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Joundi RA, King JA, Stang J, Nicol D, Hill MD, Yu AYX, Kapral MK, Smith EE. Age-Specific Association of Co-Morbidity With Home-Time After Acute Stroke. Can J Neurol Sci 2024:1-9. [PMID: 38532570 DOI: 10.1017/cjn.2024.37] [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: 03/28/2024]
Abstract
OBJECTIVE To examine the association of co-morbidity with home-time after acute stroke and whether the association is influenced by age. METHODS We conducted a province-wide study using linked administrative databases to identify all admissions for first acute ischemic stroke or intracerebral hemorrhage between 2007 and 2018 in Alberta, Canada. We used ischemic stroke-weighted Charlson Co-morbidity Index of 3 or more to identify those with severe co-morbidity. We used zero-inflated negative binomial models to determine the association of severe co-morbidity with 90-day and 1-year home-time, and logistic models for achieving ≥ 80 out of 90 days of home-time, assessing for effect modification by age and adjusting for sex, stroke type, comprehensive stroke center care, hypertension, atrial fibrillation, year of study, and separately adjusting for estimated stroke severity. We also evaluated individual co-morbidities. RESULTS Among 28,672 patients in our final cohort, severe co-morbidity was present in 27.7% and was associated with lower home-time, with a greater number of days lost at younger age (-13 days at age < 60 compared to -7 days at age 80+ years for 90-day home-time; -69 days at age < 60 compared to -51 days at age 80+ years for 1-year home-time). The reduction in probability of achieving ≥ 80 days of home-time was also greater at younger age (-22.7% at age < 60 years compared to -9.0% at age 80+ years). Results were attenuated but remained significant after adjusting for estimated stroke severity and excluding those who died. Myocardial infarction, diabetes, and cancer/metastases had a greater association with lower home-time at younger age, and those with dementia had the greatest reduction in home time. CONCLUSION Severe co-morbidity in acute stroke is associated with lower home-time, more strongly at younger age.
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Affiliation(s)
- Raed A Joundi
- Division of Neurology, Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, ON, Canada
| | - James A King
- Provincial Research Data Services, Alberta Health Services, Alberta Strategy for Patient Oriented Research Support Unit Data Platform, Calgary, AB, Canada
| | - Jillian Stang
- Data and Analytics (DnA), Alberta Health Services, Edmonton, AB, Canada
| | - Dana Nicol
- Data and Analytics (DnA), Alberta Health Services, Edmonton, AB, Canada
| | - Michael D Hill
- Department of Clinical Neuroscience and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Amy Y X Yu
- ICES, Toronto, ON, Canada
- Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Moira K Kapral
- ICES, Toronto, ON, Canada
- Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada
| | - Eric E Smith
- Department of Clinical Neuroscience and Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Prendes CF, Rantner B, Hamwi T, Stana J, Feigin VL, Stavroulakis K, Tsilimparis N. Burden of Stroke in Europe: An Analysis of the Global Burden of Disease Study Findings From 2010 to 2019. Stroke 2024; 55:432-442. [PMID: 38252754 DOI: 10.1161/strokeaha.122.042022] [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: 11/23/2022] [Accepted: 09/21/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND While most European Regions perform well in global comparisons, large discrepancies within stroke epidemiological parameters exist across Europe. The objective of this analysis was to evaluate the stroke burden across European regions and countries in 2019 and its difference to 2010. METHODS The GBD 2019 analytical tools were used to evaluate regional and country-specific estimates of incidence, prevalence, deaths, and disability-adjusted life years of stroke for the European Region as defined by the World Health Organization, with its 53 member countries (EU-53) and for European Union as defined in 2019, with its 28 member countries (EU-28), between 2010 and 2019. Results were analyzed at a regional, subregional, and country level. RESULTS In EU-53, the absolute number of incident and prevalent strokes increased by 2% (uncertainty interval [UI], 0%-4%), from 1 767 280 to 1 802 559 new cases, and by 4% (UI, 3%-5%) between 2010 and 2019, respectively. In EU-28, the absolute number of prevalent strokes and stroke-related deaths increased by 4% (UI, 2%-5%) and by 6% (UI, 1%-10%), respectively. All-stroke age-standardized mortality rates, however, decreased by 18% (UI, -22% to -14%), from 82 to 67 per 100 000 people in the EU-53, and by 15% (UI, -18% to -11%), from 49.3 to 42.0 per 100 000 people in EU-28. Despite most countries presenting reductions in age-adjusted incidence, prevalence, mortality, and disability-adjusted life year rates, these rates remained 1.4×, 1.2×, 1.6×, and 1.7× higher in EU-53 in comparison to the EU-28. CONCLUSIONS EU-53 showed a 2% increase in incident strokes, while they remained stable in EU-28. Age-standardized rates were consistently lower for all-stroke burden parameters in EU-28 in comparison to EU-53, and huge discrepancies in incidence, prevalence, mortality, and disability-adjusted life-year rates were observed between individual countries.
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Affiliation(s)
- Carlota F Prendes
- Department of Vascular Surgery, Ludwig Maximilians University, Munich, Germany (C.F.P., B.R., T.H., J.S., K.S., N.T.)
| | - Barbara Rantner
- Department of Vascular Surgery, Ludwig Maximilians University, Munich, Germany (C.F.P., B.R., T.H., J.S., K.S., N.T.)
| | - Tarek Hamwi
- Department of Vascular Surgery, Ludwig Maximilians University, Munich, Germany (C.F.P., B.R., T.H., J.S., K.S., N.T.)
| | - Jan Stana
- Department of Vascular Surgery, Ludwig Maximilians University, Munich, Germany (C.F.P., B.R., T.H., J.S., K.S., N.T.)
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, New Zealand (V.L.F.)
- Institute for Health Metrics and Evaluation, University of Washington, Seattle (V.L.F.)
- Research Center of Neurology, Moscow, Russia (V.L.F.)
| | - Konstantinos Stavroulakis
- Department of Vascular Surgery, Ludwig Maximilians University, Munich, Germany (C.F.P., B.R., T.H., J.S., K.S., N.T.)
| | - Nikolaos Tsilimparis
- Department of Vascular Surgery, Ludwig Maximilians University, Munich, Germany (C.F.P., B.R., T.H., J.S., K.S., N.T.)
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Qi L, Wang F, Sun X, Li H, Zhang K, Li J. Recent advances in tissue repair of the blood-brain barrier after stroke. J Tissue Eng 2024; 15:20417314241226551. [PMID: 38304736 PMCID: PMC10832427 DOI: 10.1177/20417314241226551] [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: 07/26/2023] [Accepted: 12/31/2023] [Indexed: 02/03/2024] Open
Abstract
The selective permeability of the blood-brain barrier (BBB) enables the necessary exchange of substances between the brain parenchyma and circulating blood and is important for the normal functioning of the central nervous system. Ischemic stroke inflicts damage upon the BBB, triggering adverse stroke outcomes such as cerebral edema, hemorrhagic transformation, and aggravated neuroinflammation. Therefore, effective repair of the damaged BBB after stroke and neovascularization that allows for the unique selective transfer of substances from the BBB after stroke is necessary and important for the recovery of brain function. This review focuses on four important therapies that have effects of BBB tissue repair after stroke in the last seven years. Most of these new therapies show increased expression of BBB tight-junction proteins, and some show beneficial results in terms of enhanced pericyte coverage at the injured vessels. This review also briefly outlines three effective classes of approaches and their mechanisms for promoting neoangiogenesis following a stroke.
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Affiliation(s)
- Liujie Qi
- School of Material Science and Engineering & Henan Key Laboratory of Advanced Magnesium Alloy & Key Laboratory of Materials Processing and Mold (Ministry of Education), Zhengzhou University, Zhengzhou, PR China
| | - Fei Wang
- School of Material Science and Engineering & Henan Key Laboratory of Advanced Magnesium Alloy & Key Laboratory of Materials Processing and Mold (Ministry of Education), Zhengzhou University, Zhengzhou, PR China
| | - Xiaojing Sun
- School of Material Science and Engineering & Henan Key Laboratory of Advanced Magnesium Alloy & Key Laboratory of Materials Processing and Mold (Ministry of Education), Zhengzhou University, Zhengzhou, PR China
| | - Hang Li
- School of Material Science and Engineering & Henan Key Laboratory of Advanced Magnesium Alloy & Key Laboratory of Materials Processing and Mold (Ministry of Education), Zhengzhou University, Zhengzhou, PR China
| | - Kun Zhang
- School of Life Science, Zhengzhou University, Zhengzhou, PR China
| | - Jingan Li
- School of Material Science and Engineering & Henan Key Laboratory of Advanced Magnesium Alloy & Key Laboratory of Materials Processing and Mold (Ministry of Education), Zhengzhou University, Zhengzhou, PR China
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4
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Rhein J, Charbonnier G, Nacher M, Gaudron M, Moulin T, Rochemont DR, Cottier JP, Montagnac C, Sabbah N, de Toffol B. Prospective observational study of stroke in Cayenne, Tours and Besançon: The BECATOUR study. Rev Neurol (Paris) 2023; 179:975-982. [PMID: 37487805 DOI: 10.1016/j.neurol.2023.02.068] [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: 07/26/2022] [Revised: 12/13/2022] [Accepted: 02/25/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND Stroke is a major public health issue. Its epidemiology is still poorly known in French Guiana. METHOD We conducted a prospective observational study including 100 consecutive patients hospitalized for stroke in Cayenne (in French Guiana), and Tours and Besançon (in metropolitan France). We compared their age, medical history, cardiovascular risk factors, pre-admission Rankin score, Glasgow and NIHSS scores, usual treatments, acute phase management, type of stroke, duration of hospitalization, mechanism of stroke according to TOAST classification, NIHSS and Rankin scores at discharge, discharge treatments, and mode of discharge. RESULTS In French Guiana, the average age of patients was 7years lower (62 y), patients were more frequently affected by hypertension (75%) and diabetes (31%). Lacunar strokes were overrepresented (16.1%), and infarctions of cardioembolic origin were underrepresented (12%). NIHSS entry and Glasgow scores were similar between French Guiana and mainland France. Acute management was different: thrombolysis rate (9.3%) was 3 to 4 times lower, thrombectomy was not available. Fewer patients were transferred to rehabilitation centers and more patients were transferred to home hospitalization. DISCUSSION In Tours and Besançon, patients eligible for thrombectomy were overrepresented. This bias explains the overrepresentation of more severe infarctions and probably the overrepresentation of strokes of cardioembolic origin. Infarctions of undetermined origin were more numerous in French Guiana because patients were often discharged from hospital with an incomplete cardiological workup. CONCLUSION Despite some caveats, the profile of patients admitted for stroke in French Guiana is different from mainland France. The establishment of a stroke unit and an information campaign on the symptoms of stroke would allow better management.
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Affiliation(s)
- J Rhein
- Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - G Charbonnier
- Neurology Department, University Hospital Centre Besançon, 25000 Besançon, France
| | - M Nacher
- Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - M Gaudron
- Neurology Department, CHU Bretonneau, 37044 Tours cedex, France
| | - T Moulin
- Neurology Department, University Hospital Centre Besançon, 25000 Besançon, France
| | - D R Rochemont
- Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - J-P Cottier
- Neuroradiology Department, CHU Bretonneau, 37044 Tours cedex, France
| | - C Montagnac
- Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana
| | - N Sabbah
- Endocrinology Department, Centre Hospitalier de Cayenne, Cayenne, French Guiana
| | - B de Toffol
- Neurology Department, Centre Hospitalier de Cayenne, Centre d'Investigation Clinique (CIC), Inserm 1424, avenue des Flamboyants, 97300 Cayenne, French Guiana.
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Peyre I, Roby-Brami A, Segalen M, Giron A, Caramiaux B, Marchand-Pauvert V, Pradat-Diehl P, Bevilacqua F. Effect of sonification types in upper-limb movement: a quantitative and qualitative study in hemiparetic and healthy participants. J Neuroeng Rehabil 2023; 20:136. [PMID: 37798637 PMCID: PMC10552218 DOI: 10.1186/s12984-023-01248-y] [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: 11/11/2022] [Accepted: 09/13/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Movement sonification, the use of real-time auditory feedback linked to movement parameters, have been proposed to support rehabilitation. Nevertheless, if promising results have been reported, the effect of the type of sound used has not been studied systematically. The aim of this study was to investigate in a single session the effect of different types of sonification both quantitatively and qualitatively on patients with acquired brain lesions and healthy participants. METHODS An experimental setup enabling arm sonification was developed using three different categories of sonification (direct sound modulation, musical interaction, and soundscape). Simple moving forward movements performed while sliding on a table with both arms were investigated with all participants. Quantitative analysis on the movement timing were performed considering various parameters (sound condition, affected arm and dominance, sonification categories). Qualitative analysis of semi-structured interviews were also conducted, as well as neuropsychological evaluation of music perception. RESULTS For both the patient and healthy groups (15 participants each), average duration for performing the arm movement is significantly longer with sonification compared to the no-sound condition (p < 0.001). Qualitative analysis of semi-structured interviews revealed different aspects of motivational and affective aspects of sonification. Most participants of both groups preferred to complete the task with sound (29 of 30 participants), and described the experience as playful (22 of 30 participants). More precisely, the soundscape (nature sounds) was the most constantly preferred (selected first by 14 of 30 participants). CONCLUSION Overall, our results confirm that the sonification has an effect on the temporal execution of the movement during a single-session. Globally, sonification is welcomed by the participants, and we found convergent and differentiated appreciations of the different sonification types.
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Affiliation(s)
- Iseline Peyre
- UMR STMS, Ircam, CNRS, Sorbonne Université, 75004, Paris, France
- ISIR, CNRS UMR 7222, Inserm U1150, Sorbonne Université, 75005, Paris, France
- Laboratoire d'Imagerie Biomédicale (LIB), Inserm, CNRS, Sorbonne Université, 75006, Paris, France
| | - Agnès Roby-Brami
- ISIR, CNRS UMR 7222, Inserm U1150, Sorbonne Université, 75005, Paris, France
| | - Maël Segalen
- UMR STMS, Ircam, CNRS, Sorbonne Université, 75004, Paris, France
- ISIR, CNRS UMR 7222, Inserm U1150, Sorbonne Université, 75005, Paris, France
| | - Alain Giron
- Laboratoire d'Imagerie Biomédicale (LIB), Inserm, CNRS, Sorbonne Université, 75006, Paris, France
| | - Baptiste Caramiaux
- ISIR, CNRS UMR 7222, Inserm U1150, Sorbonne Université, 75005, Paris, France
| | | | - Pascale Pradat-Diehl
- Laboratoire d'Imagerie Biomédicale (LIB), Inserm, CNRS, Sorbonne Université, 75006, Paris, France
- AP-HP, Hôpital Pitié-Salpêtrière, Maladies du Système Nerveux, 75013, Paris, France
- GRC HaMCRe, Sorbonne Université, 75013, Paris, France
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Metayer T, Gilard V, Piotin M, Emery E, Borha A, Robichon E, Briant AR, Derrey S, Vivien D, Gaberel T. Microsurgery and Endovascular Therapy for Distal Anterior Cerebral Artery Aneurysm: A Multicenter Retrospective Cohort Study. World Neurosurg 2023; 178:e174-e181. [PMID: 37451360 DOI: 10.1016/j.wneu.2023.07.022] [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: 05/11/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Distal anterior cerebral aneurysm (DACA) represents 4% of intracranial aneurysms. Two treatment modalities are available: microsurgery and endovascular therapy (EVT). OBJECTIVE To compare the results between microsurgery and EVT in a modern French cohort. METHODS A multicenter retrospective cohort study of 3 French neurosurgical units was carried out from January 1, 2015, to December 31, 2020. All participants were adult patients who required treatment for a ruptured or unruptured DACA aneurysm. RESULTS A total of 69 patients were included; 16 patients (23.2%) were treated by microsurgery and 53 (76.8%) were treated by EVT. Thirty-one patients (44.9%) had ruptured aneurysms. The complication rate was low, with 1 death and 1 symptomatic ischemia. There was no difference in complications between microsurgery and EVT (P = 0.22). The number of retreatments was higher in EVT (15% vs. 0%) but not significantly (P = 0.18). CONCLUSIONS In the specific subgroup of DACA, both treatment modalities are effective in ruptured and unruptured aneurysms, with a low rate of complications. Retreatment may be more frequent in EVT but it does not lead to more complications.
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Affiliation(s)
- Thomas Metayer
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie Université, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Caen, France.
| | - Vianney Gilard
- Department of Neurosurgery, University Hospital of Rouen, Rouen, France
| | - Michel Piotin
- Department of Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Evelyne Emery
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie Université, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Caen, France
| | - Alin Borha
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie Université, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Caen, France
| | - Erwan Robichon
- Department of Neuroradiology, Rothschild Foundation Hospital, Paris, France
| | - Anais R Briant
- Department of Biostatistics, University Hospital of Caen, Caen, France
| | - Stephane Derrey
- Department of Neurosurgery, University Hospital of Rouen, Rouen, France
| | - Denis Vivien
- Normandie Université, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Caen, France
| | - Thomas Gaberel
- Department of Neurosurgery, University Hospital of Caen, Caen, France; Normandie Université, UNICAEN, INSERM, PhIND "Physiopathology and Imaging of Neurological Disorders", Institut Blood and Brain @ Caen-Normandie, Caen, France; Medical School, University of Caen Normandy, Caen, France
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Joundi RA, King JA, Stang J, Nicol D, Hill MD, Quan H, Faris P, Yu AYX, Kapral MK, Smith EE. Association of co-morbidity with acute stroke mortality by age and time since stroke: A population-based study. J Stroke Cerebrovasc Dis 2023; 32:107236. [PMID: 37429113 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107236] [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: 12/11/2022] [Revised: 06/12/2023] [Accepted: 06/26/2023] [Indexed: 07/12/2023] Open
Abstract
OBJECTIVE To examine whether the association of co-morbidity with mortality after acute stroke is influenced by stroke type, age, sex, or time since stroke. MATERIALS AND METHODS We conducted a province-wide population-based study using linked administrative databases to identify all admissions for acute stroke between 2007-2018 in Alberta, Canada. We used Cox proportional hazard models to determine the association of severe co-morbidity based on the Charlson Co-morbidity Index with 1-year mortality after stroke, assessing for effect modification by stroke type, age, and sex, and with adjustment for estimated stroke severity, comprehensive stroke centre care, hypertension, atrial fibrillation, and year of study. We used a piecewise model to analyze the impact of co-morbidity across four time periods. RESULTS We had 28,672 patients in our final cohort (87.8% ischemic stroke). The hazard of mortality with severe co-morbidity was higher for individuals with ischemic stroke (adjusted hazard ratio [aHR] 2.20, 95% CI 2.07-2.32) compared to those with intracerebral hemorrhage (aHR 1.70, 95% CI 1.51-1.92; pint<0.001), and higher in individuals under age 75 (aHR 3.20, 95% CI 2.90-3.53) compared to age ≥75 (aHR 1.93, 95% CI 1.82-2.05, pint<0.001). There was no interaction by sex. The hazard ratio increased in a graded fashion at younger ages and was higher after the first 30 days of acute stroke. CONCLUSION There was a stronger association between co-morbidity and mortality at younger age and in the subacute phase of stroke. Further research is needed to determine the reason for these findings and identify ways to improve outcomes among those with stroke and co-morbid conditions at young age.
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Affiliation(s)
- Raed A Joundi
- Division of Neurology, Hamilton Health Sciences, McMaster University & Population Health Research Institute, Hamilton, ON, Canada; Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Canada.
| | - James A King
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform; Provincial Research Data Services, Alberta Health Services
| | - Jillian Stang
- Data and Analytics (DnA), Alberta Health Services, Alberta, Canada
| | - Dana Nicol
- Data and Analytics (DnA), Alberta Health Services, Alberta, Canada
| | - Michael D Hill
- Alberta Strategy for Patient Oriented Research Support Unit Data Platform; Provincial Research Data Services, Alberta Health Services
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Alberta Canada; Centre for Health Informatics, Calgary, Alberta Canada
| | - Peter Faris
- The O'Brien Institute for Public Health, University of Calgary, Health Services Statistical and Analytic Methods, Data and Analytics (DnA), Alberta Health Services, Foothills Medical Centre, Calgary, AB Canada
| | - Amy Y X Yu
- ICES, Department of Medicine (Neurology), University of Toronto, Sunnybrook Health Sciences Centre, ON, Canada
| | - Moira K Kapral
- Department of Medicine (General Internal Medicine), University of Toronto-University Health Network, ON, Canada
| | - Eric E Smith
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Canada; Department of Community Health Sciences, University of Calgary, Alberta Canada; Centre for Health Informatics, Calgary, Alberta Canada
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Lucà F, Colivicchi F, Oliva F, Abrignani M, Caretta G, Di Fusco SA, Giubilato S, Cornara S, Di Nora C, Pozzi A, Di Matteo I, Pilleri A, Rao CM, Parlavecchio A, Ceravolo R, Benedetto FA, Rossini R, Calvanese R, Gelsomino S, Riccio C, Gulizia MM. Management of oral anticoagulant therapy after intracranial hemorrhage in patients with atrial fibrillation. Front Cardiovasc Med 2023; 10:1061618. [PMID: 37304967 PMCID: PMC10249073 DOI: 10.3389/fcvm.2023.1061618] [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: 10/04/2022] [Accepted: 04/14/2023] [Indexed: 06/13/2023] Open
Abstract
Intracranial hemorrhage (ICH) is considered a potentially severe complication of oral anticoagulants (OACs) and antiplatelet therapy (APT). Patients with atrial fibrillation (AF) who survived ICH present both an increased ischemic and bleeding risk. Due to its lethality, initiating or reinitiating OACs in ICH survivors with AF is challenging. Since ICH recurrence may be life-threatening, patients who experience an ICH are often not treated with OACs, and thus remain at a higher risk of thromboembolic events. It is worthy of mention that subjects with a recent ICH and AF have been scarcely enrolled in randomized controlled trials (RCTs) on ischemic stroke risk management in AF. Nevertheless, in observational studies, stroke incidence and mortality of patients with AF who survived ICH had been shown to be significantly reduced among those treated with OACs. However, the risk of hemorrhagic events, including recurrent ICH, was not necessarily increased, especially in patients with post-traumatic ICH. The optimal timing of anticoagulation initiation or restarting after an ICH in AF patients is also largely debated. Finally, the left atrial appendage occlusion option should be evaluated in AF patients with a very high risk of recurrent ICH. Overall, an interdisciplinary unit consisting of cardiologists, neurologists, neuroradiologists, neurosurgeons, patients, and their families should be involved in management decisions. According to available evidence, this review outlines the most appropriate anticoagulation strategies after an ICH that should be adopted to treat this neglected subset of patients.
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Affiliation(s)
- Fabiana Lucà
- Cardiology Department, Grande Ospedale Metropolitano di Reggio Calabria, GOM, Azienda Ospedaliera Bianchi Melacrino Morelli, Italy
| | - Furio Colivicchi
- Cardiology Division, San Filippo Neri Hospital, ASL Roma 1, Roma, Italy
| | - Fabrizio Oliva
- De Gasperis Cardio Center, ASST Niguarda Hospital, Milano, Italy
| | | | - Giorgio Caretta
- Cardiology Unit, Sant'Andrea Hospital, ASL 5 Liguria, La Spezia, Italy
| | | | | | - Stefano Cornara
- Cardiology Division San Paolo Hospital, ASL 2, Savona, Italy
| | | | - Andrea Pozzi
- Cardiology Division, Maria della Misericordia di Udine, Italy
| | - Irene Di Matteo
- De Gasperis Cardio Center, ASST Niguarda Hospital, Milano, Italy
| | - Anna Pilleri
- Cardiology Division, Brotzu Hospital, Cagliari, Italy
| | - Carmelo Massimiliano Rao
- Cardiology Department, Grande Ospedale Metropolitano di Reggio Calabria, GOM, Azienda Ospedaliera Bianchi Melacrino Morelli, Italy
| | - Antonio Parlavecchio
- Cardiology Department, Grande Ospedale Metropolitano di Reggio Calabria, GOM, Azienda Ospedaliera Bianchi Melacrino Morelli, Italy
| | - Roberto Ceravolo
- Cardiology Division, Giovanni Paolo II Hospital, Lamezia Terme, Italy
| | - Francesco Antonio Benedetto
- Cardiology Department, Grande Ospedale Metropolitano di Reggio Calabria, GOM, Azienda Ospedaliera Bianchi Melacrino Morelli, Italy
| | | | | | - Sandro Gelsomino
- Cardiothoracic Department, Maastricht University, Maastricht, The Netherlands
| | - Carmine Riccio
- Cardiovascular Department, A.O.R.N. Sant'Anna e San Sebastiano, Caserta, Italy
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Gwon YG, Han SJ, Kim KH. Trends in the Quality of Primary Care and Acute Care in Korea From 2008 to 2020: A Cross-sectional Study. J Prev Med Public Health 2023; 56:248-254. [PMID: 37287202 DOI: 10.3961/jpmph.23.015] [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: 01/09/2023] [Accepted: 03/24/2023] [Indexed: 06/09/2023] Open
Abstract
OBJECTIVES Measuring the quality of care is paramount to inform policies for healthcare services. Nevertheless, little is known about the quality of primary care and acute care provided in Korea. This study investigated trends in the quality of primary care and acute care. METHODS Case-fatality rates and avoidable hospitalization rates were used as performance indicators to assess the quality of primary care and acute care. Admission data for the period 2008 to 2020 were extracted from the National Health Insurance Claims Database. Case-fatality rates and avoidable hospitalization rates were standardized by age and sex to adjust for patients' characteristics over time, and significant changes in the rates were identified by joinpoint regression. RESULTS The average annual percent change in age-/sex-standardized case-fatality rates for acute myocardial infarction was -2.3% (95% confidence interval, -4.6 to 0.0). For hemorrhagic and ischemic stroke, the age-/sex-standardized case-fatality rates were 21.8% and 5.9%, respectively in 2020; these rates decreased since 2008 (27.1 and 8.7%, respectively). The average annual percent change in age-/sex-standardized avoidable hospitalization rates ranged from -9.4% to -3.0%, with statistically significant changes between 2008 and 2020. In 2020, the avoidable hospitalization rates decreased considerably compared with the 2019 rate because of the coronavirus disease 2019 pandemic. CONCLUSIONS The avoidable hospitalization rates and case-fatality rates decreased overall during the past decade, but they were relatively high compared with other countries. Strengthening primary care is an essential requirement to improve patient health outcomes in the rapidly aging Korean population.
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Affiliation(s)
- Yeong Geun Gwon
- Review and Assessment Research Division, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Seung Jin Han
- Primary Care Improvement Division, Health Insurance Review & Assessment Service, Wonju, Korea
| | - Kyoung Hoon Kim
- International Policy Research Division, Health Insurance Review & Assessment Service, Wonju, Korea
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10
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Hurley L, Jauhal J, Ille S, Pull K, Malysheva OV, Jadavji NM. Maternal Dietary Deficiencies in Folic Acid and Choline Result in Larger Damage Volume, Reduced Neuro-Degeneration and -Inflammation and Changes in Choline Metabolites after Ischemic Stroke in Middle-Aged Offspring. Nutrients 2023; 15:nu15071556. [PMID: 37049396 PMCID: PMC10096593 DOI: 10.3390/nu15071556] [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: 02/14/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
Maternal dietary levels of one-carbon (1C) metabolites (folic acid and choline) during pregnancy play a vital role in neurodevelopment. However, the impact of maternal dietary deficiencies on offspring stroke outcomes later in life remains undefined. The aim of this study was to investigate the role of maternal dietary deficiencies in folic acid and choline on ischemic stroke outcomes in middle-aged offspring. Female mice were maintained on either a control or deficient diet prior to and during pregnancy and lactation. At 10 months of age ischemic stroke was induced in male and female offspring. Stroke outcome was assessed by measuring motor function and brain tissue. There was no difference in offspring motor function; however, sex differences were present. In brain tissue, maternal dietary deficiency increased ischemic damage volume and offspring from deficient mothers had reduced neurodegeneration and neuroinflammation within the ischemic region. Furthermore, there were changes in plasma 1C metabolites as a result of maternal diet and sex. Our data indicate that maternal dietary deficiencies do not impact offspring behavior after ischemic stroke but do play a role in brain histology and one-carbon metabolite levels in plasma. Additionally, this study demonstrates that the sex of mice plays an important role in stroke outcomes.
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Affiliation(s)
- Lauren Hurley
- Biomedical Sciences Program, Midwestern University, Glendale, AZ 85308, USA
- College of Veterinary Medicine, Midwestern University, Glendale, AZ 85308, USA
| | - Jesse Jauhal
- Biomedical Sciences Program, Midwestern University, Glendale, AZ 85308, USA
- College of Dental Medicine of Arizona, Midwestern University, Glendale, AZ 85308, USA
| | - Sharadyn Ille
- College of Dental Medicine of Arizona, Midwestern University, Glendale, AZ 85308, USA
| | - Kasey Pull
- Biomedical Sciences Program, Midwestern University, Glendale, AZ 85308, USA
| | - Olga V Malysheva
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
| | - Nafisa M Jadavji
- Biomedical Sciences Program, Midwestern University, Glendale, AZ 85308, USA
- College of Veterinary Medicine, Midwestern University, Glendale, AZ 85308, USA
- College of Osteopathic Medicine, Midwestern University, Glendale, AZ 85308, USA
- Department of Child Health, University of Arizona, Phoenix, AZ 85721, USA
- Department of Neuroscience, Carleton University, Ottawa, ON K1S 5B6, Canada
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11
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Abdelfattah OM, Sayed A, Munir M, Almotawally S, Wilson K, Gad MM, Abushouk AI, Elsayed M, Wazni OM, Saliba WI, Elgendy IY, Jneid H, Kapadia S. Meta-Analysis Comparing Left Atrial Appendage Occlusion, Direct Oral Anticoagulants, and Warfarin for Nonvalvular Atrial Fibrillation. Am J Cardiol 2022. [DOI: 10.1016/j.amjcard.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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12
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Tasseel-Ponche S, Delafontaine A, Godefroy O, Yelnik AP, Doutrellot PL, Duchossoy C, Hyra M, Sader T, Diouf M. Walking speed at the acute and subacute stroke stage: A descriptive meta-analysis. Front Neurol 2022; 13:989622. [PMID: 36226075 PMCID: PMC9549366 DOI: 10.3389/fneur.2022.989622] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/05/2022] [Indexed: 11/30/2022] Open
Abstract
Gait disorders are one of the leading patient complaints at the sub-acute stroke stage (SSS) and a main determinant of disability. Walking speed (WS) is a major vital and functional index, and the Ten-Meter Walk Test is considered the gold standard after stroke. Based on a systematic review of the literature, studies published between January 2000 and November 2021 were selected when WS was reported (ten-meter walk test for short distance and/or 6-min walking distance for long distance) within 6 months following a first ischemic and/or hemorrhagic stroke (SSS) in adults prior to receiving specific walking rehabilitation. Following PRISMA guidelines, a meta-analysis was conducted on two kinds of WS: the principal criterion focused on short-distance WS (ten-meter walking test) and the secondary criteria focused on long-distance WS (6-min test) and meta-regressions to study the association of WS with balance, cognitive disorders and autonomy. Nine studies comprising a total of 939 data on post-stroke patients were selected. The weighted average age was 61 years [95% IC [55-67] and males represented 62% ± 2.7 of patients [57-67]. Average short-distance WS was 0.36 ± 0.06 m.s−1 [95% CI (0.23–0.49)]. Average long-distance WS was 0.46 ± 0.1 m.s−1 [95% CI (0.26–0.66)]. The funnel plot revealed asymmetry of publication bias and high heterogeneity of the nine studies (I2 index 98.7% and Q-test p < 0.0001). Meta-regressions of secondary endpoints could not be performed due to a lack of study data. At the SSS, WS would be lower than data in general population published in literature, but above all, lower than the WS required for safe daily autonomy and community ambulation after stroke. WS must be a priority objective of stroke rehabilitation to increase walking function but also for survival, autonomy, social participation and health-related quality of life.
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Affiliation(s)
- Sophie Tasseel-Ponche
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
- Laboratory of Functional Neurosciences (EA 4559), Amiens University Hospital, Amiens, France
- *Correspondence: Sophie Tasseel-Ponche
| | - Arnaud Delafontaine
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
- CIAMS, Paris-Saclay University, Orsay, France
- CIAMS, Orléans University, Orléans, France
| | - Olivier Godefroy
- Laboratory of Functional Neurosciences (EA 4559), Amiens University Hospital, Amiens, France
- Department of Neurology, Amiens University Hospital, Amiens, France
| | - Alain P. Yelnik
- Physical Medicine and Rehabilitation Department, Hôpital Lariboisière-F. Widal AP-HP, Paris, France
- INSERM U1153 - CRESS EpiAgeing, Paris University, Hôtel-Dieu, Paris, France
| | - Pierre-Louis Doutrellot
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Charline Duchossoy
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Marie Hyra
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Thibaud Sader
- Department of Physical Medicine and Rehabilitation, Amiens University Hospital, Amiens, France
| | - Momar Diouf
- Department of Biostatistics, Amiens University Hospital, Amiens, France
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13
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Matsuzono K, Mashiko T, Ozawa T, Miura K, Suzuki M, Anan Y, Koide R, Tanaka R, Kameda T, Fujimoto S. Real-time data on the prognosis of acute ischemic stroke patients in the Tochigi Clinical ObservatioNal registry for 1-year mortality of aCute ischEmic stRoke patieNt (T-CONCERN) study. Neurol Sci 2022; 43:6855-6864. [DOI: 10.1007/s10072-022-06377-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/28/2022] [Indexed: 10/14/2022]
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14
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Le Franc S, Herrera Altamira G, Guillen M, Butet S, Fleck S, Lécuyer A, Bougrain L, Bonan I. Toward an Adapted Neurofeedback for Post-stroke Motor Rehabilitation: State of the Art and Perspectives. Front Hum Neurosci 2022; 16:917909. [PMID: 35911589 PMCID: PMC9332194 DOI: 10.3389/fnhum.2022.917909] [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: 04/11/2022] [Accepted: 06/20/2022] [Indexed: 11/28/2022] Open
Abstract
Stroke is a severe health issue, and motor recovery after stroke remains an important challenge in the rehabilitation field. Neurofeedback (NFB), as part of a brain–computer interface, is a technique for modulating brain activity using on-line feedback that has proved to be useful in motor rehabilitation for the chronic stroke population in addition to traditional therapies. Nevertheless, its use and applications in the field still leave unresolved questions. The brain pathophysiological mechanisms after stroke remain partly unknown, and the possibilities for intervention on these mechanisms to promote cerebral plasticity are limited in clinical practice. In NFB motor rehabilitation, the aim is to adapt the therapy to the patient’s clinical context using brain imaging, considering the time after stroke, the localization of brain lesions, and their clinical impact, while taking into account currently used biomarkers and technical limitations. These modern techniques also allow a better understanding of the physiopathology and neuroplasticity of the brain after stroke. We conducted a narrative literature review of studies using NFB for post-stroke motor rehabilitation. The main goal was to decompose all the elements that can be modified in NFB therapies, which can lead to their adaptation according to the patient’s context and according to the current technological limits. Adaptation and individualization of care could derive from this analysis to better meet the patients’ needs. We focused on and highlighted the various clinical and technological components considering the most recent experiments. The second goal was to propose general recommendations and enhance the limits and perspectives to improve our general knowledge in the field and allow clinical applications. We highlighted the multidisciplinary approach of this work by combining engineering abilities and medical experience. Engineering development is essential for the available technological tools and aims to increase neuroscience knowledge in the NFB topic. This technological development was born out of the real clinical need to provide complementary therapeutic solutions to a public health problem, considering the actual clinical context of the post-stroke patient and the practical limits resulting from it.
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Affiliation(s)
- Salomé Le Franc
- Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France
- Hybrid Team, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
- *Correspondence: Salomé Le Franc,
| | | | - Maud Guillen
- Hybrid Team, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
- Neurology Unit, University Hospital of Rennes, Rennes, France
| | - Simon Butet
- Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France
- Empenn Unit U1228, Inserm, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
| | - Stéphanie Fleck
- Université de Lorraine, CNRS, LORIA, Nancy, France
- EA7312 Laboratoire de Psychologie Ergonomique et Sociale pour l’Expérience Utilisateurs (PERSEUS), Metz, France
| | - Anatole Lécuyer
- Hybrid Team, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
| | | | - Isabelle Bonan
- Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France
- Empenn Unit U1228, Inserm, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
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15
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Hänsel M, Steigmiller K, Luft AR, Gebhard C, Held U, Wegener S. Neurovascular disease in Switzerland: 10-year trends show non-traditional risk factors on the rise and higher exposure in women. Eur J Neurol 2022; 29:2851-2860. [PMID: 35661347 PMCID: PMC9541902 DOI: 10.1111/ene.15434] [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: 05/22/2022] [Accepted: 05/30/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Effective risk factor modification is the prerequisite to prevent neurovascular disease such as stroke or vascular dementia. Non-traditional vascular risk factors (nt-vrf) including stress significantly add to risk of neurovascular disease arising from traditional vascular risk factors (t-vrf). In order to discover sex-specific changes that may underlie previously reported inclines in the prevalence of neuro- and cardiovascular disease in women, we assessed 10-year trends in the prevalence of vrf in Switzerland. METHODS We obtained anonymized data from 22'134 participants (51% women) of the governmental Swiss Health Survey, performed every five years (2007, 2012, and 2017). Epidemiological parameters, t-vrf and nt-vrf were analyzed in a cross-sectional study design. RESULTS Over the observation period, the number of women having full-time jobs increased considerably (2007: 38%, 2012: 39%, 2017: 44%). This was accompanied by a substantial rise in the prevalence of nt-vrf in women and men (w/m) including stress at work (2007: not available, 2012: 58%/60%, 2017: 66%/65%), low locus of control (w/m: 2007: 21%/19%, 2012: 22%/19%, 2017: 25%/22%), and sleep disorders (w/m: 2007: 30%/22%, 2012: 28%/20%, 2017: 32%/26%). Amongst t-vrf, only the prevalence of obesity and hypercholesterolemia increased over time in both sexes, while other t-vrf remained stable (hypertension [27%], diabetes [5%]) or decreased (smoking [9.4 cigarettes/day]). CONCLUSIONS A rise in women's economic participation alongside a higher affection with nt-vrf in the female Swiss population emphasizes the need to improve vascular risk stratification and implement effective preventive measures for neuro- and cardiovascular disease.
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Affiliation(s)
- Martin Hänsel
- Department of Neurology and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Switzerland
| | - Klaus Steigmiller
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Andreas R Luft
- Department of Neurology and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Switzerland
| | - Catherine Gebhard
- Department of Nuclear Medicine, University Hospital Zurich and University of Zurich, Switzerland
| | - Ulrike Held
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Susanne Wegener
- Department of Neurology and Clinical Neuroscience Center, University Hospital Zurich and University of Zurich, Switzerland
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16
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Quality of Life in the First Year after Ischemic Stroke Treated with Acute Revascularization Therapy. J Clin Med 2022; 11:jcm11113240. [PMID: 35683624 PMCID: PMC9181285 DOI: 10.3390/jcm11113240] [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: 04/11/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: we aimed to describe the disease-specific quality of life (QoL) of ischemic stroke patients treated with acute revascularization therapy, its evolution from 6 months to 12 months, and associated factors. (2) Methods: QoL was assessed with the SS-QoL in consecutive patients treated with either intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT). Variables associated with QoL scores and its evolution were studied using multivariate mixed models, and interaction with time. Analyses were performed in four domains of SS-QoL: self-care, mobility, mood, and social roles. (3) Results: Among the 501 included patients (mean (sd) age 68.9 (14.5), 49% women), lower post-stroke QoL was independently related to lower level of school education, prestroke mRS > 2, and 24 h NIHSS score > 4. Independent predictors of unfavorable evolution of QoL over time were age <75 years (Mobility p = 0.0194 and Mood p = 0.0015), NIHSS score ≤ 4, (Self-care p = 0.0053 and Mood p = 0.0048), and modified Rankin Scale score ≤ 2 (Social roles, p = 0.0006). Revascularization therapy had no significant effect on the QoL scores, but patients treated with MT (alone or as bridging therapy) had significantly greater improvement in mobility score between 6 and 12 months than patients treated with IVT alone (p = 0.0072). (4) Conclusion: QoL evolution over one year had only slight variation and was associated with the modalities of acute treatment, age, and stroke severity.
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17
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Ocak G, Boenink R, Noordzij M, Bos WJW, Vikse BE, Cases A, Kerschbaum J, Helve J, Nordio M, Arici M, Mercadal L, Wanner C, Palsson R, Hommel K, De Meester J, Kostopoulou M, Santamaria R, Rodrigo E, Rydell H, Bell S, Massy ZA, Jager KJ, Kramer A. Trends in Mortality Due to Myocardial Infarction, Stroke, and Pulmonary Embolism in Patients Receiving Dialysis. JAMA Netw Open 2022; 5:e227624. [PMID: 35435972 PMCID: PMC9016490 DOI: 10.1001/jamanetworkopen.2022.7624] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE During the past decades, improvements in the prevention and management of myocardial infarction, stroke, and pulmonary embolism have led to a decline in cardiovascular mortality in the general population. However, it is unknown whether patients receiving dialysis have also benefited from these improvements. OBJECTIVE To assess the mortality rates for myocardial infarction, stroke, and pulmonary embolism in a large cohort of European patients receiving dialysis compared with the general population. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, adult patients who started dialysis between 1998 and 2015 from 11 European countries providing data to the European Renal Association Registry were and followed up for 3 years. Data were analyzed from September 2020 to February 2022. EXPOSURES Start of dialysis. MAIN OUTCOMES AND MEASURES The age- and sex-standardized mortality rate ratios (SMRs) with 95% CIs were calculated by dividing the mortality rates in patients receiving dialysis by the mortality rates in the general population for 3 equal periods (1998-2003, 2004-2009, and 2010-2015). RESULTS In total, 220 467 patients receiving dialysis were included in the study. Their median (IQR) age was 68.2 (56.5-76.4) years, and 82 068 patients (37.2%) were female. During follow-up, 83 912 patients died, of whom 7662 (9.1%) died because of myocardial infarction, 5030 (6.0%) died because of stroke, and 435 (0.5%) died because of pulmonary embolism. Between the periods 1998 to 2003 and 2010 to 2015, the SMR of myocardial infarction decreased from 8.1 (95% CI, 7.8-8.3) to 6.8 (95% CI, 6.5-7.1), the SMR of stroke decreased from 7.3 (95% CI, 7.0-7.6) to 5.8 (95% CI, 5.5-6.2), and the SMR of pulmonary embolism decreased from 8.7 (95% CI, 7.6-10.1) to 5.5 (95% CI, 4.5-6.6). CONCLUSIONS AND RELEVANCE In this cohort study of patients receiving dialysis, mortality rates for myocardial infarction, stroke, and pulmonary embolism decreased more over time than in the general population.
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Affiliation(s)
- Gurbey Ocak
- Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, the Netherlands
| | - Rianne Boenink
- European Renal Association Registry, Department of Medical Informatics, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Marlies Noordzij
- European Renal Association Registry, Department of Medical Informatics, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Willem Jan W. Bos
- Department of Internal Medicine, Sint Antonius Hospital, Nieuwegein, the Netherlands
- Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Bjorn E. Vikse
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Medicine, Haugesund Hospital, Haugesund, Norway
| | - Aleix Cases
- Nephrology Department, Hospital Clínic, Universitat de Barcelona, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- Registre de Malalts Renals de Catalunya, Barcelona, Spain
| | - Julia Kerschbaum
- Department of Internal Medicine IV - Nephrology and Hypertension, Austrian Dialysis and Transplant Registry, Medical University Innsbruck, Innsbruck, Austria
| | - Jaakko Helve
- Finnish Registry for Kidney Diseases, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki, Helsinki University Hospital, Helsinki, Finland
| | - Maurizio Nordio
- Veneto Dialysis and Transplantation Registry, Regional Epidemiology System, Padua, Italy
- Nephrology Dialysis and Renal Transplantation Unit, Treviso, Italy
| | - Mustafa Arici
- Department of Nephrology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Lucile Mercadal
- Department of Nephrology and Renal Transplantation, Assistance Publique-Hôpitaux de Paris, Hôpital de La Pitié Salpêtrière Hospital, Paris, France
| | - Christoph Wanner
- Division of Nephrology, Department of Medicine, University Hospital of Würzburg, Würzburg, Germany
| | - Runolfur Palsson
- Division of Nephrology, Landspitali, The National University Hospital of Iceland, Reykjavik, Iceland
- Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | | | - Johan De Meester
- Department of Nephrology, Dialysis and Hypertension, Dutch-speaking Belgian Renal Registry (NBVN), Sint-Niklaas, Belgium
| | | | - Rafael Santamaria
- Andalusian Autonomous Transplant Coordination Information System, Seville, Spain
- Nephrology ServiceReina Sofia University Hospital, Cordoba, Spain
| | - Emilio Rodrigo
- Nephrology Service, University Hospital Marqués de Valdecilla/IDIVAL, University of Cantabria, Santander, Spain
| | - Helena Rydell
- Division of Renal Medicine, Department of Clinical Sciences Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Swedish Renal Registry, Department of Internal Medicine, Ryhov Regional Hospital, Jönköping, Sweden
| | - Samira Bell
- Scottish Renal Registry, Meridian Court, Glasgow, United Kingdom
- Division of Population health And Genomics, University of Dundee, Dundee, United Kingdom
| | - Ziad A. Massy
- Division of Nephrology, Ambroise Paré University Hospital, Boulogne-Billancourt, France
- Institut National de la Santé et de la Recherche Médicale, Research Centre in Epidemiology and Population Health, University of Paris Ouest-Versailles-St Quentin-en-Yveline, Villejuif, France
| | - Kitty J. Jager
- European Renal Association Registry, Department of Medical Informatics, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Anneke Kramer
- European Renal Association Registry, Department of Medical Informatics, Amsterdam Universitair Medische Centra, University of Amsterdam, Amsterdam Public Health research institute, Amsterdam, the Netherlands
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Olié V, Grave C, Tuppin P, Duloquin G, Béjot Y, Gabet A. Patients Hospitalized for Ischemic Stroke and Intracerebral Hemorrhage in France: Time Trends (2008-2019), In-Hospital Outcomes, Age and Sex Differences. J Clin Med 2022; 11:jcm11061669. [PMID: 35329995 PMCID: PMC8949281 DOI: 10.3390/jcm11061669] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 03/12/2022] [Accepted: 03/15/2022] [Indexed: 11/24/2022] Open
Abstract
Background: Rates of patients hospitalized for stroke increased among people aged under 65 years in France, as has been found in other countries. Methods: To analyze time trends in the rates of patients hospitalized for ischemic stroke (IS) and intracerebral hemorrhage (ICH) in France between 2008 and 2019 and determine related short-term outcomes mainly, we selected all patients hospitalized for stroke using the French national hospital database. Results: The average annual percentage change in the rates of patients hospitalized for IS increased significantly in men and women aged 50–64 years (+2.0%) and in men aged 18–34 years (+1.5%) and 35–44 years (+2.2%). A decrease in the average annual percentage change was observed for IS among people aged over 75 years and among those over 50 years for ICH. After adjustment on confounding factors, women were less likely to die in hospital. Case fatality rates decreased overtime in all age groups for both sexes, with a more pronounced decrease for IS than ICH. Conclusions: The increasing trend of IS among adults under 65 years is ongoing, highlighting the urgent need for stroke prevention programs in that age. For the first time, we recorded a decrease in the rates of patients hospitalized for ICH among the population over 50 years.
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Affiliation(s)
- Valérie Olié
- Department of Non-Communicable Diseases, Santé Publique France, 94410 Saint-Maurice, France; (V.O.); (C.G.)
| | - Clémence Grave
- Department of Non-Communicable Diseases, Santé Publique France, 94410 Saint-Maurice, France; (V.O.); (C.G.)
| | - Philippe Tuppin
- Department of Health Studies and Statistics, Caisse Nationale de l’Assurance Maladie, 75020 Paris, France;
| | - Gauthier Duloquin
- Dijon Stroke Registry, University Hospital of Burgundy, 21000 Dijon, France; (G.D.); (Y.B.)
| | - Yannick Béjot
- Dijon Stroke Registry, University Hospital of Burgundy, 21000 Dijon, France; (G.D.); (Y.B.)
| | - Amélie Gabet
- Department of Non-Communicable Diseases, Santé Publique France, 94410 Saint-Maurice, France; (V.O.); (C.G.)
- Correspondence:
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19
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Olié V, Grave C, Gabet A. Impact of lowering low-density lipoprotein cholesterol thresholds on the proportion of adults requiring an intervention: Application of the 2019 ESC/EAS guidelines for the management of dyslipidaemia to the French population. Arch Cardiovasc Dis 2022; 115:106-108. [DOI: 10.1016/j.acvd.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/23/2021] [Accepted: 12/02/2021] [Indexed: 11/30/2022]
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Allou A, Baschet L, Sabourin C, Montalscot G, Lorgis L, Iriart X. Cost-effectiveness analysis of patent foramen ovale closure with Amplatzer plus medical therapy compared to medical therapy in patients with a history of stroke in France. J Cardiol 2021; 80:72-79. [PMID: 34772575 DOI: 10.1016/j.jjcc.2021.10.009] [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: 05/20/2021] [Revised: 09/07/2021] [Accepted: 10/13/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND A patent foramen ovale (PFO) is formed when the ovale foramen does not close spontaneously or re-opens leaving the right and left atrium connected. The present study was conducted to analyze the cost-effectiveness of PFO closure with Amplatzer device plus medical therapy (MT) compared to MT alone in the French reimbursement system for PFO patients with a prior history of stroke, using the RESPECT study data. METHODS A multi-state Markov model was used. The analysis was conducted from a collective perspective over a 10-year time horizon with 4% discount applied for costs and health effects. The simulated population included adult patients with PFO. Sub-group analysis was limited to patients with atrial septal aneurysm and/or a large-shunt. Clinical inputs were derived from the RESPECT study and literature. Costs associated with the device, drugs, and management were sourced from literature and national databases. The outcomes of analyses included life-years (LYs), quality-adjusted LYs (QALYs), incremental cost-effectiveness ratio (ICER), and number of recurrent strokes avoided. Scenario and sensitivity analyses were conducted to assess the robustness of the results. RESULTS The use of Amplatzer plus MT provided additional QALYs (0.16) at an incremental cost of 7301€, generating an ICER of 46,288€/QALY for Amplatzer vs. MT alone. In the sub-group analysis, Amplatzer plus MT provided additional QALYs (0.20) at an incremental cost of 5818€, generating an ICER of 28,624€/QALY for Amplatzer plus MT vs. MT alone. Amplatzer plus MT led to lower number of recurrent strokes in comparison to MT alone in both populations. Scenario and sensitivity analyses confirmed the robustness of the results. CONCLUSION Amplatzer plus MT represents a cost-effective treatment option and is associated with lower stroke recurrence compared to MT alone for PFO patients with a prior history of stroke.
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Affiliation(s)
| | | | | | - Gilles Montalscot
- Sorbonne University, ACTION Study Group, Pitié-Salpêtrière Hospital (AP-HP), Paris, France
| | - Luc Lorgis
- Department of Cardiology, University Hospital, Dijon, France; Laboratory of Cerebro-Vascular Pathophysiology and Epidemiology (PEC2) EA 7460, Dijon, France; University of Burgundy, Dijon, France
| | - Xavier Iriart
- Bordeaux University Hospital (CHU), Department of Pediatric and Adult Congenital Cardiology, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
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21
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Le Franc S, Bonan I, Fleury M, Butet S, Barillot C, Lécuyer A, Cogné M. Visual feedback improves movement illusions induced by tendon vibration after chronic stroke. J Neuroeng Rehabil 2021; 18:156. [PMID: 34717672 PMCID: PMC8556973 DOI: 10.1186/s12984-021-00948-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 10/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Illusion of movement induced by tendon vibration is commonly used in rehabilitation and seems valuable for motor rehabilitation after stroke, by playing a role in cerebral plasticity. The aim was to study if congruent visual cues using Virtual Reality (VR) could enhance the illusion of movement induced by tendon vibration of the wrist among participants with stroke. METHODS We included 20 chronic stroke participants. They experienced tendon vibration of their wrist (100 Hz, 30 times) inducing illusion of movement. Three VR visual conditions were added to the vibration: a congruent moving virtual hand (Moving condition); a static virtual hand (Static condition); or no virtual hand at all (Hidden condition). The participants evaluated for each visual condition the intensity of the illusory movement using a Likert scale, the sensation of wrist's movement using a degree scale and they answered a questionnaire about their preferred condition. RESULTS The Moving condition was significantly superior to the Hidden condition and to the Static condition in terms of illusion of movement (p < 0.001) and the wrist's extension (p < 0.001). There was no significant difference between the Hidden and the Static condition for these 2 criteria. The Moving condition was considered the best one to increase the illusion of movement (in 70% of the participants). Two participants did not feel any illusion of movement. CONCLUSIONS This study showed the interest of using congruent cues in VR in order to enhance the consistency of the illusion of movement induced by tendon vibration among participants after stroke, regardless of their clinical severity. By stimulating the brain motor areas, this visuo-proprioceptive feedback could be an interesting tool in motor rehabilitation. Record number in Clinical Trials: NCT04130711, registered on October 17th 2019 ( https://clinicaltrials.gov/ct2/show/NCT04130711?id=NCT04130711&draw=2&rank=1 ).
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Affiliation(s)
- Salomé Le Franc
- Rehabilitation Medicine Unit, CHU de Rennes, University Hospital of Rennes, 2, rue Henri Le Guilloux, 35000, Rennes, France.
- Hybrid Unity, Inria, University of Rennes, Irisa, 6074 Umr Cnrs, Rennes, France.
| | - Isabelle Bonan
- Rehabilitation Medicine Unit, CHU de Rennes, University Hospital of Rennes, 2, rue Henri Le Guilloux, 35000, Rennes, France
- Empenn Unity U1228, Inserm, Inria, University of Rennes, Irisa, 6074 Umr Cnrs, Rennes, France
| | - Mathis Fleury
- Hybrid Unity, Inria, University of Rennes, Irisa, 6074 Umr Cnrs, Rennes, France
- Empenn Unity U1228, Inserm, Inria, University of Rennes, Irisa, 6074 Umr Cnrs, Rennes, France
| | - Simon Butet
- Rehabilitation Medicine Unit, CHU de Rennes, University Hospital of Rennes, 2, rue Henri Le Guilloux, 35000, Rennes, France
- Empenn Unity U1228, Inserm, Inria, University of Rennes, Irisa, 6074 Umr Cnrs, Rennes, France
| | - Christian Barillot
- Empenn Unity U1228, Inserm, Inria, University of Rennes, Irisa, 6074 Umr Cnrs, Rennes, France
| | - Anatole Lécuyer
- Hybrid Unity, Inria, University of Rennes, Irisa, 6074 Umr Cnrs, Rennes, France
| | - Mélanie Cogné
- Rehabilitation Medicine Unit, CHU de Rennes, University Hospital of Rennes, 2, rue Henri Le Guilloux, 35000, Rennes, France
- Hybrid Unity, Inria, University of Rennes, Irisa, 6074 Umr Cnrs, Rennes, France
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22
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Han J, Liu J, Wu Y, Lin Q, Guo D, Zhang X, Tu J, Ning X, Wang J. Long-Term Trends in the Stroke Prognosis Among Rural Residents in China: A Population-Based Surveillance Study. Risk Manag Healthc Policy 2021; 14:4013-4021. [PMID: 34594140 PMCID: PMC8478494 DOI: 10.2147/rmhp.s325822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/25/2021] [Indexed: 12/04/2022] Open
Abstract
Objective Although stroke mortality has remained stable over the past decade, the long-term trends of stroke burden are scarce in China, especially in low-income populations. Thus, we aimed to explore the secular trends in the prognosis of stroke in a low-income population in China. Methods This was a population-based stroke surveillance study that included all of the participants in the Tianjin Brain Study. Stroke management and outcomes were evaluated for all stroke patients. Trends in the burden of stroke were assessed as annual percentage changes. Results Overall, 1462 stroke cases occurred from 1992 to 2018, and 58.7% of patients were male. The rates of diagnosis by neuroimaging and of hospitalization increased noticeably across sexes and ages for all stroke types, and the greatest increases were observed among elderly women; diagnosis by neuroimaging increased by 4.7% and the rate of hospitalization increased by 12.4% (all P<0.001). Stroke fatality decreased by 3.7% annually among those aged <65 years and by 3.1% among patients aged ≥65 years; the corresponding rates were 7.4% and 3.5%, respectively, for women. The recurrence rate of ischemic stroke significantly decreased among all men, by 9.6% for those aged <65 years and by 3.1% for those aged ≥65 years; however, for women, this rate only significantly decreased for those aged ≥65 years. Conclusion Our findings suggest that the allocation of medical resources has improved over the past decades. However, it is crucial to enhance secondary stroke prevention for women aged <65 years by controlling risk factors in low-income populations.
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Affiliation(s)
- Jing Han
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Jie Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People's Republic of China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People's Republic of China.,Center of Clinical Epidemiology & Evidence-Based Medicine, The Jizhou People's Hospital, Tianjin, 301999, People's Republic of China
| | - Yakun Wu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China.,Department of Neurology, Tangshan Gongren Hospital, Tangshan, 063000, People's Republic of China
| | - Qiuxing Lin
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People's Republic of China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People's Republic of China.,Department of Neurology, Tangshan Gongren Hospital, Tangshan, 063000, People's Republic of China
| | - Dandan Guo
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Xin Zhang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China
| | - Jun Tu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People's Republic of China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People's Republic of China.,Department of Neurology, Tangshan Gongren Hospital, Tangshan, 063000, People's Republic of China
| | - Xianjia Ning
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People's Republic of China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People's Republic of China.,Department of Neurology, Tangshan Gongren Hospital, Tangshan, 063000, People's Republic of China
| | - Jinghua Wang
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, 300052, People's Republic of China.,Laboratory of Epidemiology, Tianjin Neurological Institute, Tianjin, 300052, People's Republic of China.,Tianjin Neurological Institute, Key Laboratory of Post-Neuroinjury Neuro-Repair and Regeneration in Central Nervous System, Ministry of Education and Tianjin City, Tianjin, 300052, People's Republic of China.,Department of Neurology, Tangshan Gongren Hospital, Tangshan, 063000, People's Republic of China
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23
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Le Franc S, Fleury M, Jeunet C, Butet S, Barillot C, Bonan I, Cogné M, Lécuyer A. Influence of the visuo-proprioceptive illusion of movement and motor imagery of the wrist on EEG cortical excitability among healthy participants. PLoS One 2021; 16:e0256723. [PMID: 34473788 PMCID: PMC8412266 DOI: 10.1371/journal.pone.0256723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 08/13/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Motor Imagery (MI) is a powerful tool to stimulate sensorimotor brain areas and is currently used in motor rehabilitation after a stroke. The aim of our study was to evaluate whether an illusion of movement induced by visuo-proprioceptive immersion (VPI) including tendon vibration (TV) and Virtual moving hand (VR) combined with MI tasks could be more efficient than VPI alone or MI alone on cortical excitability assessed using Electroencephalography (EEG). METHODS We recorded EEG signals in 20 healthy participants in 3 different conditions: MI tasks involving their non-dominant wrist (MI condition); VPI condition; and VPI with MI tasks (combined condition). Each condition lasted 3 minutes, and was repeated 3 times in randomized order. Our main judgment criterion was the Event-Related De-synchronization (ERD) threshold in sensori-motor areas in each condition in the brain motor area. RESULTS The combined condition induced a greater change in the ERD percentage than the MI condition alone, but no significant difference was found between the combined and the VPI condition (p = 0.07) and between the VPI and MI condition (p = 0.20). CONCLUSION This study demonstrated the interest of using a visuo-proprioceptive immersion with MI rather than MI alone in order to increase excitability in motor areas of the brain. Further studies could test this hypothesis among patients with stroke to provide new perspectives for motor rehabilitation in this population.
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Affiliation(s)
- Salomé Le Franc
- Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France
- Hybrid Team, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
| | - Mathis Fleury
- Hybrid Team, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
- Empenn Unit U1228, Inserm, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
| | - Camille Jeunet
- CLLE Lab, CNRS, Univ. Toulouse Jean Jaurès, Toulouse, France
| | - Simon Butet
- Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France
- Empenn Unit U1228, Inserm, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
| | - Christian Barillot
- Empenn Unit U1228, Inserm, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
| | - Isabelle Bonan
- Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France
- Empenn Unit U1228, Inserm, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
| | - Mélanie Cogné
- Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France
- Hybrid Team, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
| | - Anatole Lécuyer
- Hybrid Team, Inria, University of Rennes, Irisa, UMR CNRS 6074, Rennes, France
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24
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de Miguel-Yanes JM, Lopez-de-Andres A, Jimenez-Garcia R, Hernandez-Barrera V, de Miguel-Diez J, Méndez-Bailón M, Pérez-Farinós N, Muñoz-Rivas N, Carabantes-Alarcon D, López-Herranz M. Incidence and Outcomes of Hemorrhagic Stroke among Adults in Spain (2016-2018) According to Sex: A Retrospective, Cohort, Observational, Propensity Score Matched Study. J Clin Med 2021; 10:jcm10163753. [PMID: 34442046 PMCID: PMC8397207 DOI: 10.3390/jcm10163753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 12/12/2022] Open
Abstract
(1) Background: We aim to analyze sex differences in the incidence, clinical characteristics and in-hospital outcomes of hemorrhagic stroke (HS) in Spain (2016–2018) using the National Hospital Discharge Database. (2) Methods: Retrospective, cohort, observational study. We estimated the incidence of HS in men and women. We analyzed comorbidity, treatments, procedures, and hospital outcomes. We matched each woman with a man by age, type of HS and medical conditions using propensity score matching. (3) Results: HS was coded in 57,227 patients aged ≥18 years (44.3% women). Overall, men showed higher incidence rates (57.3/105 vs. 43.0/105; p < 0.001; IRR = 1.60; 95% CI: 1.38–1.83). Women suffered more subarachnoid hemorrhages (25.2% vs. 14.6%), whereas men more often had intracerebral hemorrhages (55.7% vs. 54.1%). In-hospital mortality (IHM) was higher for intracerebral hemorrhage in both men and women. Women underwent decompressive craniectomy less often than men (5.0% vs. 6.2%; p < 0.001). After matching, IHM among women was higher (29.0% vs. 23.7%; p < 0.001). Increments in age, comorbidity and use of anticoagulants and antiplatelet agents prior to hospitalization were associated were higher IHM, and decompressive craniectomy was associated with lower IHM in both sexes. After multivariable adjustment, women had higher IHM (OR = 1.23; 95% CI: 1.18–1.28). (4) Conclusion: Men had higher incidence rates of HS than women. Women less often underwent decompressive craniectomy. IHM was higher among women admitted for HS than among men.
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Affiliation(s)
- Jose M. de Miguel-Yanes
- Internal Medicine Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (D.C.-A.)
- Correspondence: ; Tel.: +34-91-394-1523
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (D.C.-A.)
| | - Valentin Hernandez-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcón, 28922 Madrid, Spain;
| | - Javier de Miguel-Diez
- Respiratory Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Manuel Méndez-Bailón
- Internal Medicine Department, Hospital Universitario Clínico San Carlos, Universidad Complutense de Madrid, 28040 Madrid, Spain;
| | - Napoleón Pérez-Farinós
- Public Health and Psychiatry Department, Faculty of Medicine, Universidad de Málaga, 29010 Málaga, Spain;
| | - Nuria Muñoz-Rivas
- Internal Medicine Department, Hospital Universitario Infanta Leonor, 28031 Madrid, Spain;
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.J.-G.); (D.C.-A.)
| | - Marta López-Herranz
- Nursing Department, Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, 28040 Madrid, Spain;
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25
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Lopez-de-Andres A, Jimenez-Garcia R, Hernández-Barrera V, Jiménez-Trujillo I, de Miguel-Yanes JM, Carabantes-Alarcon D, de Miguel-Diez J, Lopez-Herranz M. Sex-related disparities in the incidence and outcomes of hemorrhagic stroke among type 2 diabetes patients: a propensity score matching analysis using the Spanish National Hospital Discharge Database for the period 2016-18. Cardiovasc Diabetol 2021; 20:138. [PMID: 34243780 PMCID: PMC8272346 DOI: 10.1186/s12933-021-01334-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 07/05/2021] [Indexed: 12/29/2022] Open
Abstract
Background To analyze incidence, use of therapeutic procedures, use of oral anticoagulants (OACs) and antiplatelet agents prior to hospitalization, and in-hospital outcomes among patients who were hospitalized with hemorrhagic stroke (HS) according to the presence of type 2 diabetes mellitus (T2DM) in Spain (2016–2018) and to assess the role of sex differences among those with T2DM. Methods Using the Spanish National Hospital Discharge Database we estimated the incidence of HS hospitalizations in men and women aged ≥ 35 years with and without T2DM. Propensity score matching (PSM) was used to compare population subgroups according to sex and the presence of T2DM. Results HS was coded in 31,425 men and 24,975 women, of whom 11,915 (21.12%) had T2DM. The adjusted incidence of HS was significantly higher in patients with T2DM (both sexes) than in non-T2DM individuals (IRR 1.15; 95% CI 1.12–1.17). The incidence of HS was higher in men with T2DM than in T2DM women (adjusted IRR 1.60; 95% CI 1.57–1.63). After PSM, men and women with T2DM have significantly less frequently received decompressive craniectomy than those without T2DM. In-hospital mortality (IHM) was higher among T2DM women than matched non-T2DM women (32.89% vs 30.83%; p = 0.037), with no differences among men. Decompressive craniectomy was significantly more common in men than in matched women with T2DM (5.81% vs. 3.33%; p < 0.001). IHM was higher among T2DM women than T2DM men (32.89% vs. 28.28%; p < 0.001). After adjusting for confounders with multivariable logistic regression, women with T2DM had a 18% higher mortality risk than T2DM men (OR 1.18; 95% CI 1.07–1.29). Use of OACs and antiplatelet agents prior to hospitalization were associated to higher IHM in men and women with and without T2DM. Conclusions T2DM is associated with a higher incidence of HS and with less frequent use of decompressive craniectomy in both sexes, but with higher IHM only among women. Sex differences were detected in T2DM patients who had experienced HS, with higher incidence rates, more frequent decompressive craniectomy, and lower IHM in men than in women. Supplementary Information The online version contains supplementary material available at 10.1186/s12933-021-01334-2.
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Affiliation(s)
- Ana Lopez-de-Andres
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Rodrigo Jimenez-Garcia
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain.
| | - Valentín Hernández-Barrera
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - Isabel Jiménez-Trujillo
- Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain
| | - José M de Miguel-Yanes
- Internal Medicine Department. Hospital General, Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - David Carabantes-Alarcon
- Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, 28040, Madrid, Spain
| | - Javier de Miguel-Diez
- Respiratory Care Department, Hospital General Universitario Gregorio Marañón, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - Marta Lopez-Herranz
- Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, Madrid, Spain
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26
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Thomas Q, Crespy V, Duloquin G, Ndiaye M, Sauvant M, Béjot Y, Giroud M. Stroke in women: When gender matters. Rev Neurol (Paris) 2021; 177:881-889. [PMID: 34172293 DOI: 10.1016/j.neurol.2021.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/22/2020] [Accepted: 01/11/2021] [Indexed: 12/12/2022]
Abstract
Stroke in women may be considered as a distinct entity due to numerous differences compared with men, including specific epidemiological, etiological, and outcome features along with unique pathophysiological mechanisms. Stroke is the second cause of death in women worldwide with sex-specific causes of stroke in youger women such as pregnancy, post-partum period, oral contraception and migraine. Substitutive hormone treatment in older women is no more recommended in regard of the increased thromboembolic risk it generates. Venous thrombolysis with rtPA and mechanical thrombectomy are now proven to be as efficacious in women as in men. After a stroke, women present poorer quality of life than men attributable to age, more severe stroke, pre-stroke dependency and depression. Recent data concerning the latest epidemiological surveys reveal a shift in trends with the rise of incidence of strokes in young women (≤55 years and 64 years) contrasting with the stability of incidence rates in older women. As science is unvealing sex-related differences in cardiovascular disorders, health policies need to be adapted accordingly to improve stroke prevention and pre-stroke health in women. In the meantime, therapeutical trials should include more women in order to be able to formulate adequate management.
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Affiliation(s)
- Q Thomas
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France.
| | - V Crespy
- Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
| | - G Duloquin
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France; Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
| | - M Ndiaye
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France
| | - M Sauvant
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France
| | - Y Béjot
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France; Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
| | - M Giroud
- Department of General, Vascular and Degenerative Neurology, CHU Dijon, Bourgogne, France; Dijon Stroke Registry (Inserm-Santé Publique France)-EA7460 (Pathophysiology and Epidemiology of Cerebro-Cardio-Vascular Diseases), University of Burgundy, UBFC, Dijon, France
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27
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Béjot Y, Duloquin G, Thomas Q, Mohr S, Garnier L, Graber M, Giroud M. Temporal Trends in the Incidence of Ischemic Stroke in Young Adults: Dijon Stroke Registry. Neuroepidemiology 2021; 55:239-244. [PMID: 34044406 DOI: 10.1159/000516054] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/22/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Stroke is associated with major consequences in terms of socioeconomic impact and lost disability-adjusted life in young victims, thus justifying a careful surveillance of epidemiological trends. This study aimed to assess changes in the incidence of ischemic stroke in young adults over a long period. METHODS All cases of first-ever ischemic stroke that occurred among adults aged 18-55 years were prospectively recorded using the population-based Dijon Stroke Registry, from 1985 to 2017. Sex-specific annual incidence rates were calculated and were presented according to 6 time periods. Incidence rate ratios (IRRs) were determined to assess sex differences in stroke incidence. RESULTS Over the whole study period, 4,451 patients suffered a first-ever ischemic stroke. Among these patients, 469 (10.5%) were young adults (median age: 46 years, IQR: 39-50; 53.9% men). Incidence rates rose from the study period 2003 to 2007 compared with previous periods and remained stable thereafter, both in men and women. Hence, incidence per 100,000 per year was globally 11.0 (95% CI: 9.4-12.7) before 2003 and 22.9 (20.3-25.6) thereafter. In individuals aged 18-45 years, incidence rates were 5.4 (4.3-6.9) overall, 4.1 (2.7-6.0) in men, and 6.7 (4.9-9.0) in women, before 2003. After 2003, incidence rates rose to 12.8 (10.7-15.1) overall, 12.0 (9.2-15.4) in men, and 13.6 (10.6-17.0) in women. In this age group, the men/women IRR was 0.78 (95% CI: 0.62-1.26, p = 0.08), although sex differences decreased over time (IRR = 0.62; 95% CI: 0.36-1.02, p = 0.046 before 2003, vs. IRR = 0.88; 95% CI: 0.62-1.26, p = 0.48 after 2003). In individuals aged 45-55 years, incidence rates before 2003 were 47 (37-61) in men and 25 (17-35) in women (IRR = 1.90; 95% CI: 1.24-2.97, p < 0.001), and they increased to 82 (67-100) in men and 46 (35-59) in women (IRR = 1.79; 95% CI: 1.29-2.49, p < 0.001) after 2003. CONCLUSIONS The incidence of ischemic stroke in young adults increased during the early 2000s and remained stable thereafter. These results highlight the priority need for dedicated prevention strategies for the young to reduce the burden of stroke.
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Affiliation(s)
- Yannick Béjot
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Gauthier Duloquin
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Quentin Thomas
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Sophie Mohr
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Lucie Garnier
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Mathilde Graber
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
| | - Maurice Giroud
- Dijon Stroke Registry, EA7460, Pathophysiology and Epidemiology of Cerebro-Cardiovascular diseases (PEC2), University Hospital of Dijon, University of Burgundy, Dijon, France
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Gauthier V, Cottel D, Amouyel P, Dallongeville J, Meirhaeghe A. Large disparities in 28-day case fatality by stroke subtype: data from a French stroke registry between 2008 and 2017. Eur J Neurol 2021; 28:2208-2217. [PMID: 33942445 PMCID: PMC8252764 DOI: 10.1111/ene.14876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE The objectives of the present analysis were to assess 28-day stroke case fatality according to the stroke aetiology and to identify associated factors. METHODS All stroke events in adults aged ≥35 years between 2008 and 2017 were collected in a population-based stroke registry in northern France. RESULTS Out of a total of 2933 strokes, there were 479 (16%) haemorrhagic strokes and 2454 (84%) ischaemic strokes; the 28-day case fatality rates were 48% and 15%, respectively. Three-quarters of the 28-day case fatalities occurred within 6 days of the event for haemorrhagic strokes and within 16.5 days for ischaemic strokes. After an ischaemic stroke, the case fatality rate was higher for women (18%) than for men (12%, p < 0.0001); however, this difference disappeared after adjustment for age. Cardioembolic strokes (34%) and strokes of undetermined cause (33%) were the most common ischaemic subtypes, with case fatality rates of 16% and 18%, respectively. Large artery atherosclerosis (11%) and lacunar strokes (10%) were less common, and both types had a case fatality rate of 3%. Age at the time of the event and stroke severity were both significantly associated with case fatality. For some types of stroke, a history of cardiovascular events and residence in a nursing home were associated with a poor prognosis. Medical care in a neurology ward was inversely associated with case fatality, for all stroke subtypes. CONCLUSIONS In northern France, post-stroke case fatality remains high, especially for haemorrhagic stroke. Being treated in a neurology ward improved survival by around 80%.
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Affiliation(s)
- Victoria Gauthier
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Dominique Cottel
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Philippe Amouyel
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Jean Dallongeville
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
| | - Aline Meirhaeghe
- Facteurs de Risque et Déterminants Moléculaires des Maladies Liées au Vieillissement, INSERM, CHU Lille, Institut Pasteur de Lille, Univ. Lille, Lille, France
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Gabet A, Guenancia C, Duloquin G, Olié V, Béjot Y. Ischemic Stroke With Atrial Fibrillation: Characteristics and Time Trends 2006 to 2017 in the Dijon Stroke Registry. Stroke 2021; 52:2077-2085. [PMID: 33874745 DOI: 10.1161/strokeaha.120.030812] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Amélie Gabet
- Cardiovascular and Neurovascular Division, Department of Non-Communicable Diseases, Santé Publique France, Saint-Maurice, France (A.G., V.O.)
| | - Charles Guenancia
- Department of Cardiology (C.G.), University Hospital of Dijon, France
| | - Gauthier Duloquin
- Department of Neurology (G.D., Y.B.), University Hospital of Dijon, France
| | - Valérie Olié
- Cardiovascular and Neurovascular Division, Department of Non-Communicable Diseases, Santé Publique France, Saint-Maurice, France (A.G., V.O.)
| | - Yannick Béjot
- Department of Neurology (G.D., Y.B.), University Hospital of Dijon, France.,Dijon Stroke Registry, EA4184, University Hospital and Medical School of Dijon, University of Burgundy, France (Y.B.)
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Calmettes J, Peres R, Goncalves B, Varlan D, Turc G, Obadia M, Nardin C, Meppiel E, De Broucker T, Mazighi M, Lyoubi A. Clinical Outcome of Acute Ischemic Strokes in Patients with COVID-19. Cerebrovasc Dis 2021; 50:412-419. [PMID: 33784669 PMCID: PMC8089450 DOI: 10.1159/000514562] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/15/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Acute ischemic stroke (AIS) and thrombotic events (TEs) were reported in patients with COVID-19. Clinical outcome of AIS in the course of COVID-19 remains unknown. We compared early clinical outcome and mortality of COVID-positive (+) patients admitted for AIS with COVID-negative (-) ones. We hypothesized that COVID+ patients would have poorer clinical outcomes and present a higher rate of TEs and mortality compared with COVID- ones. METHODS In this multicentric observational retrospective study, we enrolled patients over 18 years old admitted for AIS in 3 stroke units of the Parisian region during lockdown from March 17, 2020, to May 2, 2020. COVID-19 status as well as demographic, clinical, biological, and imaging data was collected retrospectively from medical records. Poor outcome was defined as modified Rankin score (mRS) 3-6 (3-6) at discharge. We also compared TE frequency and mortality rate through a composite criterion in both groups. RESULTS Two hundred and sixteen patients were enrolled; mean age was 68 years old, and 63% were male. Forty patients were CO-VID+ (18.5%) and 176 were COVID-. Obesity was statistically more frequent in the COVID+ group (36 vs. 13% p < 0.01). The percentage of patients with mRS (3-6) at discharge was higher in the COVID+ group compared with the COVID- group (60 vs. 41%, p = 0.034). The main predictor of presenting a mRS (3-6) at discharge was high NIHSS score at admission (OR, CI 95%: 1.325, 1.22-1.43). Mortality rate was higher in the COVID+ group (12 vs. 3.4%, p = 0.033) as well as TE frequency (15 vs. 2.8%, p < 0.01). CONCLUSION In this study, patients with AIS infected by SARS-CoV-2 showed a poorer early outcome than COVID- ones. However, when compared to other factors, COVID-19 was not a significant predictor of poor outcome. Vascular morbidity and mortality rates were significantly higher in the COVID+ group compared with the COVID- group.
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Affiliation(s)
- Julie Calmettes
- Neurology Department, Delafontaine Hospital, Saint Denis, France
| | - Roxane Peres
- Neurology Department, Fondation Adolphe de Rothschild, Paris, France
| | - Bruno Goncalves
- Neurology Department, GHU Paris Psychiatry and Neuroscience, Paris, France
- Paulo Niemeyer State Brain Institute, Intensive Care Unit, Rio de Janeiro, Brazil
| | - David Varlan
- Neurology Department, Delafontaine Hospital, Saint Denis, France
| | - Guillaume Turc
- Neurology Department, GHU Paris Psychiatry and Neuroscience, Paris, France
| | - Michael Obadia
- Neurology Department, Fondation Adolphe de Rothschild, Paris, France
| | - Clotilde Nardin
- Neurology Department, Delafontaine Hospital, Saint Denis, France
| | - Elodie Meppiel
- Neurology Department, Delafontaine Hospital, Saint Denis, France
| | | | - Mikael Mazighi
- Neuroradiology Department, Fondation Adolphe de Rothschild, Paris, France
| | - Aicha Lyoubi
- Neurology Department, Delafontaine Hospital, Saint Denis, France
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Raychev R, Lo WD. The Phial of Galadriel. Neurology 2021; 96:729-730. [PMID: 33970882 DOI: 10.1212/wnl.0000000000011824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Radoslav Raychev
- From the Department of Neurology (R.R.), Ronald Reagan UCLA Medical Center, Los Angeles, CA; and Department of Pediatrics and Neurology (W.D.L.), Nationwide Children's Hospital and The Ohio State University, Columbus
| | - Warren D Lo
- From the Department of Neurology (R.R.), Ronald Reagan UCLA Medical Center, Los Angeles, CA; and Department of Pediatrics and Neurology (W.D.L.), Nationwide Children's Hospital and The Ohio State University, Columbus.
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Joundi RA, Smith EE, Yu AYX, Rashid M, Fang J, Kapral MK. Temporal Trends in Case Fatality, Discharge Destination, and Admission to Long-term Care After Acute Stroke. Neurology 2021; 96:e2037-e2047. [PMID: 33970881 DOI: 10.1212/wnl.0000000000011791] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 01/13/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To determine contemporary trends in case fatality, discharge destination, and admission to long-term care after acute ischemic stroke and intracerebral hemorrhage (ICH) using a large, population-based cohort. METHODS We used linked administrative data to identify all emergency department visits and hospital admissions for first-ever ischemic stroke or ICH in Ontario, Canada, from 2003 to 2017. We calculated crude and age-/sex-standardized risk of death at 30 days and 1 year from stroke onset. We stratified crude trends by stroke type, age, and sex and used the Kendall τ-b correlation coefficient to evaluate the significance of trends. We determined trends in discharge home and to rehabilitation and admission to long-term care at 1 year. We used Cox proportional hazard and logistic regression models to assess whether trends in outcomes persisted after adjustment for baseline factors, estimated stroke severity, and use of life-sustaining care. RESULTS There were 163,574 people with acute ischemic stroke or ICH across the study period. Between 2003 and 2017, age-/sex-standardized 30-day stroke case fatality decreased from 20.5% to 13.2% (7.3% absolute and 36% relative reduction) while that at 1 year decreased from 32.2% to 22.8% (9.3% absolute and 29% relative reduction). Findings were consistent across age, sex, and stroke type, and after adjustment for comorbid conditions, stroke severity, and use of life-sustaining care. There was a reduction in long-term care admission after ischemic stroke and an increase in discharge home or to rehabilitation for both stroke types. CONCLUSION We observed substantial reductions in acute stroke case fatality from 2003 to 2017 with a concurrent increase in discharge to home or rehabilitation and a decrease in long-term care admissions, suggesting continuous improvements in stroke systems of care.
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Affiliation(s)
- Raed A Joundi
- From the Department of Clinical Neurosciences (R.A.J., E.E.S.), Cumming School of Medicine, University of Calgary; ICES (R.A.J., A.Y.X.Y., M.R., J.F., M.K.K.), Toronto; and the Department of Medicine, Divisions of Neurology (A.Y.X.Y.) and General Internal Medicine (M.K.K.), and Institute of Health Policy, Management, and Evaluation (M.K.K.), University of Toronto, Canada
| | - Eric E Smith
- From the Department of Clinical Neurosciences (R.A.J., E.E.S.), Cumming School of Medicine, University of Calgary; ICES (R.A.J., A.Y.X.Y., M.R., J.F., M.K.K.), Toronto; and the Department of Medicine, Divisions of Neurology (A.Y.X.Y.) and General Internal Medicine (M.K.K.), and Institute of Health Policy, Management, and Evaluation (M.K.K.), University of Toronto, Canada
| | - Amy Y X Yu
- From the Department of Clinical Neurosciences (R.A.J., E.E.S.), Cumming School of Medicine, University of Calgary; ICES (R.A.J., A.Y.X.Y., M.R., J.F., M.K.K.), Toronto; and the Department of Medicine, Divisions of Neurology (A.Y.X.Y.) and General Internal Medicine (M.K.K.), and Institute of Health Policy, Management, and Evaluation (M.K.K.), University of Toronto, Canada
| | - Mohammed Rashid
- From the Department of Clinical Neurosciences (R.A.J., E.E.S.), Cumming School of Medicine, University of Calgary; ICES (R.A.J., A.Y.X.Y., M.R., J.F., M.K.K.), Toronto; and the Department of Medicine, Divisions of Neurology (A.Y.X.Y.) and General Internal Medicine (M.K.K.), and Institute of Health Policy, Management, and Evaluation (M.K.K.), University of Toronto, Canada
| | - Jiming Fang
- From the Department of Clinical Neurosciences (R.A.J., E.E.S.), Cumming School of Medicine, University of Calgary; ICES (R.A.J., A.Y.X.Y., M.R., J.F., M.K.K.), Toronto; and the Department of Medicine, Divisions of Neurology (A.Y.X.Y.) and General Internal Medicine (M.K.K.), and Institute of Health Policy, Management, and Evaluation (M.K.K.), University of Toronto, Canada
| | - Moira K Kapral
- From the Department of Clinical Neurosciences (R.A.J., E.E.S.), Cumming School of Medicine, University of Calgary; ICES (R.A.J., A.Y.X.Y., M.R., J.F., M.K.K.), Toronto; and the Department of Medicine, Divisions of Neurology (A.Y.X.Y.) and General Internal Medicine (M.K.K.), and Institute of Health Policy, Management, and Evaluation (M.K.K.), University of Toronto, Canada.
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Champeaux C, Weller J. Long-Term Survival After Decompressive Craniectomy for Malignant Brain Infarction: A 10-Year Nationwide Study. Neurocrit Care 2021; 32:522-531. [PMID: 31290068 DOI: 10.1007/s12028-019-00774-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Decompressive craniectomy (DC) has been shown to be an effective treatment for malignant cerebral infarction (MCI). There are limited nationwide studies evaluating outcome after craniectomy for MCI. OBJECTIVE To describe the evolution in DC practices for MCI, long-term survival, and associated prognostic factors. METHODS We searched the French medico-administrative national database to retrieve patients who underwent DC between 2008 and 2017. RESULTS A total of 1841 cases of DC were performed over 10 years in 51 centers. Mean age at procedure was 50.9 years, 18% were above 60 years, and 64.4% were male. There was a significant increase in DC for MCI over the 10 years (p < 0.001), and the annual volume of procedures more than doubled (95/year vs. 243/year). Early survival at one week and one month was 86%, 95%CI (84.5, 87.6) and 79.7%, 95%CI (77.8, 81.5), respectively. Long-term survival at 1 and 5 years were 73.6%, 95%CI (71.6, 75.7) and 68.9%, 95%CI (66.5, 71.4), respectively. Patients below 60 years at the time of DC (HR = 0.5; 95%CI [0.4, 0.7], p < 0.001), DC being performed in a center with a high surgical activity (HR = 0.8; 95%CI [0.6, 0.9], p = 0.002), and the patients having unimpaired consciousness (HR = 0.6; 95%CI [0.5, 0.8], p < 0.001) were associated with increased survival in both univariate and adjusted Cox regressions. 18.7% of the survivors had a cranioplasty inserted within 3 months and 57.8% within 6 months. The probability of having a cranioplasty at one year was 75.6%, 95%CI (77.9, 73.1). CONCLUSION Over the past 10 years in France, DC has been increasingly performed for MCI regardless of age. However, in-hospital mortality remains considerable, as about one quarter of patients died within the first weeks. For those who survive beyond 6 months, the risk of death significantly decreases. Early mortality is especially high for comatose patients above 60 years operated in inexperienced centers. Most of those who remain in good functional status tend to undergo a cranioplasty within the year following DC.
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Affiliation(s)
- Charles Champeaux
- INSERM U1153, Statistic and Epidemiologic Research Centre Sorbonne Paris Cité (CRESS), ECSTRA Team, Université Diderot - Paris 7, USPC, Paris, France. .,Department of Neurosurgery, Lariboisière Hospital, 75010, Paris, France. .,Department of Neurosurgery, Lariboisière Hospital, 2, rue Ambroise Paré, 75475, Paris Cedex 10, France.
| | - Joconde Weller
- Department of Medical Information, Sainte-Anne Hospital, 75014, Paris, France
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Padilla CM, Foucault A, Grimaud O, Nowak E, Timsit S. Gender difference of geographic distribution of the stroke incidence affected by socioeconomic, clinical and urban-rural factors: an ecological study based on data from the Brest stroke registry in France. BMC Public Health 2021; 21:39. [PMID: 33407274 PMCID: PMC7788878 DOI: 10.1186/s12889-020-10026-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background Mapping the spatial distribution of disease occurrence is a strategy to identify contextual factors that could be useful for public health policies. The purpose of this ecological study was to examine to which extent the socioeconomic deprivation and the urbanization level can explain gender difference of geographic distribution in stroke incidence in Pays de Brest, France between 2008 and 2013. Methods Stroke cases aged 60 years or more were extracted from the Brest stroke registry and combined at the census block level. Contextual socioeconomic, demographic, and geographic variables at the census block level come from the 2013 national census. We used spatial and non-spatial regression models to study the geographic correlation between socioeconomic deprivation, degree or urbanization and stroke incidence. We generated maps using spatial geographically weighted models, after longitude and latitude smoothing and adjustment for covariates. Results Stroke incidence was comparable in women and men (6.26 ± 3.5 vs 6.91 ± 3.3 per 1000 inhabitants-year, respectively). Results showed different patterns of the distribution of stroke risk and its association with deprivation or urbanisation across gender. For women, stroke incidence was spatially homogeneous over the entire study area, but was associated with deprivation level in urban census blocks: age adjusted risk ratio of high versus low deprivation = 1.24, [95%CI 1.04–1.46]. For men, three geographic clusters were identified. One located in the northern rural and deprived census blocks with a 9–14% increase in the risk of stroke. Two others clusters located in the south-eastern (mostly urban part) and south-western (suburban and rural part) with low deprivation level and associated with higher risk of stroke incidence between (3 and 8%) and (8.5 and 19%) respectively. There were no differences in profile of cardiovascular risk factors, stroke type and stroke severity between clusters, or when comparing clusters cases to the rest of the study population. Conclusions Understanding whether and how neighborhood and patient’s characteristics influence stroke risk may be useful for both epidemiological research and healthcare service planning.
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Affiliation(s)
- Cindy M Padilla
- Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, 15, Avenue du Professeur Léon Bernard, 35043, Rennes, France.
| | - Anais Foucault
- Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, 15, Avenue du Professeur Léon Bernard, 35043, Rennes, France
| | - Olivier Grimaud
- Univ Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins) - EA 7449, 15, Avenue du Professeur Léon Bernard, 35043, Rennes, France
| | - Emmanuel Nowak
- Centre d'Investigation Clinique-INSERM CIC 1412, CHRU, Brest, France
| | - Serge Timsit
- Univ Brest, Inserm, EFS, UMR 1078, GGB, Neurology and Stroke unit Department, CHRU de Brest, Université de Bretagne Occidentale, Inserm 1078, Brest, F-29200, France
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Le Franc S, Fleury M, Cogne M, Butet S, Barillot C, Lecuyer A, Bonan I. Influence of virtual reality visual feedback on the illusion of movement induced by tendon vibration of wrist in healthy participants. PLoS One 2020; 15:e0242416. [PMID: 33216756 PMCID: PMC7678999 DOI: 10.1371/journal.pone.0242416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/02/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction Illusion of movement induced by tendon vibration is an effective approach for motor and sensory rehabilitation in case of neurological impairments. The aim of our study was to investigate which modality of visual feedback in Virtual Reality (VR) associated with tendon vibration of the wrist could induce the best illusion of movement. Methods We included 30 healthy participants in the experiment. Tendon vibration inducing illusion of movement (wrist extension, 100Hz) was applied on their wrist during 3 VR visual conditions (10 times each): a moving virtual hand corresponding to the movement that the participants could feel during the tendon vibration (Moving condition), a static virtual hand (Static condition), or no virtual hand at all (Hidden condition). After each trial, the participants had to quantify the intensity of the illusory movement on a Likert scale, the subjective degree of extension of their wrist and afterwards they answered a questionnaire. Results There was a significant difference between the 3 visual feedback conditions concerning the Likert scale ranking and the degree of wrist’s extension (p<0.001). The Moving condition induced a higher intensity of illusion of movement and a higher sensation of wrist’s extension than the Hidden condition (p<0.001 and p<0.001 respectively) than that of the Static condition (p<0.001 and p<0.001 respectively). The Hidden condition also induced a higher intensity of illusion of movement and a higher sensation of wrist’s extension than the Static condition (p<0.01 and p<0.01 respectively). The preferred condition to facilitate movement’s illusion was the Moving condition (63.3%). Conclusions This study demonstrated the importance of carefully selecting a visual feedback to improve the illusion of movement induced by tendon vibration, and the increase of illusion by adding VR visual cues congruent to the illusion of movement. Further work will consist in testing the same hypothesis with stroke patients.
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Affiliation(s)
- Salomé Le Franc
- Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France
- * E-mail:
| | - Mathis Fleury
- Inria, Rennes, France
- Empenn Unity U1228, Inserm, Inria, University of Rennes, Irisa, Umr Cnrs 6074, Rennes, France
| | - Mélanie Cogne
- Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France
| | - Simon Butet
- Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France
| | - Christian Barillot
- Empenn Unity U1228, Inserm, Inria, University of Rennes, Irisa, Umr Cnrs 6074, Rennes, France
| | | | - Isabelle Bonan
- Rehabilitation Medicine Unit, University Hospital of Rennes, Rennes, France
- Empenn Unity U1228, Inserm, Inria, University of Rennes, Irisa, Umr Cnrs 6074, Rennes, France
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de Moraes Bernal H, de Abreu LC, Pinheiro Bezerra IM, Adami F, Takasu JM, Ji Young Suh JV, de Lira Ribeiro S, de Sousa Santos EF. Incidence of hospitalization and mortality due to stroke in young adults, residents of developed regions in Brazil, 2008-2018. PLoS One 2020; 15:e0242248. [PMID: 33196650 PMCID: PMC7668581 DOI: 10.1371/journal.pone.0242248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 10/29/2020] [Indexed: 12/22/2022] Open
Abstract
Introduction We evaluated trends in hospitalization incidence and mortality due to hemorrhagic and ischemic stroke in young adults, according to gender and developed regions in Brazil. Methods Between 2008–2018, we performed a population-based time-series study using official hospitalization and death data due to stroke, in individuals aged 10–49 years, from Southeast and South, Brazil. Data were based on reports from the Unified Health System of Hospital Information System and Mortality Information System. Stroke was defined by the International Classification of Diseases, 10th revision (I60–I63). A Prais-Winsten regression model was performed and the Annual Percentage Change was calculated. Results In total, 78,123 hospitalizations of individuals aged 10–49 years were recorded, of which 59,448 (76%) resulted from hemorrhagic stroke (HS). The hospitalizations for HS was significantly decreased (- 4.37%) among men and women in both regions. The hospitalizations for ischemic stroke (IS) was flat, except between 2011 and 2018, when IS hospitalization rates increased. In the analysis by states, HS hospitalizations declined across all states, except for Espírito Santo, where it remained unchanged (p > 0.05). IS flat hospitalizations were observed in all states, except Espírito Santo, where it increased by 24.93%. In terms of mortality, 28,625 deaths were recorded, of which 26,548 (92.7%) resulted from HS. HS mortality decreased significantly by -3.48%and IS mortality by -3.84%. Decreases also occurred in all Southeast and South states (p < 0.05). IS remained unchanged across all states, except Minas Gerais, where it decreased by -14.95%. Conclusions We identified a decline in the hospitalizations and mortality of HS and a flat trend for IS in developed regions of Brazil. The recent period (2011–2018) demonstrated increasing rates in the hospitalizations of IS in both regions and genders. The mortality rates for HS and IS decreased between 2008–2018 in Southeast and South Brazil for both genders.
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Affiliation(s)
- Henrique de Moraes Bernal
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
- * E-mail:
| | - Luiz Carlos de Abreu
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
- Programa de Mestrado em Políticas Públicas e Desenvolvimento Local, Escola Superior de Ciências da Santa Casa de Misericórdia, Vitória, Brazil
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Italla Maria Pinheiro Bezerra
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
- Programa de Mestrado em Políticas Públicas e Desenvolvimento Local, Escola Superior de Ciências da Santa Casa de Misericórdia, Vitória, Brazil
| | - Fernando Adami
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
| | - Jessica Miwa Takasu
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
| | - João Victor Ji Young Suh
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
| | - Silmara de Lira Ribeiro
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
| | - Edige Felipe de Sousa Santos
- Laboratório de Delineamento em Estudos e Escrita Científica, Centro Universitário de Saúde do ABC, Santo André, São Paulo, Brazil
- Faculdade de Saúde Pública, Universidade de São Paulo (USP), São Paulo, São Paulo, Brazil
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Gabet A, Olié V, Béjot Y. Stroke Patients with Atrial Fibrillation Treated with Oral Anticoagulants: Comparison of the Population-Based Stroke Registry of Dijon and the French National Health Databases. Neuroepidemiology 2020; 54:506-512. [PMID: 33113545 DOI: 10.1159/000511206] [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: 06/08/2020] [Accepted: 08/26/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The objective of this study was to evaluate the complementarity of the French national health database (Système national des données de Santé, SNDS) and the Dijon Stroke Registry for the epidemiology of stroke patients with anticoagulated atrial fibrillation (AF). METHODS The SNDS collects healthcare prescriptions and procedures reimbursed by the French national health insurance for almost all of the 66 million individuals living in France. A previously published algorithm was used to identify AF newly treated with oral anticoagulants. The Dijon Stroke Registry is a population-based study covering the residents of the city of Dijon since 1985 and records all stroke cases of the area. We compared the proportions of stroke patients with anticoagulated AF in the city of Dijon identified in SNDS databases to those registered in the Dijon Stroke Registry. RESULTS For the period 2013-2017 in the city of Dijon, 1,146 strokes were identified in the SNDS and 1,188 in the registry. The proportion of strokes with anticoagulated AF was 13.4% in the SNDS and 20.3% in the Dijon Stroke Registry. Very similar characteristics were found between patients identified through the 2 databases. The overall prevalence of AF in stroke patients could be estimated only in the Dijon stroke registry and was 30.4% for the study period. DISCUSSION/CONCLUSION If administrative health databases can be a useful tool to study the epidemiology of anticoagulated AF in stroke patients, population-based stroke registries as the Dijon Stroke Registry remain essential to fully study the epidemiology of strokes with anticoagulated AF.
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Affiliation(s)
- Amélie Gabet
- Non-Communicable Diseases Department, Santé Publique France, Saint-Maurice, France,
| | - Valérie Olié
- Non-Communicable Diseases Department, Santé Publique France, Saint-Maurice, France
| | - Yannick Béjot
- Neurology Unit, Dijon University Hospital, Dijon Stroke Registry, Dijon, France
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Soto Á, Guillén-Grima F, Morales G, Muñoz S, Aguinaga-Ontoso I. Trends in mortality from stroke in the European Union, 1996-2015. Eur J Neurol 2020; 28:182-191. [PMID: 32897606 DOI: 10.1111/ene.14517] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 08/31/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Stroke is the second largest single cause of death in Europe, responsible for 9% and 13% of all deaths in men and women, respectively. There have been large overall declines in stroke mortality rates in the majority of European countries in recent decades. The aim of this study was to analyse trends in mortality caused by stroke in the 28 member countries of the European Union (EU) over the last two decades. METHODS We extracted data for age-standardized stroke mortality rates per 100 000 in the EU for the period 1996-2015 from the World Health Organization database. Joinpoint regression analysis was used to analyse the trends and compute the annual percent change (APC) in the EU as a whole and by country. Analyses were conducted by gender and by European region. RESULTS Mortality from stroke has decreased in the EU over the study period by an average APC of 4.2%. All countries showed downward trends, with the sharpest decreases in Estonia, Portugal and Austria. We recorded statistically significant decreases of 4.2% and 4.3% in mortality rates in men and women, respectively, in the whole EU. Southern and western countries showed the steepest decreases, whereas mortality has increased in northern countries in recent years. CONCLUSIONS Stroke mortality has decreased in the EU, in both sexes, especially in southern and western European countries. Our results could be a reference for the development of primary prevention and acute management of stroke policies focused on countries with higher mortality.
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Affiliation(s)
- Á Soto
- Departamento de Especialidades Médicas, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile.,Unidad de Neurología, Hospital Dr. Hernán Henríquez Aravena, Temuco, Chile.,Centro de Excelencia en Capacitación, Investigación y Gestión para la Salud Basada en Evidencia (CIGES), Facultad de Medicina, Universidad de La Frontera, Temuco, Chile.,Centro de Investigación en Epidemiología Cardiovascular y Nutricional (EPICYN), Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - F Guillén-Grima
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, España.,Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, España.,Medicina Preventiva, Clínica Universidad de Navarra, Pamplona, España
| | - G Morales
- Centro de Investigación en Epidemiología Cardiovascular y Nutricional (EPICYN), Facultad de Medicina, Universidad de La Frontera, Temuco, Chile.,Departamento de Salud Pública, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - S Muñoz
- Centro de Excelencia en Capacitación, Investigación y Gestión para la Salud Basada en Evidencia (CIGES), Facultad de Medicina, Universidad de La Frontera, Temuco, Chile.,Centro de Investigación en Epidemiología Cardiovascular y Nutricional (EPICYN), Facultad de Medicina, Universidad de La Frontera, Temuco, Chile.,Departamento de Salud Pública, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
| | - I Aguinaga-Ontoso
- Departamento de Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, España.,Instituto de Investigación Sanitaria de Navarra (IDISNA), Pamplona, España
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Stroke revealing pancreatic cancer. JOURNAL DE MÉDECINE VASCULAIRE 2020; 45:347-350. [PMID: 33248538 DOI: 10.1016/j.jdmv.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/06/2020] [Indexed: 11/22/2022]
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Amin R, Kitazawa T, Hatakeyama Y, Matsumoto K, Fujita S, Seto K, Hasegawa T. Trends in hospital standardized mortality ratios for stroke in Japan between 2012 and 2016: a retrospective observational study. Int J Qual Health Care 2020; 31:G119-G125. [PMID: 31665292 DOI: 10.1093/intqhc/mzz091] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/23/2019] [Accepted: 08/30/2019] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Stroke is one of the leading causes of death and disability, and imposes a major healthcare burden. The aim of this study was to determine the characteristics of hospital standardized mortality ratios (HSMRs) for stroke in Japan for the year 2012-16 to describe the trend. DESIGN Retrospective observational study. SETTING Data from the Japanese administrative database. PARTICIPANTS All hospital admissions for stroke were identified from diagnostic procedures combination (DPC) database from 2012 to 2016. MAIN OUTCOME MEASURES HSMR was calculated using the actual number of in-hospital deaths and expected deaths. To obtain the expected death number, a logistic regression model was developed to get the coefficient with a number of explanatory variables. Predictive accuracy of the logistic models was assessed using c-index and calibration was evaluated using the Hosmer-Lemeshow test. RESULTS A total of 63 084 patients admitted for stroke from January 2012 to December 2016 were analyzed. HSMRs showed declining tendency over these 5 years, suggesting stroke-related mortality has been improving. While the HSMRs varied from year to year, a wide variation was also seen among the different hospitals in Japan. The proportion of hospitals with HSMR less than 100 increased from 41.0% in 2012 to 59.0% in 2016. CONCLUSION This study demonstrated that HSMR can be calculated using DPC data and found wide variation in HSMR of stroke among hospitals in Japan and enabled us to image the trend. By examining these trends, facilities, authorities and provinces can initiate designs that will ultimately lead to an upgraded healthcare delivery system.
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Affiliation(s)
- Rebeka Amin
- Department of Social Medicine, Toho University Graduate School of Medicine, 5-21-16, Omori-nishi, Ota-ku 143-8540 Tokyo, Japan
| | - Takefumi Kitazawa
- Faculty of Health Sciences, Tokyo Kasei University, 2-15-1, Inariyama, Sayama-shi 350-1398 Saitama, Japan
| | - Yosuke Hatakeyama
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-nishi, Ota-ku 143-8540 Tokyo, Japan
| | - Kunichika Matsumoto
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-nishi, Ota-ku 143-8540 Tokyo, Japan
| | - Shigeru Fujita
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-nishi, Ota-ku 143-8540 Tokyo, Japan
| | - Kanako Seto
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-nishi, Ota-ku 143-8540 Tokyo, Japan
| | - Tomonori Hasegawa
- Department of Social Medicine, Toho University School of Medicine, 5-21-16, Omori-nishi, Ota-ku 143-8540 Tokyo, Japan
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Rochemont DR, Mimeau E, Misslin-Tritsch C, Papaix-Puech M, Delmas E, Bejot Y, DeToffol B, Fournel I, Nacher M. The epidemiology and management of stroke in French Guiana. BMC Neurol 2020; 20:109. [PMID: 32209060 PMCID: PMC7093981 DOI: 10.1186/s12883-020-01650-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 02/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND French Guiana has the highest incidence of ischemic and hemorrhagic stroke of all French territories. However, there is no further information on the epidemiology and management of stroke in French Guiana. Our goal was to describe the characteristics of patients in French Guiana in order to generate hypotheses regarding the determinants explaining the magnitude of this public health problem. METHODS We used the data of the French multicentre INDIA prospective cohort study which included consecutive patients aged > 18 years with a first-ever stroke from June 2011 to October 2014. For the present study, only patients with ischemic or hemorrhagic stroke admitted in one of the 3 participating hospitals were analyzed. RESULTS Among the 298 patients (mean age 62.2 ± 14.5 years, 63.7% man) included in French Guiana, 52% were born abroad. Most strokes were ischemic strokes (79%), 14% of which were thrombolyzed. Hypertension (70.2%), history of smoking (22%) and diabetes (25%) were the most common risk factors and 28.4% of patients had known but untreated hypertension. Overall 89 (38%) patients with ischemic stroke were admitted less than 4.5 h after the first symptoms. In-hospital mortality was greater for intracerebral hemorrhage (18.7%) than for ischemic stroke (4.2%). Overall, 84.5% had health insurance coverage and among these, 41.9% had CMU, the universal health insurance for the poor. CONCLUSIONS The present study is the first epidemiologic description of stroke in French Guiana. The comparisons of these results show that stroke patients in French Guiana are epidemiologically atypical because they are younger, and more likely to be males than patients in mainland France. Stroke risk factors and delay between stroke and hospital admission were comparable with what is observed in France, suggesting that efforts should focus on primary care and social inequalities of health to alleviate the main determinants of stroke in French Guiana.
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Affiliation(s)
- Dévi Rita Rochemont
- CIC INSERM 1424, Clinical Investigation Center, Cayenne general hospital, Cayenne, French Guiana
| | | | - Caroline Misslin-Tritsch
- Department of Medicine, Centre Hospitalier de l’Ouest Guyanais, Saint Laurent du Maroni, French Guiana
| | | | - Emmanuel Delmas
- CIC INSERM 1432, Clinical Epidemiology Unit, University hospital of Dijon, Dijon, France
- CIC INSERM 1432, Clinical Investigation Center, University hospital of Dijon and Bourgogne university, UFR des sciences de santé, Dijon, France
| | - Yannick Bejot
- Dijon stroke Registry, EA7460, Department of Neurology, University Hospital and Medical School of Dijon, University of Burgundy, Dijon, France
| | - Bertrand DeToffol
- Department of Neurology, Cayenne general hospital, Cayenne, French Guiana
| | - Isabelle Fournel
- CIC INSERM 1432, Clinical Epidemiology Unit, University hospital of Dijon, Dijon, France
- CIC INSERM 1432, Clinical Investigation Center, University hospital of Dijon and Bourgogne university, UFR des sciences de santé, Dijon, France
| | - Mathieu Nacher
- CIC INSERM 1424, Clinical Investigation Center, Cayenne general hospital, Cayenne, French Guiana
- University of French Guiana and CIC INSERM 1424, Clinical Investigation Center, Cayenne general hospital, Cayenne, French Guiana
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Tetzlaff J, Geyer S, Tetzlaff F, Epping J. Income inequalities in stroke incidence and mortality: Trends in stroke-free and stroke-affected life years based on German health insurance data. PLoS One 2020; 15:e0227541. [PMID: 31945102 PMCID: PMC6964859 DOI: 10.1371/journal.pone.0227541] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 12/20/2019] [Indexed: 12/28/2022] Open
Abstract
Background Due to substantial improvements in prevention and therapy, stroke incidence and mortality rates have decreased during the last decades, but evidence is still lacking on whether all socioeconomic groups benefited equally and how the length of life affected by stroke developed over time. Our study investigates time trends in stroke-free life years and life years affected by stroke. Special emphasis is given to the question whether trends differ between income groups, leading to decreasing or increasing social inequalities. Methods The analyses are based on claims data of a German statutory health insurance company of the two time periods 2006–2008 and 2014–2016. Income inequalities and time trends in incidence and mortality risks were estimated using multistate survival models. Trends in stroke-free life years and life years affected by stroke are analysed separately for income groups by applying multistate life table analyses. Results Stroke incidence and mortality risks decreased in men and women in all income groups. While stroke-free lifetime could be gained in men having higher incomes, improvements in mortality counterbalanced decreasing incidences, leading to increases in life years affected by stroke among men of the lower and higher income group. Among women, no significant changes in life years could be observed. Conclusions Changes in stroke-affected life years occur among men in all income groups, but are more pronounced in the higher income group. However, irrespective of the income group the proportion of stroke-affected life years remains quite stable over time, pointing towards constant inequalities. Further research is needed on whether impairments due to stroke reduced over time and whether all socioeconomic groups are affected equally.
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Affiliation(s)
- Juliane Tetzlaff
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
- * E-mail:
| | - Siegfried Geyer
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
| | - Fabian Tetzlaff
- Institute for General Practice, Hannover Medical School, Hanover, Germany
| | - Jelena Epping
- Medical Sociology Unit, Hannover Medical School, Hanover, Germany
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Gabet A, Grimaud O, de Peretti C, Béjot Y, Olié V. Determinants of Case Fatality After Hospitalization for Stroke in France 2010 to 2015. Stroke 2019; 50:305-312. [PMID: 30621528 DOI: 10.1161/strokeaha.118.023495] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose- The aims of this study were to (1) describe early and late case fatality rates after stroke in France, (2) evaluate whether their determinants differed, and (3) analyze time trends between 2010 and 2015. Methods- Data were extracted from the Système National des données de santé database. Patients hospitalized for stroke each year from 2010 to 2015, aged ≥18 years, and affiliated to the general insurance scheme were selected. Cox regressions were used to separately analyze determinants of 30-day and 31- to 365-day case fatality rates for each stroke type (ischemic, intracerebral hemorrhage, and subarachnoid hemorrhage). Results- In 2015, of the 73 124 persons hospitalized for stroke, 26.8% died in the following year, with the majority of deaths occurring within the first 30 days (56.9%). Nonadmission to a stroke unit, older age, and having comorbidities were all associated with a poorer 30-day and 31- to 365-day prognosis. Female sex was associated with a lower 31- to 365-day case fatality rate for all patients with stroke. Living in an area with a high deprivation index was associated with both higher 30-day and 31- to 365-day case fatality rates for all stroke types. Between 2010 and 2015, significant decreases in both 30-day and 31- to 365-day case fatality rates for ischemic patients were observed. Conclusions- Case fatality rates after stroke remained high in 2015 in France, despite major improvements in stroke care and organization. Improvement in stroke awareness and preparedness, particularly in the most deprived areas, together with better follow-up after the acute phase are urgently needed.
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Affiliation(s)
- Amélie Gabet
- From Santé publique France, the French Public Health Agency, Saint-Maurice, France (A.G., V.O.)
| | - Olivier Grimaud
- French School of Public Health (EHESP), Rennes, France (O.G.)
| | - Christine de Peretti
- Directorate for Research, Studies, Assessment and Statistics, Ministry of Social Affairs and Health, Paris, France (C.d.P.)
| | - Yannick Béjot
- Dijon Stroke Registry, EA 7460 Pathophysiology and Epidemiology of Cerebro-Cardiovascular Diseases (PEC2), University Hospital and Medical School of Dijon, University of Burgundy, France (Y.B.)
| | - Valérie Olié
- From Santé publique France, the French Public Health Agency, Saint-Maurice, France (A.G., V.O.)
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Rauch B. Patient and care-giver productivity loss and indirect costs associated with cardiovascular events in Europe: A wake-up call for primary prevention. Eur J Prev Cardiol 2019; 26:1556-1558. [DOI: 10.1177/2047487319856718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Abstract
PURPOSE OF REVIEW This article revises the recent evidence on ICU admission criteria for acute neurological patients [traumatic brain injury (TBI) patients, postoperative neurosurgical procedures and stroke]. RECENT FINDINGS The appropriate utilization of ICU beds is essential, but it is complex and a challenge to attain. To date there are no widely accepted international guidelines for managing these acute brain-injured patients (stroke, TBI, postneurosurgery) in the ICU. The criteria for ICU admission after neurological acute injury, high-dependency unit or a specialized neurosurgical ward vary from institution to institution depending on local structures and characteristics of the available resources. Better evidence to standardize the treatment and the degree of monitoring is needed during neurological acute injury. It is highly recommended to implement clinical vigilance in these patients regardless of their destination (ICU, stroke unit or ward). SUMMARY Currently evidence do not allow to define standardized protocol to guide ICU admission for acute neurological patients (TBI patients, postoperative neurosurgical procedures and stroke).
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Rodríguez-Castro E, Rodríguez-Yáñez M, Arias S, Santamaría M, López-Dequidt I, López-Loureiro I, Rodríguez-Pérez M, Hervella P, Sobrino T, Campos F, Castillo J, Iglesias-Rey R. Influence of Sex on Stroke Prognosis: A Demographic, Clinical, and Molecular Analysis. Front Neurol 2019; 10:388. [PMID: 31057479 PMCID: PMC6478658 DOI: 10.3389/fneur.2019.00388] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 03/29/2019] [Indexed: 12/12/2022] Open
Abstract
Identifying the complexities of the effect of sex on stroke risk, etiology, and lesion progression may lead to advances in the treatment and care of ischemic stroke (IS) and non-traumatic intracerebral hemorrhage patients (ICH). We studied the sex-related discrepancies on the clinical course of patients with IS and ICH, and we also evaluated possible molecular mechanisms involved. The study's main variable was the patient's functional outcome at 3-months. Logistic regression models were used in order to study the influence of sex on different inflammatory, endothelial and atrial dysfunction markers. We recruited 5,021 patients; 4,060 IS (54.8% male, 45.2% female) and 961 ICH (57.1% male, 42.9% female). Women were on average 5.7 years older than men (6.4 years in IS, 5.1 years in ICH), and more likely to have previous poor functional status, to suffer atrial fibrillation and to be on anticoagulants. IS patients showed sex-related differences at 3-months regarding poorer outcome (55.6% women, 43.6% men, p < 0.0001), but this relationship was not found in ICH (56.8% vs. 61.9%, p = 0.127). In IS, women had higher levels of NT-proBNP and 3-months worse outcome in both cardioembolic and non-cardioembolic stroke patients. Stroke patients showed sex-related differences in pre-hospital data, clinical variables and molecular markers, but only IS patients presented independent sex-related differences in 3-months poor outcome and mortality. There was a relationship between the molecular marker of atrial dysfunction NT-proBNP and worse functional outcome in women, resulting in a possible indicator of increased dysfunction.
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Affiliation(s)
- Emilio Rodríguez-Castro
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Manuel Rodríguez-Yáñez
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Susana Arias
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - María Santamaría
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Iria López-Dequidt
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.,Stroke Unit, Department of Neurology, Hospital Clínico Universitario, Santiago de Compostela, Spain
| | - Ignacio López-Loureiro
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Manuel Rodríguez-Pérez
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Pablo Hervella
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Tomás Sobrino
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Francisco Campos
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - José Castillo
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Ramón Iglesias-Rey
- Clinical Neurosciences Research Laboratory, Department of Neurology, Clinical University Hospital, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Cai W, Mueller C, Li YJ, Shen WD, Stewart R. Post stroke depression and risk of stroke recurrence and mortality: A systematic review and meta-analysis. Ageing Res Rev 2019; 50:102-109. [PMID: 30711712 DOI: 10.1016/j.arr.2019.01.013] [Citation(s) in RCA: 179] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 01/14/2019] [Accepted: 01/29/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Post stroke depression is a significant neuropsychiatric manifestation, predicting a range of poor outcomes. There are several studies investigating the association between post stroke depression and stroke recurrence/mortality, but results have been inconsistent. OBJECTIVE A systematic review, meta-analysis and meta regression of observational studies assessing the association between post stroke depression and risk of stroke recurrence and mortality. METHODS A search of Medline (via PubMed), Web of Science databases, EMBASE, Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews was conducted until August 2018. We extracted and pooled hazard ratios from observational studies that reported the risk estimates of stroke recurrence and mortality in stroke survivors with/without depression. RESULTS The reviewed sample comprised 15 prospective cohort studies with 250,294 participants, 139,276 cases, and follow-up periods ranging from 1 to 15 years. The meta-analysis concluded a hazard ratio for post stroke depression and all-cause mortality of 1.59 (95% CI, 1.30-1.96), but research to date has been insufficient to determine the association between post stroke depression and stroke recurrence. CONCLUSION AND RELEVANCE Post stroke depression is associated with a significantly increased risk of mortality in stroke survivors. More researches are required on the association with stroke recurrence.
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Modig K, Talbäck M, Ziegler L, Ahlbom A. Temporal trends in incidence, recurrence and prevalence of stroke in an era of ageing populations, a longitudinal study of the total Swedish population. BMC Geriatr 2019; 19:31. [PMID: 30717697 PMCID: PMC6360781 DOI: 10.1186/s12877-019-1050-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/25/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Stroke incidence has declined during the past decades. Yet, there is a concern that an ageing population together with improved survival after stroke will result in a raised proportion of the population who have experienced a stroke, as well as increasing incidence rate of recurrent strokes, and, absolute numbers of strokes. The objectives of this study were to investigate how the age specific incidence rates of recurrent strokes have developed in relation to the incidence rates of first strokes and how the postponement in age look like, and to see how the prevalence proportion of stroke as well as the absolute number of incident strokes has changed over time. METHODS This study includes the total Swedish population born 1890-1954 living in Sweden from 1987. Stroke was identified through hospital admissions and deaths in national health registers (mandatory for all hospitals in Sweden). Age specific incidence rates were calculated for first, second, all recurrent, and all strokes for each calendar year between 1994 and 2014 for each age between 60 and 104 years. The proportion in the population with a history of stroke up to 7 years back in time was also calculated for different age groups and for different calendar years. RESULTS Not only the incidence rate of first stroke but also of recurrent strokes have declined. The declines are evident in all ages up to 90 years of age, but not in ages above 90 years. Despite improved survival in stroke, the prevalence proportion has declined over the period and was around 3% in 2014 (somewhat higher for men than women). Even incident cases of stroke in absolute number has declined. CONCLUSIONS Decreasing incidence rates of stroke have offset an increase in both absolute and relative numbers of stroke that otherwise would have taken place due to improved survival and an ageing population. The decline in stroke recurrence has been as strong as the decline in first strokes.
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Affiliation(s)
- Karin Modig
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Box 210, SE-171 77 Stockholm, Sweden
| | - Mats Talbäck
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - Louise Ziegler
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Anders Ahlbom
- Institute of Environmental Medicine, Unit of Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Centre for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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Labberton AS, Rønning OM, Thommessen B, Barra M. Changes in survival and characteristics among older stroke unit patients-1994 versus 2012. Brain Behav 2019; 9:e01175. [PMID: 30474214 PMCID: PMC6346673 DOI: 10.1002/brb3.1175] [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] [Received: 10/26/2018] [Accepted: 11/06/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Treatment on organized stroke units (SUs) improves survival after stroke, and stroke mortality has decreased worldwide in recent decades; however, little is known of survival trends among SU patients specifically. This study investigates changes in survival and characteristics of older stroke patients receiving SU treatment. MATERIALS & METHODS We compared 3-year all-cause mortality and baseline characteristics in two cohorts of stroke patients aged ≥60 consecutively admitted to the same comprehensive SU in 1994 (n = 271) and 2012 (n = 546). RESULTS Three-year survival was 53.9% in 1994 and 56.0% in 2012, and adjusted hazard ratio (HR) was 0.99 (95% CI: 0.77-1.28). Adjusted 30-day case fatality was slightly higher in 2012, 18.9% versus 16.2%, HR 1.68 (95% CI: 1.14-2.47). There were no significant between-cohort differences in survival beyond 30 days. Patients in 2012 were older (mean age: 78.8 vs. 76.7 years) and more often admitted from nursing homes. There were higher rates of atrial fibrillation (33.7% vs. 21.4%) and malignancy (19.2% vs. 8.9%), and prescription of antiplatelets (46.9% vs. 26.2%) and warfarin (16.3% vs. 5.5%) at admission. Stroke severity was significantly milder in 2012, proportion with mild stroke 66.1% versus 44.3%. CONCLUSIONS Three-year survival in older Norwegian stroke patients treated on an SU remained stable despite improved treatment in the last decades. Differences in background characteristics may explain this lack of difference; patients in 2012 were older, more often living in supported care, and had higher prestroke comorbidity; however, their strokes were milder and risk factors more often treated.
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Affiliation(s)
- Angela Susan Labberton
- Health Services Research UnitAkershus University HospitalLørenskogNorway
- Institute of Clinical MedicineUniversity of OsloLørenskogNorway
| | - Ole Morten Rønning
- Institute of Clinical MedicineUniversity of OsloLørenskogNorway
- Department of NeurologyAkershus University HospitalLørenskogNorway
| | - Bente Thommessen
- Department of NeurologyAkershus University HospitalLørenskogNorway
| | - Mathias Barra
- Health Services Research UnitAkershus University HospitalLørenskogNorway
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Admission in Neurorehabilitation and Association with Functional Outcomes after Stroke in France: A Nation-Wide Study, 2010-2014. J Stroke Cerebrovasc Dis 2018; 27:3443-3450. [DOI: 10.1016/j.jstrokecerebrovasdis.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 07/25/2018] [Accepted: 08/04/2018] [Indexed: 11/18/2022] Open
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