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Šaňáková Š, Gurková E, Štureková L, Bartoníčková D, Machálková L, Mazalová L. How to return? experiences of patients in working age after first Ischaemic stroke: an interpretative phenomenological analysis of patient´s perspective at 12 - 24 months post-stroke. Int J Qual Stud Health Well-being 2024; 19:2398249. [PMID: 39229807 PMCID: PMC11376287 DOI: 10.1080/17482631.2024.2398249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 08/26/2024] [Indexed: 09/05/2024] Open
Abstract
BACKGROUND Limited evidence of young adult patient-reported outcomes and experiences after ischaemic stroke has been conducted. AIM To investigate the meaning of the lived experiences of stroke patients in working age 12-24 months after their first IS. MATERIAL AND METHODS The exploratory qualitative study used an interpretative phenomenological analysis (IPA) design. Nine ischaemic stroke patients (with age ranges from 41 to 50 years) took part in semi-structured qualitative interviews. RESULTS Even with mild residual neurological deficit, IS negatively impacted the quality of life daily and social life. Six subthemes and three interconnected group experiential themes were generated: (i) From confusion to understanding (ii) Triggers for rebuilding; and (iii) Challenges and benefits. CONCLUSION The study highlights the current gaps and limitations in supporting the needs of stroke patients in working age in long-term post-stroke care. The findings are crucial for healthcare professionals to develop improved age- and mild- impairment-appropriate strategies or tailor self-management interventions for stroke patients of working age.ClinicalTrials.gov: NCT04839887.
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Affiliation(s)
- Šárka Šaňáková
- Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Elena Gurková
- Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Lenka Štureková
- Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Daniela Bartoníčková
- Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Lenka Machálková
- Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
| | - Lenka Mazalová
- Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Olomouc, Czech Republic
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Ibrahim S, Bielecki J, Kocabas E, Singh S, Senff JR, Casaubon LK, Rosand J, Rac VE, Pikula A. Lifestyle approaches to hypertension for prevention of stroke and vascular cognitive impairment: a realist review protocol. BMJ Open 2024; 14:e088631. [PMID: 39349379 DOI: 10.1136/bmjopen-2024-088631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2024] Open
Abstract
INTRODUCTION Stroke and vascular cognitive impairment (VCI) are major global public health pandemics. The increased incidence of stroke and VCI is in part due to modifiable risk factors (MRFs), with hypertension (HTN) being the strongest single MRF. Even though the underlying causes of HTN are multifactorial, lifestyle choices (eg, poor diet, physical inactivity, alcohol consumption) are chief contributors. Lifestyle medicine (LSM) is a medical and evidence-based discipline that is a promising approach for preventing stroke and cognitive impairment, including VCI. The empirical evidence from systematic reviews, meta-analyses and large population-based studies has reported on the effectiveness of LSM interventions. However, the evaluation of such complex, social and behavioural interventions warrants more information to allow its successful implementation into innovative clinical care models. More importantly, we need to understand how such interventions work, who it works for and under what circumstances to successfully manage HTN and other MRFs (eg, hyperlipidaemia, smoking, alcohol use and diet). METHODS AND ANALYSIS This realist review will follow the Realist and Meta-narrative Evidence Synthesis: Evolving Standards. The review will comprise four stages: (1) clarify the scope, (2) search for the evidence, (3) critically appraise primary studies and extract data focusing on the context, mechanism and outcome configuration and (4) synthesise evidence and draw conclusions. ETHICS AND DISSEMINATION Research ethics board approval is not required for this review. The primary output of this review will be an evidence-based programme theory for LSM interventions for the management of HTN and other MRFs to reduce the risk of stroke and VCI. Findings from this review will be disseminated at three levels: micro (eg, patients, caregivers, clinicians, non-research partners), meso (eg, public, national not-for-profit organisations, professional associations and centres) and macro (eg, policymakers and government partners). PROSPERO REGISTRATION NUMBER CRD42024511566.
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Affiliation(s)
- Sarah Ibrahim
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Toronto General Research Institute, Toronto, Ontario, Canada
- Jay and Sari Sonshine Centre for Stroke Prevention & Cerebrovascular Brain Health, University Health Network, Toronto, Ontario, Canada
- Centre for Advancing Collaborative Healthcare & Education (CACHE), University of Toronto, Toronto, Ontario, Canada
| | - Joanna Bielecki
- Toronto Health Economics and Health Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Emine Kocabas
- Jay and Sari Sonshine Centre for Stroke Prevention & Cerebrovascular Brain Health, University Health Network, Toronto, Ontario, Canada
| | - Sanjula Singh
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jasper R Senff
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Leanne K Casaubon
- Department of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
| | - Jonathan Rosand
- Henry and Allison McCance Center for Brain Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, Massachusetts, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Valeria E Rac
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Program for Health System and Technology Evaluation, Toronto General Research Institute, Toronto, Ontario, Canada
| | - Aleksandra Pikula
- Jay and Sari Sonshine Centre for Stroke Prevention & Cerebrovascular Brain Health, University Health Network, Toronto, Ontario, Canada
- Department of Neurology, Toronto Western Hospital, Toronto, Ontario, Canada
- Department of Medicine, Division of Neurology, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
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Amoah D, Prior S, Schmidt M, Mather C, Bird ML. Technology for Young Adults with Stroke: An Australian Environmental Scan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:1254. [PMID: 39338137 PMCID: PMC11431680 DOI: 10.3390/ijerph21091254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2024] [Revised: 09/12/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024]
Abstract
Technology has the potential to address the unique needs of young stroke survivors. Despite this, little is known about the technological resources available to support young adults with stroke. This study aimed to identify and compile available technological resources that cater to the specific needs of young adults (18-30 years) with stroke in Australia. An environmental scan was conducted from December 2023 to March 2024. Sources included websites, app stores, rehabilitation centres, hospitals, organisations, technology developers, and healthcare professionals. Of the 114 resources identified, 11% were for re-training limb movement, 40% for speech rehabilitation, 20% for medication reminders, and 29% were social media posts offering peer mentoring and support. Most limb movement (75%) and medication reminder (87%) apps were free. However, most speech therapy apps (78%) had associated costs. Social media posts were hosted on Facebook (64%), Instagram (21%), TikTok (9%), YouTube (3%), and other websites (3%). Forty-six percent of the social media posts targeting young stroke survivors did not specify the age group. These resources were identified as available to young people with stroke. Although the resources found focused on young stroke survivors, it was difficult to ascertain the specific age group that was being targeted.
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Affiliation(s)
- Dinah Amoah
- School of Health Sciences, University of Tasmania, Launceston 7250, Australia; (M.S.); (M.-L.B.)
| | - Sarah Prior
- Tasmanian School of Medicine, University of Tasmania, Burnie 7320, Australia;
| | - Matthew Schmidt
- School of Health Sciences, University of Tasmania, Launceston 7250, Australia; (M.S.); (M.-L.B.)
| | - Carey Mather
- School of Nursing, University of Tasmania, Launceston 7250, Australia;
| | - Marie-Louise Bird
- School of Health Sciences, University of Tasmania, Launceston 7250, Australia; (M.S.); (M.-L.B.)
- Department of Physical Therapy, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
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Hoffmann VS, Schönecker S, Amin M, Reidler P, Brauer A, Kopczak A, Wunderlich S, Poli S, Althaus K, Müller S, Mansmann U, Kellert L. A novel prediction score determining individual clinical outcome 3 months after juvenile stroke (PREDICT-score). J Neurol 2024; 271:6238-6246. [PMID: 39085620 PMCID: PMC11377658 DOI: 10.1007/s00415-024-12552-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Juvenile strokes (< 55 years) account for about 15% of all ischemic strokes. Structured data on clinical outcome in those patients are sparse. Here, we aimed to fill this gap by systematically collecting relevant data and modeling a juvenile stroke prediction score for the 3-month functional outcome. METHODS We retrospectively integrated and analyzed clinical and outcome data of juvenile stroke and TIA patients treated at the LMU University Hospital, LMU Munich, Munich. Good outcome was defined as a modified Rankin Scale of 0-2 or return to baseline of function. We analyzed candidate predictors and developed a predictive model. Predictive abilities were inspected using Area Under the ROC curve (AUROC) and visual representation of the calibration. The model was validated internally. RESULTS 346 patients were included in the analysis. We observed a good outcome in n = 293 patients (84.7%). The prediction model for an unfavourable outcome had an AUROC of 89.1% (95% CI 83.3-93.1%). The model includes age NIHSS, ASPECTS, blood glucose and type of vessel occlusion as predictors for the individual patient outcome. CONCLUSIONS Here, we introduce the highly accurate PREDICT-score for the 3-month outcome after juvenile stroke derived from clinical routine data. The PREDICT-score might be helpful in guiding individual patient decisions and designing future studies but needs further prospective validation which is already planned. Trial registration The study has been registered at https://drks.de (DRKS00024407) on March 31, 2022.
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Affiliation(s)
- Verena S Hoffmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians University München, Marchioninistr. 15, 81377, Munich, Germany
| | - Sonja Schönecker
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Moustafa Amin
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians University München, Marchioninistr. 15, 81377, Munich, Germany
| | - Paul Reidler
- Department of Radiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anna Brauer
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians University München, Marchioninistr. 15, 81377, Munich, Germany
| | - Anna Kopczak
- Institute for Stroke and Dementia Research (ISD), Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Silke Wunderlich
- Department of Neurology, University Hospital Rechts der Isar of the Technical University Munich, Munich, Germany
| | - Sven Poli
- Department of Neurology & Stroke, Hertie Institute for Clinical Brain Research, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | | | - Susanne Müller
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, Ludwig-Maximilians University München, Marchioninistr. 15, 81377, Munich, Germany
- Pettenkofer School for Public Health, Munich, Germany
| | - Lars Kellert
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.
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Ma Z, He W, Zhou Y, Mai L, Xu L, Li C, Li M. Global burden of stroke in adolescents and young adults (aged 15-39 years) from 1990 to 2019: a comprehensive trend analysis based on the global burden of disease study 2019. BMC Public Health 2024; 24:2042. [PMID: 39080669 PMCID: PMC11289945 DOI: 10.1186/s12889-024-19551-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 07/22/2024] [Indexed: 08/02/2024] Open
Abstract
INTRODUCTION The incidence of stroke is rising among individuals aged 15-39. Insufficient research targeting this age group hampers the development of effective strategies. This study analyzes data from the Global Burden of Disease Study 2019 (GBD 2019) to examine trends from 1990 to 2019 and propose future interventions. METHODS Data on ischemic strokes, intracerebral hemorrhage, and subarachnoid hemorrhage from 1990 to 2019 was collected from the Global Health Data Exchange (GHDx) platform. We used the Annual Average Percentage Change (AAPC) to assess global trends in incidence, prevalence, Disability-Adjusted Life Years (DALYs), and mortality rates across various stroke categories. Joinpoint models identified significant years of trend inflection. Trend analyses were segmented by age, gender, and Sociodemographic Index (SDI). FINDINGS From 1990 to 2019, the global incidence of ischemic stroke within the adolescents and young adults (AYAs) cohort declined from 1990 to 1999, further decreased from 2000 to 2009, and then increased from 2010 to 2019. The overall AAPC p-value showed no significant difference. Mortality rates for ischemic strokes were consistently reduced during this period. The overall incidence rate of intracerebral hemorrhage has exhibited a downward trend. Meanwhile, the incidence rate of subarachnoid hemorrhage decreased from 1990 to 2009, yet saw a resurgence from 2010 to 2019. Male ischemic stroke incidence grew more than female incidence, but both absolute incidence and rates were higher for females. Differences in SDI levels were observed, with the fastest increase in incidence occurring in low-middle SDI regions, followed by high SDI regions, and the smallest increase in low SDI regions. Conversely, the most rapid decline was noted in high-middle SDI regions, with no significant change observed in middle SDI regions. CONCLUSION A concerning trend of increasing ischemic stroke incidence, DALYs, and prevalence rates has emerged in the global 15-39 age group, especially among those aged 30-39. This increase is evident across regions with varying SDI classifications. To combat this alarming trend among adolescents and young adults, enhancing preventive efforts, promoting healthier lifestyles, strengthening the healthcare system's responsiveness, and maintaining vigilant epidemiological monitoring is essential.
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Affiliation(s)
- Zixuan Ma
- The Second School of Clinical Medicine, Guangzhou Medical University, Guangdong, China
| | - Wenkai He
- Department of Cardiology, Guangdong Key Laboratory of Vascular Diseases, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuanxin Zhou
- The Second School of Clinical Medicine, Guangzhou Medical University, Guangdong, China
| | - Li Mai
- Department of Cardiology, Guangdong Key Laboratory of Vascular Diseases, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Lifeng Xu
- Department of Cardiology, Guangdong Key Laboratory of Vascular Diseases, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Can Li
- Department of Cardiology, Guangdong Key Laboratory of Vascular Diseases, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Mingyan Li
- Department of Cardiology, Guangdong Key Laboratory of Vascular Diseases, Guangzhou Institute of Cardiovascular Disease, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
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Li Z, Yang Y, Wang X, Yang N, He L, Wang J, Ping F, Xu L, Zhang H, Li W, Li Y. Comparative analysis of atherosclerotic cardiovascular disease burden between ages 20-54 and over 55 years: insights from the Global Burden of Disease Study 2019. BMC Med 2024; 22:303. [PMID: 39026251 PMCID: PMC11264803 DOI: 10.1186/s12916-024-03527-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND To systematically analyze differences in atherosclerotic cardiovascular disease (ASCVD) burden between young and older adults. METHODS We estimated the prevalence, mortality, and disability-adjusted life years (DALYs) of ASCVD, including ischemic heart disease (IHD), ischemic stroke (IS), and peripheral artery disease (PAD), in individuals aged 20-54 and > 55 years from 1990-2019, utilizing data from the 2019 Global Burden of Disease Study. The annual percentage changes (EAPCs) for age-specific prevalence, mortality, or DALY rates were calculated to quantify the temporal trends of ASCVD burden. We also analyzed population attribution fractions (PAF) of premature ASCVD mortality and DALYs for different risk factors and compared the burden of extremely premature, premature, and non-premature ASCVD cases based on clinical classifications. RESULTS From 1990-2019, the global prevalence rates of IHD, IS, and PAD in the 20-54 years age group increased by 20.55% (from 694.74 to 837.49 per 100,000 population), 11.50% (from 439.48 to 490.03 per 100,000 population), and 7.38% (from 384.24 to 412.59 per 100,000 population), respectively. Conversely, the ASCVD prevalence in > 55years age group decreased. Adverse outcome burdens, including mortality and DALYs, varied among ASCVD subtypes. The decrease in the mortality/DALY burden of IHD and IS was lower in the 20-54 years group than in the > 55 years group. For PAD, DALYs among those aged 20-54 increased but decreased among those aged > 55 years. When grouped according to socio-demographic index (SDI) values, lower SDI regions exhibited a higher proportion of young ASCVD burden. The prevalence of young IHD, IS, and PAD in low SDI regions reached 20.70%, 40.05%, and 19.31% in 2019, respectively, compared with 12.14%, 16.32%, and 9.54%, respectively, in high SDI regions. Metabolic risks were the primary contributors to the ASCVD burden in both age groups. Increased susceptibility to ambient particulate matter pollution and inadequate control of high body-mass index and high fasting plasma glucose in young individuals may partially explain the differing temporal trends between young and older individuals. CONCLUSIONS The ASCVD burden in young individuals may become a growing global health concern, especially in areas with lower socioeconomic development levels that require more effective primary prevention strategies.
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Affiliation(s)
- Ziyi Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Beijing, Wangfujing, Dongcheng District, China
- Diabetes Research Center of Chinese Academy of Medical Sciences, Beijing, China
| | - Yucheng Yang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Beijing, Wangfujing, Dongcheng District, China
- Diabetes Research Center of Chinese Academy of Medical Sciences, Beijing, China
| | - Xuechen Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Beijing, Wangfujing, Dongcheng District, China
- Diabetes Research Center of Chinese Academy of Medical Sciences, Beijing, China
| | - Na Yang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Beijing, Wangfujing, Dongcheng District, China
- Diabetes Research Center of Chinese Academy of Medical Sciences, Beijing, China
| | - Liyun He
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Beijing, Wangfujing, Dongcheng District, China
- Diabetes Research Center of Chinese Academy of Medical Sciences, Beijing, China
| | - Jialu Wang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Beijing, Wangfujing, Dongcheng District, China
- Diabetes Research Center of Chinese Academy of Medical Sciences, Beijing, China
| | - Fan Ping
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Beijing, Wangfujing, Dongcheng District, China
- Diabetes Research Center of Chinese Academy of Medical Sciences, Beijing, China
| | - Lingling Xu
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Beijing, Wangfujing, Dongcheng District, China
- Diabetes Research Center of Chinese Academy of Medical Sciences, Beijing, China
| | - Huabing Zhang
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Beijing, Wangfujing, Dongcheng District, China.
- Diabetes Research Center of Chinese Academy of Medical Sciences, Beijing, China.
| | - Wei Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Beijing, Wangfujing, Dongcheng District, China.
- Diabetes Research Center of Chinese Academy of Medical Sciences, Beijing, China.
| | - Yuxiu Li
- Department of Endocrinology, Key Laboratory of Endocrinology of National Health Commission, Translation Medicine Center, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, No.1 Shuaifuyuan, Beijing, Wangfujing, Dongcheng District, China.
- Diabetes Research Center of Chinese Academy of Medical Sciences, Beijing, China.
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Le L, Lan Z, Chen C. Positive association of ethylene oxide levels with young stroke: a population-based study. Front Aging Neurosci 2024; 16:1391176. [PMID: 39015475 PMCID: PMC11249756 DOI: 10.3389/fnagi.2024.1391176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Accepted: 06/17/2024] [Indexed: 07/18/2024] Open
Abstract
Background Ethylene oxide (EtO), a highly reactive organic compound with extensive industrial applications, poses significant health risks. The association between EtO exposure and stroke was not well established. This study examined the association between EtO exposure and stroke among US adults using data from the 2013-2018 National Health and Nutrition Examination Survey (NHANES). Methods We used appropriately weighted multifactorial logistic regression models to analyze the data and validated the findings with smoothed curve fitting. Stratified analysis and interaction assessments were performed to evaluate the robustness of the findings. Results The study included 5,071 participants, balanced between men and women, with a stroke prevalence of 4.1%. Higher EtO levels were associated with rising rates of stroke (OR = 1.23, 95% CI: 1.06-1.42). Individuals in the top 25% group displayed a stroke prevalence 1.6 times higher than those in the bottom 25% group (OR = 1.60, 95%CI: 1.03-2.48). Stratified analysis demonstrated a significant positive association between EtO and stroke in individuals under 50 years (OR = 1.94, 95%CI: 1.38-2.72), while no significant association was found in those aged 50 and above (OR = 0.97, 95%CI: 0.83-1.14). Conclusion This study identified a significant association between EtO exposure and stroke occurrence in young adults in the United States.
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Affiliation(s)
- Lingying Le
- Department of Neurology, West China Xiamen Hospital of Sichuan University, Xiamen, China
| | - Ziwei Lan
- Department of Neurology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Chenxi Chen
- Department of Plastic Surgery, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, China
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Grech M, Withiel T, Klaic M, Fisher CA, Simpson L, Wong D. Characterisation of young stroke presentations, pathways of care, and support for 'invisible' difficulties: a retrospective clinical audit study. BRAIN IMPAIR 2024; 25:IB23059. [PMID: 38941488 DOI: 10.1071/ib23059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 05/31/2024] [Indexed: 06/30/2024]
Abstract
Background Young stroke survivors are likely to be discharged home from acute hospital care without rehabilitation more quickly than older survivors, but it is not clear why. File-audit studies capturing real-world clinical practice are lacking for this cohort. We aimed to compare characteristics and care pathways of young and older survivors and describe stroke presentations and predictors of pathways of care in young survivors (≤45years), including a focus on care received for 'invisible' (cognitive, psychological) difficulties. Methods A retrospective audit of 847 medical records (67 young stroke survivors, mean age=36years; 780 older patients, mean age=70years) was completed for stroke survivors admitted to an Australian tertiary hospital. Stroke characteristics and presence of cognitive difficulties (identified through clinician opinion or cognitive screening) were used to predict length of stay and discharge destination in young stroke survivors. Results There were no differences in length of stay between young and older survivors, however, young stroke survivors were more likely to be discharged home without rehabilitation (though this may be due to milder strokes observed in young stroke survivors). For young stroke survivors, stroke severity and age predicted discharge destination, while cognitive difficulties predicted longer length of stay. While almost all young survivors were offered occupational therapy and physiotherapy, none received psychological input (clinical, health or neuropsychology). Conclusions Cognitive and psychological needs of young stroke survivors may remain largely unmet by a service model designed for older people. Findings can inform service development or models of care, such as the new Australian Young Stroke Service designed to better meet the needs of young survivors.
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Affiliation(s)
- Michaela Grech
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic, Australia
| | - Toni Withiel
- Allied Health Department, The Royal Melbourne Hospital, Vic, Australia
| | - Marlena Klaic
- Melbourne School of Health Sciences, The University of Melbourne, Vic, Australia
| | - Caroline A Fisher
- Allied Health Department, The Royal Melbourne Hospital, Vic, Australia
| | - Leonie Simpson
- Allied Health Department, The Royal Melbourne Hospital, Vic, Australia
| | - Dana Wong
- School of Psychology and Public Health, La Trobe University, Melbourne, Vic, Australia
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Cisek KK, Nguyen TNQ, Garcia-Rudolph A, Saurí J, Becerra Martinez H, Hines A, Kelleher JD. Predictors of social risk for post-ischemic stroke reintegration. Sci Rep 2024; 14:10110. [PMID: 38698076 PMCID: PMC11066106 DOI: 10.1038/s41598-024-60507-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 04/24/2024] [Indexed: 05/05/2024] Open
Abstract
After stroke rehabilitation, patients need to reintegrate back into their daily life, workplace and society. Reintegration involves complex processes depending on age, sex, stroke severity, cognitive, physical, as well as socioeconomic factors that impact long-term outcomes post-stroke. Moreover, post-stroke quality of life can be impacted by social risks of inadequate family, social, economic, housing and other supports needed by the patients. Social risks and barriers to successful reintegration are poorly understood yet critical for informing clinical or social interventions. Therefore, the aim of this work is to predict social risk at rehabilitation discharge using sociodemographic and clinical variables at rehabilitation admission and identify factors that contribute to this risk. A Gradient Boosting modelling methodology based on decision trees was applied to a Catalan 217-patient cohort of mostly young (mean age 52.7), male (66.4%), ischemic stroke survivors. The modelling task was to predict an individual's social risk upon discharge from rehabilitation based on 16 different demographic, diagnostic and social risk variables (family support, social support, economic status, cohabitation and home accessibility at admission). To correct for imbalance in patient sample numbers with high and low-risk levels (prediction target), five different datasets were prepared by varying the data subsampling methodology. For each of the five datasets a prediction model was trained and the analysis involves a comparison across these models. The training and validation results indicated that the models corrected for prediction target imbalance have similarly good performance (AUC 0.831-0.843) and validation (AUC 0.881 - 0.909). Furthermore, predictor variable importance ranked social support and economic status as the most important variables with the greatest contribution to social risk prediction, however, sex and age had a lesser, but still important, contribution. Due to the complex and multifactorial nature of social risk, factors in combination, including social support and economic status, drive social risk for individuals.
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Affiliation(s)
- Katryna K Cisek
- AIDHM, Artificial Intelligence in Digital Health and Medicine, Technological University Dublin, Dublin, Ireland.
- RESQ+, Comprehensive solutions of healthcare improvement based on the global Registry of Stroke Care Quality, Horizon Europe Project, Brno, Czech Republic.
| | - Thi Nguyet Que Nguyen
- AIDHM, Artificial Intelligence in Digital Health and Medicine, Technological University Dublin, Dublin, Ireland
| | - Alejandro Garcia-Rudolph
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
- STRATIF-AI, Continuous stratification for improved prevention, treatment, and rehabilitation of stroke patients using digital twins and AI, Horizon Europe Project, Linköping, Sweden
| | - Joan Saurí
- Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Bellaterra, Spain
- Fundació Institute d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Spain
- Institut Guttmann Hospital de Neurorehabilitacio, Badalona, Spain
| | | | - Andrew Hines
- School of Computer Science, University College Dublin, Dublin, Ireland
| | - John D Kelleher
- STRATIF-AI, Continuous stratification for improved prevention, treatment, and rehabilitation of stroke patients using digital twins and AI, Horizon Europe Project, Linköping, Sweden
- ADAPT Research Centre, School of Computer Science and Statistics, Trinity College Dublin, Dublin, Ireland
- RESQ+, Comprehensive solutions of healthcare improvement based on the global Registry of Stroke Care Quality, Horizon Europe Project, Brno, Czech Republic
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Leppert MH, Poisson SN, Scarbro S, Suresh K, Lisabeth LD, Putaala J, Schwamm LH, Daugherty SL, Bradley CJ, Burke JF, Ho PM. Association of Traditional and Nontraditional Risk Factors in the Development of Strokes Among Young Adults by Sex and Age Group: A Retrospective Case-Control Study. Circ Cardiovasc Qual Outcomes 2024; 17:e010307. [PMID: 38529631 PMCID: PMC11021148 DOI: 10.1161/circoutcomes.123.010307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/11/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Despite women having fewer traditional risk factors (eg, hypertension, diabetes), strokes are more common in women than men aged ≤45 years. This study examined the contributions of traditional and nontraditional risk factors (eg, migraine, thrombophilia) in the development of strokes among young adults. METHODS This retrospective case-control study used Colorado's All Payer Claims Database (2012-2019). We identified index stroke events in young adults (aged 18-55 years), matched 1:3 to stroke-free controls, by (1) sex, (2) age±2 years, (3) insurance type, and (4) prestroke period. All traditional and nontraditional risk factors were identified from enrollment until a stroke or proxy-stroke date (defined as the prestroke period). Conditional logistic regression models stratified by sex and age group first assessed the association of stroke with counts of risk factors by type and then computed their individual and aggregated population attributable risks. RESULTS We included 2618 cases (52% women; 73.3% ischemic strokes) and 7827 controls. Each additional traditional and nontraditional risk factors were associated with an increased risk of stroke in all sex and age groups. In adults aged 18 to 34 years, more strokes were associated with nontraditional (population attributable risk: 31.4% men and 42.7% women) than traditional risk factors (25.3% men and 33.3% women). The contribution of nontraditional risk factors declined with age (19.4% men and 27.9% women aged 45-55 years). The contribution of traditional risk factors peaked among patients aged 35 to 44 years (32.8% men and 39.7% women). Hypertension was the most important traditional risk factor and increased in contribution with age (population attributable risk: 27.8% men and 26.7% women aged 45 to 55 years). Migraine was the most important nontraditional risk factor and decreased in contribution with age (population attributable risk: 20.1% men and 34.5% women aged 18-35 years). CONCLUSIONS Nontraditional risk factors were as important as traditional risk factors in the development of strokes for both young men and women and have a stronger association with the development of strokes in adults younger than 35 years of age.
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Affiliation(s)
- Michelle H. Leppert
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
- Colorado Cardiovascular Outcomes Research (CCOR) Group, Denver, Colorado
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora, CO
| | - Sharon N. Poisson
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO
| | - Sharon Scarbro
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado, School of Medicine, Aurora, CO
- Rocky Mountain Prevention Research Center, Colorado School of Public Health, Aurora, CO
| | - Krithika Suresh
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Lynda D. Lisabeth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI
| | - Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Lee H. Schwamm
- Department of Neurology, Massachusetts General Hospital, Boston, MA
| | - Stacie L. Daugherty
- Colorado Cardiovascular Outcomes Research (CCOR) Group, Denver, Colorado
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Cathy J. Bradley
- Colorado Comprehensive Cancer Center, University of Colorado, Aurora, CO
| | - James F. Burke
- Department of Neurology, The Ohio State University, Columbus, OH
| | - P. Michael Ho
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO
- Cardiology Section, VA Eastern Colorado Health Care System, Aurora, CO
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11
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Liu S, Lv Y, Zhang Y, Suo H, Wang F, Gao S. Global trends and burden of stroke attributable to particulate matter pollution from 1990 to 2019. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 274:116205. [PMID: 38503105 DOI: 10.1016/j.ecoenv.2024.116205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 03/08/2024] [Accepted: 03/09/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE To investigate the association between particulate matter and the incidence, disability, and mortality of stroke, we reported the burden of stroke attributable to particulate matter (PM2.5) pollution, including ambient particulate matter pollution (APMP) and household air pollution from solid fuels (HAP), from 1990 to 2019. METHODS We retrieved the detailed data on the burden of stroke attributable to PM2.5 from the Global Burden of Disease (GBD) 2019. The number of disability-adjusted life-years (DALYs) and deaths, age-standardized death rates (ASMR), and age-standardized disability-adjusted life-years rates (ASDR) attributable to PM2.5 were estimated by age, sex, geographical location, socio-demographic index (SDI), and stroke subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage). The estimated annual percentage change (EAPC) was calculated to assess the trends in ASDR and ASMR during the period 1990-2019. RESULTS Regarding stroke subtypes, the proportion of ischemic stroke burden is increasing, while intracerebral hemorrhage carries the heaviest burden. Both APMP and HAP contributed the most to stroke-related deaths and DALYs of stroke among the elderly populations and males. The highest ASDR and ASMR of stroke attributable to APMP were in the middle SDI regions, especially in East Asia. For HAP, the highest ASDR and ASMR were in the low SDI regions, mainly in Oceania. From 1990-2019, in terms of the EAPC results, APMP caused an increased burden of stroke, whereas the impact of HAP significantly fell. The most pronounced increase in ASDR and ASMR for strokes attributed to APMP were in the low-middle SDI and low SDI regions, particularly among the 25-35 age group. CONCLUSIONS Stroke attributed to PM2.5 is a global health problem, and the patterns and trends were heterogeneous across APMP and HAP. Targeted interventions should be formulated for APMP and HAP.
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Affiliation(s)
- Siqi Liu
- Department of Toxicology, School of Public Health, Harbin Medical University, Heilongjiang Province, China
| | - Yanming Lv
- Department of Toxicology, School of Public Health, Harbin Medical University, Heilongjiang Province, China
| | - Ya Zhang
- Department of Toxicology, School of Public Health, Harbin Medical University, Heilongjiang Province, China
| | - Huimin Suo
- Department of Toxicology, School of Public Health, Harbin Medical University, Heilongjiang Province, China
| | - Fan Wang
- Department of Epidemiology, School of Public Health, Harbin Medical University, Heilongjiang Province, China
| | - Shuying Gao
- Department of Toxicology, School of Public Health, Harbin Medical University, Heilongjiang Province, China.
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12
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Zhang X, Chen Z, Fang A, Kang L, Xu W, Xu B, Chen J, Zhang X. Trends in prevalence, risk factor control and medications in atherosclerotic cardiovascular disease among US Adults, 1999-2018. Am J Prev Cardiol 2024; 17:100634. [PMID: 38313771 PMCID: PMC10837059 DOI: 10.1016/j.ajpc.2024.100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/07/2024] [Accepted: 01/15/2024] [Indexed: 02/06/2024] Open
Abstract
Objectives Trends in prevalence and treatments of atherosclerotic cardiovascular disease (ASCVD) remains to be documented, with frequent update of relevant guidelines. We aimed to characterize trends in prevalence of ASCVD, and risk factor control and medications among ASCVD adults. Methods We conducted a cross-sectional analysis of data from 55,081 adults in the National Health and Nutrition Examination Surveys (NHANES) 1999-2018. Results The age-standardized prevalence of ASCVD did not change significantly from 1999-2002 (7.9 %, 95 % CI 7.1 %-8.7 %) to 2015-2018 (7.5 %, CI 6.8 %-8.3 %) (P for trend =0.18), representing an estimated 19.9 million individuals with ASCVD in 2015-2018. The prevalence of premature ASCVD was 2.0 % (CI, 1.6 %-2.5 %). Over 60.0 % of ASCVD participants were at very-high risk. From 1999-2002 to 2015-2018, the percentage with lipid control (non-high-density lipoprotein cholesterol <100 mg/dL) increased from 7.0 % (CI, 3.5 %-12.3 %) to 26.4 % (CI, 16.2 %-38.9 %). The percentage with blood-pressure control (<130/80 mmHg) increased from 51.2 % (CI, 41.0 %-61.3 %) in 1999-2002 to 57.2 % (CI, 48.4 %-65.6 %) in 2011-2014, but then declined to 52.8 % (CI, 44.4 %-81.3 %) in 2015-2018. The percentage with glycemic control (HbA1c <7.0 %) decreased from 95.0 % (CI, 90.2 %-97.9 %) to 84.0 % (CI, 75.9 %-90.3 %). The percentage who achieved all 3 targets was 18.6 % (CI, 8.2 %-33.8 %) in 2015-2018. The percentage of ASCVD participants who were taking statins increased from 1999-2002 to 2011-2014, but then leveled off. Approximately 60 % of individuals with ASCVD and less than 40 % of those with premature ASCVD were taking statins in 2015-2018. The utilization of blood-pressure-lowering drugs remained largely constant over time, whereas the use of glucose-lowering drugs increased. Conclusions Based on NHANES data from US adults, the estimated prevalence of ASCVD remained relatively stable between 1999 and 2018. Substantial undertreatment with stains was found in individuals with ASCVD, and the percentage achieving optimal lipid control was low.
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Affiliation(s)
- Xiaowen Zhang
- Department of Endocrinology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine. PR China
- Endocrine and Metabolic Disease Medical Center, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, PR China
| | - Zheng Chen
- Department of Cardiology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, PR China
| | - Aijuan Fang
- Medical Image Center, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, PR China
| | - Lina Kang
- Department of Cardiology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, PR China
| | - Wei Xu
- Department of Cardiology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, PR China
| | - Biao Xu
- Department of Cardiology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, PR China
| | - Jianzhou Chen
- Department of Cardiology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, PR China
| | - Xinlin Zhang
- Department of Cardiology, Affiliated Drum Tower Hospital, Nanjing University School of Medicine, PR China
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13
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Zhou Y, Han X, Mu Q, Xing L, Wu Y, Li C, Liu Y, Wang F. The effect of the interaction of sleep onset latency and age on ischemic stroke severity via inflammatory chemokines. Front Neurol 2024; 15:1323878. [PMID: 38434201 PMCID: PMC10906267 DOI: 10.3389/fneur.2024.1323878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/07/2024] [Indexed: 03/05/2024] Open
Abstract
Objective Prolonged sleep onset latency (PSOL) and age have been linked to ischemic stroke (IS) severity and the production of chemokines and inflammation, both of which contribute to IS development. This study aimed to explore the relationship between chemokines, inflammation, and the interplay between sleep onset latency (SOL) and age in influencing stroke severity. Methods A cohort of 281 participants with mild to moderate IS was enrolled. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS), and SOL was recorded. Serum levels of macrophage inflammatory protein-1alpha (MIP-1α), macrophage inflammatory protein-1beta (MIP-1β), monocyte chemoattractant protein-1 (MCP-1), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α) were measured. Results NIHSS scores of middle-aged participants with PSOL were significantly higher than those with normal sleep onset latency (NSOL) (p = 0.046). This difference was also observed when compared to both the elderly with NSOL (p = 0.022), and PSOL (p < 0.001). Among middle-aged adults with PSOL, MIP-1β exhibited a protective effect on NIHSS scores (β = -0.01, t = -2.11, p = 0.039, R2 = 0.13). MIP-1α demonstrated a protective effect on NIHSS scores in the elderly with NSOL (β = -0.03, t = -2.27, p = 0.027, R2 = 0.12). Conclusion This study reveals a hitherto undocumented association between PSOL and IS severity, along with the potential protective effects of MIP-1β in mitigating stroke severity, especially among middle-aged patients.
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Affiliation(s)
- Yuyu Zhou
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
- Medical Neurobiology Lab, Inner Mongolia Medical University, Huhhot, China
| | - Xiaoli Han
- Clinical Nutrition Department, Friendship Hospital of Urumqi, Urumqi, China
| | - Qingshuang Mu
- Xinjiang Key Laboratory of Neurological Disorder Research, The Second Affiliated Hospital of Xinjiang Medical University, Urumqi, China
| | - Lifei Xing
- Department of Neurology, Sinopharm North Hospital, Baotou, China
| | - Yan Wu
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
| | - Cunbao Li
- Medical Neurobiology Lab, Inner Mongolia Medical University, Huhhot, China
| | - Yanlong Liu
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Fan Wang
- Beijing Hui-Long-Guan Hospital, Peking University, Beijing, China
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14
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Shareef MAH, Narasimhalu K, Saffari SE, Woon FP, De Silva DA. Recurrent vascular events partially explain association between diabetes and poor prognosis in young ischemic stroke patients. J Neurol Sci 2024; 457:122881. [PMID: 38219383 DOI: 10.1016/j.jns.2024.122881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 01/07/2024] [Accepted: 01/08/2024] [Indexed: 01/16/2024]
Abstract
BACKGROUND AND AIMS Stroke is the second leading cause of death and third leading cause of disability worldwide. There is an increasing incidence of stroke among the young. In this study, we aimed to identify factors associated with poor long-term prognosis in young stroke patients. METHODS In this longitudinal observational study, we recruited 147 young ischemic stroke patients within one week of ischemic stroke and followed them up for functional outcome (modified Rankin score (mRS)), recurrent vascular events, and recurrent hospitalisation. Poor function was labelled as mRS score of 3 and above. We performed univariate and multivariable logistic regression analyses to determine factors associated with poor long term functional outcome. RESULTS At a median follow-up of 7-years, 32 (22%) of the 147 patients had poor functional outcome. In multivariable analyses, diabetes mellitus (OR = 9.01, CI 3.15 to 26.92), was the only independent predictor of poor function. In analyses stratified by diabetic status, recurrent vascular events (OR = 4.47, CI 1.40 to 14.28) were associated with poor functional outcome within young diabetic patients but not in non-diabetic patients. CONCLUSIONS Our findings suggest that diabetes mellitus affects long-term functional outcome in young ischemic stroke and that its effect is mediated partly by recurrent vascular events. DATA ACCESS STATEMENT Data obtained from Multi-Centre Retinal study (MCRS), Singapore site. Data cannot be made publicly available due to potentially identifiable research participant information.
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Affiliation(s)
| | - Kaavya Narasimhalu
- Duke-NUS Medical School, Singapore; National Neuroscience Institute (Singapore General Hospital Campus), Department of Neurology, Singapore.
| | | | - Fung Peng Woon
- Singapore General Hospital, Department of Neurology, Singapore
| | - Deidre Anne De Silva
- Duke-NUS Medical School, Singapore; National Neuroscience Institute (Singapore General Hospital Campus), Department of Neurology, Singapore
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15
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Sun Y, Jiang X, Gao J. Stem cell-based ischemic stroke therapy: Novel modifications and clinical challenges. Asian J Pharm Sci 2024; 19:100867. [PMID: 38357525 PMCID: PMC10864855 DOI: 10.1016/j.ajps.2023.100867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/25/2023] [Accepted: 10/07/2023] [Indexed: 02/16/2024] Open
Abstract
Ischemic stroke (IS) causes severe disability and high mortality worldwide. Stem cell (SC) therapy exhibits unique therapeutic potential for IS that differs from current treatments. SC's cell homing, differentiation and paracrine abilities give hope for neuroprotection. Recent studies on SC modification have enhanced therapeutic effects for IS, including gene transfection, nanoparticle modification, biomaterial modification and pretreatment. These methods improve survival rate, homing, neural differentiation, and paracrine abilities in ischemic areas. However, many problems must be resolved before SC therapy can be clinically applied. These issues include production quality and quantity, stability during transportation and storage, as well as usage regulations. Herein, we reviewed the brief pathogenesis of IS, the "multi-mechanism" advantages of SCs for treating IS, various SC modification methods, and SC therapy challenges. We aim to uncover the potential and overcome the challenges of using SCs for treating IS and convey innovative ideas for modifying SCs.
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Affiliation(s)
- Yuankai Sun
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Xinchi Jiang
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
| | - Jianqing Gao
- Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
- Hangzhou Institute of Innovative Medicine, College of Pharmaceutical Sciences, Zhejiang University, Hangzhou 310058, China
- Dr. Li Dak Sum & Yip Yio Chin Center for Stem Cell and Regenerative Medicine, Zhejiang University, Hangzhou 310058, China
- Department of Pharmacy, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
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Tsiakiri A, Christidi F, Tsiptsios D, Vlotinou P, Kitmeridou S, Bebeletsi P, Kokkotis C, Serdari A, Tsamakis K, Aggelousis N, Vadikolias K. Processing Speed and Attentional Shift/Mental Flexibility in Patients with Stroke: A Comprehensive Review on the Trail Making Test in Stroke Studies. Neurol Int 2024; 16:210-225. [PMID: 38392955 PMCID: PMC10893544 DOI: 10.3390/neurolint16010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
The Trail Making Test (TMT) is one of the most commonly administered tests in clinical and research neuropsychological settings. The two parts of the test (part A (TMT-A) and part B (TMT-B)) enable the evaluation of visuoperceptual tracking and processing speed (TMT-A), as well as divided attention, set-shifting and cognitive flexibility (TMT-B). The main cognitive processes that are assessed using TMT, i.e., processing speed, divided attention, and cognitive flexibility, are often affected in patients with stroke. Considering the wide use of TMT in research and clinical settings since its introduction in neuropsychological practice, the purpose of our review was to provide a comprehensive overview of the use of TMT in stroke patients. We present the most representative studies assessing processing speed and attentional shift/mental flexibility in stroke settings using TMT and applying scoring methods relying on conventional TMT scores (e.g., time-to-complete part A and part B), as well as derived measures (e.g., TMT-(B-A) difference score, TMT-(B/A) ratio score, errors in part A and part B). We summarize the cognitive processes commonly associated with TMT performance in stroke patients (e.g., executive functions), lesion characteristics and neuroanatomical underpinning of TMT performance post-stroke, the association between TMT performance and patients' instrumental activities of daily living, motor difficulties, speech difficulties, and mood statue, as well as their driving ability. We also highlight how TMT can serve as an objective marker of post-stroke cognitive recovery following the implementation of interventions. Our comprehensive review underscores that the TMT stands as an invaluable asset in the stroke assessment toolkit, contributing nuanced insights into diverse cognitive, functional, and emotional dimensions. As research progresses, continued exploration of the TMT potential across these domains is encouraged, fostering a deeper comprehension of post-stroke dynamics and enhancing patient-centered care across hospitals, rehabilitation centers, research institutions, and community health settings. Its integration into both research and clinical practice reaffirms TMT status as an indispensable instrument in stroke-related evaluations, enabling holistic insights that extend beyond traditional neurological assessments.
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Affiliation(s)
- Anna Tsiakiri
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Foteini Christidi
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Dimitrios Tsiptsios
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Pinelopi Vlotinou
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Sofia Kitmeridou
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Paschalina Bebeletsi
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 691 00 Komotini, Greece; (C.K.); (N.A.)
| | - Aspasia Serdari
- Department of Child and Adolescent Psychiatry, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece;
| | - Konstantinos Tsamakis
- Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King’s College London, London SE5 8AB, UK;
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 691 00 Komotini, Greece; (C.K.); (N.A.)
| | - Konstantinos Vadikolias
- Neurology Department, School of Medicine, Democritus University of Thrace, 681 00 Alexandroupolis, Greece; (A.T.); (F.C.); (P.V.); (S.K.); (P.B.); (K.V.)
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Karimi E, Arab A, Sepidarkish M, Khorvash F, Saadatnia M, Amani R. Effects of the royal jelly consumption on post-stroke complications in patients with ischemic stroke: results of a randomized controlled trial. Front Nutr 2024; 10:1227414. [PMID: 38260068 PMCID: PMC10800663 DOI: 10.3389/fnut.2023.1227414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 12/26/2023] [Indexed: 01/24/2024] Open
Abstract
Aims There is a paucity of evidence regarding the benefit of royal jelly (RJ) on post-stroke complications in patients with ischemic stroke. To address this knowledge gap, this randomized, triple-blind, placebo-controlled clinical trial was carried out to determine the effects of RJ consumption on post-stroke clinical outcomes. Methods Of 64 eligible ischemic stroke patients (45-80 years), 32 were randomized to the RJ and 32 to the placebo groups and completed a 12-week intervention. The intervention group was advised to receive 1,000 mg of RJ dragee daily after breakfast. Post-stroke complications including cognition, fatigue, mental health, and appetite, along with serum levels of brain-derived neurotrophic factor (BDNF), and mid-upper arm circumference (MUAC) were assessed in groups pre-and post-intervention. Results After 12 weeks of RJ consumption, cognitive function [adjusted mean difference, 4.71; 95% confidence interval (CI), 1.75 to 7.67], serum levels of BDNF (adjusted mean difference, 0.36; 95% CI, 0.05 to 0.67), stress (adjusted mean difference, -3.33; 95% CI, -6.50 to -0.17), and appetite (adjusted mean difference, 1.38; 95% CI, 0.19 to 2.56) were significantly improved. However, the findings for fatigue (adjusted mean difference, -4.32; 95% CI, -10.28 to 1.63), depression (adjusted mean difference, -1.71; 95% CI, -5.58 to 2.16), anxiety (adjusted mean difference, -2.50; 95% CI, -5.50 to 0.49), and MUAC (adjusted mean difference, 0.36; 95% CI, -0.11 to 0.84) were less favorable. Conclusion Findings support the benefits of RJ consumption in improving post-stroke complications and clinical outcomes.Clinical trial registration: https://www.irct.ir/trial/59275, Identifier IRCT20180818040827N4.
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Affiliation(s)
- Elham Karimi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
- Research Development Center, Arash Women’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Arman Arab
- Division of Sleep Medicine, Harvard Medical School, Boston, MA, United States
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Department of Medicine and Neurology, Brigham and Women’s Hospital, Boston, MA, United States
| | - Mahdi Sepidarkish
- Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Fariborz Khorvash
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Saadatnia
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Reza Amani
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Pizov NA, Baranova NS. [Ischemic stroke in men 18-50 years of age]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:5-11. [PMID: 38512088 DOI: 10.17116/jnevro20241240325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To evaluate the main modifiable risk factors for ischemic stroke (IS) and features of the course in atherothrombotic, cardioembolic, and lacunar subtypes of IS in men aged 18-50 years. MATERIAL AND METHODS The study included 125 men (the mean age was 42.6±5.3 years) who were admitted to the Vascular department before the COVID-19 pandemic and survived for the first 30 days after IS. Information on patients' baseline characteristics, traditional vascular risk factors, and lifestyle risk factors was systematically collected. Neuroimaging, ultrasound and laboratory tests were performed. RESULTS Atherothrombotic subtype was identified in 60 patients, lacunar subtype in 46 patients and cardioembolic subtype in 19 patients. In the group as a whole, major risk factors included arterial hypertension (83.2%), dyslipidemia (50.4%), smoking (67.2%), alcohol consumption (29.6%), obesity (16.8%), heart rhythm disorders (12%), and diabetes mellitus (8%). CONCLUSION The study revealed the main risk factors, the frequency of which differed depending on the stroke subtype and the age of the patients.
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Affiliation(s)
- N A Pizov
- Yaroslavl State Medical University, Yaroslavl, Russia
| | - N S Baranova
- Yaroslavl State Medical University, Yaroslavl, Russia
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Ali M, Tibble H, Brady MC, Quinn TJ, Sunnerhagen KS, Venketasubramanian N, Shuaib A, Pandyan A, Mead G. Prevalence, Trajectory, and Predictors of Poststroke Pain: Retrospective Analysis of Pooled Clinical Trial Data Set. Stroke 2023; 54:3107-3116. [PMID: 37916457 DOI: 10.1161/strokeaha.123.043355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 08/14/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Poststroke pain remains underdiagnosed and inadequately managed. To inform the optimum time to initiate interventions, we examined prevalence, trajectory, and participant factors associated with poststroke pain. METHODS Eligible studies from the VISTA (Virtual International Stroke Trials Archives) included an assessment of pain. Analyses of individual participant data examined demography, pain, mobility, independence, language, anxiety/depression, and vitality. Pain assessments were standardized to the European Quality of Life Scale (European Quality of Life 5 Dimensions 3 Level) pain domain, describing no, moderate, or extreme pain. We described pain prevalence, associations between participant characteristics, and pain using multivariable models. RESULTS From 94 studies (n>48 000 individual participant data) in VISTA, 10 (n=10 002 individual participant data) included a pain assessment. Median age was 70.0 years (interquartile range [59.0-77.1]), 5560 (55.6%) were male, baseline stroke severity was National Institutes of Health Stroke Scale score 10 (interquartile range [7-15]). Reports of extreme pain ranged between 3% and 9.5% and were highest beyond 2 years poststroke (31/328 [9.5%]); pain trajectory varied by study. Poorer independence was significantly associated with presence of moderate or extreme pain (5 weeks-3 months odds ratio [OR], 1.5 [95% CI, 1.4-1.6]; 4-6 months OR, 1.7 [95% CI, 1.3-2.1]; >6 months OR, 1.5 [95% CI, 1.2-2.0]), and increased severity of pain (5 weeks-3 months: OR, 1.2 [95% CI, 1.1-1.2]; 4-6 months OR, 1.1 [95% CI, 1.1-1.2]; >6 months, OR, 1.2 [95% CI, 1.1-1.2]), after adjusting for covariates. Anxiety/depression and lower vitality were each associated with pain severity. CONCLUSIONS Between 3% and 9.5% of participants reported extreme poststroke pain; the presence and severity of pain were independently associated with dependence at each time point. Future studies could determine whether and when interventions may reduce the prevalence and severity of poststroke pain.
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Affiliation(s)
- Myzoon Ali
- Institute of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (M.A., T.J.Q.)
- NMAHP Research Unit, Glasgow Caledonian University, United Kingdom (M.A., M.C.B.)
| | | | - Marian C Brady
- NMAHP Research Unit, Glasgow Caledonian University, United Kingdom (M.A., M.C.B.)
| | - Terence J Quinn
- Institute of Cardiovascular and Metabolic Health, University of Glasgow, United Kingdom (M.A., T.J.Q.)
| | - Katharina S Sunnerhagen
- Department of Clinical Neuroscience, University of Gothenburg, Sweden (K.S.S.)
- Sahlgrenska University Hospital, Gothenburg, Sweden (K.S.S.)
| | | | - Ashfaq Shuaib
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Canada (A.S.)
| | - Anand Pandyan
- Faculty of Health and Social Sciences, Bournemouth University, United Kingdom (A.P.)
| | - Gillian Mead
- Division of Health Sciences, Geriatric Medicine, University of Edinburgh, United Kingdom (G.M.)
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20
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Tan XM, Liao ZX, Zhao YY, Sun XC, Yi FL. Changes in depressive symptoms before and after the first stroke: A longitudinal study from China Family Panel Study (CFPS). J Affect Disord 2023; 340:567-574. [PMID: 37573890 DOI: 10.1016/j.jad.2023.08.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 07/27/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVES The study sought to examine the impact of longitudinal changes in depressive symptoms in middle-aged adults before and after their first stroke, and the impact of different ages. METHODS The study monitored middle-aged patients with a first stroke in the China Family Panel Study (CFPS) survey from 2016 to 2020. This study examined longitudinal changes in depressive symptoms in middle-aged adults and their controls before and after stroke using multilevel models, and also explored factors influencing middle-aged adults at the time of their respective stroke and depressive symptoms using conditional regression models and stepwise regression models, respectively. A chi-square test was used to determine whether long-term changes in depressive symptoms in patients before and after stroke could be attributed to changes in a single depressive symptom. RESULTS The study identified 582 first-time stroke patients and 5522 controls from a population of 17,588 participants. Middle-aged populations may have an increased risk of depressive symptoms after a first stroke compared to older populations. First-time stroke victims showed increased severity of depressive symptoms in both the two years before and the two years after stroke when depressive symptoms were assessed. Differences in the presentation of a single depressive symptom were most pronounced in sleep-related symptoms. CONCLUSIONS The link between first stroke and changes in the trajectory of increased depressive symptoms is complex and bidirectional. Age is an important factor influencing changes in depressive symptoms, some attention should be paid to the middle-aged population. Special attention should also be paid to sleep-related symptoms in the long-term care of patients.
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Affiliation(s)
- Xiao-Min Tan
- Guangdong Pharmaceutical University, Guangzhou, China
| | - Zi-Xuan Liao
- Guangdong Pharmaceutical University, Guangzhou, China
| | | | - Xiao-Cui Sun
- Guangdong Pharmaceutical University, Guangzhou, China; Engineering and Technology Research Center of Guangdong Universities-Real World Engineering and Technology Research Center of Medical Information, Guangzhou, China
| | - Fa-Ling Yi
- Guangdong Pharmaceutical University, Guangzhou, China; Engineering and Technology Research Center of Guangdong Universities-Real World Engineering and Technology Research Center of Medical Information, Guangzhou, China.
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21
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Han B, Raynald, Sun D, Tong X, Jia B, Wang A, Mo D, Gao F, Ma N, Nguyen TN, Miao Z. Endovascular treatment for young patients with acute large vessel occlusion stroke in China: analysis of the ANGEL-ACT registry. Front Neurol 2023; 14:1255043. [PMID: 37928147 PMCID: PMC10623312 DOI: 10.3389/fneur.2023.1255043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 10/04/2023] [Indexed: 11/07/2023] Open
Abstract
Background The incidence of acute ischemic stroke caused by large vessel occlusion is relatively infrequent in the young adult population. We sought to evaluate their clinical outcomes after endovascular treatment (EVT) and stroke etiology compared with older patients. Methods We examined data from the ANGEL-ACT registry, a nationwide study in China focusing on EVT for acute ischemic stroke. We compared two age groups: <50 years old and ≥50 years old. Our analysis focused on outcome measures such as the 90-day modified Rankin Scale (mRS) score, mortality, and symptomatic intracranial hemorrhage (sICH). We adjusted for confounding variables. Results We included 1,691 patients, and 216 patients (13%) were <50 years old. Young patients had lower median National Institutes of Health Stroke Scale (NIHSS) scores (14 vs. 17, P < 0.001) and fewer cardiovascular comorbidities than older patients. Underlying intracranial atherosclerosis disease (ICAD) was higher in young patients (39.4 vs. 28.7%, P = 0.001). Clinical outcome was less favorable in older compared to younger patients (mRS shift: 0.76 [95% confidence interval (CI), 0.58-0.99]); functional independence [mRS score 0-2] 61% vs. 39% (adjusted odds ratio (OR), 0.7 [95% CI, 0.51-0.97]). Mortality and sICH did not differ between groups. Onset to puncture time (OTP) was longer in young patients (357 min vs. 294 min, P = 0.001). Conclusion An estimated 13% of patients who underwent endovascular thrombectomy for acute ischemic stroke were <50 years old. Symptomatic underlying ICAD was more prevalent in the younger patient population. Despite a prehospital delay, younger patients exhibited more favorable outcomes than their older counterparts.
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Affiliation(s)
- Bin Han
- Shanxi Key Laboratory of Brain Disease Control, Department of Neurology, Shanxi Provincial People's Hospital, Taiyuan, China
| | - Raynald
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Sun
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xu Tong
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Baixue Jia
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Anxin Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Mo
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Feng Gao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Ning Ma
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Thanh N. Nguyen
- Department of Neurology, Radiology, Boston Medical Center, Boston, MA, United States
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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Wan M, Lindsay P, Yu AYX, Hill MD, Holodinsky JK. Sex Differences of Hospital and Emergency Department Presentations of Stroke in Canada. Can J Neurol Sci 2023:1-5. [PMID: 37830291 DOI: 10.1017/cjn.2023.290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
We provide an updated estimate of adult stroke event rates by age group, sex, and stroke type using Canadian administrative data. In the 2017-2018 fiscal year, there were an estimated 81,781 hospital or emergency department visits for stroke events in Canada, excluding Quebec. Our findings show that overall, the event rate of stroke is similar between women and men. There were slight differences in stroke event rate at various ages by sex and stroke type and emerging patterns warrant attention in future studies. Our findings emphasize the importance of continuous surveillance to monitor the epidemiology of stroke in Canada.
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Affiliation(s)
- Miranda Wan
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Amy Y X Yu
- Department of Medicine (Neurology), University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michael D Hill
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Foothills Medical Centre, Calgary, AB, Canada
| | - Jessalyn K Holodinsky
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Center for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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23
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Naknoi S, Li J, Ramasoota P, Liu X, Chen L, Phuanukoonnon S, Soonthornworasiri N, Kaewboonchoo O. Associations of effort-reward imbalance at work and quality of life among workers after stroke: a one-year longitudinal study in Thailand. BMC Public Health 2023; 23:1910. [PMID: 37789277 PMCID: PMC10548574 DOI: 10.1186/s12889-023-16784-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/18/2023] [Indexed: 10/05/2023] Open
Abstract
Stroke incidence is increasing among working-age population, but the role of psychosocial stress in the workplace in predicting quality of life (QoL) after stroke onset is understudied. This longitudinal study aimed to investigate the relationship between work stress, measured by the effort-reward imbalance (ERI) model, and QoL over one-year period among 103 Thai workers who had experienced a stroke. The study evaluated the effort (E)-reward (R) ratio and over-commitment, the extrinsic and intrinsic components of the ERI model, before discharge; QoL was repeatedly measured at baseline, six months, and 12 months after discharge, respectively, using the Short Form Version 2 (SF-12v2) indicators of physical and mental health composite scores. Generalized estimating equations were used to examine longitudinal relationships between work stress at baseline and QoL over one year by testing the hypotheses that E-R ratio and over-commitment would have direct effects on QoL, and potential moderating effects of over-commitment on E-R ratio and QoL. The results supported the ERI model partially, as over-commitment was significantly associated with poor mental health (coefficient - 8.50; 95% CI: -13.79, -3.20) after adjusting baseline sociodemographic, behavioral, and clinical characteristics, while the E-R ratio was not significantly associated with physical or mental health; the interaction between the E-R ratio and over-commitment was also not significant. These findings suggest that more attention should be paid to workers' personal coping skills and ability to handle work-related problems and prioritize interventions that address over-commitment to promote long-term mental health among workers with stroke.
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Affiliation(s)
- Siripan Naknoi
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Jian Li
- Department of Environmental Health Sciences, Fielding School of Public Health, School of Nursing, University of California Los Angeles, Los Angeles, CA, 90095, USA
- Department of Public health Nursing, Faculty of Public health, Mahidol University, Bangkok, 10400, Thailand
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Pongrama Ramasoota
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Xinyue Liu
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Liwei Chen
- Department of Epidemiology, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, 90095, USA
| | - Suparat Phuanukoonnon
- Department of Social and Environmental Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Ngamphol Soonthornworasiri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, 10400, Thailand
| | - Orawan Kaewboonchoo
- Department of Public health Nursing, Faculty of Public health, Mahidol University, Bangkok, 10400, Thailand.
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Cho SJ, Kim SR, Cho KH, Shin NM, Oh WO. Effect of a Hospital-To-Home Transitional Intervention Based on an Interaction Model of Client Health Behavior for Adult Patients with Stroke. J Community Health Nurs 2023; 40:273-288. [PMID: 37431105 DOI: 10.1080/07370016.2023.2227154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
To develop and identify the effectiveness of a hospital-to-home transitional intervention based on an interaction model of client health behavior in adult patients with stroke. A non-equivalent control group pretest-posttest. Thirty-eight patients participated (18=intervention, 20=control); the intervention group received 12 weeks of the intervention. The intervention influenced anxiety, disease severity, health behavior adherence, patient satisfaction, and quality of life in adult patients with stroke. Transitional programs have potential to improve the health behaviors of subjects, and community health nurses can assist in the implementation of these programs. Health behaviors and quality of life scores were significantly higher in the intervention group than in the control group; these findings support the need for continuity of nursing care during the transitional period for patients with stroke. Given the challenges faced by adult stroke patients after stroke, community nurses should pay attention to patients' transitional experiences.
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Affiliation(s)
- Su-Jin Cho
- Research Institute of Nursing Science, Pusan National University, Yangsan, Republic of Korea
| | - Sung Reul Kim
- College of Nursing, Korea University Nursing Research Institute, Korea University, Seoul, Republic of Korea
| | - Kyung-Hee Cho
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Nah-Mee Shin
- College of Nursing, Korea University Nursing Research Institute, Korea University, Seoul, Republic of Korea
| | - Won-Oak Oh
- College of Nursing, Korea University Nursing Research Institute, Korea University, Seoul, Republic of Korea
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Guo X, Osouli S, Shahripour RB. Review of Cerebral Radiotherapy-Induced Vasculopathy in Pediatric and Adult Patients. Adv Biol (Weinh) 2023; 7:e2300179. [PMID: 37401794 DOI: 10.1002/adbi.202300179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/04/2023] [Indexed: 07/05/2023]
Abstract
Radiation therapy (RT) causes radiation-induced vasculopathy, which requires clinicians to identify and manage this side effect in pediatric and adult patients. This article reviews previous findings about the pathophysiology of RT-induced vascular injury, including endothelial cell injury, oxidative stress, inflammatory cytokines, angiogenic pathways, and remodeling. The vasculopathy is categorized into ischemic vasculopathy, hemorrhagic vasculopathy, carotid artery injury, and other malformations (cavernous malformations and aneurysms) in populations of pediatric and adult patients separately. The prevention and management of this RT-induced side effect are also discussed. The article summarizes the distribution and risk factors of different types of RT-induced vasculopathy. This will help clinicians identify high-risk patients with corresponding vasculopathy subtypes to deduce prevention and treatment strategies accordingly.
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Affiliation(s)
- Xiaofan Guo
- Department of Neurology, Loma Linda University, Loma Linda, CA, 92354, USA
| | - Sima Osouli
- Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, 1516745811, Iran
| | - Reza Bavarsad Shahripour
- Department of Neurology, Loma Linda University, Loma Linda, CA, 92354, USA
- Comprehensive Stroke Center, Department of Neurology, University of California San Diego, San Diego, CA, 92103, USA
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Di Carlo A, Baldereschi M, Bovis F, Piccardi B, Linoli G, Orlandi G, Volpi G, Chiti A, Tassi R, Brescia A, Inzitari D. Effect of an educational intervention to increase stroke awareness among Italian high school students: A prospective study in Tuscany. Eur Stroke J 2023; 8:769-776. [PMID: 37641553 PMCID: PMC10472968 DOI: 10.1177/23969873231175405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 04/25/2023] [Indexed: 08/31/2023] Open
Abstract
INTRODUCTION Stroke in young people shares traditional modifiable risk factors with older groups, and greatly affects quality of life. However, evidence on the effectiveness of educational interventions in young populations, aiming at spreading stroke knowledge and enhancing prevention, is still scarce. We evaluated baseline knowledge of stroke and possible improvements after an educational intervention among Italian high school students, also considering differences related to sex and type of school. SUBJECTS AND METHODS Using a mixed educational strategy, a prospective evaluation of stroke knowledge was performed in five humanities and sciences (lyceums) and five vocational high schools of Tuscany (students of the 12th and 13th grade). A baseline assessment with a structured questionnaire (21 questions) was followed by a standardized oral presentation, using audiovisual materials. After 3 months, the same questionnaire was re-administered to evaluate the long-term impact of the educational intervention. RESULTS Overall, 573 students (50.8% males; age range, 17-19 years) were enrolled; 288 (50.3%) were from lyceums and 285 (49.7%) from vocational schools. Follow-up participation was 97.2%. Baseline performances were comparable between groups for most variables examined. At 3 months, all groups showed a significant improvement from baseline regarding reaction to a stroke event, identification of stroke risk factors, such as smoking (from 62.9% to 83.7%; p < 0.001) and alcohol abuse (from 49.6% to 67.2%; p < 0.001), and symptoms. Knowledge of the existence of stroke units and thrombolysis increased from 25.4% to 60.7% (p < 0.001) and from 35.8% to 84.0% (p < 0.001), respectively. CONCLUSIONS Our educational intervention improved stroke awareness in high school students. The effects persisted after 3 months. Improved knowledge in young populations may reduce stroke burden in adult life, increase timely access to therapies, and spread knowledge across families.
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Affiliation(s)
- Antonio Di Carlo
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
| | - Marzia Baldereschi
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
| | - Francesca Bovis
- Department of Health Sciences, University of Genoa, Genova, Liguria, Italy
| | | | - Giovanni Linoli
- Neurology Unit, San Donato Hospital, South-East Tuscany Local Health Authority, Arezzo, Italy
| | - Giovanni Orlandi
- Department of Clinical and Experimental Medicine, Neurology Unit, University of Pisa, Pisa, Italy
| | - Gino Volpi
- Neurology and Neurophysiopathology Unit, San Iacopo and SS Cosma e Damiano Hospitals, Central Tuscany Local Health Authority, Pistoia and Pescia, Italy
| | - Alberto Chiti
- Neurology Unit, Apuane Hospital, North-West Tuscany Local Health Authority, Massa, Italy
| | - Rossana Tassi
- Stroke Unit, Santa Maria alle Scotte University Hospital, Siena, Italy
| | - Alfonso Brescia
- Scientific Committee Stroke Patients Association ALICe, Grosseto, Italy
| | - Domenico Inzitari
- Institute of Neuroscience, Italian National Research Council, Florence, Italy
- Department of Neurofarba, University of Florence, Firenze, Italy
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Leys D. Long-term follow-up after minor ischaemic strokes or transient ischaemic attacks: not as good as previously thought. Eur J Neurol 2023; 30:2591-2592. [PMID: 37272222 DOI: 10.1111/ene.15906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 06/06/2023]
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Broman J, Fandler-Höfler S, von Sarnowski B, Elmegiri M, Gattringer T, Holbe C, von der Linden J, Malinowski R, Martola J, Pinter D, Ropele S, Schminke U, Tatlisumak T, Enzinger C, Putaala J, Aarnio K. Long-term risk of recurrent vascular events and mortality in young stroke patients: Insights from a multicenter study. Eur J Neurol 2023; 30:2675-2683. [PMID: 37159485 DOI: 10.1111/ene.15850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 04/07/2023] [Accepted: 04/12/2023] [Indexed: 05/11/2023]
Abstract
BACKGROUND Although the incidence of stroke in the young is rising, data on long-term outcomes in these patients are scarce. We thus aimed to investigate the long-term risk of recurrent vascular events and mortality in a multicenter study. METHODS We followed 396 consecutive patients aged 18-55 years with ischemic stroke (IS) or transient ischemic attack (TIA) enrolled in three European centers during the period 2007-2010. A detailed outpatient clinical follow-up assessment was performed between 2018 and 2020. When an in-person follow-up visit was not possible, outcome events were assessed using electronic records and registry data. RESULTS During a median follow-up of 11.8 (IQR 10.4-12.7) years, 89 (22.5%) patients experienced any recurrent vascular event, 62 (15.7%) had any cerebrovascular event, 34 (8.6%) had other vascular events, and 27 (6.8%) patients died. Cumulative 10-year incidence rate per 1000 person-years was 21.6 (95% CI 17.1-26.9) for any recurrent vascular event and 14.9 (95% CI 11.3-19.3) for any cerebrovascular event. The prevalence of cardiovascular risk factors increased over time, and 22 (13.5%) patients lacked any secondary preventive medication at the in-person follow-up. After adjustment for demographics and comorbidities, atrial fibrillation at baseline was found to be significantly associated with recurrent vascular events. CONCLUSIONS This multicenter study shows a considerable risk of recurrent vascular events in young IS and TIA patients. Further studies should investigate whether detailed individual risk assessment, modern secondary preventive strategies, and better patient adherence may reduce recurrence risk.
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Affiliation(s)
- Jenna Broman
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | | | | | - Mohamed Elmegiri
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Thomas Gattringer
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
| | - Christine Holbe
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | | | - Robert Malinowski
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Juha Martola
- Department of Radiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Daniela Pinter
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Stefan Ropele
- Department of Neurology, Medical University of Graz, Graz, Austria
| | - Ulf Schminke
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - Turgut Tatlisumak
- Department of Clinical Neuroscience, Institute of Neurosciences and Physiology, Sahlgrenska Academy at University of Gothenburg & Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Jukka Putaala
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karoliina Aarnio
- Department of Neurology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Fujiwara G, Oka H, Fujii A. In-hospital recurrence and functional outcome between ischemic stroke caused by intracranial arterial dissection and intracranial atherosclerosis: Retrospective cohort study of the nationwide multicenter registry. J Stroke Cerebrovasc Dis 2023; 32:107212. [PMID: 37331251 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 06/04/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023] Open
Abstract
BACKGROUND Intracranial arterial dissection (ICAD) and intracranial atherosclerotic stenosis (ICAS) are often difficult to differentiate, and studies on their background factors and prognosis are scarce. Information on prognosis, including recurrence, is necessary for stroke care, and clarification of epidemiological and clinical differences between the two diseases is important for appropriately handling their heterogeneity. This study aimed to determine the association of ICAD and ICAS with in-hospital recurrence and prognosis and compare their background and clinical findings. METHODS In this multicenter cohort study, we retrospectively analyzed data from the Saiseikai Stroke Database. Adults with ischemic stroke caused by ICAD or ICAS were included in this study. Patients' backgrounds and clinical findings were compared between the ICAD and ICAS groups. The outcome showed an association of ICAD with in-hospital recurrence of ischemic stroke and poor functional outcome relative to ICAS. Multivariable logistic regression analyses were performed to calculate the adjusted odds ratios (ORs) for ICAD with 95% confidence intervals (CIs) for each outcome. RESULTS Among 15,622 patients registered in the Saiseikai Stroke Database, 2,020 were enrolled (ICAD group: 89; ICAS group: 1,931). In the ICAD group, 65.2% of the patients were aged <64 years. Vascular lesion location was more common in ICAD with the vertebral artery [42 (47.2%)], anterior cerebral artery [20 (22.5%)], and middle cerebral artery (MCA) [16 (18.0%)], and in ICAS with MCA 1046 (52.3%). Multivariable logistic regression analyses of the association between ICAD and in-hospital recurrence and poor functional outcome yielded a crude OR (95% CI) of 3.26 (1.06-9.97) and 0.97 (0.54-1.74), respectively, relative to ICAS. CONCLUSION ICAD was associated with a higher in-hospital recurrence than ICAS; however, there was no significant difference in prognosis between the two groups. Differences in background characteristics and vessel lesions may be of interest in these two diseases.
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Affiliation(s)
- Gaku Fujiwara
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Shiga, Japan.
| | - Hideki Oka
- Department of Neurosurgery, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Shiga, Japan.
| | - Akihiro Fujii
- Department of Neurology, Saiseikai Shiga Hospital, Imperial Gift Foundation Inc., Shiga, Japan.
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Bukhari S, Yaghi S, Bashir Z. Stroke in Young Adults. J Clin Med 2023; 12:4999. [PMID: 37568401 PMCID: PMC10420127 DOI: 10.3390/jcm12154999] [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: 05/20/2023] [Revised: 07/25/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023] Open
Abstract
Stroke in young adults is associated with significant morbidity, and its prevalence is rising in the United States. This is partly attributed to a rise in the prevalence of traditional risk factors including hypertension, hypercholesterolemia, obesity, diabetes mellitus, smoking and heart disease. In addition, there are non-modifiable risk factors comprising migraine, pregnancy and postpartum state, illicit drug use, oral contraceptives and hypercoagulable state. The mechanisms causing stroke in young adults are unique and include cervical dissection, cardioembolic phenomenon, vasculitis and vasculopathy, connective tissue disease, patent foramen ovale and cerebral venous thrombosis. The diagnosis of stroke in the young population can be challenging given its myriad clinical presentations. In this document, we provide an overview of the epidemiology of stroke in young adults, explore mechanisms that may explain increasing rates of stroke in this population, and provide a critical updated overview of the existing literature on the management and prevention of stroke in young adults.
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Affiliation(s)
- Syed Bukhari
- Temple University Hospital, Philadelphia, PA 19140, USA
| | - Shadi Yaghi
- Department of Medicine, Brown University, Providence, RI 02912, USA; (S.Y.); (Z.B.)
| | - Zubair Bashir
- Department of Medicine, Brown University, Providence, RI 02912, USA; (S.Y.); (Z.B.)
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Li Z, Wu S, Liang F, Tan F, Li N, Bao M. Predictors of favorable outcome and mortality after endovascular thrombectomy in young Chinese patients with large vascular occlusions. Front Neurol 2023; 14:1227642. [PMID: 37503515 PMCID: PMC10369457 DOI: 10.3389/fneur.2023.1227642] [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: 05/23/2023] [Accepted: 06/30/2023] [Indexed: 07/29/2023] Open
Abstract
Background Endovascular thrombectomy (EVT) has evolved into the standard treatment for patients with acute ischemic stroke (AIS) and large vessel occlusion (LVO). However, little information is available on the management of EVT in young patients with AIS-LVO in China. The purpose of this study was to assess the favorable outcomes and mortality rates after 90 days of EVT in young Chinese patients with AIS-LVO and their predictors. Methods This retrospective study included young Chinese patients aged 18-50 years with AIS-LVO. The primary efficacy endpoint was the modified Rankin scale (mRS) score at day 90, and the primary safety endpoint was mortality within 90 days. Using univariate and multivariate logistic regression analyses, the associations between clinical, imaging, and procedure variables and favorable (mRS 0-2) outcomes or mortality at 90 days were analyzed. Results A total of 113 patients were included in the study with a mean age of 43.1 ± 6.3 years. Symptomatic intracranial hemorrhage (sICH) occurred in 8 (7.1%) patients. Favorable functional outcomes (mRS 0-2) were recovered in 42.5% of patients at 3 months. After 90 days, the mortality rate was 32.3%. Multivariate analysis revealed that the increase in admission NIHSS score was associated with a lower probability of functional independence (aOR 1.08, 95% CI 1.02-1.15, p = 0.01 and aOR 1.01, 95% CI 1-1.01, p = 0.008, respectively) and a higher probability of death at 90 days (aOR 1.1, 95% CI 1.03-1.18, p = 0.007 and aOR 1.00, 95% CI 1-1.01, p = 0.021, respectively). Conclusion This study demonstrate that EVT provides higher rates of arterial recanalization, rather than better favorable outcomes and lower risk of death at 3 months in young Chinese patients with AIS-LVO. Increased NIHSS scores on admission may be associated with poor patient prognosis.
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Affiliation(s)
- Zhiqiang Li
- Department of Neurology, Liaocheng People’s Hospital, Liaocheng, Shandong, China
| | - Shuhui Wu
- Department of Traditional Chinese Medicine, Liaocheng Third People’s Hospital, Liaocheng, Shandong, China
| | - Fang Liang
- Department of Intensive Care Unit, Liaocheng Third People’s Hospital, Liaocheng, Shandong, China
| | - Fengjiao Tan
- Department of Neurology, Liaocheng Third People’s Hospital, Liaocheng, Shandong, China
| | - Ning Li
- Department of Neurology, Liaocheng People’s Hospital, Liaocheng, Shandong, China
| | - Mengxin Bao
- Department of Neurology, Liaocheng People’s Hospital, Liaocheng, Shandong, China
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Ratner M, Garg K, Chang H, Johnson W, Sadek M, Maldonado T, Cayne N, Siracuse J, Jacobowitz G, Rockman C. Young patients undergoing carotid endarterectomy have increased rates of recurrent disease and late neurological events. J Vasc Surg 2023; 78:123-130. [PMID: 36870458 DOI: 10.1016/j.jvs.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVES There are few data regarding outcomes of patients with premature cerebrovascular disease (age ≤55 years) who undergo carotid endarterectomy (CEA). The objective of this study was to analyze the demographics, presentation, perioperative and later outcomes of younger patients undergoing CEA. METHODS The Society for Vascular Surgery Vascular Quality Initiative was queried for CEA cases between 2012 and 2022. Patients were stratified based on age of less than 55 or age greater than 55 years. Primary end points were periprocedural stroke, death, myocardial infarction, and composite outcomes. Secondary end points included restenosis (≥80%) or occlusion, late neurological events and reintervention. RESULTS Of 120,549 patients undergoing CEA, 7009 (5.5%) were 55 years old or younger (mean age, 51.3 years). Younger patients were more likely to be African American (7.7% vs 4.5%; P < .001), female (45.2% vs 38.9%; P < .001), and active smokers (57.3% vs 24.1%; P < .001). They were less likely than older patients to have hypertension (82.5% vs 89.7%; P < .001), coronary artery disease (25.0% vs 27.3%; P < .001), and congestive heart failure (7.8% vs 11.4%; P < .001). Younger patients were significantly less likely than older patients to be on aspirin, anticoagulation, statins, or beta-blockers, but were more likely to be taking P2Y12 inhibitors (37.2 vs 33.7%; P < .001). Younger patients were more likely to present with symptomatic disease (35.1% vs 27.6%; P < .001) and were more likely to undergo nonelective CEA (19.2% vs 12.8%; P < .001). Younger and older patients had similar rates of perioperative stroke/death (2% vs 2%; P = NS) and postoperative neurological events (1.9% vs 1.8%; P = NS). However, younger patients had lower rates of overall postoperative complications compared with their older counterparts (3.7% vs 4.7%; P < .001). Of these patients, 72.6% had recorded follow-up (mean, 13 months). During follow-up, younger patients were significantly more likely than older patients to experience a late failure, defined as significant restenosis (≥80%) or complete occlusion of the operated artery (2.4% vs 1.5%; P < .001) and were more likely to experience any neurological event (3.1% vs 2.3%; P < .001). Reintervention rates did not significantly differ between the two cohorts. After controlling for covariates using a logistic regression model, age 55 years or younger was independently associated with increased odds of late restenosis or occlusion (odds ratio, 1.591; 95% confidence interval, 1.221-2.073; P < .001) as well as late neurological events (odds ratio, 1.304; 95% confidence interval, 1.079-1.576; P = .006). CONCLUSIONS Young patients undergoing CEA are more likely to be African American, female, and active smokers. They are more likely to present symptomatically and undergo nonelective CEA. Although perioperative outcomes are similar, younger patients are more likely to experience carotid occlusion or restenosis as well as subsequent neurological events, during a relatively short follow-up period. These data suggest that younger CEA patients may require more diligent follow-up, as well as a continued aggressive approach to medical management of atherosclerosis to prevent future events related to the operated artery, given the particularly aggressive nature of premature atherosclerosis.
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Affiliation(s)
- Molly Ratner
- New York University Langone Medical Center, Department of Surgery, Division of Vascular Surgery, New York, NY
| | - Karan Garg
- New York University Langone Medical Center, Department of Surgery, Division of Vascular Surgery, New York, NY
| | - Heepeel Chang
- Westchester Medical Center, Department of Surgery, Division of Vascular Surgery, Valhalla, NY
| | - William Johnson
- New York University Langone Medical Center, Department of Surgery, Division of Vascular Surgery, New York, NY
| | - Mikel Sadek
- New York University Langone Medical Center, Department of Surgery, Division of Vascular Surgery, New York, NY
| | - Thomas Maldonado
- New York University Langone Medical Center, Department of Surgery, Division of Vascular Surgery, New York, NY
| | - Neal Cayne
- New York University Langone Medical Center, Department of Surgery, Division of Vascular Surgery, New York, NY
| | - Jeffrey Siracuse
- Boston Medical Center, Department of Surgery, Division of Vascular and Endovascular Surgery, Boston, MA
| | - Glenn Jacobowitz
- New York University Langone Medical Center, Department of Surgery, Division of Vascular Surgery, New York, NY
| | - Caron Rockman
- New York University Langone Medical Center, Department of Surgery, Division of Vascular Surgery, New York, NY.
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Moosa A, Osama D, Alnidawi F, Algillidary S, Hussein A, Das P. Risk Factors, Incidence, and Outcome of Stroke: A Retrospective Cross-Sectional Hospital-Based Study Comparing Young Adults and Elderly. Cureus 2023; 15:e40614. [PMID: 37476123 PMCID: PMC10354461 DOI: 10.7759/cureus.40614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
A noticeable increase of up to 40% in the incidence of stroke among young population over the past decade has been noted. This study aimed to investigate the incidence, risk factors, and outcomes of stroke and its subtypes in young adults compared to older population. A retrospective study of patients which included patients with confirmed diagnosis of stroke based on the International Classification of Diseases 10th Revision (ICD-10) classification between the years 2018 and 2020 was conducted. The results indicated that patients less than 45 years of age had a higher incidence of hemorrhagic stroke as compared to the other age groups (p=0.011). Hypertension leading to hemorrhagic stroke was higher in patients less than 45 years of age as compared to other groups (18 years {19.4%} versus 33 years {7.5%}, p=0.001). Hypertension was noted to be the leading risk factor for stroke among the younger population.
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Affiliation(s)
- Ameena Moosa
- Internal Medicine, King Hamad University Hospital, Muharraq, BHR
| | - Dana Osama
- Internal Medicine, King Hamad University Hospital, Muharraq, BHR
| | - Firas Alnidawi
- Neurology, King Hamad University Hospital, Muharraq, BHR
| | | | - Ali Hussein
- Internal Medicine, King Hamad University Hospital, Muharraq, BHR
| | - Priya Das
- Scientific Research and Development, King Hamad University Hospital, Muharraq, BHR
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Han J, Chen J, Tong X, Han M, Peng F, Niu H, Liu L, Liu F, Liu A. Association between smoking and intracranial artery dissection in patients aged less than 50 years: A propensity score-matched analysis. Tob Induc Dis 2023; 21:62. [PMID: 37215191 PMCID: PMC10193922 DOI: 10.18332/tid/162380] [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: 05/25/2022] [Revised: 09/07/2022] [Accepted: 03/19/2023] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION Smoking is a common risk factor for stroke in the young population. Intracranial artery dissection (ICAD) is a major cause of stroke in this population. However, the association between smoking and ICAD in young patients is not well characterized. We aimed to evaluate the association between smoking and ICAD in young individuals using propensity score-matched analysis. METHODS We conducted a retrospective study of consecutive patients aged <50 years with ICAD who were admitted to Beijing Tiantan Hospital between January 2016 and December 2020. Patients with other non-atherosclerotic/non-aneurysmal cerebrovascular diseases were selected as controls. Propensity score matching was based on age and sex. Smoking and other vascular risk factors were compared between the two groups. RESULTS The ICAD and control group included 120 and 197 patients, respectively. Propensity score matching resulted in 70 matched pairs. Smoking was the only significant factor association with ICAD in the matched cohort (p=0.031). CONCLUSIONS In this propensity score-matched analysis, smoking showed a positive association with ICAD in young patients with common cerebrovascular diseases that were neither atherosclerotic nor aneurysmal. Further studies are required to investigate the predictive role of smoking for ICAD in the young population.
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Affiliation(s)
- Jiangli Han
- Department of Neurosurgery, Affiliated Haikou Hospital, Xiangya School of Medicine, Central South University, Haikou, China
| | - Jigang Chen
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xin Tong
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Mingyang Han
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Fei Peng
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hao Niu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Lang Liu
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Fei Liu
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
- Department of Neurosurgery, the Fifth Affiliated Hospital of Sun Yatsen University, Zhuhai, China
| | - Aihua Liu
- Beijing Neurosurgical Institute, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, the Third Xiangya Hospital, Central South University, Changsha, China
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Khan M, Wasay M, O'Donnell MJ, Iqbal R, Langhorne P, Rosengren A, Damasceno A, Oguz A, Lanas F, Pogosova N, Alhussain F, Oveisgharan S, Czlonkowska A, Ryglewicz D, Yusuf S. Risk Factors for Stroke in the Young (18-45 Years): A Case-Control Analysis of INTERSTROKE Data from 32 Countries. Neuroepidemiology 2023; 57:275-283. [PMID: 37231971 DOI: 10.1159/000530675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/29/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND It is not clear whether conventional vascular risk factors are responsible for most strokes in patients younger than 45 years of age. Our objective was to evaluate the association of common risk factors with stroke in individuals under 45 years. METHODS INTERSTROKE was a case-control study carried out in 32 countries between 2007 and 2015. Patients presenting within 5 days of symptom onset of a first stroke were enrolled as cases. Controls were age and sex matched to cases and had no history of stroke. Cases and controls underwent similar evaluations. Odds ratios (ORs) and population attributable risks (PARs) were calculated to determine the association of various risk factors with all stroke, ischemic stroke, and intracranial hemorrhage, for patients 45 years of age or younger. FINDINGS 1,582 case-control pairs were included in this analysis. The mean age of this cohort was 38.5 years (SD 6.32). Overall, 71% strokes were ischemic. Cardiac causes {OR: 8.42 (95% confidence interval [CI]: 3.01-23.5)}; binge drinking of alcohol (OR: 5.44 [95% CI: 1.81-16.4]); hypertension (OR: 5.41 [95% CI: 3.40-8.58]); ApoB/ApoA1 ratio (OR: 2.74 [95% CI: 1.69-4.46]); psychosocial stress (OR: 2.33 [95% CI: 1.01-5.41]); smoking (OR: 1.85 [95% CI: 1.17-2.94]); and increased waist-to-hip ratio (OR: 1.69 [95% CI: 1.04-2.75]) were the most important risk factors for ischemic stroke in these young cases. For intracerebral hemorrhage, only hypertension (OR: 9.08 [95% CI: 5.46-15.1]) and binge drinking (OR: 4.06 [95% CI: 1.27-13.0]) were significant risk factors. The strength of association and population attributable risk (PAR) for hypertension increased with age (PAR 23.3% in those <35 years of age, 50.7% in 35-45 years of age). INTERPRETATION Conventional risk factors such as hypertension, smoking, binge drinking of alcohol, central obesity, cardiac causes, dyslipidemia, and psychosocial stress are important risk factors for stroke in those younger than 45 years of age. Hypertension is the most significant risk factor in all age groups and across all regions and both stroke subtypes. These risk factors should be identified and modified in early adulthood to prevent strokes in young individuals.
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Affiliation(s)
- Maria Khan
- Rashid Hospital, Dubai Medical College for Girls, Dubai, United Arab Emirates
| | - Mohammad Wasay
- Department of Neurology, Aga Khan University, Karachi, Pakistan
| | | | - Romaina Iqbal
- Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Annika Rosengren
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Region Västra Götaland, Gothenburg, Sweden
- Department of Medicine Geriatrics and Emergency Medicine, Sahlgrenska University Hospital Östra Hospital, Region Västra Götaland, Gothenburg, Sweden
| | | | - Aytekin Oguz
- Faculty of Medicine, Department of Internal Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Fernando Lanas
- Department of Neurology, Universidad de La Frontera, Temuco, Chile
| | - Nana Pogosova
- National Medical Research Center of Cardiology, Moscow, Russian Federation
| | - Fawaz Alhussain
- Department of Neurology, King Saud University, Riyadh, Saudi Arabia
| | - Shahram Oveisgharan
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA
| | | | | | - Salim Yusuf
- Population Health Research Institute, Mc Master University, Hamilton, Ontario, Canada
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Diner C, Mathieu L, Pfister G, Mourtialon R, Denormandie P, de L Escalopier N. Nerve transfer in the spastic equino varus foot: Anatomical feasibility study. Foot Ankle Surg 2023; 29:346-349. [PMID: 37095035 DOI: 10.1016/j.fas.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/23/2022] [Accepted: 04/01/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE We want to evaluate the feasibility of transferring a motor branch of the anterior tibial muscle (ATM) to the extensor digitorum longus (EDL) to evaluate this procedure in patients with spastic equinovarus foot (EVF) following post-stroke hemiplegia. METHODS Ten cadaveric dissections from five fresh frozen human cadavers were performed to establish the anatomic feasibility of transferring a motor branch of the deep peroneal nerve, usually destinated to the ATM, to the branch of the EDL to manage spastic EVF. RESULTS Six cases (60%) presented three branches destinated to the ATM, one case (10%) presented give branches, and three cases (30%) had four branches. In all specimens, the coaptation between the motor branch to the ATM, referred as the "effector" branch, and the branch of the EDL "receiver" branch was feasible without tension and did not require any intraneural dissection. CONCLUSION This anatomical study confirms the feasibility of transferring a motor branch from the ATM to the EDL to correct a spastic EVF.
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Affiliation(s)
- Constance Diner
- Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Teaching Hospital, Clamart 92140, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris 75005, France
| | - Laurent Mathieu
- Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Teaching Hospital, Clamart 92140, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris 75005, France; Orthopedic Department, Raymond Poincaré Hospital, AP-HP, Garches, France
| | - Georges Pfister
- Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Teaching Hospital, Clamart 92140, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris 75005, France
| | - Romain Mourtialon
- Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Teaching Hospital, Clamart 92140, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris 75005, France
| | - Philippe Denormandie
- Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Teaching Hospital, Clamart 92140, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris 75005, France; Orthopedic Department, Raymond Poincaré Hospital, AP-HP, Garches, France
| | - Nicolas de L Escalopier
- Clinic of Orthopedics, Traumatology and Reconstructive Surgery, Percy Military Teaching Hospital, Clamart 92140, France; French Military Health Service Academy, Ecole du Val-de-Grâce, Paris 75005, France; Centre Borelli, UMR 9010 Université Paris-Saclay, ENS Paris-Saclay, CNRS, French Military Health Service, F-94235, Cachan, France.
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Weller JM, Dorn F, Meissner JN, Stösser S, Beckonert NM, Nordsiek J, Kindler C, Deb-Chatterji M, Petzold GC, Bode FJ. Endovascular thrombectomy in young patients with stroke. Int J Stroke 2023; 18:453-461. [PMID: 35912650 DOI: 10.1177/17474930221119602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Endovascular treatment (ET) is standard of care in patients with acute ischemic stroke due to large vessel occlusion, but data on ET in young patients remain limited. AIM We aim to compare outcomes for young stroke patients undergoing ET in a matched cohort. METHODS We analyzed patients from an observational multicenter cohort with acute ischemic stroke and ET, the German Stroke Registry-Endovascular Treatment trial. Baseline characteristics, procedural parameters, and functional outcome at 90 days were compared between young (<50 years) and older (⩾50 years) patients with and without nearest-neighbor 1:1 propensity score matching. RESULTS Out of 6628 acute ischemic stroke patients treated with ET, 363 (5.5%) were young. Young patients differed with regard to prognostic outcome characteristics. Specifically, National Institutes of Health Stroke Scale (NIHSS) at admission was lower (median 13, interquartile range (IQR) 8-17 vs. 15, IQR 9-19, p < 0.001), and prestroke dependence was less frequent (2.9% vs. 12.2%, p < 0.001) than in older patients. Compared to a matched cohort of older patients, ET was faster (time from groin puncture to flow restoration, 35 vs. 45 min, p < 0.001) and intracranial hemorrhage was less frequent in young patients (10.0% vs. 25.9%, p < 0.001). Good functional outcome (modified Rankin Scale (mRS) 0-2) at 3 months was achieved more frequently in young patients (71.6% vs. 44.1%, p < 0.001), and overall mortality was lower (6.7% vs. 25.4%, p < 0.001). Among previously employed young patients (n = 177), 37.9% returned to work at 3-month follow-up, while 74.1% of the remaining patients were still undergoing rehabilitation. CONCLUSION Young stroke patients undergoing ET have better outcomes compared to older patients, even when matched for prestroke condition, comorbidities, and stroke severity. Hence, more liberal guidelines to perform ET for younger patients may have to be established by future studies.
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Affiliation(s)
- Johannes M Weller
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Franziska Dorn
- Department of Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Julius N Meissner
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Sebastian Stösser
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Niklas M Beckonert
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Julia Nordsiek
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Christine Kindler
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Milani Deb-Chatterji
- Department of Neurology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Gabor C Petzold
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
| | - Felix J Bode
- Division of Vascular Neurology, Department of Neurology, University Hospital Bonn, Bonn, Germany
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Kõrv L, Vibo R, Kõrv J. Declining first-ever stroke incidence rates in 15- to 54-year-old residents of Tartu, Estonia, from 1991 to 2017. Int J Stroke 2023; 18:462-468. [PMID: 36053147 DOI: 10.1177/17474930221125345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Having a stroke at a young age has a huge socioeconomic impact. Data on the trends of stroke incidence in young adults from prospective population-based studies are scarce. AIMS The aim of this study was to analyze the trends in stroke incidence in 15- to 54-year-old residents of Tartu, Estonia from 1991 to 2017. METHODS Three population-based studies with identical study protocols determining the incidence of first-ever stroke have previously been conducted in Tartu, Estonia (1991-1993, 2001-2003, and 2013-2017). All residents of Tartu with first-ever stroke (ischemic stroke, spontaneous intracerebral hemorrhage, and subarachnoid hemorrhage) who were hospitalized to the Department of Neurology, Tartu University Hospital in respective study periods were included prospectively. Overlapping data sources for case ascertainment were used to include both hospitalized and non-hospitalized cases. Trends in first-ever stroke incidence in 15- to 54-year-old residents of Tartu were calculated and compared using rate ratio (RR). RESULTS Altogether 259 strokes were identified. From 1991 to 2017, the proportion of women increased from 38.3% to 43.6%. Mean age at onset in women decreased from 46.9 (standard deviation (SD): 7.3) to 42.6 (SD: 8.9). Overall crude incidence rates per 100,000 decreased significantly from 1991 to 2003 (from 57.2 (95% confidence interval (CI): 46.9-69.1) to 35.7 (95% CI: 25.7-48.3)); RR: 0.62 (95% CI: 0.44-0.89). While also present in women, the decrease was most notable in 45- to 54-year-old men (RR: 0.55 (95% CI: 0.30-0.99)). In 35- to 44-year-old men, the incidence rates decreased significantly from 2001 to 2017 (RR: 0.37 (95% CI: 0.14-0.99)). CONCLUSION The overall first-ever stroke incidence rates decreased from 1991 to 2003 and remained stable thereafter.
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Affiliation(s)
- Liisa Kõrv
- Department of Neurology and Neurosurgery, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Riina Vibo
- Department of Neurology and Neurosurgery, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, Faculty of Medicine, University of Tartu, Tartu, Estonia
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Volz M, Ladwig S, Werheid K. Return to work and depressive symptoms in young stroke survivors after six and twelve months: cross-sectional and longitudinal analyses. Top Stroke Rehabil 2023; 30:263-271. [PMID: 35068384 DOI: 10.1080/10749357.2022.2026562] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND While depression after stroke is common and stroke prevalence globally increases in working age populations, the role of return-to-work (RTW) in the pathogenesis of post-stroke depression (PSD) remains unclear. This study examined if RTW is linked to PSD within the first year after ischemic stroke, independently from established risk factors. METHOD Stroke survivors (n = 176) in their working age (<65 years) recruited from two rehabilitation clinics were assessed for established risk factors: pre-stroke depression, activities of daily living, stroke severity, cognitive impairment, and social support. RTW and depressive symptoms (Geriatric Depression Scale: GDS-15) were assessed six- and twelve-months post-stroke. Multivariate regression analyses were used to assess the cross-sectional and longitudinal relationship between RTW and GDS-15, while controlling for established PSD risk factors. RESULTS Successful RTW was independently associated with lower GDS-15 at both measurement occasions (p < .05), next to the absence of pre-stroke depression and higher social support. Stroke severity predicted GDS-15 at twelve months. The predictive value of six-months RTW for subsequent depressive symptoms beyond the influence of established risk factors was ß = -1.73 (p = .09). DISCUSSION RTW was independently associated with PSD in young stroke survivors within the first-year post-stroke, and exerted a (marginally significant) effect on subsequent depression. Our study highlights the relevance of RTW for young stroke survivors' PSD, beyond the influence of established risk factors. Further assessments examining to what extent fostering RTW contributes to mental well-being after stroke might be promising for PSD prevention, next to evident beneficial economic effects.
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Affiliation(s)
- Matthias Volz
- Department of Psychology, Universität Kassel, Kassel, Germany
| | - Simon Ladwig
- Department of Psychology, Humboldt Universität zu Berlin, Berlin, Germany.,Clinic of Neurology, Klinikum Ernst von Bergmann, Potsdam, Germany
| | - Katja Werheid
- Department of Psychology, Universität Bielefeld, Bielefeld, Germany
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Saapar M, Vibo R, Schneider S, Kõrv L, Mallene S, Kõrv J. Health behavior of young patients with ischemic stroke in Estonia: A score of five factors. Brain Behav 2023; 13:e2908. [PMID: 36788655 PMCID: PMC10013939 DOI: 10.1002/brb3.2908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 12/11/2022] [Accepted: 01/16/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Behavioral risk factors are common among young patients with stroke. This study aimed to compare the health behavior of patients and healthy controls and develop a combined risk score of health behavior. METHODS The health behavior of patients aged 18-54 years who suffered an ischemic stroke from 2013 to 2020 in Estonia was compared to the Health Behavior among Estonian Adult Population 2014 study sample. We chose five risk factors for comparison: smoking status, body mass index, physical exercise, diet (salt use and vegetable consumption), alcohol intake (quantity and frequency), and composed a summary score. RESULTS Comparing 342 patients and 1789 controls, daily smoking (49.0% vs. 22.7%), obesity (33.4% vs. 15.9%), low physical activity (< twice/week) (72.2% vs. 60.5%), excessive salt use (8.6% vs. 4.5%), and frequent alcohol use (≥ weekly) (39.9% vs. 34.0%) were more prevalent among patients. The differences in infrequent vegetable consumption (<6 days/week) and excessive alcohol consumption (7 days, >8 units/females, >16 units/males) were not significant. The observed differences were similar for age groups 18-44 years and 45-54 years. The average Health Behavior Stroke Risk Score (0-10) was 4.6 points (CI 4.4-4.8, SD ± 1.97) for patients and 3.5 points (CI 3.4-3.6, SD ± 1.90) for controls. CONCLUSIONS Before stroke, young patients displayed significantly worse health behavior than the general population. The largest differences were found for smoking and obesity, and a cumulation of risk factors was observed via the HBSR score.
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Affiliation(s)
- Minni Saapar
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Riina Vibo
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Siim Schneider
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.,Department of Neurology, North Estonia Medical Centre, Tallinn, Estonia
| | - Liisa Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia.,Department of Neurology, North Estonia Medical Centre, Tallinn, Estonia
| | - Sandra Mallene
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Janika Kõrv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
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Ahn HJ, Lee SR, Choi EK, Bae NY, Ahn HJ, Kwon S, Lee SW, Han KD, Oh S, Lip GYH. Increased risk of incident atrial fibrillation in young adults with mental disorders: A nationwide population-based study. Heart Rhythm 2023; 20:365-373. [PMID: 36563829 DOI: 10.1016/j.hrthm.2022.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/09/2022] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Mental disorders and cardiovascular diseases are closely related. However, a paucity of information on the risk of incident atrial fibrillation (AF) in patients with mental disorders exists. OBJECTIVE We aimed to assess the association between mental disorders and the risk of AF, particularly in young adults. METHODS Using the Korean National Health Insurance Database between 2009 and 2012, we identified adults aged 20-39 years without a history of AF and who have been diagnosed with mental disorders. Mental disorders were defined as having one of the following diagnoses: depression, insomnia, anxiety disorder, bipolar disorder, or schizophrenia. The primary outcome was new-onset AF during follow-up. RESULTS A total of 6,576,582 subjects (mean age 30.9 ± 5.0 years; 3,919,339 [59.6%] men) were included. Among the total population, 10% had mental disorders. During the follow-up period, 8932 incident AF events occurred. Patients with mental disorders showed a higher AF incidence than did those without (25.4 per 100,000 person-years vs 17.7 per 100,000 person-years). After multivariable adjustment, mental disorders were associated with a significantly higher risk of AF (adjusted hazard ratio 1.526; 95% confidence interval 1.436-1.621). Patients with bipolar disorder or schizophrenia had a 2-fold higher risk of AF and those with depression, insomnia, and anxiety disorder had a 1.5- to 1.7-fold higher risk of AF than did those without mental disorders. CONCLUSION Young adults diagnosed with mental disorders have a higher risk of incident AF. Awareness for AF in high-risk populations should thus be considered.
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Affiliation(s)
- Hyun Jin Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Nan Young Bae
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soonil Kwon
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Woo Lee
- Department of Medical Statistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Kyung-Do Han
- Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Gregory Y H Lip
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Chest and Heart Hospital, Liverpool, United Kingdom; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Pipes GM, Logue TC, Wen T, Booker WA, D'Alton ME, Friedman AM. Postpartum stroke trends, risk factors, and associated adverse outcomes. Am J Obstet Gynecol MFM 2023; 5:100864. [PMID: 36791844 DOI: 10.1016/j.ajogmf.2023.100864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/05/2023] [Accepted: 01/10/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Management of postpartum stroke has been the focus of several quality improvement efforts in the past decade. However, there is little recent national trends data for postpartum stroke readmissions. OBJECTIVE This study aimed to determine trends, risk factors, and complications associated with postpartum stroke readmission. STUDY DESIGN The 2013 to 2019 Nationwide Readmissions Database was used to perform a retrospective cohort study that evaluated the risk for readmission for stroke within 60 days of delivery hospitalization discharge. Temporal trends in readmissions were analyzed using the National Cancer Institute's Joinpoint Regression Program to estimate the average annual percent change with 95% confidence intervals. Stratified trends were analyzed for hemorrhage stroke, ischemic stroke, and stroke readmissions at 1 to 10, 11 to 30, and 31 to 60 days after delivery discharge. Risk factors for stroke were analyzed using unadjusted and adjusted logistic regression models with odds ratios and 95% confidence intervals as measures of association. The risk for stroke complications, including mechanical ventilation, seizures, death, and a prolonged stay ≥14 days, was analyzed. RESULTS Of an estimated 21,754,603 delivery hospitalizations, 5006 were complicated by a 60-day postpartum readmission with a diagnosis of stroke. The average annual percent change for all stroke readmissions over the study period was not significant (average annual percent change, 0.1%; 95% confidence interval, -2.2% to 2.4%). When the trends in readmission for ischemic and hemorrhagic stroke were analyzed, the results were similar, as were the stratified analyses by readmission timing. Risk factors associated with increased odds included superimposed preeclampsia (odds ratio, 4.8; 95% confidence interval, 3.9-5.9), preeclampsia with severe features (odds ratio, 3.7; 95% confidence interval, 3.0-4.4), maternal cardiac disease (odds ratio, 3.0; 95% confidence interval, 2.5-3.7), chronic kidney disease (odds ratio, 5.0; 95% confidence interval, 3.4-7.5), and lupus (odds ratio, 7.0; 95% confidence interval, 4.9-10.2). Risk was retained in adjusted analyses. Common stroke-related complications included a prolonged hospital stay ≥14 days (12.1 per 1000 stroke-related readmissions), seizures (9.9 per 1000 stroke-related readmissions), and mechanical ventilation (6.6 per 1000 stroke-related readmissions). CONCLUSION This analysis of nationally representative data demonstrated no change in the rate of 60-day postpartum hospitalizations for stroke from 2013 to 2019. Further clinical research is indicated to optimize risk reduction for stroke after delivery hospitalization discharge.
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Affiliation(s)
- Grace M Pipes
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Pipes and Drs Logue, Booker, D'Alton, and Friedman)
| | - Teresa C Logue
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Pipes and Drs Logue, Booker, D'Alton, and Friedman)
| | - Timothy Wen
- and Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California-San Francisco, San Francisco, CA (Dr Wen)
| | - Whitney A Booker
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Pipes and Drs Logue, Booker, D'Alton, and Friedman)
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Pipes and Drs Logue, Booker, D'Alton, and Friedman)
| | - Alexander M Friedman
- Department of Obstetrics and Gynecology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY (Ms Pipes and Drs Logue, Booker, D'Alton, and Friedman).
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Chung JW, Lee SR, Choi EK, Park SH, Lee H, Choi J, Han M, Ahn HJ, Kwon S, Lee S, Han K, Kim S, Oh S, Lip GYH. Cumulative Alcohol Consumption Burden and the Risk of Stroke in Young Adults: A Nationwide Population-Based Study. Neurology 2023; 100:e505-e515. [PMID: 36323515 PMCID: PMC9931082 DOI: 10.1212/wnl.0000000000201473] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 09/12/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Alcohol consumption is one of the important modifiable risk factors for stroke in young adults. The association between the cumulative burden of alcohol consumption and its impact on incident stroke in young adults is unknown. We aimed to investigate the association between cumulative alcohol burden and the risk for stroke among young adults. METHODS Using data from the Korean National Health Insurance Service database, patients age between 20 and 39 years, who underwent 4 consecutive annual health examinations between 2009 and 2012, were included. The cumulative alcohol burden score of moderate-to-heavy drinking was evaluated by assigning a score of 1 for alcohol consumption ≥105 g/wk at the health examination each year and calculating the sum of 4 years (0-4). The main outcome was incident stroke and its subtypes, ischemic stroke, and hemorrhagic stroke during the follow-up period. RESULTS Of 1 536 668 patients (mean age of 29.5 years, 71.5% male, and median follow-up of 6-year), 3 153 experienced an incident stroke (incidence rate, 0.37 per 1,000 person-years). After multivariable adjustment, patients with alcohol burden scores of 2, 3, and 4, who consumed more than 105 g/wk of alcohol for 2, 3, and 4 years, demonstrated significantly higher risks for stroke (hazard ratio [HR] 1.19, 95% CI 1.05-1.34 for 2; HR 1.22, 95% CI 1.09-1.38 for 3; HR 1.23, 95% CI 1.10-1.38 for 4) compared with those with a burden score of 0. This positive dose-response relationship was primarily driven by hemorrhagic rather than ischemic stroke. High alcohol burden scores (i.e., 2, 3, and 4) were significantly associated with higher risks for hemorrhagic stroke (HR 1.30, 95% CI 1.10-1.54 for 2; HR 1.42, 95% CI 1.21-1.67 for 3; HR 1.36, 95% CI 1.16-1.59 for 4) compared with a burden score of 0. DISCUSSION Young adults who engaged in moderate-to-heavy drinking demonstrated a higher risk for incident stroke, especially hemorrhagic stroke. Reducing alcohol consumption should be emphasized in young adults with heavy drinking habits as part of any stroke prevention strategy.
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Affiliation(s)
- Jae-Wook Chung
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - So-Ryoung Lee
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Eue-Keun Choi
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark.
| | - Sang-Hyeon Park
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - HuiJin Lee
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - JungMin Choi
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark.
| | - Minju Han
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Hyo-Jeong Ahn
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Soonil Kwon
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - SeungWoo Lee
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Kyungdo Han
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Sunhwa Kim
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Seil Oh
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
| | - Gregory Y H Lip
- From the Departments of Internal Medicine (J.-w.C., S.-R.L., E.-K.C., S.-H.P., H.L., J.C., M.H., H.-J.A., Soonil Kwon, Sunhwa Kim, S.O.) and Internal Medicine (E.-K.C., S.O., G.Y.H.L.), Seoul National University College of Medicine; Department of Medical Statistics (S.L.), College of Medicine, Catholic University of Korea, Seoul; Statistics and Actuarial Science (K.H.), Soongsil University, Seoul, Republic of Korea; Liverpool Centre for Cardiovascular Science (G.Y.H.L.), University of Liverpool and Liverpool Heart and Chest Hospital, United Kingdom; and Department of Clinical Medicine (G.Y.H.L.), Aalborg University, Denmark
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Fong TCT, Lo TLT, Ho RTH. Psychometric properties of the 12-item Stroke-Specific Quality of Life Scale among stroke survivors in Hong Kong. Sci Rep 2023; 13:1510. [PMID: 36707541 PMCID: PMC9883526 DOI: 10.1038/s41598-023-28636-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 01/23/2023] [Indexed: 01/28/2023] Open
Abstract
The present study examined the psychometric properties of the 12-item Stroke-Specific Quality of Life Scale (SSQOL-12) in 184 stroke survivors in Hong Kong. The participants completed a self-report questionnaire including the SSQOL-12, SF-12 health survey, and validating variables at baseline and 148 stroke survivors completed SSQOL-12 two months later. Confirmatory factor analysis investigated the construct validity, reliability, and measurement invariance of SSQOL-12 across two months. Concurrent, convergent, and divergent validity was examined with respect to SF-12, hope, self-esteem, functional disability, anxiety, and depression. The original 2-factor model did not reveal a superior fit over the 1-factor model and a modified 1-factor model provided an acceptable fit to the data in both waves. The SSQOL-12 factor displayed substantial factor loadings (λ = 0.40-0.87), good internal consistency (Ω = 0.88), temporal stability (r = 0.70), and scalar measurement invariance across time. Stroke-specific quality of life was significantly associated with higher levels of SF-12, hope, and self-esteem and lower levels of functional disability, anxiety, and depression. Most correlations remained significant after controlling for demographic covariates and SF-12. The present findings offered empirical support for the validity and reliability of the unidimensional structure for SSQOL-12 as a measure of stroke-specific quality of life among stroke survivors.
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Affiliation(s)
- Ted C T Fong
- Centre on Behavioral Health, University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong, China.
| | - Temmy L T Lo
- Centre on Behavioral Health, University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong, China
| | - Rainbow T H Ho
- Centre on Behavioral Health, University of Hong Kong, 2/F, The Hong Kong Jockey Club Building for Interdisciplinary Research, 5 Sassoon Road, Pokfulam, Hong Kong, China. .,Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China.
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Han X, Geng B, Deng F, Ma Y, Fan N, Huang S, Xue M, Wu L, Li B, Liao S, Ye Q, Liu Y. Galectin-3 is associated with the functional outcome and mortality in stroke patients: A systematic review and meta-analysis. Heliyon 2023; 9:e13279. [PMID: 36846691 PMCID: PMC9947260 DOI: 10.1016/j.heliyon.2023.e13279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 12/12/2022] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
Introduction There is still a lack of sensitive predictive tools for stroke outcomes. High galectin-3 concentration is associated with an increased risk of stroke. This study investigated the relationship between blood galectin-3 levels and stroke prognosis. Methods The PubMed, EMBASE, and Cochrane Library databases were searched as of May 2021. Data from eligible studies on the relationship between galectin-3 and stroke prognosis were extracted for the meta-analysis. Results The outcomes included the modified Rankin Scale (mRS), mortality rate, and prognostic accuracy of galectin-3 on mRS after stroke. Odds ratio (OR) and 95% CI were used to assess the association between galectin-3 and the prognostic outcomes. Subgroup analysis based on the study design was performed to evaluate the correlation of galectin-3 with mRS and mortality. A random-effects model was adopted for this meta-analysis. A total of 5 studies involving 3607 stroke patients were included. Higher serum galectin-3 level was associated with mRS (OR [95% CI]: 2.02 [1.08, 3.77]) and mortality (OR [95% CI]: 2.17 [1.17, 4.02]) after stroke. Subgroup analysis revealed a similar relationship between galectin-3 and mRS for both prospective and retrospective studies. There were no associations between galectin-3 level and mortality rate in prospective studies. Galectin-3 had a good predictive ability on mRS after stroke (AUC: 0.88, 95% CI:0.85, 0.91). Conclusion Elevated blood galectin-3 levels were associated with prognostic outcomes after stroke, including functional outcome mRS and mortality rate. Moreover, galectin-3 had a good predictive ability for the prognosis of stroke.
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Affiliation(s)
- Xiaoling Han
- Interventional Medical Center, Zhuhai People’s Hospital (Zhuhai People’s Hospital of Jinan University), Zhuhai, Guangdong, China
| | - Bingbing Geng
- Interventional Medical Center, Zhuhai People’s Hospital (Zhuhai People’s Hospital of Jinan University), Zhuhai, Guangdong, China
| | - Feiyan Deng
- Interventional Medical Center, Zhuhai People’s Hospital (Zhuhai People’s Hospital of Jinan University), Zhuhai, Guangdong, China
| | - Ying Ma
- Interventional Medical Center, Zhuhai People’s Hospital (Zhuhai People’s Hospital of Jinan University), Zhuhai, Guangdong, China
| | - Ningning Fan
- Ophthalmology Department, Zhuhai People’s Hospital, Zhuhai, Guangdong, China
| | - Shaomin Huang
- Ophthalmology Department, Zhuhai People’s Hospital, Zhuhai, Guangdong, China
| | - Ming Xue
- Interventional Medical Center, Zhuhai People’s Hospital (Zhuhai People’s Hospital of Jinan University), Zhuhai, Guangdong, China
| | - Lei Wu
- Interventional Medical Center, Zhuhai People’s Hospital (Zhuhai People’s Hospital of Jinan University), Zhuhai, Guangdong, China
| | - Bixia Li
- Interventional Medical Center, Zhuhai People’s Hospital (Zhuhai People’s Hospital of Jinan University), Zhuhai, Guangdong, China
| | - Shaoqin Liao
- Interventional Medical Center, Zhuhai People’s Hospital (Zhuhai People’s Hospital of Jinan University), Zhuhai, Guangdong, China,Corresponding author.
| | - Qiao Ye
- Nursing Department, Zhuhai People’s Hospital, Zhuhai, Guangdong, China,Corresponding author.
| | - Yu Liu
- Interventional Medical Center, Zhuhai People’s Hospital (Zhuhai People’s Hospital of Jinan University), Zhuhai, Guangdong, China,Corresponding author.
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Zhang R, Liu H, Pu L, Zhao T, Zhang S, Han K, Han L. Global Burden of Ischemic Stroke in Young Adults in 204 Countries and Territories. Neurology 2023; 100:e422-e434. [PMID: 36307222 DOI: 10.1212/wnl.0000000000201467] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 09/09/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES To estimate the rates of incidence, death, and disability-adjusted life years (DALYs) of ischemic stroke in young adults aged 15-49 years and the relevant risk factors by sex, age group, and sociodemographic index (SDI) in 204 countries and territories. METHODS Data from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) 2019 study were used. The estimated annual percentage changes (EAPCs) were calculated to evaluate the temporal trends from 1990 to 2019. We also estimated the risk factors contributing to DALYs resulting from ischemic stroke. RESULTS From 1990 to 2019, the global age-standardized incidence (EAPC = -0.97), death (EAPC = -0.11), and DALYs rates (EAPC = -0.55) of ischemic stroke in young adults decreased. The largest increases in age-standardized incidence, death, and DALYs rates were observed in the low and low-middle SDI quintiles. At the regional level, North Africa and the Middle East and Southeast Asia showed the largest increases in the age-standardized incidence, death, and DALYs rates of ischemic stroke. The age-standardized incidence rate was higher among young women than among young men in 2019. Globally, a high environmental temperature, high body mass index (BMI), and a high fasting plasma glucose contributed to the largest increases in age-standardized DALYs rates between 1990 and 2019. In the same period, the largest increases in the age-standardized DALYs rates in high-SDI and low-SDI regions were attributable to high environmental temperatures and alcohol use, respectively. DISCUSSION The burden of ischemic stroke in young adults continues to increase in low-SDI regions such as North Africa and the Middle East and Southeast Asia. There were differences in the primary risk factors related to the burden of ischemic stroke in different SDI regions. Targeted implementation of cost-effective policies and interventions is an urgent need to reduce the burden of ischemic stroke in young adults.
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Affiliation(s)
- Ruijie Zhang
- From the Ningbo No. 2 Hospital (R.Z., H.L., L.P., T.Z., L.H.), Ningbo, Zhejiang; Department of Global Health (R.Z., L.P., L.H.), Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang; Ningbo Institute of Life and Health Industry (H.L., S.H.), University of Chinese Academy of Sciences, Ningbo, Zhejiang; Ningbo Clinical Research Center for Digestive System Tumors (S.Z.) and Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province (S.Z.), Ningbo No. 2 Hospital, Ningbo, Zhejiang; and Department of Neurology (K.H.), The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, Guangdong, PR China
| | - Huina Liu
- From the Ningbo No. 2 Hospital (R.Z., H.L., L.P., T.Z., L.H.), Ningbo, Zhejiang; Department of Global Health (R.Z., L.P., L.H.), Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang; Ningbo Institute of Life and Health Industry (H.L., S.H.), University of Chinese Academy of Sciences, Ningbo, Zhejiang; Ningbo Clinical Research Center for Digestive System Tumors (S.Z.) and Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province (S.Z.), Ningbo No. 2 Hospital, Ningbo, Zhejiang; and Department of Neurology (K.H.), The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, Guangdong, PR China
| | - Liyuan Pu
- From the Ningbo No. 2 Hospital (R.Z., H.L., L.P., T.Z., L.H.), Ningbo, Zhejiang; Department of Global Health (R.Z., L.P., L.H.), Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang; Ningbo Institute of Life and Health Industry (H.L., S.H.), University of Chinese Academy of Sciences, Ningbo, Zhejiang; Ningbo Clinical Research Center for Digestive System Tumors (S.Z.) and Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province (S.Z.), Ningbo No. 2 Hospital, Ningbo, Zhejiang; and Department of Neurology (K.H.), The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, Guangdong, PR China
| | - Tian Zhao
- From the Ningbo No. 2 Hospital (R.Z., H.L., L.P., T.Z., L.H.), Ningbo, Zhejiang; Department of Global Health (R.Z., L.P., L.H.), Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang; Ningbo Institute of Life and Health Industry (H.L., S.H.), University of Chinese Academy of Sciences, Ningbo, Zhejiang; Ningbo Clinical Research Center for Digestive System Tumors (S.Z.) and Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province (S.Z.), Ningbo No. 2 Hospital, Ningbo, Zhejiang; and Department of Neurology (K.H.), The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, Guangdong, PR China
| | - Shun Zhang
- From the Ningbo No. 2 Hospital (R.Z., H.L., L.P., T.Z., L.H.), Ningbo, Zhejiang; Department of Global Health (R.Z., L.P., L.H.), Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang; Ningbo Institute of Life and Health Industry (H.L., S.H.), University of Chinese Academy of Sciences, Ningbo, Zhejiang; Ningbo Clinical Research Center for Digestive System Tumors (S.Z.) and Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province (S.Z.), Ningbo No. 2 Hospital, Ningbo, Zhejiang; and Department of Neurology (K.H.), The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, Guangdong, PR China
| | - Kun Han
- From the Ningbo No. 2 Hospital (R.Z., H.L., L.P., T.Z., L.H.), Ningbo, Zhejiang; Department of Global Health (R.Z., L.P., L.H.), Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang; Ningbo Institute of Life and Health Industry (H.L., S.H.), University of Chinese Academy of Sciences, Ningbo, Zhejiang; Ningbo Clinical Research Center for Digestive System Tumors (S.Z.) and Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province (S.Z.), Ningbo No. 2 Hospital, Ningbo, Zhejiang; and Department of Neurology (K.H.), The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, Guangdong, PR China
| | - Liyuan Han
- From the Ningbo No. 2 Hospital (R.Z., H.L., L.P., T.Z., L.H.), Ningbo, Zhejiang; Department of Global Health (R.Z., L.P., L.H.), Ningbo Institute of Life and Health Industry, University of Chinese Academy of Sciences, Ningbo, Zhejiang; Ningbo Institute of Life and Health Industry (H.L., S.H.), University of Chinese Academy of Sciences, Ningbo, Zhejiang; Ningbo Clinical Research Center for Digestive System Tumors (S.Z.) and Key Laboratory of Diagnosis and Treatment of Digestive System Tumors of Zhejiang Province (S.Z.), Ningbo No. 2 Hospital, Ningbo, Zhejiang; and Department of Neurology (K.H.), The First Dongguan Affiliated Hospital, Guangdong Medical University, Dongguan, Guangdong, PR China.
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Efremova D, Ciolac D, Zota E, Glavan D, Ciobanu N, Aulitzky W, Nics AM, Trinka E, Yamada C, Movila A, Groppa SA. Dissecting the Spectrum of Stroke Risk Factors in an Apparently Healthy Population: Paving the Roadmap to Primary Stroke Prevention. J Cardiovasc Dev Dis 2023; 10:35. [PMID: 36826531 PMCID: PMC9965290 DOI: 10.3390/jcdd10020035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/24/2022] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
We aimed to investigate, for the first time, the spectrum of stroke risk factors specific to the population of the Republic of Moldova. The subjects were examined according to a pre-established protocol of risk factor estimation. The study involved 300 subjects, including 60% women and 40% men, with a mean age of 49.9 ± 14.5 years. The most common risk factor was abdominal obesity, identified in 75% of subjects; general obesity was detected in 48%, while 32% of subjects were overweight and 20% were normally weighted. Hypertension was observed in 44%; 8% of those examined had atrial fibrillation, and 9% had diabetes mellitus. Left myocardial hypertrophy on ECG was present in 53% of subjects, and acute ischemic changes in 2%. Laboratory observations detected that glycosylated hemoglobin increased by 7%, and >50% had dyslipidemia. Total cholesterol was significantly elevated by 58%, LDL-cholesterol was increased by 32%, and HDL-cholesterol was decreased by 9%. Homocysteine was increased in 55% and high-sensitivity C-reactive protein in 28% of subjects. These results indicate the presence of modifiable risk factors and the necessity to elaborate on the primary prevention strategies aimed at minimizing the burden of stroke in the population of the Republic of Moldova.
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Affiliation(s)
- Daniela Efremova
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Dumitru Ciolac
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Eremei Zota
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Danu Glavan
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Natalia Ciobanu
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
| | - Wolfgang Aulitzky
- Open Medical Institute, American Austrian Foundation, 5020 Salzburg, Austria
| | - Anna Maria Nics
- Open Medical Institute, American Austrian Foundation, 5020 Salzburg, Austria
| | - Eugen Trinka
- Department of Neurology, Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, 5020 Salzburg, Austria
- Neuroscience Institute, Christian Doppler University Hospital, Paracelsus Medical University, Centre for Cognitive Neuroscience, 5020 Salzburg, Austria
- Department of Public Health, Health Services Research and Health Technology Assessment, UMIT—University for Health Sciences, Medical Informatics and Technology, 6060 Hall in Tirol, Austria
| | - Chiaki Yamada
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN 46202, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Alexandru Movila
- Department of Biomedical Sciences and Comprehensive Care, Indiana University School of Dentistry, Indianapolis, IN 46202, USA
- Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Stanislav A. Groppa
- Department of Neurology, Institute of Emergency Medicine, 2004 Chisinau, Moldova
- Department of Neurology, Nicolae Testemitanu State University of Medicine and Pharmacy, 2004 Chisinau, Moldova
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Gurková E, Štureková L, Mandysová P, Šaňák D. Factors affecting the quality of life after ischemic stroke in young adults: a scoping review. Health Qual Life Outcomes 2023; 21:4. [PMID: 36653785 PMCID: PMC9850784 DOI: 10.1186/s12955-023-02090-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 01/11/2023] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To synthesize the body of knowledge on the factors influencing the quality of life (QoL) after ischemic stroke (IS) in young adults. METHODS Guidelines regarding the scoping review methodology developed by the Joanna Briggs Institute, and the PRISMA-ScR checklist for a scoping review was used in this paper. A total of 1197 studies were identified through a bibliographic search in Web of Science, MEDLINE, PsycInfo, ScienceDirect, Scopus, and ProQuest Science Database. Articles published between the years 2000-2021 were included. RESULTS A total of nine papers were finally selected to respond to the research question. Three studies were prospective longitudinal studies compared QoL between young stroke and age-matched controls from the general population. Across all the analysed studies, 14 variables potentially associated with QoL were identified. QoL in young patients is mainly affected by clinical outcomes after IS (scored by the modified Rankin scale and the Barthel index-favourable initial functional status and higher independence in ADL leads to higher QoL) and psychological factors (post-stroke fatigue and depression-higher levels of fatigue and depression lead to lower QoL). The reviewed studies emphasized the importance of functional outcomes, post-stroke depression, fatigue and anxiety and early return to work. CONCLUSION Further longitudinal studies are needed to identify the trajectory of post-stroke psychosocial symptoms over time and other potential predictors of unfavourable long-term QoL, thus specific young stroke rehabilitation and stroke self-management support programmes should be developed (address physical, psychological factors which influence the psychosocial adaptation post-stroke and the perception of the QoL).
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Affiliation(s)
- Elena Gurková
- grid.10979.360000 0001 1245 3953Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic
| | - Lenka Štureková
- grid.10979.360000 0001 1245 3953Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic
| | - Petra Mandysová
- grid.10979.360000 0001 1245 3953Department of Nursing, Faculty of Health Sciences, Palacký University Olomouc, Hněvotínská 976/3, 775 15 Olomouc, Czech Republic
| | - Daniel Šaňák
- grid.10979.360000 0001 1245 3953Comprehensive Stroke Center, Department of Neurology, Palacký University Medical School and Hospital, Olomouc, Czech Republic
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Lee D, Jeon H, Ahn Y, Kim HJ, Shin HE, Koh JH. Case 6: A 27-Year-Old Woman With Dysarthria. J Korean Med Sci 2023; 38:e5. [PMID: 36625170 PMCID: PMC9829511 DOI: 10.3346/jkms.2023.38.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/26/2022] [Indexed: 01/09/2023] Open
Affiliation(s)
- Donghan Lee
- Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Howook Jeon
- Division of Rheumatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Yuran Ahn
- Division of Cardiology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hwa Jung Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hae-Eun Shin
- Department of Neurology, Bucheon St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jung Hee Koh
- Division of Rheumatology, Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
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Pan X, Wang Z, Yao L, Xu L. The reasons for not returning to work and health-related quality of life among young and middle-aged patients with stroke: A cross-sectional study. Front Neurol 2023; 14:1078251. [PMID: 36908631 PMCID: PMC9995965 DOI: 10.3389/fneur.2023.1078251] [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: 10/24/2022] [Accepted: 01/31/2023] [Indexed: 02/25/2023] Open
Abstract
Objectives This study aimed to explore the reasons and influencing factors for non-return to work (non-RTW) within 1 year among young and middle-aged patients with stroke and to assess their health-related quality of life (HRQoL) at 1 year across different reasons. Methods The study was conducted as a telephone-based cross-sectional survey. Seven hundred eighty-nine young and middle-aged patients with stroke aged between 18 and 54 years for men and 18 and 49 years for women in the electronic medical system were included. Data collection included demographic characteristics, socioeconomic status, behavioral habits, history of chronic diseases, work status, reasons for non-RTW, and HRQoL. Results Of 789 patients, 435 (55.1%) (mean [SD] age, 47.7 [7.8] years) did not return to work within 1 year after stroke. Among the patients who did not RTW, 58.9% were unable to work, 9.7% retired early, 11.03% became full-time homemakers or were unemployed, and 20.5% were reluctant to work. The disordered multiclass logistic regression model showed that the factors influencing the reasons for non-RTW included age, gender, education, income, health insurance, diabetes comorbidity, ability to perform activities of daily living, and mobility of the right upper extremity. Furthermore, patients who were unable to work had significantly lower HRQoL compared to those who had RTW, followed by those who retired early. Conclusions More than half did not RTW within 1 year in our study. The results will help inform future research to identify interventions to promote RTW and improve HRQoL for young and middle-aged patients with stroke.
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Affiliation(s)
- Xi Pan
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Zhi Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Lin Yao
- Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Lan Xu
- Nursing Department, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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