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Wahbeh F, Restifo D, Laws S, Pawar A, Parikh NS. Impact of tobacco smoking on disease-specific outcomes in common neurological disorders: A scoping review. J Clin Neurosci 2024; 122:10-18. [PMID: 38428126 DOI: 10.1016/j.jocn.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 01/27/2024] [Accepted: 02/12/2024] [Indexed: 03/03/2024]
Abstract
Although the association of smoking with the risk of incident neurological disorders is well established, less is known about the impact of smoking and smoking cessation on outcomes of these conditions. The objective of this scoping review was to synthesize what is known about the impact of smoking and smoking cessation on disease-specific outcomes for seven common neurological disorders. We included 67 studies on the association of smoking and smoking cessation on disease-specific outcomes. For multiple sclerosis, smoking was associated with greater clinical and radiological disease progression, relapses, risk for disease-related death, cognitive decline, and mood symptoms, in addition to reduced treatment effectiveness. For stroke and transient ischemic attack, smoking was associated with greater rates of stroke recurrence, post-stroke cardiovascular outcomes, post-stroke mortality, post-stroke cognitive impairment, and functional impairment. In patients with cognitive impairment and dementia, smoking was associated with faster cognitive decline, and smoking was also associated with greater cognitive decline in Parkinson's disease, but not motor symptom worsening. Patients with amyotrophic lateral sclerosis who smoked faced increased mortality. Last, in patients with cluster headache, smoking was associated with more frequent and longer cluster attack periods. Conversely, for multiple sclerosis and stroke, smoking cessation was associated with improved disease-specific outcomes. In summary, whereas smoking is detrimentally associated with disease-specific outcomes in common neurological conditions, there is growing evidence that smoking cessation may improve outcomes. Effective smoking cessation interventions should be leveraged in the management of common neurological disorders to improve patient outcomes.
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Affiliation(s)
- Farah Wahbeh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Daniel Restifo
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Sa'ad Laws
- Education and Research, Health Sciences Library, Weill Cornell Medicine - Qatar, Doha, Qatar
| | - Anokhi Pawar
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, New York, NY, USA.
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2
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Wang L, Ge J, Chen Y, Liu Y, Li C, Dong Y, Liu L, Xing Y. Predictors for the prognosis and recurrence of ischaemic stroke among young Chinese patients: a cohort study. BMJ Open 2022; 12:e052289. [PMID: 35501080 PMCID: PMC9062810 DOI: 10.1136/bmjopen-2021-052289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To identify predictors of young Chinese patients with ischaemic stroke outcome and recurrence of stroke. DESIGN Through considered the risk factors, neuroimaging findings, distribution, vascular stenosis, and the post-stroke treatment of young Chinese patients with ischemic stroke. SETTING The First Hospital of Jilin University. PARTICIPANTS We enrolled 579 patients (median age 45 years, range 15-49, men 81.0%) treated for the first occurrence of ischaemic stroke between January 2014 and December 2017. MAIN OUTCOME MEASURES We assessed stroke outcome based on the modified Rankin Scale (mRS) scores and recurrence of cerebrovascular events at 12 months. Multivariate logistic regression was used to identify the independent predictors of unfavourable outcomes (mRS score ≥2) and recurrence. RESULTS We observed stenosis in 295 patients (50.9%)-middle cerebral artery stenosis was the most common (18.1%). Of all 579 included patients, normal or mild, moderate and severe stenoses or occlusions were observed in 51.8%, 6.0% and 42.1% of patients, respectively. Unfavourable outcomes were observed in 91 patients (15.7%), including 10 patients (1.7%) who died. The rate of stroke recurrence was 7.9%. Independent predictors of unfavourable outcomes included a high National Institutes of Health Stroke Scale score (OR 1.151, 95% CI 1.094 to 1.210; p<0.001) and severe vascular stenosis or occlusion (OR 1.867, 95% CI 1.181 to 2.952; p=0.008). Predictors of recurrence included age of ≥45 years (OR 2.072, 95% CI 1.066 to 4.025; p=0.032) and atrial fibrillation (OR 15.207, 95% CI 4.273 to 54.120; p<0.001). CONCLUSIONS Our research shows that when developing prevention strategies for young people, measures that focus on mitigating risk factors should be considered. In addition, vascular screening of young populations is also of vital importance for stroke prevention and poor prognosis prediction.
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Affiliation(s)
- Lijuan Wang
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Jiaojiao Ge
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ying Chen
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Ying Liu
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Cong Li
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Yanan Dong
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Li Liu
- Department of Neurology, The First Hospital of Jilin University, Changchun, Jilin, China
- Department of Neurology, Changchun People's Hospital, Changchun, Jilin, China
| | - Yingqi Xing
- Department of Vascular Ultrasonography, Xuanwu Hospital Capital Medical University, Beijing, China
- Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
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3
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Del Brutto VJ, Rundek T, Sacco RL. Prognosis After Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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4
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Reinert NJ, Patel BM, Shaer QN, Wu L, Wisniewski S, Hager ES, Dyer MR, Thirumala PD. Cause-Specific Mortality as a Sequalae of Perioperative Stroke Following Cardiac and Vascular Surgery. Neurologist 2021; 27:21-26. [PMID: 34855676 PMCID: PMC8727499 DOI: 10.1097/nrl.0000000000000384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a paucity of data regarding cause-specific mortality following a perioperative stroke. In this study, we aim to establish the risk of cause-specific mortality associated with perioperative stroke following cardiac and vascular procedures at 30 days, 90 days, and 1-year postoperative. It is hoped that this fund of knowledge will enhance perioperative risk stratification and medical management for patients who have suffered a perioperative stroke. METHODS This is a retrospective cohort study evaluating 277,654 cardiac and vascular surgical patients dually documented within the Inpatient Discharge Claims Database and the Pennsylvania Department of Health Death Statistics database. A univariate assessment followed by a multivariate logistic regression analysis was used to determine the odds of cerebrovascular, cardiovascular, pulmonary, malignancy, infectious, and dementia causes of mortality following perioperative stroke. RESULTS Perioperative stroke significantly increased the odds of overall mortality (P<0.0001) as well as cause-specific mortality in all categories (P<0.05) except dementia (P=0.8907) at all-time endpoints. Cerebrovascular-related mortality was most impacted by perioperative stroke [adjusted odds ratio: 34.5 (29.1, 40.9), P<0.0001 at 30 d]. CONCLUSIONS Perioperative stroke in the cardiac and vascular surgical population is associated with increased odds of overall, cerebrovascular, cardiovascular, pulmonary, malignancy, and infectious causes of mortality at 30 days, 90 days, and 1-year postoperatively when compared with patients who did not experience a perioperative stroke.
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Affiliation(s)
- Nathan J. Reinert
- University of Pittsburgh Department of Neurology
- University of Pittsburgh Department of Neurosurgery
| | - Bansri M. Patel
- University of Pittsburgh Department of Neurology
- University of Pittsburgh Department of Neurosurgery
| | | | - Liwen Wu
- University of Pittsburgh Department of Biostatistics
| | | | - Eric S. Hager
- University of Pittsburgh Department of Vascular Surgery
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Wabnitz AM, Chandler J, Treiber F, Sen S, Jenkins C, Newman JC, Mueller M, Tinker A, Flynn A, Tagge R, Ovbiagele B. Program to Avoid Cerebrovascular Events through Systematic Electronic Tracking and Tailoring of an Eminent Risk factor: Protocol of a RCT. J Stroke Cerebrovasc Dis 2021; 30:105815. [PMID: 34052785 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105815] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/31/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Geographical and racial disparities in stroke outcomes are especially prominent in the Southeastern United States, which represents a region more heavily burdened with stroke compared to the rest of the country. While stroke is eminently preventable, particularly via blood pressure control, fewer than one third of patients with a stroke have their blood pressure controlled ≥ 75% of the time, and low consistency of blood pressure control is linked to higher stroke risk. OBJECTIVE To demonstrate that a mHealth technology-centered, integrated approach can effectively improve sustained blood pressure control among stroke patients (half of whom will be Black). DESIGN The Program to Avoid Cerebrovascular Events through Systematic Electronic Tracking and Tailoring of an Eminent Risk-factor is a prospective randomized controlled trial, which will include a cohort of 200 patients with a stroke, encountered at two major safety net health care systems in South Carolina. The intervention comprises utilization of a Vaica electronic pill tray & blue-toothed UA-767Plus BT blood pressure device and a dedicated app installed on patients' smart phones for automatic relay of data to a central server. Providers will follow care protocols based on expert consensus practice guidelines to address optimal blood pressure management. STUDY OUTCOMES Primary outcome is systolic blood pressure at 12-months, which is the major modifiable step to stroke event rate reduction. Secondary endpoints include control of other stroke risk factors, medication adherence, functional status, and quality of life. DISCUSSION We anticipate that a successful intervention will serve as a scalable model of effective chronic blood pressure management after stroke, to bridge racial and geographic disparities in stroke outcomes in the United States. TRIAL REGISTRATION ClinicalTrials.gov - NCT03401489.
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Affiliation(s)
- Ashley M Wabnitz
- College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Jessica Chandler
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States.
| | - Frank Treiber
- College of Medicine, Medical University of South Carolina, Charleston, SC, United States; College of Nursing, Medical University of South Carolina, Charleston, SC, United States.
| | - Souvik Sen
- College of Medicine, University of South Carolina School of Medicine, Columbia, SC, United States.
| | - Carolyn Jenkins
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States.
| | - Jill C Newman
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States.
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States.
| | - Ariana Tinker
- College of Medicine, Medical University of South Carolina, Charleston, SC, United States.
| | - Amelia Flynn
- College of Medicine, University of South Carolina School of Medicine, Columbia, SC, United States.
| | - Raelle Tagge
- Northern California Institute of Research and Education, United States.
| | - Bruce Ovbiagele
- Department of Neurology, University of California, San Francisco, CA, United States.
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Phan HT, Gall S, Blizzard CL, Lannin NA, Thrift AG, Anderson CS, Kim J, Grimley R, Castley HC, Kilkenny MF, Cadilhac DA. Sex Differences in Causes of Death After Stroke: Evidence from a National, Prospective Registry. J Womens Health (Larchmt) 2021; 30:314-323. [DOI: 10.1089/jwh.2020.8391] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hoang T. Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
- Department of Public Health Management, Pham Ngoc Thach University of Medicine, Hồ Chí Minh, Vietnam
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Seana Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | | | - Natasha A. Lannin
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
| | - Amanda G. Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
| | - Craig S. Anderson
- Faculty of Medicine, The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Joosup Kim
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Rohan Grimley
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Sunshine Coast Clinical School, University of Queensland, Birtinya, Australia
| | | | - Monique F. Kilkenny
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
| | - Dominique A. Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
- Stroke Theme, The Florey Institute of Neuroscience and Mental Health, Heidelberg, Victoria, Australia
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7
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Norouzi S, Jafarabadi MA, Shamshirgaran SM, Farzipoor F, Fallah R. Modeling Survival in Patients With Brain Stroke in the Presence of Competing Risks. J Prev Med Public Health 2021; 54:55-62. [PMID: 33618500 PMCID: PMC7939750 DOI: 10.3961/jpmph.20.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives After heart disease, brain stroke (BS) is the second most common cause of death worldwide, underscoring the importance of understanding preventable and treatable risk factors for the outcomes of BS. This study aimed to model the survival of patients with BS in the presence of competing risks. Methods This longitudinal study was conducted on 332 patients with a definitive diagnosis of BS. Demographic characteristics and risk factors were collected by a validated checklist. Patients’ mortality status was investigated by telephone follow-up to identify deaths that may be have been caused by stroke or other factors (heart disease, diabetes, high cholesterol, etc.). Data were analyzed by the Lunn-McNeil approach at alpha=0.1. Results Older age at diagnosis (59–68 years: adjusted hazard ratio [aHR], 2.19; 90% confidence interval [CI], 1.38 to 3.48; 69–75 years: aHR, 5.04; 90% CI, 3.25 to 7.80; ≥76 years: aHR, 5.30; 90% CI, 3.40 to 8.44), having heart disease (aHR, 1.65; 90% CI, 1.23 to 2.23), oral contraceptive pill use (women only) (aHR, 0.44; 90% CI, 0.24 to 0.78) and ischemic stroke (aHR, 0.52; 90% CI, 0.36 to 0.74) were directly related to death from BS. Older age at diagnosis (59–68 years: aHR, 21.42; 90% CI, 3.52 to 130.39; 75–69 years: aHR, 16.48; 90% CI, 2.75 to 98.69; ≥76 years: aHR, 26.03; 90% CI, 4.06 to 166.93) and rural residence (aHR, 2.30; 90% CI, 1.15 to 4.60) were directly related to death from other causes. Significant risk factors were found for both causes of death. Conclusions BS-specific and non-BS-specific mortality had different risk factors. These findings could be utilized to prescribe optimal and specific treatment.
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Affiliation(s)
- Solmaz Norouzi
- Department of Statistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology and Road Traffic Injury Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Morteza Shamshirgaran
- Department of Statistics and Epidemiology, Faculty of Health Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Farshid Farzipoor
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ramazan Fallah
- Department of Statistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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8
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Chen CM, Lee M, Yang YH, Huang SS, Lin CH. Association between Clinical and Laboratory Markers and 5-year Mortality among Patients with Stroke. Sci Rep 2019; 9:11521. [PMID: 31395912 PMCID: PMC6687732 DOI: 10.1038/s41598-019-47975-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 07/16/2019] [Indexed: 12/16/2022] Open
Abstract
Factors influencing long-term stroke mortality have not been comprehensively investigated. This study aimed to identify the baseline clinical, laboratory, demographic/socioeconomic, and hospital factors influencing 5-year mortality in patients with first stroke. Total 3,956 patients with first-stroke hospitalization from 2004 to 2008 were connected to the longitudinal National Health Insurance Research Database. Post-admission baseline data that significantly increased 5-year mortality were red cell distribution width (RDW) >0.145 (adjusted hazard ratio [aHR] = 1.71), hemoglobin <120 g/L (aHR = 1.25), blood sugar <3.89 mmol/L (70 mg/dL)(aHR = 2.57), serum creatinine >112.27 μmol/L (aHR = 1.76), serum sodium <134 mmol/L (aHR = 1.73), body mass index (BMI) < 18.5 kg/m2 (aHR = 1.33), Glasgow Coma Scale <15 (aHR = 1.43), Stroke Severity Index ≥20 (aHR = 3.92), Charlson–Deyo Comorbidity Index ≥3 (aHR = 4.21), no rehabilitation (aHR = 1.86), and age ≥65 years (aHR = 2.25). Hemoglobin, RDW, blood sugar, serum creatinine and sodium, BMI, consciousness, stroke severity, comorbidity, rehabilitation, and age were associated with 5-year mortality in patients with first stroke.
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Affiliation(s)
- Chien-Min Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan. .,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Meng Lee
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Neurology, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Shih-Shin Huang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chu-Hsu Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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9
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Liu CH, Lin JR, Liou CW, Lee JD, Peng TI, Lee M, Lee TH. Causes of Death in Different Subtypes of Ischemic and Hemorrhagic Stroke. Angiology 2017; 69:582-590. [DOI: 10.1177/0003319717738687] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Causes of death in both ischemic stroke (IS) and hemorrhagic stroke (HS) subtypes are not comprehensively studied. Between 2008 and 2011, we enrolled 11 215 first-ever stroke patients from the Stroke Registry of Chang-Gung Healthcare System and linked these data to the national death registry. The main causes of death in each stroke subtype were assessed. Patients with HS had higher overall mortality than IS (32.0% vs 18.1%, P < .001). In IS subtypes, large-artery atherosclerosis plus cardioembolism had the worst mortality (40.7%, P < .001). Stroke was the leading cause of death in both IS and HS within the first year. Stroke remained the major cause of death in HS, but cancer was the leading cause of death in IS after the first year. After excluding the patients with previous cancer history, cancer was still an important cause of death in IS and HS, particularly in the IS subtypes of small vessel occlusion, stroke of undetermined etiology, and transient ischemic attack.
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Affiliation(s)
- Chi-Hung Liu
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Chia-Wei Liou
- Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Jiann-Der Lee
- Department of Neurology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tsung-I Peng
- Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Meng Lee
- Department of Neurology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Tsong-Hai Lee
- Stroke Center and Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and College of Medicine, Chang Gung University, Taoyuan, Taiwan
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10
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Yuan MZ, Li F, Fang Q, Wang W, Peng JJ, Qin DY, Wang XF, Liu GW. Research on the cause of death for severe stroke patients. J Clin Nurs 2017; 27:450-460. [PMID: 28677276 DOI: 10.1111/jocn.13954] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore the characteristics of mortality among severe stroke patients, analyse their causes of death and provide evidence for improving the survival rate of stroke patients. BACKGROUND Stroke is an important fatal and disabling disease that poses a large burden on its patients, and its high death rates have caused substantial concern to the World Health Organization. DESIGN A retrospective case-control study. METHODS A total of 188 patients who died of stroke in the neurological intensive care unit of the First Affiliated Hospital of Chongqing Medical University from January 2012-December 2015 were selected as cases. Additionally, 188 stroke survivors from the same neurological intensive care unit were randomly selected as paired cases. The clinical characteristics of the severe stroke patient deaths were analysed, and a univariate analysis was conducted to determine potential mortality risk factors. A logistic regression analysis was then conducted to determine the independent risk factors of mortality. RESULTS We investigated a total of 231 cases of death in neurological intensive care unit patients, 188 of whom died of stroke. Therefore, the death rate from stroke accounted for 81.3% of the total population, with ischaemic, haemorrhagic and mixed strokes accounting for 47.19%, 26.84% and 7.36% of the patients, respectively. The leading cause of death was central nervous system-related causes (central respiratory and circulatory failure, brain herniation), followed by multisystemic causes. The independent risk factors of death among the neurological intensive care unit patients were as follows: brain herniation (OR = 18.15), multiple organ failure (OR = 13.12), dyslipidemia (OR = 4.64), community-acquired lung infection (OR = 4.15), use of mechanical ventilation (OR = 3.37), hypoproteinemia (OR = 2.29), history of hypertension (OR = 2.03) and hospital-acquired pneumonia (OR = 1.75). CONCLUSIONS The most common cause of death in stroke patients was damage to the central nervous system. Independent risk factors were brain herniation, multiple organ failure, dyslipidemia, community-acquired lung infection, the use of mechanical ventilation, hypoproteinemia, a history of hypertension and hospital-acquired pneumonia. Clinicians should be aware of the presence and possible effects of these conditions. Early prevention, monitoring and intervention to modify controllable risk factors will improve patient prognosis. RELEVANCE TO CLINICAL PRACTICE Clinicians should be aware of the multiple independent risk factors of death and implement timely treatment measures to reduce the incidence of death in severe stroke patients.
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Affiliation(s)
- Mei-Zhen Yuan
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Feng Li
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Qin Fang
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Wei Wang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Jing-Jing Peng
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - De-Yu Qin
- The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Xue-Feng Wang
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
| | - Guang-Wei Liu
- Department of Neurology, The First Affiliated Hospital, Chongqing Medical University, Chongqing, China
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11
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Ingeman A, Andersen G, Thomsen RW, Hundborg HH, Rasmussen HH, Johnsen SP. Lifestyle Factors and Early Clinical Outcome in Patients With Acute Stroke. Stroke 2017; 48:611-617. [DOI: 10.1161/strokeaha.116.015784] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 11/02/2016] [Accepted: 12/05/2016] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
We examined the associations of individual and combined lifestyle factors with early adverse stroke outcomes.
Methods—
A total of 82 597 patients were identified from nationwide registries. Lifestyle factors at the time of stroke admission included body mass index (kg/m
2
), smoking habits, and alcohol intake, which were grouped (healthy, moderately healthy, moderately unhealthy, and unhealthy). The associations between lifestyle and outcomes were examined using multivariable regression.
Results—
A total of 18.3% had a severe stroke, 7.8% pneumonia, 12.5% urinary tract infection, and 9.9% died within 30 days. The association between lifestyle, stroke severity, and mortality, respectively, differed according to sex. Unhealthy lifestyle was associated with lower risk of severe stroke (adjusted odds ratio [OR], 0.73; 95% confidence interval [CI], 0.63–0.84) and 30-day mortality among men (adjusted OR, 0.71; 95% CI, 0.58–0.87), but not among women (severe stroke: adjusted OR, 1.14; 95% CI, 0.85–1.55, and mortality: adjusted OR, 1.34; 95% CI, 0.90–1.99). No sex differences were found for pneumonia and urinary tract infection. Unhealthy lifestyle was not associated with a statistically significant increased risk of developing in-hospital pneumonia (adjusted OR, 1.30; 95% CI, 0.98–1.73) or urinary tract infection (adjusted OR, 0.98; 95% CI, 0.72–1.33). Underweight was associated with a higher 30-day mortality (men: adjusted OR, 1.71; 95% CI, 1.50–1.96, and women: adjusted OR, 1.46; 95% CI, 1.34–1.60).
Conclusions—
Healthy lifestyle was not associated with a lower risk of adverse stroke outcomes, in particularly among men. However, underweight may be a particular concern being associated with an increased risk of adverse outcomes among both sexes.
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Affiliation(s)
- Annette Ingeman
- From the Department of Clinical Epidemiology (A.I., R.W.T., H.H.H., S.P.J.) and Department of Neurology (G.A.), Aarhus University Hospital, Denmark; and Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Denmark (H.H.R.)
| | - Grethe Andersen
- From the Department of Clinical Epidemiology (A.I., R.W.T., H.H.H., S.P.J.) and Department of Neurology (G.A.), Aarhus University Hospital, Denmark; and Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Denmark (H.H.R.)
| | - Reimar W. Thomsen
- From the Department of Clinical Epidemiology (A.I., R.W.T., H.H.H., S.P.J.) and Department of Neurology (G.A.), Aarhus University Hospital, Denmark; and Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Denmark (H.H.R.)
| | - Heidi H. Hundborg
- From the Department of Clinical Epidemiology (A.I., R.W.T., H.H.H., S.P.J.) and Department of Neurology (G.A.), Aarhus University Hospital, Denmark; and Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Denmark (H.H.R.)
| | - Henrik H. Rasmussen
- From the Department of Clinical Epidemiology (A.I., R.W.T., H.H.H., S.P.J.) and Department of Neurology (G.A.), Aarhus University Hospital, Denmark; and Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Denmark (H.H.R.)
| | - Søren P. Johnsen
- From the Department of Clinical Epidemiology (A.I., R.W.T., H.H.H., S.P.J.) and Department of Neurology (G.A.), Aarhus University Hospital, Denmark; and Centre for Nutrition and Bowel Disease, Aalborg University Hospital, Denmark (H.H.R.)
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Stefanovic Budimkic M, Pekmezovic T, Beslac-Bumbasirevic L, Ercegovac M, Berisavac I, Stanarcevic P, Padjen V, Jovanović DR. Long-Term Prognosis in Ischemic Stroke Patients Treated with Intravenous Thrombolytic Therapy. J Stroke Cerebrovasc Dis 2016; 26:196-203. [PMID: 28341074 DOI: 10.1016/j.jstrokecerebrovasdis.2016.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 08/30/2016] [Accepted: 09/12/2016] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND AND PURPOSE It remains unclear if intravenous thrombolysis (IVT) with recombinant tissue plasminogen activator has an impact on the survival and maintenance of a favorable effect on functional recovery over a long follow-up period. The aim of this study was to assess whether or not IVT treatment has a favorable effect on functional recovery and survival less than 1 year after a stroke. METHODS This matched cohort study included 259 patients with acute ischemic stroke (IS) who were treated with IVT and standard care and 259 patients treated with standard care alone in the stroke unit between February 2006 and January 2013. RESULTS After a median follow-up period of 3 years (range, 1-7 years), survival did not differ significantly between the groups; specifically, 56 patients (21.6%) in the thrombolysed group died versus 62 patients (23.94%) in the nonthrombolysed group (log-rank, .240, P = .624). Based on a multivariate Cox proportional hazards regression model, older age (>70 years), stroke severity (National Institutes of Health Stroke Scale score ≥ 15), diabetes mellitus, and a history of atrial fibrillation were independent predictors of long-term mortality after stroke. After the follow-up period, 144 patients (55.6%) in the IVT-treated group versus 112 patients (43.2%) in the control group had an excellent outcome, with a modified Rankin Scale score of 0-1 (hazard ratio [HR] = 1.64, 95% confidence interval [CI] = 1.16-2.32). Based on a multivariate Cox proportional hazards regression model, an excellent 3-month functional recovery was a strong predictor of favorable outcome (HR = 11.27, 95% CI = 6.45-19.63). CONCLUSION The results suggest that IVT for acute IS has a favorable effect on functional recovery more than 1 year after stroke.
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Affiliation(s)
| | - Tatjana Pekmezovic
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty University of Belgrade, Belgrade, Serbia; Institute of Epidemiology, Belgrade, Serbia
| | - Ljiljana Beslac-Bumbasirevic
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty University of Belgrade, Belgrade, Serbia
| | - Marko Ercegovac
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty University of Belgrade, Belgrade, Serbia
| | - Ivana Berisavac
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty University of Belgrade, Belgrade, Serbia
| | | | - Visnja Padjen
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - Dejana R Jovanović
- Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia; Medical Faculty University of Belgrade, Belgrade, Serbia.
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Shoeibi A, Salehi M, Thrift AG, Kapral MK, Farzadfard MT, Azarpazhooh A, Layegh P, Hashemi P, Amiri A, Mokhber N, Hassankhani B, Azarpazhooh MR. One-year case fatality rate following stroke in the Mashhad Stroke Incidence Study: a population-based study of stroke in Iran. Int J Stroke 2015; 10 Suppl A100:96-102. [DOI: 10.1111/ijs.12611] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 04/28/2015] [Indexed: 11/29/2022]
Abstract
Background In developing countries, there are few comprehensive studies of mortality following stroke. Aims and/or hypothesis We aimed to determine the one-year case fatality rate following stroke and to identify factors associated with death in a population-based stroke incidence study in Iran. Methods Six hundred eighty-four patients who had suffered a stroke between November 21, 2006, and November 20, 2007, and were recruited to the Mashhad Stroke Incidence Study were followed up at one-year. Most patients were seen in an outpatient visit. When patients had died, a verbal autopsy was conducted by telephone with the next of kin. Results A total of 226 (34.3%) patients died during the first year following stroke. The cumulative one-year case fatality rate was 30.6% following ischemic stroke and 53.0% following hemorrhagic stroke (55.8% after intracerebral hemorrhage and 35.7% after subarachnoid hemorrhage). The majority of these deaths occurred in the first 28 days after stroke (17.7% with ischemic and 43.0% with hemorrhagic stroke). Factors associated with greater mortality at one-year (excluding those who died during the first week) were hemorrhagic stroke [hazard ratio (HR) 3.99; 95% confidence interval 1.90-8.37], age (HR 1.05; 95% confidence interval 1.03-1.08), previous transient ischemic attack (HR 2.45; 95% confidence interval 1.00-5.99), and National Institutes of Health Stroke Scale on admission (HR 1.14; 95% confidence interval 1.10-1.17). Conclusion Despite the younger age of stroke occurrence in Iran, the one-year case fatality rate following stroke is similar to that reported in developed countries.
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Affiliation(s)
- Ali Shoeibi
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Salehi
- Departments of Community Medicine, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amanda G. Thrift
- Stroke and Ageing Research, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Stroke Division, the Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia
| | - Moira K. Kapral
- Medicine and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences and Toronto General Research Institute, Toronto, Canada
| | | | - Amir Azarpazhooh
- Faculty of Dentistry and Institute of Health Policy, Management and Evaluation, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Parvaneh Layegh
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Peyman Hashemi
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amin Amiri
- Department of Neurology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Naghmeh Mokhber
- School of Medicine, Department of the Elderly, Ave Sina Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
- Psychiatry and Behavioural Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Bahare Hassankhani
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahmoud Reza Azarpazhooh
- School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- London Health Science Center, London, Ontario, Canada
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Stroke patients after neurological inpatient rehabilitation: a prospective study to determine whether functional status or health-related quality of life predict living at home 2.5 years after discharge. Int J Rehabil Res 2015; 37:212-9. [PMID: 24681770 DOI: 10.1097/mrr.0000000000000060] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We carried out a prospective study to determine whether stroke patients' functional status or health-related quality of life would predict whether they lived at home 2.5 years after discharge from neurological inpatient rehabilitation. We carried out a single-center prospective cohort study. The outcome 'home care' versus 'death' or 'institutionalization' (nursing home admission) was evaluated 30 months after discharge. A total of 204 stroke survivors with remaining moderate to severe functional deficits at admission to neurological inpatient rehabilitation were included. Clinical data were obtained at admission to and/or discharge from inpatient rehabilitation. Functional status was determined using the Barthel Index; health-related quality of life was assessed using the SF-36 and EQ-5D. The outcome was assessed by telephone interview. Predictors of living at home were calculated using binary logistic regression analysis. In total, 30 months after discharge, 75% of the stroke survivors were still living at home. Multivariate analysis showed that patients continued to live at home significantly more frequently when they had fewer mortality-relevant comorbidities (P=0.001), a higher BMI (P=0.040), a higher increase in functional independence during inpatient rehabilitation (P=0.017), and above all, a better health-related quality of life, measured using the EQ-5D (P<0.001), at discharge. Stroke survivors' health-related quality of life measured with the EQ-5D and the change in functional status during multimodal neurological rehabilitation appear to be the strongest clinically relevant long-term predictors of staying at home.
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Doğan NÖ, Akıncı E, Gümüş H, Akıllı NB, Aksel G. Predictors of Inhospital Mortality in Geriatric Patients Presenting to the Emergency Department With Ischemic Stroke. Clin Appl Thromb Hemost 2014; 22:280-4. [PMID: 25228671 DOI: 10.1177/1076029614550820] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
AIM To determine the most important predictors of inhospital mortality that could be assessed in geriatric patients presenting with ischemic stroke at admission to the emergency department(ED). METHODS A retrospective cohort study was carried out in geriatric patients with ischemic stroke who were diagnosed in the ED. The primary outcome measure was determined as all-cause inhospital mortality after 30 days of ischemic cerebrovascular event. RESULTS During the study period, 247 (35.7%) patients died in the hospital and 445 (64.3%) patients survived the 30-day period. The median age of the patients was 78 (72-83). Higher National Institutes of Health Stroke Scale (NIHSS) scores (odds ratio [OR]: 2.085; 95% confidence interval [CI]: 1.835-2.370), increased creatinine levels (OR: 2.002; 95% CI: 1.235-3.243), increased platelet levels (OR:1.006; 95% CI: 1.002-1.010), and hyperglycemia (OR: 2.610; 95% CI: 1.023-6.660) were found as independent predictors of inhospital mortality. CONCLUSION In evaluating geriatric patients with ischemic stroke, laboratory values including platelet count, creatinine levels, hyperglycemia, and NIHSS scores should be considered to predict inhospital mortality in the ED.
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Affiliation(s)
| | - Emine Akıncı
- Department of Emergency Medicine, Keçiören Training and Research Hospital, Ankara, Turkey
| | - Haluk Gümüş
- Department of Neurology, Konya Training and Research Hospital, Konya, Turkey
| | - Nazire Belgin Akıllı
- Department of Emergency Medicine, Konya Training and Research Hospital, Konya, Turkey
| | - Gökhan Aksel
- Department of Emergency Medicine, Ümraniye Training and Research Hospital, İstanbul, Turkey
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Rantakömi SH, Kurl S, Sivenius J, Kauhanen J, Laukkanen JA. The frequency of alcohol consumption is associated with the stroke mortality. Acta Neurol Scand 2014; 130:118-24. [PMID: 24606050 DOI: 10.1111/ane.12243] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the association between the frequency of alcohol consumption and stroke mortality among eastern Finnish men. MATERIAL AND METHODS This study is a population-based sample of men with an average follow-up of 20.2 years. A total of 2609 men with no history of stroke at baseline participated in the study. During the follow-up, 66 deaths from stroke occurred. RESULTS After adjustment for systolic blood pressure, smoking, BMI, diabetes, and socioeconomic status, the relative risk (RR) among men who consumed alcohol <0.5 times per week was 0.70 (95% CI, 0.30-1.66; P = 0.419) compared with nondrinkers. Respective RR was 1.08 (95% CI, 0.51-2.27; P = 0.846) for men with alcohol consumption of 0.5-2.5 times per week and 2.44 (95% CI, 1.11-5.40; P = 0.027) for men who consumed alcohol >2.5 times per week after adjustment for risk factors. When the total amount of alcohol consumption (g/week) was taken into account with other covariates, RR was 0.71 (95% CI, 0.30-1.68; P = 0.437) for men with alcohol consumption <0.5 times per week and 1.16 (95% CI, 0.54-2.50; P = 0.704) among men who consumed alcohol 0.5-2.5 times per week. Among men who consumed alcohol >2.5 times per week compared with nondrinkers, RR was 3.03 (95% CI, 1.19-7.72; P = 0.020). CONCLUSIONS This study shows a strong association between the frequency of alcohol consumption and stroke mortality, independent of total amount of alcohol consumption. The risk of stroke death was the highest among men who consumed alcohol >2.5 times per week.
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Affiliation(s)
- S. H. Rantakömi
- Institute of Public Health and Clinical Nutrition; University of Eastern Finland; Kuopio Finland
| | - S. Kurl
- Institute of Public Health and Clinical Nutrition; University of Eastern Finland; Kuopio Finland
| | - J. Sivenius
- Department of Neurology; University Hospital of Kuopio and Brain Research and Rehabilitation Centre Neuron; Kuopio Finland
| | - J. Kauhanen
- Institute of Public Health and Clinical Nutrition; University of Eastern Finland; Kuopio Finland
| | - J. A. Laukkanen
- Institute of Public Health and Clinical Nutrition; University of Eastern Finland; Kuopio Finland
- Department of Internal Medicine; Lapland Central Hospital; Rovaniemi Finland
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Chen X, Zhou L, Zhang Y, Yi D, Liu L, Rao W, Wu Y, Ma D, Liu X, Zhou XHA, Lin H, Cheng D, Yi D. Risk factors of stroke in Western and Asian countries: a systematic review and meta-analysis of prospective cohort studies. BMC Public Health 2014; 14:776. [PMID: 25081994 PMCID: PMC4246444 DOI: 10.1186/1471-2458-14-776] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 07/03/2014] [Indexed: 01/11/2023] Open
Abstract
Background There has been an increasing trend in the incidence of stroke worldwide in recent years, and the number of studies focusing on the risk factors for stroke has also increased every year. To comprehensively evaluate the risk factors of stroke identified in prospective Western and Asian cohort studies. Methods Population-based cohort studies on stroke were searched in databases (PubMed, EMBASE, Web of Science, Google Scholar, etc.), and the library of the Third Military Medical University was manually searched for relevant information. A meta-analysis of Western and Asian studies on risk factors was performed. The pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated to assess the final group of cohort studies. Results After screening, 22 prospective cohort studies were included in the analyses of this investigation. Two factors, smoking and alcohol consumption, showed statistically significant differences between Western and Asian populations, and the results were as follows (W/A): 2.05 (95% CI, 1.68 ~ 2.49)/1.27 (95% CI, 1.04 ~ 1.55) and 0.89 (95% CI, 0.76 ~ 1.04)/1.28 (95% CI, 1.07 ~ 1.53). The factor BMI = 18.5-21.9 kg/m2 showed statistically significant differences only in Western populations, 0.96 (95% CI, 0.93 ~ 0.99); the factor SBP = 120-139 mm Hg showed statistically significant differences only in Asian populations, 2.29 (95% CI, 1.04 ~ 5.09). Conclusions The prevalences of risk factors affect the stroke morbidity in Western and Asian populations, which may be biased by race. The meta-analysis of population-based studies suggests that different preventive measures should be adopted for Western and Asian population groups that are at high risk for stroke. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-776) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Dong Yi
- Department of Health Statistics, College of Preventive Medicine, Third Military Medical University, PO Box 400038, Chongqing, China.
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Martínez-Pérez B, de la Torre-Díez I, López-Coronado M, Sainz-De-Abajo B. Comparison of mobile apps for the leading causes of death among different income zones: a review of the literature and app stores. JMIR Mhealth Uhealth 2014; 2:e1. [PMID: 25099695 PMCID: PMC4114467 DOI: 10.2196/mhealth.2779] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/07/2013] [Accepted: 12/03/2013] [Indexed: 12/11/2022] Open
Abstract
Background The advances achieved in technology, medicine, and communications in the past decades have created an excellent scenario for the improvement and expansion of eHeath and mHealth in particular. Mobile phones, smartphones, and tablets are exceptional means for the application of mobile health, especially for those diseases and health conditions that are the deadliest worldwide. Objective The main aim of this paper was to compare the amount of research and the number of mobile apps dedicated to the diseases and conditions that are the leading causes of death according to the World Health Organization grouped by different income regions. These diseases and conditions were ischemic heart disease; stroke and other cerebrovascular diseases; lower respiratory infections; chronic obstructive pulmonary disease; diarrheal diseases; HIV/AIDS; trachea, bronchus, and lung cancers; malaria; and Alzheimer disease and other dementias. Methods Two reviews were conducted. In the first, the systems IEEE Xplore, Scopus, Web of Knowledge, and PubMed were used to perform a literature review of applications related to the mentioned diseases. The second was developed in the currently most important mobile phone apps stores: Google play, iTunes, BlackBerry World, and Windows Phone Apps+Games. Results Search queries up to June 2013 located 371 papers and 557 apps related to the leading causes of death, and the following findings were obtained. Alzheimer disease and other dementias are included in the diseases with more apps, although it is not among the top 10 causes of death worldwide, whereas lower respiratory infections, the third leading cause of death, is one of the less researched and with fewer apps. Two diseases that are the first and second of low-income countries (lower respiratory infections and diarrheal diseases) have very little research and few commercial applications. HIV/AIDS, in the top 6 of low-income and middle-income zones, is one of the diseases with more research and applications, although it is not in the top 10 in high-income countries. Trachea, bronchus, and lung cancers are the third cause of death in high-income countries but are one of the least researched diseases with regard to apps. Conclusions Concerning mobile apps, there is more work done in the commercial field than in the research field, although the distribution among the diseases is similar in both fields. In general, apps for common diseases of low- and middle-income countries are not as abundant as those for typical diseases of developed countries. Nevertheless, there are some exceptions such as HIV/AIDS, due to its important social conscience; and trachea, bronchus and lung cancers, which was totally unexpected.
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Affiliation(s)
- Borja Martínez-Pérez
- University of Valladolid, Department of Signal Theory and Communications, and Telematics Engineering, University of Valladolid, Valladolid, Spain.
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Gnonlonfoun DD, Adjien C, Ossou-Nguiet PM, Avlessi I, Goudjinou G, Houannou O, Acakpo J, Houinato D, Avode GD. Stroke: Medium and long-term mortality and associated factors in French-speaking West Africa, case of Benin. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/wjns.2014.41008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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The incidence and relative risk of stroke among patients with bipolar disorder: a seven-year follow-up study. PLoS One 2013; 8:e73037. [PMID: 24023667 PMCID: PMC3758282 DOI: 10.1371/journal.pone.0073037] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 07/16/2013] [Indexed: 11/19/2022] Open
Abstract
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.
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Markaki I, Franzén I, Talani C, Loizou L, Kostulas N. Long-term survival of ischemic cerebrovascular disease in the acute inflammatory stroke study, a hospital-based cohort described by TOAST and ASCO. Cerebrovasc Dis 2013; 35:213-9. [PMID: 23466736 DOI: 10.1159/000346094] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 11/22/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Ischemic cerebrovascular disease (ICVD) comprises multiple etiological phenotypes that share common clinical characteristics. Etiological classification of patients with ICVD is of major clinical interest to achieve optimal medical treatment and predict prognosis. The TOAST classification system has been widely used to describe stroke etiology but provides restricted phenotypic homogeneity within groups. The ASCO classification system has introduced a new approach in phenotypic classification, and aims to describe clinical characteristics without merging concurrent comorbidities. Inflammatory processes have been suggested to mediate stroke etiology and pathology. The Acute Inflammatory Stroke Study (AISS), a hospital-based cohort, is here introduced and described by TOAST and ASCO classification systems. The aim of this first analysis of AISS was to investigate long-term mortality in relation to ischemic stroke subtypes, and clinical and biochemical markers. METHODS AISS consecutively follows patients on 6 occasions up to 1 year after stroke onset. Complete workup according to ASCO comprised CT or MRI of the head, ECG, duplex of the extracranial arteries or CT/MR angiography and ultrasound of the heart. Level 2 evidence was required in each domain to obtain a comparable system to TOAST (ASCO2). Clinical and biochemical characteristics and mortality rates were documented and compared by the two classification systems. RESULTS Of 142 patients consecutively evaluated and recruited in the study, a total of 101 ICVD patients (ischemic stroke, n = 84; transient ischemic attack, n = 17) were included in the final analysis. Agreement between ASCO2 and TOAST was very good. During the mean observation period of 28 months, 26 patients died. The 1- and 4-year mortality rates were 0 and 4% for large artery atherosclerosis (LAA); 23 and 36% for cardioembolism (CE); 0% for small artery occlusion (SAO); 63 and 100% for the subtype with unknown etiology due to incomplete workup (Unknown), and 12 and 29% for the cryptogenic subtype. As for the ASCO2 groups, the 1- and 4-year mortality rates were 0 and 6% in LAA, 25 and 36% in CE, 0% in SAO, 0 and 14% in LAA + CE, 0% in SAO + CE, 16 and 36% in the subgroup with undetermined etiology despite complete workup, and 56 and 100% in Unknown. Regression analysis showed that age, white blood cell count, fibrinogen and bilirubin, but not etiological subgroup, were independent predictors of mortality. CONCLUSION Our findings indicate that clinical and biochemical markers may differentiate phenotypically homogeneous etiological subtypes and predict long-term mortality. Further studies with larger patient numbers are needed to investigate possible causative mechanisms.
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Affiliation(s)
- Ioanna Markaki
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
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Gustafsson PE, Gustafsson PA, Ivarsson T, Nelson N. Diurnal cortisol levels and cortisol response in youths with obsessive-compulsive disorder. Neuropsychobiology 2008; 57:14-21. [PMID: 18424906 DOI: 10.1159/000123117] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Accepted: 01/22/2008] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Recent results indicate a role of the hypothalamic-pituitary-adrenal (HPA) axis in the pathophysiology of obsessive-compulsive disorder (OCD). Although childhood onset is common, the HPA axis has scarcely been studied in young OCD subjects. Therefore, the present study aimed at examining basal and response levels of salivary cortisol in a sample of young OCD subjects. METHODS Twenty-three children and adolescents with DSM-IV OCD were compared to a reference group of school children (n = 240-336). The basal cortisol rhythm was measured through saliva samples 3 times/day. The cortisol response to a psychological stressor (exposure therapy in the OCD group and a fire alarm in the reference group) was also examined. RESULTS Compared to the reference group, OCD subjects displayed higher early-morning cortisol values (p = 0.005) with no difference between the late-morning and evening values. The cortisol levels in the OCD group diminished in response to the psychological stressor, compared to a positive response in the reference group (p < 0.001). No relation was found between cortisol and clinical parameters. CONCLUSION These results support the idea that HPA hyperactivity, commonly found in adult OCD patients, is also present at an earlier stage of development, with specificity for the early-morning peak.
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Affiliation(s)
- Per E Gustafsson
- Division of Child and Adolescent Psychiatry, Faculty of Health Sciences, Linkoping University, Linkoping, Sweden.
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