stroke: One Cross-Sectional Study in Iran

Background and Aim

Lifestyle changes are associated with an increased incidence of stroke especially in young adults. The purpose of this study was to investigate the lifestyle of ischemic stroke cases under the age of 50 years.

Methods

This descriptive cross-sectional study was conducted on young adults with ischemic stroke who were admitted to some hospitals, Tehran, Iran between 2018 and 2019. Total lifestyle information collected in the form then was compared in males and females.

Results

Totally 11% ischemic stroke was under age 50 years. 60.7% of young adult patients were men. There was significant difference between body mass index (BMI) (P = 0.03), type of job (P = 0.04), physical activity (P = 0.02), fruit and vegetables consumption, and gender of patients (P = 0.02).

Conclusion

According to the association between inappropriate lifestyle and ischemic stroke in young adults, it is recommended to set preventive medicine and health promotion units with insurance coverage in all clinics for risk assessment of stroke in healthy general population specialty young adults.

Predicting Risk of Stroke From Lab Tests Using Machine Learning Algorithms: Development and Evaluation of Prediction Models

Background

Stroke, a cerebrovascular disease, is one of the major causes of death. It causes significant health and financial burdens for both patients and health care systems. One of the important risk factors for stroke is health-related behavior, which is becoming an increasingly important focus of prevention. Many machine learning models have been built to predict the risk of stroke or to automatically diagnose stroke, using predictors such as lifestyle factors or radiological imaging. However, there have been no models built using data from lab tests.

Objective

The aim of this study was to apply computational methods using machine learning techniques to predict stroke from lab test data.

Methods

We used the National Health and Nutrition Examination Survey data sets with three different data selection methods (ie, without data resampling, with data imputation, and with data resampling) to develop predictive models. We used four machine learning classifiers and six performance measures to evaluate the performance of the models.

Results

We found that accurate and sensitive machine learning models can be created to predict stroke from lab test data. Our results show that the data resampling approach performed the best compared to the other two data selection techniques. Prediction with the random forest algorithm, which was the best algorithm tested, achieved an accuracy, sensitivity, specificity, positive predictive value, negative predictive value, and area under the curve of 0.96, 0.97, 0.96, 0.75, 0.99, and 0.97, respectively, when all of the attributes were used.

Conclusions

The predictive model, built using data from lab tests, was easy to use and had high accuracy. In future studies, we aim to use data that reflect different types of stroke and to explore the data to build a prediction model for each type.

Association of CYP26C1 Promoter Hypomethylation with Small Vessel Occlusion in Korean Subjects

The risk factors for stroke, a fatal disease, include type two diabetes, hypertension, and genetic influences. Small vessel occlusion (SVO) can be affected by epigenetic alterations, but an association between SVO and the methylation of cytochrome P450 family 26 subfamily C member 1 (CYP26C1) has not been identified. In this study, we measured the level of DNA methylation in the CYP26C1 promoter and the 5′ untranslated region of 115 normal subjects and 56 patients with SVO in Korea. The DNA methylation level of each subject was measured by bisulfite amplicon sequencing, and statistical analysis was performed using the general linear model or Pearson’s correlation. The average level of DNA methylation was markedly lower in patients with SVO than in normal subjects (20.4% vs. 17.5%). We found that the methylation of CYP26C1 has a significant positive correlation with blood parameters including white blood cells, hematocrit, lactate dehydrogenase, and Na+ in subjects with SVO. We predicted that binding of RXR-α and RAR-β might be affected by CYP26C1 methylation at CpG sites −246–237 and −294–285. These findings suggest that CYP26C1 methylation in the promoter region may be a predictor of SVO.

Association between adiposity and cardiovascular outcomes: an umbrella review and meta-analysis of observational and Mendelian randomization studies

AIMS

The aim of this study was to investigate the causal relationship and evidence of an association between increased adiposity and the risk of incident cardiovascular disease (CVD) events or mortality.

METHODS AND RESULTS

Observational (informing association) and Mendelian randomization (MR) (informing causality) studies were assessed to gather mutually complementary insights and elucidate perplexing epidemiological relationships. Systematic reviews and meta-analyses of observational and MR studies that were published until January 2021 and evaluated the association between obesity-related indices and CVD risk were searched. Twelve systematic reviews with 53 meta-analyses results (including over 501 cohort studies) and 12 MR studies were included in the analysis. A body mass index (BMI) increase was associated with higher risks of coronary heart disease, heart failure, atrial fibrillation, all-cause stroke, haemorrhagic stroke, ischaemic stroke, hypertension, aortic valve stenosis, pulmonary embolism, and venous thrombo-embolism. The MR study results demonstrated a causal effect of obesity on all indices but stroke. The CVD risk increase for every 5 kg/m2 increase in BMI varied from 10% [relative risk (RR) 1.10; 95% confidence interval (CI) 1.01-1.21; certainty of evidence, low] for haemorrhagic stroke to 49% (RR 1.49; 95% CI 1.40-1.60; certainty of evidence, high) for hypertension. The all-cause and CVD-specific mortality risks increased with adiposity in cohorts, but the MR studies demonstrated no causal effect of adiposity on all-cause mortality.

CONCLUSION

High adiposity is associated with increased CVD risk despite divergent evidence gradients. Adiposity was a causal risk factor for CVD except all-cause mortality and stroke. Half (49%; 26/53) of the associations were supported by high-level evidence. The associations were consistent between sexes and across global regions. This study provides guidance on how to integrate evidence from observational (association) and genetics-driven (causation) studies accumulated to date, to enable a more reliable interpretation of epidemiological relationships.

Association Between Intracerebral Hemorrhage and Subsequent Arterial Ischemic Events in Participants From 4 Population-Based Cohort Studies

Importance

Intracerebral hemorrhage and arterial ischemic disease share risk factors, to our knowledge, but the association between the 2 conditions remains unknown.

Objective

To evaluate whether intracerebral hemorrhage was associated with an increased risk of incident ischemic stroke and myocardial infarction.

Design, Setting, and Participants

An analysis was conducted of pooled longitudinal participant-level data from 4 population-based cohort studies in the United States: the Atherosclerosis Risk in Communities (ARIC) study, the Cardiovascular Health Study (CHS), the Northern Manhattan Study (NOMAS), and the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. Patients were enrolled from 1987 to 2007, and the last available follow-up was December 31, 2018. Data were analyzed from September 1, 2019, to March 31, 2020.

Exposure

Intracerebral hemorrhage, as assessed by an adjudication committee based on predefined clinical and radiologic criteria.

Main Outcomes and Measures

The primary outcome was an arterial ischemic event, defined as a composite of ischemic stroke or myocardial infarction, centrally adjudicated within each study. Secondary outcomes were ischemic stroke and myocardial infarction. Participants with prevalent intracerebral hemorrhage, ischemic stroke, or myocardial infarction at their baseline study visit were excluded. Cox proportional hazards regression was used to examine the association between intracerebral hemorrhage and subsequent arterial ischemic events after adjustment for baseline age, sex, race/ethnicity, vascular comorbidities, and antithrombotic medications.

Results

Of 55 131 participants, 47 866 (27 639 women [57.7%]; mean [SD] age, 62.2 [10.2] years) were eligible for analysis. During a median follow-up of 12.7 years (interquartile range, 7.7-19.5 years), there were 318 intracerebral hemorrhages and 7648 arterial ischemic events. The incidence of an arterial ischemic event was 3.6 events per 100 person-years (95% CI, 2.7-5.0 events per 100 person-years) after intracerebral hemorrhage vs 1.1 events per 100 person-years (95% CI, 1.1-1.2 events per 100 person-years) among those without intracerebral hemorrhage. In adjusted models, intracerebral hemorrhage was associated with arterial ischemic events (hazard ratio [HR], 2.3; 95% CI, 1.7-3.1), ischemic stroke (HR, 3.1; 95% CI, 2.1-4.5), and myocardial infarction (HR, 1.9; 95% CI, 1.2-2.9). In sensitivity analyses, intracerebral hemorrhage was associated with arterial ischemic events when updating covariates in a time-varying manner (HR, 2.2; 95% CI, 1.6-3.0); when using incidence density matching (odds ratio, 2.3; 95% CI, 1.3-4.2); when including participants with prevalent intracerebral hemorrhage, ischemic stroke, or myocardial infarction (HR, 2.2; 95% CI, 1.6-2.9); and when using death as a competing risk (subdistribution HR, 1.6; 95% CI, 1.1-2.1).

Conclusions and Relevance

This study found that intracerebral hemorrhage was associated with an increased risk of ischemic stroke and myocardial infarction. These findings suggest that intracerebral hemorrhage may be a novel risk marker for arterial ischemic events.

Correlation between Stroke Risk and Systolic Blood Pressure in Patients over 50 Years with Uncontrolled Hypertension: Results from the SYSTUP-India Study

Objectives

To assess mean systolic and diastolic blood pressure (SBP and DBP) levels in patients ≥50 years with uncontrolled hypertension (HTN) and evaluate the correlation between BP and stroke risk. It also assessed therapeutic drug classes prescribed in these patients.

Methods

A cross-sectional, observational study was conducted at 176 outpatient centers across India, including patients aged ≥50 years with elevated SBP (≥140 mmHg). The relationship between stroke risk, calculated using Stroke Riskometer™, and mean SBP, mean DBP, and other risk factors was evaluated using Pearson correlation coefficient and logistic regression analysis.

Results

The study included 3791 patients (men, 60.0%; mean age: 62.1 ± 8.3 years; mean BMI: 27 kg/m²) with mean SBP 157.3 ± 12.8 mmHg and mean DBP 89.8 ± 9.7 mmHg. Five-year stroke risk in 33.9% and 10-year stroke risk in 70% patients were moderate to severe. A ~4% increase in both 5- and 10-year stroke risk with each 1 mmHg increase in mean SBP (p < 0.0001) was seen. However, mean DBP did not exhibit any significant correlation with 5-year (p = 0.242) or 10-year (p = 0.8038) stroke risk. There was a positive correlation between mean SBP and patient age, comorbid diabetes, and smoking and alcohol habits (p < 0.0001). Comorbid diabetes and smoking increased 5- and 10-year stroke risk by 2- to 5-fold. Irrespective of the risk category, most patients received antihypertensive therapy with an angiotensin receptor blocker.

Conclusion

Findings corroborate an association between stroke risk and mean SBP. These real-world clinical findings indicate that efforts are required to improve primary prevention of stroke and reduce the prevalence of recurrent stroke in India.

Hospitalisation for lower respiratory tract infection is associated with an increased incidence of acute myocardial infarction and stroke in tropical Northern Australia

Acute respiratory infections appear to precipitate vascular events. Acute myocardial infarction (AMI) and stroke are the leading cause of death and disability globally. This study was based on a cohort of patients admitted to Townsville University Hospital between January 2006 and December 2016. Using a self-controlled case series design, we investigated the risk of AMI or ischaemic stroke after an episode of pneumonia. We defined the ‘risk interval’ as the first 14 days after hospitalisation for pneumonia and the ‘control interval’ as one year before and one year after the risk interval. Among a population (N = 4557) with a median age of over 70, a total of 128 AMI and 27 stroke cases were identified within 1 year of an episode of pneumonia in this study. Ten and two admissions occurred during the risk interval, while 118 and 25 admissions occurred during the control period. The relative incidence ratios (RIR) of AMI increased after an episode of pneumonia (RIR=4.85, 95% confidence interval (CI) 2.44–9.67). The risk for stroke after the exposure period of 14 days was 4.94 (95% CI 1.12–21.78) considering only the first stroke incidence. The RIR results for AMI and stroke were not altered by adjusting for age, sex or Indigenous status. The risk of AMI and stroke were significantly higher two weeks after an episode of pneumonia.

Antihypercholesterolemic and antiatherosclerotic potencies of Pandanus tectorius fruits via increasing scavenger receptor-B1 genes expression and inhibition of 3-hydroxy-3-methylglutaryl coenzyme A reductase activity

Atherosclerosis is a leading cause of death worldwide. The adverse side effects of currently available drugs urge to find more effective and safe remedial agents. Alternative candidates from natural resources are of great consequence in the emerging of new drugs. Pandanus tectorius (Pandanaceae) was traditionally used in Ayurvedic medicine to cure certain diseases. Thus, the current study conducted to elucidate the potency of P. tectorius fruit as antiatherosclerosis and antihypercholesterolemia agents through the regulation of high density lipoprotein (HDL) receptor (scavenger receptor [SR]-B1) gene expression and 3-hydroxy-3-methylglutaryl coenzyme A reductase reductase (HMGCR) in vitro, respectively. The P. tectorius fruit was noncytotoxic against the HepG2 cell line confirmed by 3-(4,5-dimethylthiazol-2-yl) 2,5-diphenyl tetrazolium bromide assay. The P. tectorius fruit successfully upregulates the SR-B1 gene expression and downregulate the HMGCR. Moreover, an in vivo study showed that P. tectorius has good activity on the upregulation of HDL and subsequently downregulation of total cholesterol level. Moreover, P. tectorius fruit did not show any increase in toxicity biomarkers serum glutamic oxaloacetic transaminase and serum glutamate pyruvate transaminase in vivo. These results found that P. tectorius fruits have potency as the preventive agent for hypercholesterolemia and atherosclerosis via SR-B1 and HMGCR mechanisms of action.

The Association of Social Isolation With the Risk of Stroke Among Middle-Aged and Older Adults in China

Given that there is limited research examining the specific role social isolation plays in stroke risk, we aimed to estimate the controlled direct effect of social isolation on stroke risk in China. A nationally representative sample (n = 12,662) of persons aged 45 years or more at baseline (2011), with corresponding follow-ups in 2013 and 2015, was taken from the China Health and Retirement Longitudinal Study. Stroke was assessed through a self- or proxy-reported physician's diagnosis. Social isolation was measured by incorporating marital status, frequency of contact with friends, family, and children, and participation in social activities. A marginal structural model with stabilized inverse probability weights was applied to examine the controlled direct effect of social isolation on stroke risk. Overall, 245 persons had a stroke within the 4-year timeline under study. The total effect model indicated that persons experiencing social isolation had a 64% increased risk of stroke (odds ratio (OR) = 1.64, 95% confidence interval (CI): 1.26, 2.13). Results from the marginal structural model also indicated that socially isolated persons had an increased risk of stroke (OR = 2.39, 95% CI: 1.49, 3.82) after adjustment for depression. Interventions to reduce social isolation may be particularly beneficial in preventing the occurrence of stroke among middle-aged and older adults in China.

Acupuncture treatment is associated with a decreased risk of developing stroke in patients with depression: A propensity-score matched cohort study

BACKGROUND

Depression had a significantly increased risk of stroke. Some patients with depression seek acupuncture treatment. The aim of this study is to investigate the association between acupuncture treatment and risk of developing stroke in patients with depression.

METHODS

Patients with newly diagnosed depression above 18 years old between 1997 and 2010 were selected from the Taiwanese National Health Insurance Research Database, and followed up until the end of 2013. The 1:1 propensity score method was used to match an equal number of patients (N = 13,823) in the acupuncture and non-acupuncture cohorts, based on characteristics including sex, age, baseline comorbidity and drug used. The outcome measurement was the comparison of stroke incidence in the two cohorts. We used the Cox regression model and the Kaplan-Meier method to estimate the risk of developing stroke.

RESULTS

Compared with the non-acupuncture cohort, patients who received acupuncture treatment had a lower risk of stroke (adjusted hazard ratio (HR) = 0.49, 95% confidential interval = 0.45-0.52) after adjustment for age, sex, comorbidities and drugs used. Regarding the two types of stroke, acupuncture users also had lower risk of hemorrhagic or ischemic stroke (adjusted HR = 0.37 and 0.49, respectively). The cumulative incidence of stroke in the acupuncture cohort was significantly lower than that of the non-acupuncture cohort (log-rank test, p < 0.001). At the 5th year of follow-up, 7.22% of acupuncture users had stroke onset compared with 14% in the non-acupuncture cohort.

LIMITATIONS

The database provided information of antidepressants but not the severity of depression. Details of the life style and selection of acupoints were also not provided.

CONCLUSIONS

The present study revealed that acupuncture reduced the risk of developing stroke in depression patients in Taiwan. Further clinical studies investigating the mechanisms and efficacy of acupuncture are warranted.

A simple approach to studying cerebral blood flow during psychological stress

The purpose of this work was to determine, in the Wistar male rats, the role of the stress system in the control of cerebral hemodynamics induced by emotional stress (air jet). Blood flow rates in the internal carotid arteries have been obtained using chronically implanted Doppler probes. In this investigation, air-jet stress provokes a rapid and substantial elevation of blood pressure combined with hyperemia and vasodilation. Spectral analysis reveals an increase in the variability of carotid blood flow and carotid vascular conductance during stress compared to the baseline state. The coherence between the two carotid blood flow, which provides a linear correlation index in the frequency domain, was calculated before (ordinary coherence) and after mathematical elimination of the influence of blood pressure (partial coherence). The main advantages of the technique are as follows:• It allows the measurement of cerebral blood flow while comparing them with the physiological parameters of the animal such as blood pressure.• Air-jet stress is a psychological rather than physical stress that generates hyperemia in a non-pharmacological way (no side effects) without injuring the animal or damaging the experimental installation during the recording sessions.• A simple method for tracing a kinetic path before and at the moment of stress initiation.• The presence of a catheter facilitates the administration of drug substances if required.• Laboratory-developed software, based on the Lab VIEW 5.1, allows real-time monitoring of blood pressure and carotid flow rates signals using fast Fourier transform.

Relationship between Respiratory and Periodontal Health in Adults: A Case-Control Study

Aims and Objectives

The colonization of the respiratory pathogens has been found in the oral cavity. In the high-risk patients for lung infection; the risk factor is the high colonization of the respiratory pathogens in the oral cavity. The present study was performed with an aim to investigate the relationship between periodontal health and respiratory diseases.

Material and Methods

The present cross-sectional study was conducted in the individuals who were attending the outpatient department of dentistry and those who signed the informed consent to participate in the study. A total of 198 patients were included in the present study. Ninety-nine patients with respiratory diseases were included in the test group and 99 patients with normal pulmonary function were added in the control group. Spirometry was used for the confirmation of the lung diseases. We had assessed the clinical parameters such as plaque index, gingival index, loss of attachment, and community periodontal index with the help of SPSS software 15 and compared between cases and controls.

Results

The mean age of control patients were 35.12 and for respiratory patients was 43.32. There were 65 males and 34 females in case group with respiratory diseases. The controls consisted of 63 males and 36 females. The high scores for various gingival and periodontal indexes in respiratory patients confirmed more periodontal destruction with respect to that group, compared to the nonrespiratory group.

Conclusion

It is concluded that a strong association between periodontitis and chronic obstructive pulmonary disease was found. The assessment of the risk factors along with patient education regarding the risk should be done so that suitable intervention strategies can be implemented.

Fractal properties and morphological investigation of Nano hydrochlorothiazide is used to treat hypertension

PURPOSE

High blood pressure (hypertension) is a relatively common condition that increases blood pressure in the arteries abnormally, causing problems such as heart disease and stroke. Blood pressure is a force that is felt through the walls of the blood vessels and has a direct relationship to the power of pumping the heart and vascular resistance to the blood flow. One of the lowing of blood pressure medications is hydrochlorothiazide (Hctz) which is used to treat high blood pressure and swelling from heart failure, liver damage, and other minor actions.

PROCEDURES

This study explains the effectiveness of Hctz with the help of "fractal dimension". To perfect investigate the fractal dimension, we used the Hctz drug nanoparticle form then using MATLAB software, homogeneity levels or heterogeneity of Nano Hctz using SEM images were computed.

RESULTS

We calculated histogram plot with SEM image by MATLAB software which that its standard deviation was eclose to zero and it can explain that the scattering of data is low and their amount is in one suffering. Fractal dimensions obtained from Matlab and SPSS software for normal distribution, correlation, standard deviation, mean, cumulative frequency and variance analysis were analyzed.

CONCLUSIONS

In this research, the association between Hctz treatment effects with the point of view of the fractal dimension of the drug was demonstrated to prove the properties of the drug in the body. in the near future, drug fractal studies can improve the development of new drugs and treatments with minimal cost than clinical approaches by linking chemistry, mathematical sciences and pharmaceutical sciences.

Time Series Visualizations of Mobile Phone-Based Daily Diary Reports of Stress, Physical Activity, and Diet Quality in Mostly Ethnic Minority Mothers: Feasibility Study

Background

Health behavior patterns reported through daily diary data are important to understand and intervene upon at the individual level in N-of-1 trials and related study designs. There is often interest in relationships between multiple outcomes, such as stress and health behavior. However, analyses often utilize regressions that evaluate aggregate effects across individuals, and standard analyses target single outcomes.

Objective

This paper aims to illustrate how individuals’ daily reports of stress and health behavior (time series) can be explored using visualization tools.

Methods

Secondary analysis was conducted on 6 months of daily diary reports of stress and health behavior (physical activity and diet quality) from mostly ethnic minority mothers who pilot-tested a self-monitoring mobile health app. Time series with minimal missing data from 14 of the 44 mothers were analyzed. Correlations between stress and health behavior within each time series were reported as a preliminary step. Stress and health behavior time series patterns were visualized by plotting moving averages and time points where mean shifts in the data occurred (changepoints).

Results

Median correlation was small and negative for associations of stress with physical activity (r=−.14) and diet quality (r=−.08). Moving averages and changepoints for stress and health behavior were aligned for some participants but not for others. A third subset of participants exhibited little variation in stress and health behavior reports.

Conclusions

Median correlations in this study corroborate prior findings. In addition, time series visualizations highlighted variations in stress and health behavior across individuals and time points, which are difficult to capture through correlations and regression-based summary measures.

Gender-specific HIV and substance abuse prevention strategies for South African men: study protocol for a randomized controlled trial

BACKGROUND

Young men in South Africa face concurrent epidemics of HIV, drug and alcohol abuse, and unemployment. Standard HIV prevention programs, located in healthcare settings and/or using counseling models, fail to engage men. Soccer and vocational training are examined as contexts to deliver male-specific, HIV prevention programs.

METHODS

Young men (n = 1200) are randomly assigned by neighborhood to one of three conditions: 1) soccer league (n = 400; eight neighborhoods); 2) soccer league plus vocational training (n = 400; eight neighborhoods); or 3) a control condition (n = 400; eight neighborhoods). Soccer practices and games occur three times per week and vocational training is delivered by Silulo Ulutho Technologies and Zenzele Training and Development. At baseline, 6 months, 12 months, and 24 months, the relative efficacy of these strategies to increase the number of significant outcomes (NSO) among 15 outcomes which occur (1) or not (0) are summed and compared using binomial logistic regressions. The summary primary outcome reflects recent HIV testing, substance abuse, employment, sexual risk, violence, arrests, and mental health status.

DISCUSSION

The failure of men to utilize HIV prevention programs highlights the need for gender-specific intervention strategies. However, men in groups can provoke and encourage greater risk-taking among themselves. The current protocol evaluates a male-specific strategy to influence men's risk for HIV, as well as to improve their ability to contribute to family income and daily routines. Both interventions are expected to significantly benefit men compared with the control condition.

TRIAL REGISTRATION

ClinicalTrials.gov registration, NCT02358226 . Registered 24 November 2014.

Effect of Dietary Purified Xanthohumol from Hop (Humulus lupulus L.) Pomace on Adipose Tissue Mass, Fasting Blood Glucose Level, and Lipid Metabolism in KK-Ay Mice

We previously showed that xanthohumol-rich hop extract (XRHE, ~18% xanthohumol) exerts anti-obesity effects in rats fed a high-fat diet through regulation of fatty acid metabolism. In this study, we examined the effects of dietary purified xanthohumol from XRHE (PX, ~91.9% xanthohumol) in KK-Ay mice in order to understand the anti-obesity effects of xanthohumol alone because XRHE contains 82% unknown compounds. Dietary consumption of PX significantly inhibited an increase in the visceral fat weight of mice compared to those fed control diet without PX. Plasma leptin level was significantly lower in the PX-fed group than in the control group. Dietary PX lowered hepatic fatty acid synthesis by down-regulation of SREBP1c mRNA expression in the liver. On the other hand, fatty acid β-oxidation in the liver was promoted by dietary PX through the up-regulation of PPARα mRNA expression. Moreover, the fecal levels of fatty acids and carbohydrates increased by dietary PX. PX inhibited lipase or α-amylase activity in vitro. Thus, we found that PX may exert anti-obesity effects through the regulation of lipid metabolism and inhibition of intestinal fat and carbohydrate absorption, and that xanthohumol alone may exert anti-obesity effects.

Relationship of Self-Rated Health to Stroke Incidence and Mortality in Older Individuals with and without a History of Stroke: A Longitudinal Study of the MRC Cognitive Function and Ageing (CFAS) Population

INTRODUCTION

Poor self-rated health (SRH) has been associated with increased risk of death and poor health outcomes even after adjusting for confounders. However its' relationship with disease-specific mortality and morbidity has been less studied. SRH may also be particularly predictive of health outcomes in those with pre-existing conditions. We studied whether SRH predicts new stroke in older people who have never had a stroke, or a recurrence in those with a prior history of stroke.

METHODS

MRC CFAS I is a multicentre cohort study of a population representative sample of people in their 65th year and older. A comprehensive interview at baseline included questions about presence of stroke, self-rated health and functional disability. Follow-up at 2 years included self-report of stroke and stroke death obtained from death certificates. Multiple logistical regression determined odds of stroke at 2 years adjusting for confounders including disability and health behaviours. Survival analysis was performed until June 2014 with follow-up for up to 13 years.

RESULTS

11,957 participants were included, of whom 11,181 (93.8%) had no history of stroke and 776 (6.2%) one or more previous strokes. Fewer with no history of stroke reported poor SRH than those with stroke (5 versus 21%). In those with no history of stroke, poor self-rated health predicted stroke incidence (OR 1.5 (1.1-1.9)), but not stroke mortality (OR 1.2 (0.8-1.9)) at 2 years nor for up to 13 years (OR 1.2(0.9-1.7)). In those with a history of stroke, self-rated health did not predict stroke incidence (OR 0.9(0.6-1.4)), stroke mortality (OR 1.1(0.5-2.5)), or survival (OR 1.1(0.6-2.1)).

CONCLUSIONS

Poor self-rated health predicts risk of stroke at 2 years but not stroke mortality among the older population without a previous history of stroke. SRH may be helpful in predicting who may be at risk of developing a stroke in the near future.

Nonpsychotic Mental Disorders in Teenage Males and Risk of Early Stroke: A Population-Based Study

BACKGROUND AND PURPOSE

Although the incidence of stroke is on the decline worldwide, this is not the case for early stroke. We aimed to determine whether nonpsychotic mental disorder at the age of 18 years is a risk factor for early stroke, and if adolescent cardiovascular fitness and intelligence quotient might attenuate the risk.

METHOD

Population-based Swedish cohort study of conscripts (n=1 163 845) who enlisted during 1968 to 2005. At conscription, 45 064 males were diagnosed with nonpsychotic mental disorder. Risk of stroke during follow-up (5-42 years) was calculated with Cox proportional hazards models. Objective baseline measures of fitness and cognition were included in the models in a second set of analyses.

RESULTS

There were 7770 first-time stroke events. In adjusted models, increased risk for stroke was observed in men diagnosed with depressive/neurotic disorders (hazard ratio [HR], 1.23; 95% confidence interval [CI], 1.11-1.37), personality disorders (HR, 1.52; 95% CI, 1.29-1.78), and alcohol/substance use disorders (HR, 1.61; 95% CI, 1.41-1.83) at conscription. Corresponding figures for fatal stroke were HR, 1.38; 95% CI, 1.06 to 1.79; HR, 2.26; 95% CI, 1.60 to 3.19; and HR, 2.20; 95% CI, 1.63 to 2.96. HRs for stroke were attenuated when fitness level and intelligence quotient were introduced. Associations remained significant for personality disorders and alcohol/substance use in the fully adjusted models. The interaction term was statistically significant for fitness but not for intelligence quotient.

CONCLUSIONS

Our findings suggest that fitness may modify associations between nonpsychotic disorders and stroke. It remains to be clarified whether interventions designed to improve fitness in mentally ill youth can influence future risk of early stroke.

Food Insecurity: A Concept Analysis

AIM

To report an analysis of the concept of food insecurity in order to (a) propose a theoretical model of food insecurity useful to nursing; and (b) discuss its implications for nursing practice, nursing research, and health promotion.

BACKGROUND

A total of 48 million Americans are food insecure. As food insecurity is associated with multiple negative health effects, nursing intervention is warranted.

DESIGN

Concept analysis.

DATA SOURCES

A literature search was conducted in May 2014 in Scopus and MEDLINE using the exploded term "food insecur*." No year limit was placed. Government websites and popular media were searched to ensure a full understanding of the concept.

REVIEW METHODS

Iterative analysis, using the Walker and Avant method.

RESULTS

Food insecurity is defined by uncertain ability or inability to procure food, inability to procure enough food, being unable to live a healthy life, and feeling unsatisfied. A proposed theoretical model of food insecurity, adapted from the Socio-Ecological Model, identifies three layers of food insecurity (individual, community, society), with potential for nursing impact at each level.

CONCLUSION

Nurses must work to fight food insecurity. There exists a potential for nursing impact that is currently unrealized. Nursing impact can be guided by a new conceptual model, Food Insecurity Within the Nursing Paradigm.

Consumption of a high n-3 polyunsaturated fatty acid diet during gradual mild physiological stress in rats

n-3 Polyunsaturated fatty acids (n-3PUFAs) may be beneficial for anxiety and depression under stressful conditions. Studies however, typically utilise physical or sudden physiological stress, while gradual physiological stress is also relevant to human conditions. Using deoxycorticosterone acetate (DOCA) administration to induce gradual physiological stress, this study investigated the impact of n-3PUFAs under gradual physiological stress in rats. Animals (aged 2 months) (N=8-12/group) received daily injections of DOCA or vehicle and were concurrently fed a high n-3PUFA or control diet for eight weeks. Behavioural measures were taken throughout. Behavioural tests and physiological measures were conducted after six and eight weeks respectively. DOCA administration decreased plasma renin, plasma proteins and relative adrenal weight, and increased water intake, relative kidney weight, and anxiety in the open field. These findings demonstrate disruptions to the renin-angiotensin-aldosterone system, a result of mild physiological stress, that also impact on anxiety behaviours. No effects of n-3PUFAs were found.

Personality Traits Predict the Onset of Disease

While personality traits have been linked concurrently to health status and prospectively to outcomes such as mortality, it is currently unknown whether traits predict the diagnosis of a number of specific diseases (e.g., lung disease, heart disease, and stroke) that may account for their mortality effects more generally. A sample ( N = 6,904) of participants from the Health and Retirement Study, a longitudinal study of older adults, completed personality measures and reported on current health conditions. Four years later, participants were followed up to see if they developed a new disease. Initial cross-sectional analyses replicated past findings that personality traits differ across disease groups. Longitudinal logistic regression analyses predicting new disease diagnosis suggest that traits are associated with the risk of developing disease—most notably the traits of conscientiousness, neuroticism, and openness. Findings are discussed as a means to identify pathways between personality and health.

Participation of the central melanocortin system in metabolic regulation and energy homeostasis

Obesity and metabolic disorders, such as type 2 diabetes and hypertension, have attracted considerable attention as life-threatening diseases not only in developed countries but also worldwide. Additionally, the rate of obesity in young people all over the world is rapidly increasing. Accumulated evidence suggests that the central nervous system may participate in the development of and/or protection from obesity. For example, in the brain, the hypothalamic melanocortin system senses and integrates central and peripheral metabolic signals and controls the degree of energy expenditure and feeding behavior, in concert with metabolic status, to regulate whole-body energy homeostasis. Currently, researchers are studying the mechanisms by which peripheral metabolic molecules control feeding behavior and energy balance through the central melanocortin system. Accordingly, recent studies have revealed that some inflammatory molecules and transcription factors participate in feeding behavior and energy balance by controlling the central melanocortin pathway, and have thus become new candidates as therapeutic targets to fight metabolic diseases such as obesity and diabetes.

Primary Preventive Potential for Stroke by Avoidance of Major Lifestyle Risk Factors

Background and Purpose—

Because primary prevention of stroke is a priority, our aim was to assess the primary preventive potential of major lifestyle risk factors for stroke in middle-aged women and men.

Methods—

Among 23 927 persons, 551 (195 women and 356 men) had a first diagnosis of stroke during an average follow-up of 12.7 years. Using Cox proportional hazards models, we estimated the associations of adiposity, smoking, physical activity, alcohol consumption, and diet with risk of developing stroke. A competing risk model built from cause-specific proportional hazards models accounting for concurrent risk of death was used to calculate relative and absolute reductions in stroke occurrences that could have been achieved by maintaining a healthy lifestyle pattern.

Results—

Obesity, smoking, alcohol consumption, diet, and physical inactivity were each identified as modifiable lifestyle risk factors for stroke. About 38% of stroke cases were estimated as preventable through adherence to a healthy lifestyle profile (never smoking, maintaining optimal body mass index and waist circumference, performing physical exercise, consuming a moderate quantity of alcohol, and following a healthy dietary pattern). Age-specific estimates of 5-year incidence rates for stroke in the actual cohort and in a hypothetical, comparable cohort of individuals following a healthy lifestyle would be reduced from 153 to 94 per 100 000 women and from 261 to 161 per 100 000 men for the age group 60 to 65 years.

Conclusions—

Our analysis confirms the strong primary prevention potential for stroke based on avoidance of excess body weight, smoking, heavy alcohol consumption, unhealthy diet, and physical inactivity.

[What motivates smoking and alcohol drinking of young people? A behavioural epidemiologic study]

INTRODUCTION

Adolescence is a life period of trying harmful habits. It is helpful for prevention to map youth's motivations.

AIM

The main goal of the present study was to investigate high school students' motivations related to alcohol and cigarette use.

METHOD

A questionnaire survey was performed in Debrecen including students from four high schools (n = 501; age range, between 14 and 22 years; mean age, 16.4 years; 34% boys and 66% girls). Beyond descriptive statistics, logistic regression analysis was used to detect odds ratios explaining relationships between substance use and motivations.

RESULTS

Besides a slight difference in gender, there were significant differences by substance user status in the structure of motivations. In case of alcohol use, social motivation proved to be a predictor. In case of cigarette smoking, besides social motivation, boredom relief and affect regulation (coping) were also significant.

CONCLUSIONS

These data suggest that young people start to smoke cigarette and drink alcohol in social situations due to peer pressure. Therefore, prevention strategies should be built on social skills training.

The incidence and relative risk of stroke among patients with bipolar disorder: a seven-year follow-up study

Objective

This study aimed to estimate the incidence and relative risk of stroke and post-stroke all-cause mortality among patients with bipolar disorder.

Methods

This study identified a study population from the National Health Insurance Research Database (NHIRD) between 1999 and 2003 that included 16,821 patients with bipolar disorder and 67,284 age- and sex-matched control participants without bipolar disorder. The participants who had experienced a stroke between 1999 and 2003 were excluded and were randomly selected from the NHIRD. The incidence of stroke (ICD-9-CM code 430–438) and patient survival after stroke were calculated for both groups using data from the NIHRD between 2004 and 2010. A Cox proportional-hazards model was used to compare the seven-year stroke-free survival rate and all-cause mortality rate across the two cohorts after adjusting for confounding risk factors.

Results

A total of 472 (2.81%) patients with bipolar disorder and 1,443 (2.14%) controls had strokes over seven years. Patients with bipolar disorder were 1.24 times more likely to have a stroke (95% CI = 1.12–1.38; p<0.0001) after adjusting for demographic characteristics and comorbid medical conditions. In addition, 513 (26.8%) patients who had a stroke died during the follow-up period. The all-cause mortality hazard ratio for patients with bipolar disorder was 1.28 (95% CI = 1.06–1.55; p = 0.012) after adjusting for patient, physician and hospital variables.

Conclusions

The likelihood of developing a stroke was greater among patients with bipolar disorder than controls, and the all-cause mortality rate was higher among patients with bipolar disorder than controls during a seven-year follow-up period.

Worldwide socioeconomic status and stroke mortality: an ecological study

Introduction

The effect of socioeconomic status (SES) on stroke mortality at population level has been controversial. This study explores the association of SES in childhood and adulthood with stroke mortality, as well as variations in this association among countries/regions.

Methods

Sex-specific stroke mortality at country level with death registry covering ≥ 70% population was obtained from the World Health Organization. Human Development Index (HDI) developed by the United Nations was chosen as the SES indicator. The associations between the latest available stroke mortality with HDI in 1999 (adulthood SES) and with HDI in 1960 (childhood SES) for the group aged 45–54 years among countries were examined with regression analysis. Age-standardized stroke mortality and HDI during 1974–2001 were used to estimate the association by time point.

Results

The population data were available mostly for low-middle to high income countries. HDI in 1960 and 1999 were both inversely associated with stroke mortality in the group aged 45–54 years in 39 countries/regions. HDI in 1960 accounted for 37% of variance of stroke mortality among countries/regions; HDI in 1999 for 35% in men and 53% in women (P < 0.001). There was a quadratic relationship between age-standardized stroke mortality and HDI for the countries from 1974 to 2001: the association was positive when HDI < 0.77 but it became negative when HDI > 0.80.

Conclusions

SES is a strong predictor of stroke mortality at country level. Stroke mortality increased with improvement of SES in less developed countries/region, while it decreased with advancing SES in more developed areas.

Type 2 diabetes and cognitive impairment: linking mechanisms

This manuscript provides a brief review of current concepts in the mechanisms potentially linking type-2-diabetes (T2D) with cognitive impairment. Existing epidemiologic studies, imaging studies, autopsy studies, and clinical trials provide insights into the mechanisms linking T2D and cognitive impairment. There seems to be little dispute that T2D can cause cerebrovascular disease and thus cause vascular cognitive impairment (VCI). Whether T2D can cause late onset Alzheimer's disease (LOAD) remains to be elucidated. Many epidemiologic studies show an association between T2D and cognitive impairment, but the association with VCI seems to be stronger compared to LOAD, suggesting that cerebrovascular disease may be the main mechanism linking T2D and cognitive impairment. Imaging studies show an association between T2D and imaging markers of LOAD, but these observations could still be explained by cerebrovascular mechanisms. Autopsy studies are few and conflicting, with some suggesting a predominantly cerebrovascular mechanism, and others providing support for a neurodegenerative mechanism. Thus far, the evidence from clinical trials is mixed in supporting a causal association between T2D and cognitive impairment, and most clinical trials that can answer this question are yet to be reported or finished. Given the epidemic of T2D in the world, it is important to elucidate whether the association between T2D and cognitive impairment, particularly LOAD, is causal, and if so, what the mechanisms are.

A community based study of the relationship between homocysteine and some of the life style factors

Till date no community based data on plasma homocysteine is available in North Eastern Region. Hence, the present study was conducted to analyze and correlate the plasma homocysteine level with some life style factors like diet, alcohol intake, smoking habit and body weight, in a cross-section of population. 12 h fasting samples of 970 apparently healthy, Assamese population of both genders in the age group of 35-86 years, mostly from the urban area of Assam were tested for plasma total homocysteine level over a period of 3 years. Out of 970 volunteers, hyperhomocysteinemia was detected in 533 (55%) individuals with a mean value of 18.41 μmol/l. Of that hyperhomocysteinemia, 89.1% were in the range of moderately high and rest 10.9% were intermediate high. Another finding was that males had a tendency towards greater value (mean = 20.36 μmol/l) than females (mean = 16.37 μmol/l). It was observed that the relationship of homocysteine levels to gender and some of the life style factors were also significant.

The association of alcohol, tea, and other modifiable lifestyle factors with myocardial infarction and stroke in Chinese men

BACKGROUND: Studies of the lifestyle predictors of cardiovascular diseases (CVD) have been predominantly conducted in Caucasian populations. There are few data from other populations, such as Chinese men, who have different lifestyles and a different spectrum of CVD as compared with Caucasian populations. METHODS: Based on the baseline data of the Shanghai Men's Health Study during March 2002-June 2006, a matched case-control analysis including 518 myocardial infarction, 333 hemorrhagic stroke, and 1927 ischemic stroke cases was conducted. Five controls were selected for each case. The lifestyle factors under study included alcohol, tea and ginseng consumption, physical activity during adolescence, and weight change from age 20 to 40. The associations of these lifestyle factors with myocardial infarction and stroke were evaluated. To account for the misclassification of exposures and disease diagnosis, a sensitivity analysis was conducted. RESULTS: Alcohol consumption was inversely associated with myocardial infarction (OR=0.63, 95% CI: 0.50, 0.80). Tea consumption was inversely associated with hemorrhagic (OR=0.63, 95% CI: 0.49, 0.81) and ischemic stroke (OR=0.77, 95% CI: 0.69, 0.85). Weight increase from age 20 to 40 was positively associated with myocardial infarction and stroke in a dose-response manner (trend p<0.001). CONCLUSIONS: Alcohol and tea consumption may decrease the prevalence of myocardial infarction and stroke, respectively. Weight increase from age 20 to 40 may increase the prevalence of myocardial infarction and stroke in Chinese men.

Diversity of risk factors for stroke: The putative roles and mechanisms of depression and air pollution

Several conventional risk factors for stroke and cerebrovascular disease, such as hypertension, smoking, and atrial fibrillation, are widely recognized. Correct management of these modifiable factors significantly reduces stroke risk. We review the research evidence that depressive symptoms and increased atmospheric pollution are associated with an increased risk of stroke, and outline putative mechanisms that may account for these associations. The data on depression and stroke risk strongly indicate the need for treatment intervention studies. The design and implementation of intervention studies related to air pollution requires better understanding of the pathophysiologic mechanisms linking exposures to the onset of stroke.

Neuroprotective potential of the Bahadori leanness program: A “mini-fast with exercise” strategy

The Bahadori Leanness Program (BLP) is a multi-step strategy for weight control, the most innovative feature of which is "mini-fast with exercise" - every 24h includes a fast of 12-14 h duration within which is nested a session of aerobic exercise. Low-fat, low-glycemic-index foods choices help to insure that diurnal levels of glucose and insulin remain relatively low. Clinical experience demonstrates that clients can achieve good compliance with this protocol, and the long term impact on body weight is gratifying. Rodent studies demonstrate that alternate-day feeding is even more effective than caloric restriction for promoting neuroprotection, suggesting that intermittent periods of mild metabolic stress induce protective adaptations in the brain; exercise training is also neuroprotective in these models. Mattson has raised the possibility that regular meal-skipping might be a feasible strategy for achieving similar - though perhaps less potent - protection in humans. Thus, it is suggested that exercise superimposed on regular short-term fasts, as in the BLP, might provide meaningful neuroprotection. Studies assessing CSF levels of brain neurotrophic hormones might be useful for evaluating the impact of such a strategy on brain neurochemistry. It should not be overlooked that leanness, good insulin sensitivity, and regular exercise are likely to be neuroprotective in their own right. The episodic metabolic stress associated with BLP may also have potential for prevention and therapy of cancer, inasmuch as down-regulation of systemic IGF-I activity during the mini-fasts would be expected to boost the rate of apoptosis in IGF-I-responsive neoplastic or pre-neoplastic tissues. Moreover, the relatively low-diurnal insulin levels and exercise training associated with BLP would be expected to down-regulate sympathetic activity while boosting cardiac parasympathetic tone - effects that should decrease risk for hypertension and sudden-death arrhythmias. Thus, it is conceivable that BLP will provide a range of health benefits extending beyond those attributable to its favorable impact on body composition.

Effect of submaximal exercise on horse homocysteinaemia: possible implications for immune cells

Physical exercise induces a reduction of immune defences and an imbalance of red-ox status. In this study plasma levels of cysteine and homocysteine (Hcy) were determined in horses before and after submaximal treadmill exercise as well as the effect on horse lymphocyte proliferation. The exercise induced a significant increase in plasma Hcy levels, which remained high both after the 20 min recovery period and after 2 h of rest. Moreover, a reduction of lymphocyte responsiveness to the proliferative stimulus induced by Concanavalin A was observed. The effects of different Hcy concentrations on the proliferative capacity of lymphocytes in culture were also tested. The results indicated that 10 microM of this amino acid can reduce the proliferative capacity of resting lymphocytes as well as their responsiveness to mitogen. Moreover, our results suggest that homocysteinaemia could be considered one of the parameters affected by physical exercise in horses and that this amino acid could be implicated in the effects of physical exercise on the immune system.

Alcoholic muscle disease and biomembrane perturbations (review)

Excessive alcohol ingestion is damaging and gives rise to a number of pathologies that influence nutritional status. Most organs of the body are affected such as the liver and gastrointestinal tract. However, skeletal muscle appears to be particularly susceptible, giving rise to the disease entity alcoholic myopathy. Alcoholic myopathy is far more common than overt liver disease such as cirrhosis or gastrointestinal tract pathologies. Alcohol myopathy is characterised by selective atrophy of Type II (anaerobic, white glycolic) muscle fibres: Type I (aerobic, red oxidative) muscle fibres are relatively protected. Affected patients have marked reductions in muscle mass and impaired muscle strength with subjective symptoms of cramps, myalgia and difficulty in gait. This affects 40-60% of chronic alcoholics (in contrast to cirrhosis, which only affects 15-20% of chronic alcohol misuers).Many, if not all, of these features of alcoholic myopathy can be reproduced in experimental animals, which are used to elucidate the pathological mechanisms responsible for the disease. However, membrane changes within these muscles are difficult to discern even under the normal light and electron microscope. Instead attention has focused on biochemical and other functional studies. In this review, we provide evidence from these models to show that alcohol-induced defects in the membrane occur, including the formation of acetaldehyde protein adducts and increases in sarcoplasmic-endoplasmic reticulum Ca(2+)-ATPase (protein and enzyme activity). Concomitant increases in cholesterol hydroperoxides and oxysterol also arise, possibly reflecting free radical-mediated damage to the membrane. Overall, changes within muscle membranes may reflect, contribute to, or initiate the disturbances in muscle function or reductions in muscle mass seen in alcoholic myopathy. Present evidence suggest that the changes in alcoholic muscle disease are not due to dietary deficiencies but rather the direct effect of ethanol or its ensuing metabolites.