Prevalence of Stroke and Associated Risk Factors in Sleman District of Yogyakarta Special Region, Indonesia

Positive genetic effect of hypertension family history on stroke: A cross Mendelian randomization study

BACKGROUND

Clinical observational study demonstrated that hypertension is an independent risk factor for stroke. Furthermore, both hypertension and stroke exhibit genetic predispositions. However, the genetic relationship between hypertension and stroke in first-degree relatives remains unclear.

METHOD

The Genetic effects were validated using an across-Mendelian randomization (MR) approach. The Genome-Wide Association Study summary data used in this study were obtained from a publicly available platform. The primary MR effect employed was inverse-variance weighted (IVW), and the other analysis methods included MR-Egger, weighted median, simple mode, and weighted mode. Prior to MR analysis, tests for MR_PRESSO, pleiotropy, and heterogeneity were conducted.

RESULT

The presence of family history of hypertension significantly contributed to the genetic predisposition to various types of stroke, including ischemic stroke, subarachnoid hemorrhage, lacunar stroke, cardioembolic ischemic stroke, small vessel ischemic stroke, and large artery atherosclerosis-related ischemic stroke.

CONCLUSION

Briefly, hypertension in first-degree relatives has a genetic impact on the risk of stroke development. Shared genetic factors may exist between hypertension and stroke.

Urdu translation and cross-cultural validation of neurological fatigue index on post stroke

BACKGROUND

The Neurological Fatigue Index (NFI) is the instrument used to evaluate stroke patients' fatigue. There was no Urdu version of NFI available officially.

OBJECTIVE

This study aimed to translate the Neurological Fatigue Index into Urdu and to determine the validity and reliability of Urdu NFI among stroke patients.

METHODOLOGY

It is a cross-cultural validation study. According to international guidelines in phase I, a process of translation was carried out. In phase II, using the sample of 120 participants, validity and reliability of the Urdu version of the Neurological Fatigue Index scale was conducted. The Urdu version's content validity, convergent/concurrent validity, test-retest reliability, and internal consistency were determined. The latest version of SPSS was used for the data analysis.

RESULTS

The Urdu version of NFI was drafted after the expert's review. The content validity index was used to analyze the content validity. The reliability and validity of the Urdu version NFI were evaluated by calculating Cronbach's alpha (α = 0.86), and intra-class correlation coefficient (ICC = 0.823). Correlations with other scales were the fatigue Severity Scale (FSS) (r = 0.76), Mental Fatigue Scale (MFS) (r = 0.68), Beck Depression Inventory (BDI) (r = 0.53) and Epworth Sleepiness Scale (ESS) (r = 0.47).

CONCLUSION

The Urdu Version was linguistically acceptable for the fatigue assessment in post-stroke patients. It showed good content validity, convergent/concurrent validity, internal consistency, and test-retest reliability.

Prevalence and Risk Factors of Stroke in Inpatients with Type 2 Diabetes Mellitus in China

OBJECTIVE

The prevalence and the cluster characteristics of risk factors of stroke were assessed in a Chinese diabetic population.

METHODS

Clinical data of 30 693 inpatients who were diagnosed with type 2 diabetes mellitus (T2DM) and admitted between 2013 and 2018 were retrospectively analyzed. The age-standardized prevalence of stroke was estimated using the 2010 Chinese population census data, and risk factors were analyzed by multiple imputation and regression.

RESULTS

The crude and standardized prevalence rates of stroke in patients with T2DM were 34.4% and 21.5%, respectively, and 85.2% of the stroke patients had ischemic stroke. Nearly half of the patients who experienced stroke had clusters of more than 4 risk factors. Compared with no-risk-factor clustering, the risk of stroke significantly increased 3-4 times in the presence of more than 4 risk-factor clusters (P<0.001). Hypertension was the most common major risk factor for ischemic stroke [odds ratio (OR), 2.34; 95% confidence interval (CI), 2.18-2.50] and hemorrhagic stroke (OR, 3.68; 95% CI 2.95-4.59; P<0.001). Moreover, a 1-standard-deviation increase in fasting blood glucose (FBG) was significantly negatively correlated with ischemic stroke risk, and the same change in FBG was significantly associated with an 8% increased risk of hemorrhagic stroke.

CONCLUSION

The prevalence of stroke in patients with T2DM is rather high, and the clustering of risk factors is associated with the development of stroke in T2DM patients. Risk factors differ in different stroke subtypes. Identifying risk factors for a specific high-risk group is necessary.

Endovascular Thrombectomy for Acute Ischemic Stroke in Indonesia: Challenging and Strategic Planning

High rates of morbidity and mortality indicate that stroke is a major health concern. Unfortunately, the management of ischemic stroke is hindered by several obstacles, particularly in developing countries such as Indonesia, where the burden of morbidity and mortality remains high. In this literature review, we intend to conduct a thorough investigation and analysis of the obstacles to stroke thrombectomy in developing countries, with a focus on Indonesia. Even though numerous studies and recent advances in thrombectomy techniques have been developed, many centers around the world continue to struggle to implement them. The majority of these institutions are located in developing nations like Indonesia. It faces numerous obstacles, including a lack of public awareness, infrastructure, human resources, and financial difficulties. The absence of early education and large-scale campaigns contributes to the dearth of public awareness. Inadequate imaging facilities, prehospital and referral systems, as well as disparities in healthcare expenditure and accessibility, contribute to the absence of infrastructure. Inadequate numbers of neurointerventionists, neurologists, and neurosurgeons, as well as a disparate distribution of these professionals, contribute to human resource issues. Inadequate national insurance coverage, high import tariffs on medical devices, and the high cost of healthcare have a negative impact on the financial situation. We provide related strategies regarding the current situation in Indonesia based on the recent evidence and comparison with developed countries. Academic institutions, medical associations, and government agencies must collaborate to overcome these challenges.

Relationships between stroke prevalence, health literacy, and oral health-related quality of life in middle-aged and older adults: a national survey study

BACKGROUND

Stroke may cause debilitating neurological deficiencies that result in motor, sensory, and cognitive deficits and poorer psychosocial functioning. Prior studies have provided some initial evidence for the significant roles of health literacy and poor oral health for old people. However, few studies have focused on the health literacy of individuals who had a stroke; therefore, the relationships between the health literacy and oral health-related quality of life (OHRQoL) among middle-aged and older adults who had a stroke are unknown. We aimed to assess the relationships between stroke prevalence, health literacy status, and OHRQoL in middle-aged and older adults.

METHODS

We retrieved the data from The Taiwan Longitudinal Study on Aging, a population-based survey. For each eligible subject, we gathered data in 2015 on age, sex, level of education, marital status, health literacy, the activity daily living (ADL), stroke history and OHRQoL. We evaluated the respondents' health literacy by using a nine-item health literacy scale and categorized their health literacy level as low, medium, or high. OHRQoL was identified based on the Taiwan version of the Oral Health Impact Profile (OHIP-7T).

RESULTS

The final study contained 7702 community-based dwelling elderly people (3630 male and 4072 female) were analysis in our study. Stroke history was reported in 4.3% of participants, 25.3% reported low health literacy, and 41.9% had at least one ADL disability. Furthermore, 11.3% of participants had depression, 8.3% had cognitive impairment, and 3.4% had poor OHRQoL. Age, health literacy, ADL disability, stroke history, and depression status were significantly associated with poor OHRQoL after sex and marital status was adjusted. Medium (odds ratio [OR] = 1.784, 95% confidence interval [CI] = 1.177, 2.702) to low health literacy (OR = 2.496, 95% CI = 1.628, 3.828) was significantly associated with poor OHRQoL.

CONCLUSIONS

Base our study results, people with stroke history had poor OHRQoL. Lower health literacy and ADL disability were associated with worse QHRQoL. Further studies are necessary to define practical strategies for reducing the risk of stroke and oral health with constantly lower health literacy, thereby improving the quality of life and providing health care of older people.

Relationships between illness perception, functional status, social support, and self-care behavior among Thai people at high risk of stroke: A cross-sectional study

Background

People at high risk of stroke reported having difficulty performing self-care behavior. Although the literature has identified various factors related to self-care behavior in this population; however, there is a lack of studies to conclude the associated antecedents of self-care behavior, particularly in Thailand.

Objective

This study aimed to examine the relationships between illness perception, functional status, social support, and self-care behavior among people at high risk of stroke.

Methods

A correlational cross-sectional study design was used. One hundred and seventy people at high risk of stroke were selected from ten health-promoting hospitals in the Northeast region of Thailand using multi-stage sampling. Data were gathered using self-report questionnaires, including the brief illness perception questionnaire, functional status scale, multidimensional scale of perceived social support, and self-care behavior questionnaire, from November 2021 to February 2022. Data were analyzed using mean, standard deviation, and Pearson's product-moment correlation.

Results

One hundred percent of the participants completed the questionnaires. The participants had a moderate level of self-care behavior (M = 64.54, SD = 7.46). Social support and functional status had medium positive significant correlations with self-care behavior among people at high risk of stroke (r = 0.460 and r = 0.304, p <0.01), respectively. In contrast, illness perception had a small negative significant correlation with self-care behavior among people at high risk of stroke (r = -0.179, p <0.05).

Conclusion

Social support, functional status, and illness perception are essential factors of self-care behavior among people at high risk of stroke. The findings shed light that nurses and other healthcare professionals should promote self-care behavior in these people by enhancing them to maintain proper functioning, positive illness-related perception, and family members' involvement. However, further study is needed to determine a causal relationship between these factors with self-care behavior.

Prevalence and the age of onset patterns of stroke in Jiangsu Province, China

OBJECTIVES

Little was known regarding the current age of onset patterns of stroke. This study aimed to examine the prevalence of stroke and explore the age of onset patterns of stroke in Jiangsu Province, China.

MATERIALS AND METHODS

Participants were recruited from April 2012 to April 2013 in Jiangsu Province, China. Survival analysis models were used to evaluate the hazards of stroke by a single year of age. Kaplan-Meier analysis and the log-rank test were used to explore the disparities of the age of onset patterns of stroke.

RESULTS

This population-based study was conducted among 39,887 participants aged ≥ 18 years in Jiangsu Province, China. Of the 740 (1.9%) events of stroke, 13.2% suffered from hemorrhagic stroke (HS) and 86.8% suffered from ischemic stroke (IS). The prevalence of HS and IS were 0.3% and 1.7%, respectively. The estimated mean age of onset of stroke was 71.98 (95% CI: 71.97-71.99) years by the survival model. Up to age of 45 years, the estimated hazards of stroke onset were at a relatively low level. From the age of 45 years, the increases in hazards accelerated and peaked at age 75 years. Urban, smoking, and drinking males had a higher risk of stroke than their counterparts (P < 0.05). However, no such difference was found among females.

CONCLUSIONS

The findings emphasize the importance of implementing stroke prevention interventions in Jiangsu Province, China, especially for urban, smoking, and drinking males. It is of great significance to strengthen comprehensive management of health-related behaviors, including smoking cessation and moderate consumption of alcohol to have sustained beneficial effects on stroke risk. Chenlu He and Qian Chen contributed equally to this work.

Risk profile, clinical presentation, and determinants of stroke subtypes among patients with stroke admitted to public referral hospitals, Northwest Ethiopia in 2021: A cross-sectional study

Background

Stroke is the second leading cause of death worldwide, with a significant increase in stroke burden over the last two and half decades, especially in developing countries. African countries are undergoing an epidemiological transition from being dominated by infectious diseases to being double-burdened by non-communicable diseases, with existing infectious diseases driven by sociodemographic and lifestyle changes and a weak healthcare system. Data on the risk profile, clinical presentation, and predictors of stroke subtypes are still limited. Therefore, the main aim of this study was to assess the risk profile, clinical presentation, and predictors of stroke in public referral hospitals of Northwest Ethiopia.

Methods

For this study, 554 patients with stroke admitted to three public referral hospitals were prospectively followed up. Data were collected using a pre-tested interviewer-administered questionnaire. STATA version 16 was used for data analyses. Candidate variables significant in bivariate analysis were selected for multivariate binary logistic regression, and statistical significance was set at a p &lt; 0.05.

Results

Of the 554 patients with stroke, 60.3% had an ischemic stroke. The mean age of the participants was 61 ± 12.85 years, and more than half (53.25%) of them were women. The most common risk factor identified was hypertension (29.7%), followed by congestive heart failure. The most common clinical presentation was hemiparesis, which was reported by 57.7% of the patients, followed by loss of consciousness (20.7%) and aphasia (9%). Through multivariable logistic regression, age (AOR = 1.03, 95% CI:1.01–1.05), sedentary physical activity level (AOR = 6.78, 95% CI:1.97–23.32), absence of a family history of chronic illness (AOR = 3.79, 95% CI:2.21–6.48), hypertension (AOR=0.51, 95% CI:0.31–0.85), and past stroke (AOR = 3.54, 95% CI:0.93–13.49) were found to be independent determinants of the stroke subtype.

Conclusion

Age, the level of sedentary physical activity, absence of a family history of chronic illness, hypertension, and past stroke were independent determinants of stroke subtype.

Awareness of Being at Risk of Stroke and Its Determinant Factors among Hypertensive Patients in Banyumas, Indonesia

Background

The global burden of stroke is still high, particularly in developing countries, with hypertension serving as the main risk factor. The awareness of stroke among hypertensive patients is crucial for stroke prevention. This study was aimed at identifying the awareness of being at risk of stroke and its determinant factors among hypertensive patients in Banyumas, Indonesia.

Methods

This was a cross-sectional study conducted in Primary Health Centers (PHCs) in Banyumas Regency, Indonesia, from April to August 2019. A simple random sampling technique was used to select the representatives' PHCs. Hypertensive patients who came regularly to the PHCs were consecutively recruited. Data were collected through a self-reported questionnaire and medical records. The main outcome was the level of participants' awareness of being at risk of stroke. Multivariate logistic regression analysis was performed to measure determinant factors associated with the level of awareness.

Results

Out of 457 patients investigated, 77.46% had a low level of awareness. Low knowledge of hypertension, low income, and no history of previous stroke were associated with a low-level of awareness (odds ratio (OR) 1.942, 95% CI 1.195-3.158, p 0.007; OR 2.321, 95% CI 1.326-4.064, p 0.003; and OR 6.033, 95% CI 2.450-14.858, p < 0.001, respectively).

Conclusion

Majority of hypertensive patients were unaware of being at risk of stroke. Knowledge of hypertension, income, and history of previous stroke are factors that may influence the awareness of being at risk of stroke among them. This emphasizes the need to provide better campaigns and education programs to raise the awareness of stroke in a community setting, particularly for the population at risk.

Gender Differences in Prevalence and Risk Factors for Hypertension among Adult Populations: A Cross-Sectional Study in Indonesia

Although hypertension is among the main public health concerns in Indonesia, due to the scarcity of data, few studies have investigated the factors associated with hypertension in men and women. This study aimed to examine the prevalence of and factors associated with hypertension among adult men and women in Indonesia. The 2018 Survey of the Sleman Health Demographic and Surveillance System was utilized, consisting of 4328 individuals aged 18+ years. Multivariable logistic regression analysis was performed to determine the sociodemographic and health behavior factors of hypertension. Overall, the prevalence of hypertension was 40% (42% in men and 38% in women). Age, abdominal obesity and chronic non-communicable diseases were the common predictors of hypertension in men and women (p < 0.05). The odds ratio of hypertension among men with low education was lower than among those with high education (OR = 0.52, 95% CI: 0.29–0.94). For women, being in the poorest socioeconomic condition increased the risk of hypertension by 1.67 times compared to the richest (95% CI: 1.21–2.32). Gender differences in the prevalence of and factors associated with hypertension were observed among adult populations in Sleman District, Yogyakarta, Indonesia. Therefore, a gender-based approach in the health prevention strategy to control hypertension for men and women is needed.

Hypertension and stroke in Asia: A comprehensive review from HOPE Asia

Stroke is the primary cause of disability and vascular death worldwide, including Asia. Asian characteristics that differ from the West lead to higher stroke incidence. Stroke epidemiology studies in Asia have shown varying levels of mortality, incidence, prevalence, and burden of disease. Hypertension is the most prevalent risk factor found in Asia. Besides ethnicity that is associated with stroke incidence, both systolic blood pressure, diastolic blood pressure, and blood pressure variability are positively correlated with stroke incidence. Post-stroke cognitive impairment is one of the sequelae that affect one-third of stroke survivors and has become a significant public health concern that is often neglected despite its increasing prevalence. Therefore, it is very important to prevent recurrence by treating stroke optimally and effectively. Increasing awareness and treatment adherence to hypertension, the leading risk factor for stroke, became the main goal in several countries in Asia.

A Stress Syndrome Prototype Reflects Type 3 Diabetes and Ischemic Stroke Risk: The SABPA Study

Type 3 diabetes (T3D) accurately reflects that dementia, e.g., Alzheimer's disease, represents insulin resistance and neurodegeneration in the brain. Similar retinal microvascular changes were observed in Alzheimer's and chronic stressed individuals. Hence, we aimed to show that chronic stress relates to T3D dementia signs and retinopathy, ultimately comprising a Stress syndrome prototype reflecting risk for T3D and stroke. A chronic stress and stroke risk phenotype (Stressed) score, independent of age, race or gender, was applied to stratify participants (N = 264; aged 44 ± 9 years) into high stress risk (Stressed, N = 159) and low stress risk (non-Stressed, N = 105) groups. We determined insulin resistance using the homeostatic model assessment (HOMA-IR), which is interchangeable with T3D, and dementia risk markers (cognitive executive functioning (cognitiveexe-func); telomere length; waist circumference (WC), neuronal glia injury; neuron-specific enolase/NSE, S100B). Retinopathy was determined in the mydriatic eye. The Stressed group had greater incidence of HOMA-IR in the upper quartile (≥5), larger WC, poorer cognitiveexe-func control, shorter telomeres, consistently raised neuronal glia injury, fewer retinal arteries, narrower arteries, wider veins and a larger optic cup/disc ratio (C/D) compared to the non-Stressed group. Furthermore, of the stroke risk markers, arterial narrowing was related to glaucoma risk with a greater C/D, whilst retinal vein widening was related to HOMA-IR, poor cognitiveexe-func control and neuronal glia injury (Adjusted R2 0.30; p ≤ 0.05). These associations were not evident in the non-Stressed group. Logistic regression associations between the Stressed phenotype and four dementia risk markers (cognitiveexe-func, telomere length, NSE and WC) comprised a Stress syndrome prototype (area under the curve 0.80; sensitivity/specificity 85%/58%; p ≤ 0.001). The Stress syndrome prototype reflected risk for HOMA-IR (odds ratio (OR) 7.72) and retinal glia ischemia (OR 1.27) and vein widening (OR 1.03). The Stressed phenotype was associated with neuronal glia injury and retinal ischemia, potentiating glaucoma risk. The detrimental effect of chronic stress exemplified a Stress syndrome prototype reflecting risk for type 3 diabetes, neurodegeneration and ischemic stroke.