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Mahajan C, Kapoor I, Prabhakar H. The Urban-Rural Divide in Neurocritical Care in Low-Income and Middle-Income Countries. Neurocrit Care 2024:10.1007/s12028-024-02040-z. [PMID: 38960992 DOI: 10.1007/s12028-024-02040-z] [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: 02/26/2024] [Accepted: 06/05/2024] [Indexed: 07/05/2024]
Abstract
The term "urban-rural divide" encompasses several dimensions and has remained an important concern for any country. The economic disparity; lack of infrastructure; dearth of medical specialists; limited opportunities to education, training, and health care; lower level of sanitation; and isolating effect of geographical location deepens this gap, especially in low-income and middle-income countries (LMICs). This article gives an overview of the rural-urban differences in terms of facilities related to neurocritical care (NCC) in LMICs. Issues related to common clinical conditions such as stroke, traumatic brain injury, myasthenia gravis, epilepsy, tubercular meningitis, and tracheostomy are also discussed. To facilitate delivery of NCC in resource-limited settings, proposed strategies include strengthening preventive measures, focusing on basics, having a multidisciplinary approach, promoting training and education, and conducting cost-effective research and collaborative efforts. The rural areas of LMICs bear the maximum impact because of their limited access to preventive health services, high incidence of acquired brain injury, inability to have timely management of neurological emergencies, and scarcity of specialist services in a resource-deprived health center. An increase in the health budget allocation for rural areas, NCC education and training of the workforce, and provision of telemedicine services for rapid diagnosis, management, and neurorehabilitation are some of the steps that can be quite helpful.
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Affiliation(s)
- Charu Mahajan
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Indu Kapoor
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India
| | - Hemanshu Prabhakar
- Department of Neuroanaesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, 110029, India.
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Bailey RR, Miner N. Differences in health characteristics and health behaviors between rural and non-rural community-dwelling stroke survivors aged ≥65 years in the USA. BRAIN IMPAIR 2023; 24:521-528. [PMID: 38167358 DOI: 10.1017/brimp.2022.17] [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: 11/07/2022]
Abstract
OBJECTIVES To examine differences in health characteristics and health behaviors between rural and non-rural stroke survivors in the USA. METHODS Data were extracted from the 2017 and 2019 Behavioral Risk Factor Surveillance System (BRFSS) to compare prevalences of health characteristics (i.e., diabetes, disability, poor health, high cholesterol, hypertension, no health care coverage, weight status) and health behaviors (i.e., fruit consumption, vegetable consumption, physical inactivity, high alcohol consumption, smoking) among community-dwelling stroke survivors, stratified by rural status (i.e., rural vs. non-rural). Logistic regression was used to calculate odds ratios (ORs) for health characteristics and health behaviors to examine the association of rural status with each variable of interest (reference group=non-rural). RESULTS Data from 14,599 respondents (rural: n = 5,039; non-rural: n = 9,560) were available for analysis. The majority of respondents were female (61.4%), non-Hispanic white (83.2%), previously married (56.1%), had at least some college education (55.2%), and had an annual household income ≥USD $25,000 (56.9%). Prevalences of disability, poor health, weekly aerobic exercise, and smoking were higher among rural respondents compared to non-rural respondents. Logistic regression showed increased odds (odds ratio range: 1.1-1.2) for these variables among rural respondents; however, odds ratios were attenuated after controlling for sociodemographic and health characteristics. CONCLUSIONS We did not find evidence of differences in the investigated health characteristics and health behaviors between rural and non-rural community-dwelling stroke survivors in the USA. Additional research is needed to confirm these findings and to identify alternative sociodemographic and health factors that may differ between rural and non-rural community-dwelling stroke survivors.
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Affiliation(s)
- Ryan R Bailey
- Department of Occupational and Recreational Therapies, College of Health, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA
| | - Natalie Miner
- Department of Occupational and Recreational Therapies, College of Health, University of Utah, 520 Wakara Way, Salt Lake City, UT, 84108, USA
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Song Y, Cheng F, Du Y, Zheng J, An Y, Lu Y. Higher Adherence to the AMED, DASH, and CHFP Dietary Patterns Is Associated with Better Cognition among Chinese Middle-Aged and Elderly Adults. Nutrients 2023; 15:3974. [PMID: 37764758 PMCID: PMC10535050 DOI: 10.3390/nu15183974] [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: 07/14/2023] [Revised: 08/21/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023] Open
Abstract
The available evidence regarding the association between adherence to the Alternate Mediterranean Diet (AMED) and Dietary Approaches to Stop Hypertension (DASH) dietary patterns and cognitive performance exhibits inconsistency, and its applicability within the Asian population remains uncertain. The association between adherence to the Chinese Food Pagoda (CHFP) and cognitive function is also unknown. In this study, we aimed to assess the association between adherence to the AMED, DASH, and CHFP different dietary patterns and cognitive function. The study included 3353 Chinese adults aged 55 years and over from the China Health and Nutrition Survey (CHNS) in 2006. A 24 h dietary recall over three consecutive days was used to collect dietary information. Dietary patterns included AMED, DASH, and CHFP. A subset of items from the Telephone Interview for Cognitive Status-Modified was used for cognitive screening. Poor cognitive performance was defined as a global cognitive function score < 7. Binary logistic regression was used to estimate the association between adherence to the three different dietary patterns and cognitive function. Binary logistic regression analysis showed that there is a negative association between higher adherence to the AMED, DASH, and CHFP and poorer cognitive performance (AMED: OR = 0.594, 95% CI = 0.458-0.771, p < 0.001; DASH: OR = 0.652, 95% CI = 0.504-0.843, p = 0.001; CHFP: OR = 0.599, 95% CI = 0.417-0.861, p = 0.006). There was a significant interaction between each of the three dietary patterns and residential regions (AMED: p for interaction = 0.045; DASH: p for interaction = 0.003; CHFP: p for interaction < 0.001). Higher adherence to the AMED, DASH, and CHFP dietary patterns was inversely associated with poor cognition in Chinese middle-aged and elderly adults, particularly among urban residents.
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Affiliation(s)
- Ying Song
- School of Nursing, Peking University, Beijing 100191, China; (Y.S.); (Y.D.); (J.Z.)
| | - Fangxiao Cheng
- Institute of Medical Technology, Peking University Health Science Center, Beijing 100191, China;
| | - Yage Du
- School of Nursing, Peking University, Beijing 100191, China; (Y.S.); (Y.D.); (J.Z.)
| | - Jie Zheng
- School of Nursing, Peking University, Beijing 100191, China; (Y.S.); (Y.D.); (J.Z.)
| | - Yu An
- Endocrinology Department, Beijing Chaoyang Hospital, Beijing 100020, China;
| | - Yanhui Lu
- School of Nursing, Peking University, Beijing 100191, China; (Y.S.); (Y.D.); (J.Z.)
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Lin B, Xue L, An B, Zhang Z, Zhang W. An Age-Stratified Cross-Sectional Study of Physical Activity and Exercise Adherence of Stroke Survivors in Rural Regions. Patient Prefer Adherence 2023; 17:2013-2023. [PMID: 37601092 PMCID: PMC10439803 DOI: 10.2147/ppa.s417220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/04/2023] [Indexed: 08/22/2023] Open
Abstract
Objective To describe the Physical Activity and Exercise (PAE) adherence of stroke survivors in rural regions, additionally, to analyze the influential factors through age stratification. Methods This is a cross-sectional study. Totally, 596 stroke patients (65.70±10.76 years) from three rural regions were selected, PAE scale was used for measuring compliance. The influential factors among different age groups were explored separately. This study adheres to the EQUATOR checklist, SROBE. Results Only 17.8% (106) of participants regularly participated in PAE. Altogether, 42.45% were classified as a young-middle age group, and the rest 57.55% were in the old age group. Positive attitudes and better PAE-relevant knowledge were protective factors for adherence in the young and middle-aged group (OR=0.683; 95% CI 0.173~0.588 and OR=0.939; 95% CI 0.013~0.114), as well as in the old group (OR=0.704; 95% CI 0.193~0.534 and OR=0.929; 95% CI 0.035~0.118); having no home rehabilitation equipment was a strong risk factor for younger patients (OR=16.078; 95% CI 1.235~4.320); however, without hemiplegia can positively affect their adherence (OR=0.891; 95% CI 0.045~0.229). In addition, the presence of a spouse can lead to a better compliance among old patients (OR=0.436; 95% CI -0.496~-0.165). Conclusion It is necessary to improve the knowledge of physical activity in rural stroke patients of all ages. It is of great significance to install home rehabilitation equipment to promote exercise for young and middle-aged stroke patients. While for the old stroke patients, we strongly suggest focusing on the role of spouses, which would be more useful in low-income regions.
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Affiliation(s)
- Beilei Lin
- Nursing Department, Henan Huaxian People Hospital, Anyang City, Henan Province, People’s Republic of China
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, People’s Republic of China
| | - Lihong Xue
- Nursing Department, Henan Huaxian People Hospital, Anyang City, Henan Province, People’s Republic of China
| | - Baoxia An
- Nursing Department, Henan Huaxian People Hospital, Anyang City, Henan Province, People’s Republic of China
| | - Zhenxiang Zhang
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, People’s Republic of China
| | - Weihong Zhang
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, People’s Republic of China
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Ding X, Ding R, Chen L, Jiao Y, Xu J, Zhang G, Wang Q, Xie J, Gao Y, Yang X. The Epidemic Characteristics of Stroke Death from 2012 to 2021 in Chongqing, China. Cerebrovasc Dis 2023; 53:198-204. [PMID: 37437549 DOI: 10.1159/000531488] [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: 03/20/2023] [Accepted: 05/29/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION Stroke has become a major disease that threatens the global population's health and is a major public health problem that needs to be solved in China. Therefore, it is essential to analyze the trend of the mortality of stroke and its epidemic characteristic of stroke death. METHODS Death cases of stroke were reported to the national death registry system by the medical staff of all medical institutions, and the population data every year were obtained from District or County's Statistic Bureau in Chongqing. They were analyzed to calculate the mortality, age-standardized mortality rate by Chinese standardization population (ASMRC), age-specific mortality, proportion, and annual percent of change (APC) according to the ICD-10 code. ASMRC was based on the standard population of the 6th census in China, 2010. The stroke mortality of each subgroup was compared using the χ2 test. Trend analysis was presented by APC. RESULTS The crude mortality of stroke increased from 96.29 per 100,000 in 2012 to 115.93 per 100,000 significantly, with the APC of 2.02% (t = 2.82, p = 0.022) in Chongqing. ASMRC of stroke was 56.47 per 100,000 in 2012 and 54.70 per 100,000 in 2021, and its trend change was stable (APC = -0.01, t = 0.07, p = 0.947). The crude mortality of stroke in males was higher than that in females every year (p < 0.05). The death proportion of intracerebral hemorrhage dwindled from 60.53% in 2012 to 49.88% in 2021, whereas the death proportion of ischemic stroke increased from 20.92% in 2012 to 39.96% in 2021. The average age of stroke death was delayed from 73.43 years old in 2012 to 76.52 years old in 2021 significantly (t = 18.12, p < 0.001). The percentage of stroke death at home increased from 75.23% in 2012 to 79.23% in 2021, while the percentage of stroke death at hospitals decreased from 17.89% in 2012 to 15.89% in 2021. CONCLUSION The crude mortality of stroke surged, and intracerebral hemorrhage was the main death cause of all subtypes. The mortality of stroke in males and rural residents was higher than that in females and urban residents. Most stroke deaths occurred at home. Male and rural residents were crucial populations for stroke prevention and control. There should be improved medical resources in rural areas and enhanced capability of stroke diagnosis and treatment.
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Affiliation(s)
- Xianbin Ding
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Rui Ding
- First Medical College, Chongqing Medical University, Chongqing, China
| | - Liling Chen
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Yan Jiao
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Jie Xu
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Guiting Zhang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Qiuting Wang
- Medical and Social Development Research Center, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Jiaxi Xie
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Yang Gao
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Xianxian Yang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
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Liu X, Zhang Z, Lin B, Guo Y, Mei Y, Ping Z, Wang W, Jiang H, Wang S, Zhang C, Chen S, Zhang Q. Relationship between perceptions of recurrence risk and depression state among first-episode ischemic stroke patients in rural areas: The mediating role of coping style. Nurs Open 2023; 10:4515-4525. [PMID: 37014075 PMCID: PMC10277436 DOI: 10.1002/nop2.1695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 01/05/2023] [Accepted: 02/14/2023] [Indexed: 04/05/2023] Open
Abstract
AIMS To investigate the relationship between stroke survivors' perceptions of recurrence risk, coping styles and depression state, and the role coping styles play in mediating that relationship. DESIGN A cross-sectional descriptive study. METHODS From one hospital in Huaxian, China, 320 stroke survivors were randomly selected as a convenience sample. In this research, the Simplified Coping Style Questionnaire, the Patient Health Questionnaire-9 and the Stroke Recurrence Risk Perception Scale were all used. Structural equation modelling and correlation analysis were used to analyse the data. This research followed the EQUATOR and STROBE checklists. RESULTS There were 278 valid survey responses. There were mild to severe depressive symptoms in 84.8% of stroke survivors. In stroke survivors, there was a significant negative relationship (p < 0.01) between the positive coping of perceptions of recurrence risk and their depression state. Recurrence risk perception's impact on depression state was partly mediated, according to mediation studies, by coping style, with the mediation effect accounting for 44.92% of the overall effect. CONCLUSIONS The connection between perceptions of recurrence risk and depression state was mediated by the coping mechanisms of stroke survivors. A lower degree of depression state among survivors was connected with positive coping to the beliefs of recurrence risk.
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Affiliation(s)
- Xueting Liu
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Zhenxiang Zhang
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Beilei Lin
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
- Academic of Medical Science, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Yunfei Guo
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, Zhengzhou City, China
| | - Yongxia Mei
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Zhiguang Ping
- School of Public Health, Zhengzhou University, Zhengzhou City, China
| | - Wenna Wang
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Hu Jiang
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Shaoyang Wang
- The Second Affiliated Hospital, Zhengzhou University, Zhengzhou City, China
| | - Chunhui Zhang
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Suyan Chen
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
| | - Qiushi Zhang
- Nursing and Health School, Zhengzhou University, Zhengzhou City, Henan Province, China
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Lidetu T, Muluneh EK, Wassie GT. Incidence and Predictors of Aspiration Pneumonia Among Stroke Patients in Western Amhara Region, North-West Ethiopia: A Retrospective Follow Up Study. Int J Gen Med 2023; 16:1303-1315. [PMID: 37089139 PMCID: PMC10115200 DOI: 10.2147/ijgm.s400420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/12/2023] [Indexed: 04/25/2023] Open
Abstract
Background Aspiration pneumonia is one of the major complications among hospitalized stroke patients, with global incidence ranging from 5-83% and hospital mortality rate of up to 70%. This study aimed to assess the incidence and identify predictors of aspiration pneumonia among stroke patients in Western Amhara region, North-West Ethiopia. Methods An institution-based retrospective follow-up study was conducted on a simple random sample of 568 stroke patients in Western Amhara region admitted at Felege Hiwot Referral Hospital. Log binomial regression model, a generalized linear model with log link, was applied to identify significant predictors of aspiration pneumonia. Results Cumulative incidence of aspiration pneumonia among the 568 sampled patients was 23.06%. Males were 1.71 times more at risk to acquire aspiration pneumonia than females (ARR = 1.71, 95% CI 1.07-2.74). Patients with vomiting and dysphagia were at more risk of acquiring aspiration pneumonia as compared with patients without vomiting and dysphagia (ARR = 1.81, 95% CI 1.04-3.14 and ARR = 1.95, 95% CI 1.10-3.48, respectively). Patients who received antibiotic prophylaxis and patients with Glasgow Coma Scale greater than 12 had less risk of acquiring aspiration pneumonia as compared with those who did not receive antibiotic prophylaxis and patients with Glasgow Coma Scale less than 8 (ARR = 0.10, 95% CI 0.04-0.28 and ARR = 0.45, 95% CI 0.22-0.94, respectively). Conclusion The cumulative incidence of aspiration pneumonia among sampled patients was 23.06%. Vomiting, dysphagia, antibiotic treatment and Glasgow Coma Scale showed significant correlation with the acquiring of aspiration pneumonia. Therefore, we recommend health-care providers should give special attention for patients with these risk factors to prevent aspiration pneumonia.
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Affiliation(s)
- Tadios Lidetu
- School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia
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Ding K, Chen H, Wang Y, Liu H, Ceceke B, Zhang W, Geng L, Deng G, Sun T, Zhang W, Wu Y. Emergency medical service utilization among acute ischemic stroke patients in Beijing: An observational study. Front Neurol 2022; 13:969947. [PMID: 36147042 PMCID: PMC9485477 DOI: 10.3389/fneur.2022.969947] [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: 06/15/2022] [Accepted: 08/10/2022] [Indexed: 11/18/2022] Open
Abstract
Objective To investigate emergency medical service (EMS) utilization and its associated factors in patients with acute ischemic stroke (AIS), and further explore the urban-rural differences. Methods Medical records for AIS in all emergency departments in Beijing were obtained from the Beijing Emergency Care Database from January 2018 to December 2021. EMS utilization was described and factors associated with EMS use were examined by multivariable logistic regression models with the generalized estimating equations. Results were compared between urban and rural districts. Results A total of 24,296 AIS patients were included in the analysis, and 11,190 (46.1%) were transported to hospitals by EMS. The percentage of EMS usage in urban areas was significantly higher than that in rural areas (53.6 vs. 34.4%, P < 0.001). From 2018 to 2021, EMS utilization was on the increase (P-value for trend <0.001) with a higher average annual growth rate in rural areas (12.6%) than in urban (6.4%). Factors associated with EMS utilization were age (OR: 1.20 per 10-year increase, 95% CI: 1.17–1.23), NIHSS scores, off-hour arrival (OR: 1.32, 95% CI: 1.23–1.37), treatment in tertiary hospitals (OR: 1.75, 95% CI: 1.60–1.92), and possessing comorbidities such as coronary artery disease (OR: 1.15, 95% CI: 1.17–1.24), atrial fibrillation (OR: 1.56, 95% CI: 1.41–1.73), prior stroke (OR: 0.84, 95% CI: 0.78-0.90) or dyslipidemia (OR: 0.78, 95% CI: 0.71–0.85). Conclusion This study demonstrated an inadequate use of EMS among AIS patients in Beijing, especially in rural areas, and revealed several associated factors. Enhanced education programs and EMS accessibility are necessary particularly for high-risk individuals and regions.
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Affiliation(s)
- Kexin Ding
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
| | - Hui Chen
- Department of Internet Management and Quality Control, Beijing Emergency Medical Center, Beijing, China
| | - Yong Wang
- Beijing Emergency Medical Center, Beijing, China
| | - Hongmei Liu
- Beijing Emergency Medical Center, Beijing, China
| | - Bayier Ceceke
- Department of Internet Management and Quality Control, Beijing Emergency Medical Center, Beijing, China
| | - Wei Zhang
- Department of Internet Management and Quality Control, Beijing Emergency Medical Center, Beijing, China
| | - Ling Geng
- Department of Internet Management and Quality Control, Beijing Emergency Medical Center, Beijing, China
| | - Guifang Deng
- Department of Internet Management and Quality Control, Beijing Emergency Medical Center, Beijing, China
| | - Tao Sun
- Department of Internet Management and Quality Control, Beijing Emergency Medical Center, Beijing, China
| | | | - Yiqun Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
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Llanos-Leyton N, Pardo C, Pinilla-Monsalve GD, Arango A, Valderrama J, Pugliese I, Amaya P. Disparities Influencing Functional Outcomes Between Rural and Urban Patients With Acute Stroke. Front Neurol 2022; 13:869772. [PMID: 35614927 PMCID: PMC9124848 DOI: 10.3389/fneur.2022.869772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 03/29/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThere is scarce information in Latin America about factors related to stroke patient outcomes in rural areas compared to urban ones.ObjectiveTo evaluate functional outcomes of stroke code patients from rural and urban areas and their relationship with socioeconomic disparity.MethodsProspective cohort study included patients of urban, semi-urban, and rural origin with stroke code from a high complexity hospital in southwestern Colombia between 2018 and 2019. Demographic, clinical data modified Rankin at discharge, and 3-month follow-up were analyzed. The poverty index, barriers to health access and availability of ambulances by the municipality was assessed at an ecological level.ResultsFive hundred and fifty five stroke patients were registered, 21.2% from rural areas, 432 (77.98%) had an ischemic stroke. There were no significant differences in sociodemographic factors and medical background. Urban patients had lower reperfusion therapies rates (23.25%). Favorable mRS at discharge (<3) was higher in urban areas (63.03%) and mortality was superior in rural patients (13.56%). The ambulance rate in semi-urban and rural areas was as low as 0.03 per 100.000 inhabitants, the poverty index was 11.9% in urban areas vs. 23.3% in semi urban and rural areas.ConclusionsRural patients treated in our center were more likely to present with severe strokes and unfavorable mRS at hospital discharge and 3-month follow-up compared to urban, despite having similar risk factors. There is an inverse relationship, which is not related to the poverty rate or the percentage of people with barriers to access to health. There is a need for further studies that assess barriers inherent in rural patients and establish a regional stroke network.
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Affiliation(s)
| | - Carlos Pardo
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Gabriel D. Pinilla-Monsalve
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
- Stroke Clinic, Fundación Valle del Lili, Cali, Colombia
| | - Akemi Arango
- Clinical Research Center, Fundación Valle del Lili, Cali, Colombia
| | | | - Isabella Pugliese
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
- Stroke Clinic, Fundación Valle del Lili, Cali, Colombia
| | - Pablo Amaya
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
- Stroke Clinic, Fundación Valle del Lili, Cali, Colombia
- *Correspondence: Pablo Amaya
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Zhao WY, Zhang L, Wan Y, Chen X, Jin Y, Zhang L, Sum G, Katar A, Song L, Anderson CS. The association between functional status and physical pain with depressive symptoms after a stroke event: A cross-sectional analysis of the China Health and Retirement Longitudinal Study 2018. Front Psychiatry 2022; 13:927856. [PMID: 36172512 PMCID: PMC9512144 DOI: 10.3389/fpsyt.2022.927856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Stroke is a major cause of mortality and long-term physical and cognitive impairment. This study aims to: (1) examine the prevalence of depressive symptoms, disability and pain among Chinese adults with stroke; (2) test the associations of functional limitations and body pain with occurrence of depressive symptoms; (3) investigate gender and urban-rural disparities in these associations. METHODS This study utilized the data from the China Health and Retirement Longitudinal Study in 2018, involving 969 patients with stroke among 17,970 participants aged ≥ 45 years. Depressive symptoms were assessed using the 10-item Center for Epidemiologic Studies Depression (CES-D) Scale. We performed multivariable logistic regression models to estimate the associations between activities of daily life (ADL), instrumental activities of daily life (IADL) and pain with depressive symptoms. RESULTS Depressive symptoms were found among 40.2% of stroke patients, with a higher prevalence in females (48.2%) than males (32.7%). Prevalence of ADL limitations, IADL limitations and pain among stroke patients were 39.2, 49.8 and 14.0%, respectively. ADL and IADL limitations and pain were more prevalent among females and residents in rural areas. Multivariable regression analyses showed a significant association between ADL limitation (OR = 1.535, 95% CI = 1.168, 2.018), IADL limitation (OR = 1.666, 95% CI = 1.260, 2.203) and pain (OR = 2.122, 95% CI = 1.466, 3.073) with depressive symptoms. Stratified analyses revealed stronger associations among urban residents. Females had a higher association of ADL and IADL with depressive symptoms but similar in that of pain to the males. The impact of ADL and IADL in male patients is higher than in females, but the impact of pain on depressive symptoms is higher in female patients. CONCLUSION Depressive symptoms are common amongst post-stroke patients in China and are significantly associated with functional disability and physical pain. Our findings have implications for practitioners on the early assessment of pain and depression after stroke. Future research should explore effective intervention measures for physical-mental stroke complications.
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Affiliation(s)
- William Yang Zhao
- The George Institute for Global Health, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Luwen Zhang
- School of Health Services Management, Southern Medical University, Guangzhou, China
| | - Yingfeng Wan
- Department of Neurology, University of California, Davis, Davis, CA, United States
| | - Xiaoying Chen
- The George Institute for Global Health, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Yinzi Jin
- Department of Global Health, School of Public Health, Peking University, Beijing, China.,Institute for Global Health and Development, Peking University, Beijing, China
| | - Lin Zhang
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Grace Sum
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Ameera Katar
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Lili Song
- The George Institute for Global Health, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia
| | - Craig S Anderson
- The George Institute for Global Health, Beijing, China.,The George Institute for Global Health, University of New South Wales, Sydney, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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Co-existence and interrelationship between intracranial artery stenosis and extracranial carotid atherosclerosis in an asymptomatic rural population of 13 villages in northern China. Clin Neurol Neurosurg 2021; 210:107013. [PMID: 34775363 DOI: 10.1016/j.clineuro.2021.107013] [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: 09/27/2020] [Revised: 10/19/2021] [Accepted: 10/25/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We investigated the characteristics and relationship of co-existing intracranial artery stenosis (ICAS) and extracranial carotid atherosclerosis in an asymptomatic rural population in northern China. METHODS Asymptomatic residents ≥ 30 years old in 13 villages underwent simultaneous cervical vascular and transcranial Doppler ultrasound. ICAS was defined as ≥ 50% stenosis. Extracranial carotid atherosclerosis severity was classified as increased intimal medial thickness (IMT), plaques, and a plaque with ≥ 50% extracranial artery stenosis (ECAS). Demographic details, medical history, and blood biochemistry results were collected. The relationship between ICAS and extracranial carotid atherosclerosis severity was determined using the chi-square trend test and binary logistic regression analysis. RESULTS A total of 2598 asymptomatic participants were included; 122 (4.7%) had ICAS, 1071 (41.2%) had extracranial carotid atherosclerosis, and 84 (3.2%) had co-existing extracranial carotid atherosclerosis and ICAS. Those with co-existing ICAS and extracranial carotid atherosclerosis were older (P = 0.006) and had a higher hypertension (HTN) and diabetes mellitus (DM) prevalence (P < 0.001). HTN (95% confidence interval [CI]=1.31-3.55, odds ratio [OR]=2.15) and DM (95% CI=1.17-4.30, OR=2.24) were found to be independent risk factors for asymptomatic ICAS with extracranial carotid atherosclerosis. Among those with ICAS, 38/122 had no extracranial carotid atherosclerosis, 8/122 had increased IMT, 64/122 had a plaque, and 12/122 had ECAS. As extracranial carotid atherosclerosis severity increases, ICAS prevalence increases. CONCLUSION Co-existing ICAS and extracranial carotid atherosclerosis occurred in 3.2% of asymptomatic populations in rural areas of northern China. As extracranial carotid atherosclerosis severity increased, ICAS prevalence also increased. HTN and DM might be independent indicators of co-existing ICAS and extracranial carotid atherosclerosis.
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12
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Contribution of WNT2B Genetic Variants to Ischemic Stroke Occurrence in a Chinese Han Population. J Cardiovasc Pharmacol 2021; 78:e128-e135. [PMID: 34009855 DOI: 10.1097/fjc.0000000000001032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/20/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT Wnt signaling pathway-related WNT2B gene was upregulated in ischemic brain damage. We aimed to assess the contribution of WNT2B genetic variant to ischemic stroke (IS) susceptibility in the Chinese Han population. Five polymorphisms including rs3790606, rs351364, rs3790608, rs12037987, and rs10776752 in WNT2B were genotyped using Agena MassARRAY platform in 476 healthy controls and 501 patients with IS. Odds ratio (OR) and 95% confidence interval (CI) adjusted for age and gender were estimated by logistic regression analysis. Analysis of variance was used to evaluate the association between genotypes of WNT2B variants and blood lipid parameters. Rs12037987 (OR = 1.82, 95% CI: 1.18-2.82, P = 0.007) and rs10776752 (OR = 1.74, 95% CI: 1.13-2.68, P = 0.012) were related to the increased IS susceptibility. Interestingly, rs12037987 (OR = 2.01, P = 0.028) and rs10776752 (OR = 2.02, P = 0.028) had the higher IS risk in the subjects younger than or equal to 65 years. Rs12037987 (OR = 2.70, P = 0.013), rs10776752 (OR = 2.71, P = 0.012), and rs3790606 (OR = 1.89, P = 0.036) manifested an increasing-risk association with IS occurrence in women. Moreover, rs3790606 genotype was related to serum levels of triglyceride (P = 0.008) and total cholesterol (P = 0.001). Our study reported that rs12037987 and rs10776752 were associated with the increased risk for IS in the Chinese Han population. Our findings may be useful for insight into the contribution of WNT2B variants to the complex pathogenesis of IS.
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Norouzi S, Jafarabadi MA, Shamshirgaran SM, Farzipoor F, Fallah R. Modeling Survival in Patients With Brain Stroke in the Presence of Competing Risks. J Prev Med Public Health 2021; 54:55-62. [PMID: 33618500 PMCID: PMC7939750 DOI: 10.3961/jpmph.20.463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022] Open
Abstract
Objectives After heart disease, brain stroke (BS) is the second most common cause of death worldwide, underscoring the importance of understanding preventable and treatable risk factors for the outcomes of BS. This study aimed to model the survival of patients with BS in the presence of competing risks. Methods This longitudinal study was conducted on 332 patients with a definitive diagnosis of BS. Demographic characteristics and risk factors were collected by a validated checklist. Patients’ mortality status was investigated by telephone follow-up to identify deaths that may be have been caused by stroke or other factors (heart disease, diabetes, high cholesterol, etc.). Data were analyzed by the Lunn-McNeil approach at alpha=0.1. Results Older age at diagnosis (59–68 years: adjusted hazard ratio [aHR], 2.19; 90% confidence interval [CI], 1.38 to 3.48; 69–75 years: aHR, 5.04; 90% CI, 3.25 to 7.80; ≥76 years: aHR, 5.30; 90% CI, 3.40 to 8.44), having heart disease (aHR, 1.65; 90% CI, 1.23 to 2.23), oral contraceptive pill use (women only) (aHR, 0.44; 90% CI, 0.24 to 0.78) and ischemic stroke (aHR, 0.52; 90% CI, 0.36 to 0.74) were directly related to death from BS. Older age at diagnosis (59–68 years: aHR, 21.42; 90% CI, 3.52 to 130.39; 75–69 years: aHR, 16.48; 90% CI, 2.75 to 98.69; ≥76 years: aHR, 26.03; 90% CI, 4.06 to 166.93) and rural residence (aHR, 2.30; 90% CI, 1.15 to 4.60) were directly related to death from other causes. Significant risk factors were found for both causes of death. Conclusions BS-specific and non-BS-specific mortality had different risk factors. These findings could be utilized to prescribe optimal and specific treatment.
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Affiliation(s)
- Solmaz Norouzi
- Department of Statistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Mohammad Asghari Jafarabadi
- Department of Statistics and Epidemiology and Road Traffic Injury Research Center, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Seyed Morteza Shamshirgaran
- Department of Statistics and Epidemiology, Faculty of Health Sciences, Neyshabur University of Medical Sciences, Neyshabur, Iran
| | - Farshid Farzipoor
- Department of Health Education and Promotion, Faculty of Health, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ramazan Fallah
- Department of Statistics and Epidemiology, Faculty of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
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Yu L, Cai Y, Qin R, Zhao B, Li X. Association between triglyceride glucose index and abnormal liver function in both urban and rural Chinese adult populations: Findings from two independent surveys. Medicine (Baltimore) 2019; 98:e18265. [PMID: 31852096 PMCID: PMC6922364 DOI: 10.1097/md.0000000000018265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The purpose of this study was to investigate the association between triglyceride glucose (TyG) index and abnormal liver function both in urban and rural Chinese adult populations. The 5824 urban (Nanjing) and 20,269 rural (Hefei) Chinese adults, from random selected households provided clinical history, glucose, lipids, anthropometric, and blood pressure measurements. Liver functions were assessed using Alanine Aminotransferase (ALT). Linear regression was applied to examine the dose-response relationship between TyG index and ALT. Logistic regression was used to estimate the association between TyG index and abnormal liver and function. Cubic spline models were applied to investigate the dose-response association between TyG index and abnormal liver function. C-statistics was used to compare the discriminable capacity over triglyceride, glucose and TyG index. Linear dose-response relationship was identified between TyG index and ALT as 1.222 IU increase by 1 unit increase of TyG index (1.242 for urban population and 1.210 for rural population). The 6.0% of urban and 11.0% of rural Chinese adults were observed to have abnormal liver function. The linear association between TyG index and abnormal liver function was revealed as 2.044 (1.930 to 2.165) of odds ratio by in unit increase of TyG index (2.334 for urban population and 1.990 for rural population). Higher C-statistics was found for TyG index compared with fasting glucose and triglyceride both in Chinese urban and rural populations. This study suggested in both urban and rural Chinese adult populations, TyG index is associated with abnormal liver function. TyG index is a potential indicator to identify high-risk individuals with metabolic disorders, for example impaired liver function in Chinese population, especially in Chinese urban population.
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Affiliation(s)
- Lanfang Yu
- The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou
| | - Yamei Cai
- Department of Nephrology, the First Affiliated Hospital, Zhengzhou University, Zhengzhou
| | - Rui Qin
- Jiangsu Province Hospital on Integration of Chinese and Western Medicine, Nanjing
| | - Bin Zhao
- The Second Division of Internal Medicine, Kejing Community Health Centre, Jiyuan, China
| | - Xiaona Li
- The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou
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