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Simaan N, Filioglo A, Cohen JE, Lorberboum Y, Leker RR, Honig A. Effects in Israel of Arab and Jewish Ethnicity on Intracerebral Hemorrhage. J Clin Med 2022; 11:jcm11082117. [PMID: 35456208 PMCID: PMC9024802 DOI: 10.3390/jcm11082117] [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: 10/20/2021] [Revised: 02/27/2022] [Accepted: 04/08/2022] [Indexed: 02/01/2023] Open
Abstract
Intracerebral hemorrhages (ICH) characteristics reportedly differ between different ethnic groups. We aimed to compare the characteristics of Jewish and Arab ICH patients in Israel. Consecutive patients with primary ICH were included in a prospective institutional database. Demographics, vascular risk factors, clinical and radiological parameters were compared between Arab and Jewish ICH patients residing in Jerusalem. The study included 455 patients (311 Jews). Arab patients were younger (66.1 ± 13.4 vs. 72.2 ± 12.2 years, p < 0.001) and had higher rates of diabetes (60% vs. 29%, p < 0.001) and smoking (26% vs. 11%, p < 0.001). Arab patients had higher rates of deep ICH (74% vs. 62%, p = 0.01) and lower rates of lobar ICH (18% vs. 31%, p = 0.003). In a sub-analysis of deep ICH patients only, Arab patients were younger (64.3 ± 12.9 vs. 71.4 ± 11.8 years, p < 0.001) and less frequently male (56% vs. 68%, p = 0.042), with higher rates of diabetes (61% vs. 35%, p < 0.001) and smoking (31% vs. 14%, p < 0.001). In conclusion, the two ethnic populations in Israel differ in the causes and attributes of ICH. Heavy smoking and poorly controlled diabetes are commonly associated with deep ICH in the Arab population and may offer specific targets for secondary prevention in this population.
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Affiliation(s)
- Naaem Simaan
- Department of Neurology, Ziv Medical Center, Safed 13100, Israel;
- Azrieli Faculty of Medicine, Bar Ilan University, Safed 13115, Israel
| | - Andrei Filioglo
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel; (A.F.); (Y.L.); (A.H.)
| | - José E. Cohen
- Department of Neurosurgery, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel;
| | - Yonatan Lorberboum
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel; (A.F.); (Y.L.); (A.H.)
| | - Ronen R. Leker
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel; (A.F.); (Y.L.); (A.H.)
- Correspondence:
| | - Asaf Honig
- Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel; (A.F.); (Y.L.); (A.H.)
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Wang P, Cheng S, Song W, Li Y, Liu J, Zhao Q, Luo S. Daily Meteorological Parameters Influence the Risk of Intracerebral Hemorrhage in a Subtropical Monsoon Basin Climate. Risk Manag Healthc Policy 2021; 14:4833-4841. [PMID: 34916860 PMCID: PMC8667755 DOI: 10.2147/rmhp.s331314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/02/2021] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose The correlation between meteorological parameters and intracerebral hemorrhage (ICH) occurrence is controversial. Our research explored the effect of daily meteorological parameters on ICH risk in a subtropical monsoon basin climate. Methods We retrospectively analyzed patients with ICH in a teaching hospital. Daily meteorological parameters including temperature (TEM), atmospheric pressure (PRE), relative humidity (RHU), and sunshine duration (SSD) were collected, with the diurnal variation (daily maximum minus minimum) and day-to-day variation (average of the day minus the previous day) calculated to represent their fluctuation. We adopted a time-stratified case-crossover approach and selected conditional logistic regression to explore the effect of meteorological parameters on ICH risk. The influence of monthly mean temperature proceeded via stratified analysis. Air pollutants were gathered as covariates. Results Our study included 1052 eligible cases with ICH. In a single-factor model, the risk of ICH decreased by 5.9% (P<0.001) for each 1°C higher of the daily mean TEM, and the risk increased by 2.4% (P=0.002) for each 1hPa higher of the daily mean PRE. Prolongation of daily SSD inhibited the risk of ICH, and OR was 0.959 (P=0.007). The risk was raised by 7.5% (P=0.0496) with a 1°C increment of day-to-day variation of TEM. In a two-factor model, the effect of daily mean TEM or daily SSD on ICH risk was still statistically significant after adjusting another factor. The influence of meteorological parameters on ICH risk continued in cold months but disappeared in warm months after stratified analysis. Conclusion This research indicates daily TEM and SSD had an inverse correlation to ICH risk in a subtropical monsoon basin climate. They were independent when adjusted by another factor. Daily PRE and day-to-day TEM variation were positively related to ICH risk. The correlation of daily meteorological factors on ICH risk was affected by the monthly thermal background.
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Affiliation(s)
- Peng Wang
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, People's Republic of China
| | - Shuwen Cheng
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, People's Republic of China
| | - Weizheng Song
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, People's Republic of China
| | - Yaxin Li
- West China Fourth Hospital/West China School of Public Health, Sichuan University, Chengdu, People's Republic of China
| | - Jia Liu
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, People's Republic of China
| | - Qiang Zhao
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, People's Republic of China
| | - Shuang Luo
- Department of Neurosurgery, Chengdu Fifth People's Hospital/Affiliated Chengdu No.5 People's Hospital of Chengdu University of TCM, Chengdu, People's Republic of China
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Vilanilam GK, John AE, Badi MK, Surapaneni PK, Gopal N. Barometric Pressure in Cerebral Amyloid Angiopathy: A Pressure to Bleed? J Stroke Cerebrovasc Dis 2019; 28:1781. [PMID: 30910266 DOI: 10.1016/j.jstrokecerebrovasdis.2019.02.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 02/28/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Abha E John
- Department of Pathology, Christian Medical College Vellore, Tamil Nadu, India
| | | | | | - Neethu Gopal
- Department of Neurology, Mayo Clinic Jacksonville, Florida
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Climate Change and Healthcare Sustainability in the Agincourt Sub-District, Kruger to Canyons Biosphere Region, South Africa. SUSTAINABILITY 2019. [DOI: 10.3390/su11020496] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
As low-income communities are most vulnerable to climate-associated health concerns, access to healthcare will increase in importance as a key priority in South Africa. This study explores healthcare sustainability in the Agincourt sub-district, Kruger to Canyons Biosphere Region in Mpumalanga, South Africa. A rapid assessment and response methodology (RAR) was implemented, which includes the examination of previous studies conducted in the sub-district, the mapping of healthcare facilities in the area, and the implementation of a facility infrastructure and workforce capacity investigation by means of key informant (KI) interviews at eight healthcare facilities. Findings indicate that the greatest need across the facilities relate to access to medical doctors and pharmacists. None of the facilities factored climate associations with health into their clinical care strategies. The necessity to train healthcare facility staff on aspects related to climate change, health, and sustainability is highlighted. Environmental health practitioners should also be incorporated in grassroots community climate adaptation strategies. Outcomes further indicate the need for the advancement of integrated healthcare and climate adaptation strategies that focus on strengthening healthcare systems, which may include novel technological approaches such as telemedicine. Policy makers need to be proactive and pre-emptive in finding and improving processes and models to render healthcare services prepared for climate change.
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Garg RK, Ouyang B, Pandya V, Garcia-Cano R, Da Silva I, Hall D, John S, Bleck TP, Berkelhammer M. The Influence of Weather on the Incidence of Primary Spontaneous Intracerebral Hemorrhage. J Stroke Cerebrovasc Dis 2018; 28:405-411. [PMID: 30415919 DOI: 10.1016/j.jstrokecerebrovasdis.2018.10.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/04/2018] [Accepted: 10/09/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Intracerebral hemorrhage has been associated with changes in various weather conditions. The primary aim of this study was to examine the collective influence of temperature, barometric pressure, and dew point temperature on the incidence of primary spontaneous intracerebral hemorrhage (sICH). METHODS Between January 2013 and December 2016, patients with sICH due to hypertension or amyloid angiopathy with a known time of onset were identified prospectively. Meteorological variables 6 hours prior to time of onset were obtained from the National Oceanic Atmospheric Administration via two weather stations. Using a Monte-Carlo simulation, random populations of meteorological conditions in a 6-hour time window during the same years were generated. The actual meteorological conditions 6-hours prior to sICH were compared to those from the randomly generated populations. The false discovery rate method was used to identify significant meteorological variables. RESULTS Time of onset was identified in 455 of 603 (75.5%) patients. Distribution curves for change in temperature, mean barometric pressure, and change in barometric pressure 6-hours prior to hemorrhage ictus were found to be significantly different from the random populations. (FDR approach P < .05). For a given change in temperature associated with intracerebral hemorrhage, mean barometric pressure was higher (1018 millibar (mb) versus 1016 mb, P = .03). Barometric pressure data was not influenced by variations in temperature. CONCLUSIONS We concluded that barometric pressure primarily influences the incidence of intracerebral hemorrhage. The association described in the literature between temperature and intracerebral hemorrhage is likely confounded by variations in barometric pressure.
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Affiliation(s)
- Rajeev Kumar Garg
- Rush University Medical Center, Department of Neurological Sciences, Chicago, Illinois.
| | - Bichun Ouyang
- Rush University Medical Center, Department of Neurological Sciences, Chicago, Illinois.
| | - Vishal Pandya
- Medical College of Wisconsin, Department of Neurology, Milwaukee, Wisconsin.
| | - Raquel Garcia-Cano
- Rush University Medical Center, Department of Neurological Sciences, Chicago, Illinois.
| | - Ivan Da Silva
- Rush University Medical Center, Department of Neurological Sciences, Chicago, Illinois.
| | - Deborah Hall
- Rush University Medical Center, Department of Neurological Sciences, Chicago, Illinois.
| | - Sayona John
- Rush University Medical Center, Department of Neurological Sciences, Chicago, Illinois.
| | | | - Max Berkelhammer
- University of Illinois at Chicago, Department of Earth and Environmental Sciences, Chicago, Illinois.
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Mehta A, Zusman BE, Choxi R, Shutter LA, Yassin A, Antony A, Thirumala PD. Seizures After Intracerebral Hemorrhage: Incidence, Risk Factors, and Impact on Mortality and Morbidity. World Neurosurg 2018; 112:e385-e392. [PMID: 29355799 DOI: 10.1016/j.wneu.2018.01.052] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 01/10/2018] [Accepted: 01/11/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Spontaneous intracerebral hemorrhage (ICH) is one of the most frequent causes of epilepsy in the United States. However, reported risk factors for seizure after are inconsistent, and their impact on inpatient morbidity and mortality is unclear. We aimed to study the incidence, risk factors, and impact of seizures after ICH in a nationwide patient sample. METHODS We queried the Nationwide Inpatient Sample for patients admitted to the hospital with a primary diagnosis of ICH between the years 1999 and 2011. Patients were subsequently dichotomized into groups of those with a diagnosis consistent with seizure and those without. Multivariate logistic regression was used to assess risk factors for seizure in this patient sample, and the association between seizures and mortality and morbidity. Logistic regression was then used for trend analysis of incidence of seizure diagnoses over time. RESULTS We identified 220,075 patients admitted with a primary diagnosis of ICH. Of these, 11.87% had a diagnosis consistent with seizure. Factors associated with increased risk of seizure after ICH included higher categorical van Walraven score, encephalopathy, alcohol abuse, solid tumor, and prior stroke. Seizure was independently associated with decreased odds of morbidity (odds ratio [OR], 0.89; 95% confidence interval [CI], 0.86-0.92) and mortality (OR, 0.75; 95% CI, 0.72-0.77) in multivariate models controlling for existing comorbidities. CONCLUSIONS Seizures after were associated with decreased mortality and morbidity despite attempts to correct for existing comorbidities. Continuous monitoring of these patients for seizures may not be necessary in all circumstances, despite their frequency.
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Affiliation(s)
- Amol Mehta
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Benjamin E Zusman
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Ravi Choxi
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Lori A Shutter
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ahmed Yassin
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Arun Antony
- Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Parthasarathy D Thirumala
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA; Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
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Kim J, Yoon K, Choi JC, Kim H, Song JK. The association between wind-related variables and stroke symptom onset: A case-crossover study on Jeju Island. ENVIRONMENTAL RESEARCH 2016; 150:97-105. [PMID: 27268974 DOI: 10.1016/j.envres.2016.05.041] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 05/19/2016] [Accepted: 05/20/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Although several studies have investigated the effects of ambient temperature on the risk of stroke, few studies have examined the relationship between other meteorological conditions and stroke. Therefore, the aim of this study was to analyze the association between wind-related variables and stroke symptoms onset. METHODS Data regarding the onset of stroke symptoms occurring between January 1, 2006, and December 31, 2007 on Jeju Island were collected from the Jeju National University Hospital stroke registry. A fixed-strata case-crossover analysis based on time of onset and adjusted for ambient temperature, relative humidity, air pressure, and pollutants was used to analyze the effects of wind speed, the daily wind speed range (DWR), and the wind chill index on stroke symptom onset using varied lag terms. Models examining the modification effects by age, sex, smoking status, season, and type of stroke were also analyzed. RESULTS A total of 409 stroke events (381 ischemic and 28 hemorrhagic) were registered between 2006 and 2007. The odds ratios (ORs) for wind speed, DWR, and wind chill among the total sample at lag 0-8 were 1.18 (95% confidence interval (CI): 1.06-1.31), 1.08 (95% CI: 1.02-1.14), and 1.22 (95% CI: 1.07-1.39) respectively. The ORs for wind speed, DWR, and wind chill for ischemic stroke patients were slightly greater than for patients in the total sample (OR=1.20, 95% CI: 1.08-1.34; OR=1.09, 95% CI: 1.03-1.15; and OR=1.22, 95% CI: 1.07-1.39, respectively). Statistically significant season-specific effects were found for spring and winter, and various delayed effects were observed. In addition, age, sex, and smoking status modified the effect size of wind speed, DWR, and wind chill. CONCLUSIONS Our analyses showed that the risk of stroke symptoms onset was associated with wind speed, DWR, and wind chill on Jeju Island.
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Affiliation(s)
- Jayeun Kim
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Kyuhyun Yoon
- Nursing Science Research Institute, Chung-Ang University, Seoul, Republic of Korea
| | - Jay Chol Choi
- Department of Neurology, School of Medicine, Jeju National University, Jeju, Republic of Korea
| | - Ho Kim
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea; Department of Biostatistics and Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Jung-Kook Song
- Department of Preventive Medicine, School of Medicine, Jeju National University, 1-Ara-1-dong, Jeju-si, Jeju, Republic of Korea.
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