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Bright L, Baum CM, Roberts P. Person and Environment Factors Supporting Self-Care Performance and Social Participation After Mild Stroke. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2024; 44:455-466. [PMID: 38654705 DOI: 10.1177/15394492241246546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Mild stroke survivors seldom receive occupational therapy services as their deficits are assumed to be minor enough to not affect their daily occupations. Yet many mild stroke survivors report deficits in self-care performance and social participation. This study investigates person and environment factors influencing self-care performance and social participation among mild stroke survivors, using the Person-Environment-Occupation-Performance (PEOP) model. A retrospective cohort analysis of 736 mild stroke survivors was conducted using electronic health records. Person factors included demographic characteristics and clinical characteristics, and environment factors included the Social Vulnerability Index. The analysis included logistic regression. Approximately, 10% of patients reported deficits in self-care or social participation. Disability level was the only person factor associated with self-care performance. Person factors affecting social participation included mobility and unemployment. Socioeconomic status was associated with both occupation measures. Occupational therapy practitioners must address the person and environment factors affecting mild stroke survivors' self-care performance and social participation.
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Affiliation(s)
- Lindsay Bright
- Washington University School of Medicine, St. Louis, MO, USA
| | - Carolyn M Baum
- Washington University School of Medicine, St. Louis, MO, USA
- Washington University in St. Louis, MO, USA
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Nguyen MTH, Sakamoto Y, Maeda T, Woodward M, Anderson CS, Catiwa J, Yazidjoglou A, Carcel C, Yang M, Wang X. Influence of Socioeconomic Status on Functional Outcomes After Stroke: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2024; 13:e033078. [PMID: 38639361 PMCID: PMC11179939 DOI: 10.1161/jaha.123.033078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/06/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND This review aimed to quantify the impact of socioeconomic status on functional outcomes from stroke and identify the socioeconomic status indicators that exhibit the highest magnitude of association. METHODS AND RESULTS We performed a systematic literature search across Medline and Embase from inception to May 2022, to identify observational studies (n≥100, and in English). Risk of bias was assessed using the modified Newcastle Ottawa Scale. Random effects meta-analysis was used to pool data. We included 19 studies (157 715 patients, 47.7% women) reporting functional outcomes measured with modified Rankin Scale or Barthel index, with 10 assessed as low risk of bias. Measures of socioeconomic status reported were education (11 studies), income (8), occupation (4), health insurance status (3), and neighborhood socioeconomic deprivation (3). Pooled data suggested that low socioeconomic status was significantly associated with poor functional outcomes, including incomplete education or below high school level versus high school attainment and above (odds ratio [OR], 1.66 [95% CI, 1.40-1.95]), lowest income versus highest income (OR, 1.36 [95% CI, 1.02-1.83]), a manual job/being unemployed versus a nonmanual job/working (OR, 1.62 [95% CI, 1.29-2.02]), and living in the most disadvantaged socioeconomic neighborhood versus the least disadvantaged (OR, 1.55 [95% CI, 1.25-1.92]). Low health insurance status was also associated with an increased risk of poor functional outcomes (OR, 1.32 [95% CI, 0.95-1.84]), although this was association was not statistically significant. CONCLUSIONS Despite great strides in stroke treatment in the past decades, social disadvantage remains a risk factor for poor functional outcome after an acute stroke. Further research is needed to better understand causal mechanisms and disparities.
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Affiliation(s)
- Mai T. H. Nguyen
- The George Institute for Global Health, The University of New South WalesSydneyNew South WalesAustralia
- Centre of Epidemiology for Policy and Practice, National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Yuki Sakamoto
- The George Institute for Global Health, The University of New South WalesSydneyNew South WalesAustralia
- Department of NeurologyGraduate School of Medicine, Nippon Medical SchoolTokyoJapan
| | - Toshiki Maeda
- The George Institute for Global Health, The University of New South WalesSydneyNew South WalesAustralia
- Department of Preventive Medicine and Public Health, Faculty of MedicineFukuoka UniversityFukuokaJapan
| | - Mark Woodward
- The George Institute for Global Health, The University of New South WalesSydneyNew South WalesAustralia
- The George Institute for Global Health, School of Public Health, Imperial College LondonLondonUnited Kingdom
| | - Craig S. Anderson
- The George Institute for Global Health, The University of New South WalesSydneyNew South WalesAustralia
- Prince of Wales Clinical SchoolUniversity of New South WalesSydneyNew South WalesAustralia
- The George Institute ChinaRegistered Office of The George Institute for Global Health AustraliaBeijingChina
| | - Jayson Catiwa
- The George Institute for Global Health, The University of New South WalesSydneyNew South WalesAustralia
| | - Amelia Yazidjoglou
- Centre of Epidemiology for Policy and Practice, National Centre for Epidemiology and Population HealthAustralian National UniversityCanberraAustralian Capital TerritoryAustralia
| | - Cheryl Carcel
- The George Institute for Global Health, The University of New South WalesSydneyNew South WalesAustralia
| | - Min Yang
- Department of NeurologyFirst Affiliated Hospital of Chengdu Medical CollegeChengduChina
| | - Xia Wang
- The George Institute for Global Health, The University of New South WalesSydneyNew South WalesAustralia
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Martins Dos Santos H, Pereira GS, de Oliveira LC, Da Silva PK, Gonçalves Lima M, Faria CDCDM, Silva SM. Biopsychosocial factors associated with the state of disability after hemiparesis in the chronic phase of stroke: exploratory analysis based on the International Classification of Functioning, Disability and Health. Disabil Rehabil 2024; 46:1366-1373. [PMID: 37029629 DOI: 10.1080/09638288.2023.2196444] [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: 07/12/2022] [Accepted: 03/24/2023] [Indexed: 04/09/2023]
Abstract
OBJECTIVE To identify the main biopsychosocial factors associated with disability level after stroke using the International Classification of Functioning, Disability and Health (ICF) model. METHODS A cross-sectional study was conducted with chronic stroke survivors. Disability was assessed using the World Health Disability Assessment Schedule 2.0. The independent variables were: Body functions: emotional functioning and whether the dominant upper limb was affected. For the Activities & Participation component, satisfaction regarding the execution of activities and participation were assessed using the SATIS-Stroke, as well as the locomotion ability for adults (ABILOCO), manual ability (ABILHAND) and the return to work. For environmental factors, income and facilitators and obstacles were assessed using the Measure of the Quality of the Environment (MQE). Personal factors: age and sex. Multiple Linear Regression was employed. RESULTS Limited locomotor ability (β = -0.281; t = -3.231 p = 0.002), dissatisfaction regarding activities and participation (β = -0.273; t = -3.070 p = 0.003), and the non-return to work (β = 0.162; t = 2.085 p = 0.04) were associated with disability. CONCLUSION The reduction in locomotor ability, dissatisfaction regarding activities and participation and the non-return to work were associated with disability in the chronic phase following a stroke.
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Affiliation(s)
| | - Gabriela Santos Pereira
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Leia Cordeiro de Oliveira
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Paula Karina Da Silva
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Michael Gonçalves Lima
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | | | - Soraia Micaela Silva
- Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
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Lindmark A, Eriksson M, Darehed D. Mediation Analyses of the Mechanisms by Which Socioeconomic Status, Comorbidity, Stroke Severity, and Acute Care Influence Stroke Outcome. Neurology 2023; 101:e2345-e2354. [PMID: 37940549 PMCID: PMC10752643 DOI: 10.1212/wnl.0000000000207939] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/28/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Low socioeconomic status (SES) is associated with increased risk of death and disability after stroke, but interventional targets to minimize disparities remain unclear. We aim to assess the extent to which SES-based disparities in the association between low SES and death and dependency at 3 months after stroke could be eliminated by offsetting differences in comorbidity, stroke severity, and acute care. METHODS This nationwide register-based cohort study included all 72 hospitals caring for patients with acute stroke in Sweden. All patients registered with an acute ischemic stroke in the Swedish Stroke Register in 2015-2016 who were independent in activities of daily living (ADL) during stroke were included. Data on survival and SES the year before stroke were retrieved by cross-linkage with other national registers. SES was defined by education and income and categorized into low, mid, and high. Causal mediation analysis was used to study the absolute risk of death and ADL dependency at 3 months depending on SES and to what extent hypothetical interventions on comorbidities, stroke severity, and acute care would equalize outcomes. RESULTS Of the 25,846 patients in the study, 6,798 (26.3%) were dead or ADL dependent 3 months after stroke. Adjusted for sex and age, low SES was associated with an increased absolute risk of 5.4% (95% CI 3.9%-6.9%; p < 0.001) compared with mid SES and 10.1% (95% CI 8.1%-12.2%; p < 0.001) compared with high SES. Intervening to shift the distribution of all mediators among patients with low SES to those of the more privileged groups would result in absolute reductions of these effects by 2.2% (95% CI 1.2%-3.2%; p < 0.001) and 4.0% (95% CI 2.6%-5.5%; p < 0.001), respectively, with the largest reduction accomplished by equalizing stroke severity. DISCUSSION Low SES patients have substantially increased risks of death and ADL dependency 3 months after stroke compared with more privileged patient groups. This study suggests that if we could intervene to equalize SES-related differences in the distributions of comorbidity, acute care, and stroke severity, up to 40 of every 1,000 patients with low SES could be prevented from dying or becoming ADL dependent.
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Affiliation(s)
- Anita Lindmark
- From the Department of Statistics (A.L., M.E.), Umeå School of Business, Economics and Statistics, and Sunderby Research Unit (D.D.), Department of Public Health and Clinical Medicine, Umeå University, Sweden.
| | - Marie Eriksson
- From the Department of Statistics (A.L., M.E.), Umeå School of Business, Economics and Statistics, and Sunderby Research Unit (D.D.), Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - David Darehed
- From the Department of Statistics (A.L., M.E.), Umeå School of Business, Economics and Statistics, and Sunderby Research Unit (D.D.), Department of Public Health and Clinical Medicine, Umeå University, Sweden
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Buus SMØ, Schmitz ML, Cordsen P, Paaske Johnsen S, Andersen G, Simonsen CZ. Socioeconomic Inequalities in Functional Outcome After Reperfusion-Treated Ischemic Stroke. Stroke 2023; 54:2040-2049. [PMID: 37377030 DOI: 10.1161/strokeaha.123.043547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND We aimed to investigate whether socioeconomic status (SES) was associated with functional outcome in patients with ischemic stroke treated with reperfusion therapy (intravenous thrombolysis and/or thrombectomy). METHODS This nationwide cohort study included reperfusion-treated patients with ischemic stroke ≥18 years registered in the Danish Stroke Registry between 2015 and 2018. Functional outcome was determined by the modified Rankin Scale score 90 days after stroke. SES was defined by educational attainment, family income, and employment status before stroke. SES data were available from Statistics Denmark and linked on the individual level with data from the Danish Stroke Registry. Uni- and multivariable ordinal logistic regression was performed for each socioeconomic parameter individually (education, income, and employment) to estimate the common odds ratios (cORs) for lower 90-day modified Rankin Scale scores. RESULTS A total of 5666 patients were included. Mean age was 68.7 years (95% CI, 68.3-69.0), and 38.4% were female. Low SES was associated with lower odds for achieving lower 90-day modified Rankin Scale score: Low versus high education, cOR, 0.69 (95% CI, 0.61-0.79), low versus high income, cOR, 0.59 (95% CI, 0.53-0.67), and unemployed versus employed, cOR, 0.70 (95% CI, 0.58-0.83). Inequalities were reduced after adjusting for age, sex, and immigrant status, except for unemployed versus employed patients, adjusted cOR, 0.66 (95% CI, 0.54-0.80). No statistically significant differences remained after adjusting for potentially mediating variables (eg, stroke severity, prestroke modified Rankin Scale, and smoking). CONCLUSIONS Socioeconomic inequalities were observed in functional outcome after reperfusion treated ischemic stroke. In particular, prestroke unemployment was negatively associated with good functional outcome. A more adverse prognostic profile among patients with low SES appeared to explain the majority of these inequalities.
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Affiliation(s)
- Sine Mette Øgendahl Buus
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark (S.M.Ø.B., M.L.S., G.A., C.Z.S.)
| | - Marie Louise Schmitz
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark (S.M.Ø.B., M.L.S., G.A., C.Z.S.)
| | - Pia Cordsen
- Danish Center for Health Services Research, Aalborg University, Gistrup, Denmark (P.C., S.P.J.)
| | - Søren Paaske Johnsen
- Danish Center for Health Services Research, Aalborg University, Gistrup, Denmark (P.C., S.P.J.)
| | - Grethe Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark (S.M.Ø.B., M.L.S., G.A., C.Z.S.)
- Department of Clinical Medicine, Aarhus University, Denmark (G.A., C.Z.S.)
| | - Claus Ziegler Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark (S.M.Ø.B., M.L.S., G.A., C.Z.S.)
- Department of Clinical Medicine, Aarhus University, Denmark (G.A., C.Z.S.)
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Stamm B, Royan R, Trifan G, Alvarado-Dyer R, Velez FGS, Taylor W, Pinna P, Reish NJ, Vargas A, Goldenberg FD, Schneck MJ, Biller J, Testai F, Caprio FZ, Chou SH, Gorelick PB, Liotta EM, Batra A. Household income is associated with functional outcomes in a multi-institutional cohort of patients with ischemic stroke and COVID-19. J Stroke Cerebrovasc Dis 2023; 32:107059. [PMID: 36842351 PMCID: PMC9939399 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107059] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 02/15/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVES The COVID-19 pandemic has heightened awareness of health disparities associated with socioeconomic status (SES) across the United States. We examined whether household income is associated with functional outcomes after stroke and COVID-19. MATERIALS AND METHODS This was a multi-institutional, retrospective cohort study of consecutively hospitalized patients with SARS-CoV-2 and radiographically confirmed stroke presenting from March through November 2020 to any of five comprehensive stroke centers in metropolitan Chicago, Illinois, USA. Zip-code-derived household income was dichotomized at the Chicago median. Logistic regression was used to examine the relationship between household income and good functional outcome (modified Rankin Scale 0-3 at discharge, after ischemic stroke). RESULTS Across five hospitals, 159 patients were included. Black patients comprised 48.1%, White patients 38.6%, and Hispanic patients 27.7%. Median household income was $46,938 [IQR: $32,460-63,219]. Ischemic stroke occurred in 115 (72.3%) patients (median NIHSS 7, IQR: 0.5-18.5) and hemorrhagic stroke in 37 (23.7%). When controlling for age, sex, severe COVID-19, and NIHSS, patients with ischemic stroke and household income above the Chicago median were more likely to have a good functional outcome at discharge (OR 7.53, 95% CI 1.61 - 45.73; P=0.016). Race/ethnicity were not included in final adjusted models given collinearity with income. CONCLUSIONS In this multi-institutional study of hospitalized patients with stroke, those residing in higher SES zip codes were more likely to have better functional outcomes, despite controlling for stroke severity and COVID-19 severity. This suggests that area-based SES factors may play a role in outcomes from stroke and COVID-19.
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Affiliation(s)
- Brian Stamm
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Regina Royan
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Gabriela Trifan
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine at Chicago, Chicago, IL
| | | | - Faddi G. Saleh Velez
- Department of Neurology, University of Chicago, Chicago, IL,Department of Neurology, The University of Oklahoma College of Medicine, Oklahoma City, OK
| | - William Taylor
- Ascension Medical Group, Milwaukee, WI,Department of Neurology, Loyola University Medical Center, Chicago, IL
| | - Pranusha Pinna
- Department of Neurology, Rush University Medical Center, Chicago, IL,National Institute of Neurological Disorders and Stroke, National Institute of Health, Bethesda, MD
| | - Nicholas J. Reish
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alejandro Vargas
- Department of Neurology, Rush University Medical Center, Chicago, IL
| | | | - Michael J Schneck
- Department of Neurology, Loyola University Medical Center, Chicago, IL
| | - José Biller
- Department of Neurology, Loyola University Medical Center, Chicago, IL
| | - Fernando Testai
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Fan Z. Caprio
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sherry H. Chou
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip B. Gorelick
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Eric M. Liotta
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ayush Batra
- Ken & Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL,Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Chen K, Pan Y, Xiang X, Meng X, Yao D, Lin L, Li X, Wang Y. The nonalcoholic fatty liver risk in prediction of unfavorable outcome after stroke: A nationwide registry analysis. Comput Biol Med 2023; 157:106692. [PMID: 36924734 DOI: 10.1016/j.compbiomed.2023.106692] [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: 12/25/2022] [Revised: 01/31/2023] [Accepted: 02/14/2023] [Indexed: 03/05/2023]
Abstract
Few researches have looked at the relationship between nonalcoholic fatty liver disease (NAFLD) at the time of admission and the long-term outcomes of patients suffering from acute ischemic stroke (AIS). We aimed to probe the relationship between NAFLD risk evaluated by NAFLD indices and long-term endpoints, along with the prognostic value of merging NAFLD indices with established risk markers for the prognosis of AIS patients. The fatty liver index (FLI) and the Hepatic steatosis index (HSI) were used to evaluate NAFLD risk in the Third China National Stroke Registry (CNSR-III), a large, prospective, national, multicenter cohort registry study. NAFLD was defined as FLI ≥35 for males and FLI ≥ 20 for females, as well as HSI>36. Death or major disability (modified Rankin Scale score ≥3) were the primary outcomes following the beginning of a stroke. On patient outcomes, the prognostic performance of two objective NAFLD parameters was evaluated. NAFLD was detected in 32.10-51.90% of AIS patients. After 1-year, 14.5% of the participants had died or suffered a severe outcome. After controlling for known risk factors, NAFLD was associated with a modest probability of adverse outcome (odds ratio,0.72[95% CI, 0.61-0.86] for FLI; odds ratio,0.68[95% CI, 0.55-0.85] for HSI). The inclusion of the two NAFLD indicators in the conventional prediction model was justified by the integrated discrimination index, continuing to increase the model's overall predictive value for long-term adverse outcomes. NAFLD risk was linked to a lower risk of long-term death or major disability in people with AIS. The predictive value of objective NAFLD after AIS was demonstrated in our study.
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Affiliation(s)
- Keyang Chen
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China; School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Research Units of Clinical Translation of Cell Growth Factors and Diseases Research, Chinese Academy of Medical Science, Wenzhou Medical University, Wenzhou, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xianglong Xiang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Dongxiao Yao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Li Lin
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China; Research Units of Clinical Translation of Cell Growth Factors and Diseases Research, Chinese Academy of Medical Science, Wenzhou Medical University, Wenzhou, China
| | - Xiaokun Li
- School of Pharmaceutical Sciences, Wenzhou Medical University, Wenzhou, China; Research Units of Clinical Translation of Cell Growth Factors and Diseases Research, Chinese Academy of Medical Science, Wenzhou Medical University, Wenzhou, China.
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China; China National Clinical Research Center for Neurological Diseases, Beijing, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, China; Research Unit of Artificial Intelligence in Cerebrovascular Disease, Chinese Academy of Medical Sciences, 2019RU018, China.
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Tian J, Wang Y, Guo L, Li S. Association of Income with Post-Stroke Cognition and the Underlying Neuroanatomical Mechanism. Brain Sci 2023; 13:brainsci13020363. [PMID: 36831905 PMCID: PMC9954609 DOI: 10.3390/brainsci13020363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 02/01/2023] [Accepted: 02/18/2023] [Indexed: 02/22/2023] Open
Abstract
OBJECTIVE To investigate the association between income and post-stroke cognition at 3 months, and the underlying neuroanatomical mechanism. METHODS Patients with first-ever ischemic stroke were enrolled and analyzed. Baseline information on income and neuroimaging measurements with predictive values for post-stroke cognitive impairment (PSCI) were collected within 7 days of the admission. Three months after the index stroke, all participants underwent a detailed neuropsychological test battery. The associations between income and PSCI and between income and brain structural measurements were investigated. RESULTS A total of 294 patients were recruited for this study. Lower income was independently associated with poor cognitive performance on Stroop tests, Clinical Dementia Rating, Boston Naming Test, and Verbal Fluency Test. Regarding neuroimaging parameters, lower income was associated with a lower total brain volume (TBV)/total intracranial volume (TICV) ratio (p = 0.004). CONCLUSIONS Lower income is associated with an increased chance of post-stroke cognitive decline, particularly in executive function and language domains. Since global brain atrophy (measured by TBV/TICV ratio) is a strong predictor for PSCI, its correlation with income may help explain the neuroanatomical mechanism between income and post-stroke cognition.
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Affiliation(s)
- Jingyuan Tian
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Yue Wang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100069, China
- National Clinical Research Center for Neurological Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing 100069, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China
| | - Li Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang 050051, China
- Correspondence: (L.G.); (S.L.); Tel.: +86-18531135618 (L.G.)
| | - Shiping Li
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100069, China
- National Clinical Research Center for Neurological Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing 100069, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100069, China
- Correspondence: (L.G.); (S.L.); Tel.: +86-18531135618 (L.G.)
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Lalo R, Zekja I, Kamberi F. Association of Cardiovascular Disease Risk and Health-Related Behaviors in Stroke Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3693. [PMID: 36834389 PMCID: PMC9963426 DOI: 10.3390/ijerph20043693] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/12/2023] [Accepted: 02/16/2023] [Indexed: 05/29/2023]
Abstract
Brain stroke continues to be a leading cause of mortality and disability in both developed and developing countries, with higher healthcare costs due to the long-term care and rehabilitation that it incurs. The purpose of the current study was to assess the association between brain stroke patients' health-related behaviors and their risk for cardiovascular disease. METHODS A cross-sectional study was carried out from March to August 2022 in the Vlora district regional hospital in Albania. The study included 150 out of 170 participants who met the necessary criteria, achieving an 88% response rate. Measurement tools included the Framingham Cardiovascular Risk Scale (FRS) and the Lifestyle Health Promotion Profile II (HPLP II). RESULTS The patients' average age was 65.9 ± 9.04 years. Over 65% of the stroke patients suffer from diabetes, and 47% from hypertension. About 31% of them have a high risk of hyperlipidemia (mean TC = 179 ± 28.5). About 32% of the brain stroke patients manifested unhealthy behaviors, while 84% of them had a high risk of cardiovascular disease (FRS = 19.5 ± 0.53). Cardiovascular disease (CVD) risk was statistically associated with stress management behaviors (p = 0.008; OR = 0.20; CI = 95%). This risk was highest in the over-70 age group as well as in men. CONCLUSION Brain stroke patients had a high probability of developing CVD. For better health among stroke patients, new evidence-based behavior change approaches must be introduced into preventative and management programs.
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Affiliation(s)
- Rezarta Lalo
- Department of Health Care, Faculty of Health, University of Vlora “Ismail Qemali”, L. Pavarësia, 9400 Vlorë, Albania
| | - Ilirjana Zekja
- Faculty of Technical Medical Sciences, University of Medicine Tirana, 8RRM+W7X, Rruga e Dibrës, 1001 Tirana, Albania
| | - Fatjona Kamberi
- Research Centre for Public Health, Faculty of Health, University of Vlora “Ismail Qemali”, L. Pavarësia, 9400 Vlorë, Albania
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Pawlak A, Tang EYH. Socioeconomic deprivation and post-stroke care in the community. Br J Gen Pract 2023; 73:56-57. [PMID: 36702607 PMCID: PMC9888554 DOI: 10.3399/bjgp23x731781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Affiliation(s)
- Anna Pawlak
- Population Health Sciences Institute, Newcastle University, Newcastle
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11
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Nayak A, Bhave AC, Misri Z, Unnikrishnan B, Mahmood A, Joshua AM, Karthikbabu S. Facilitators and barriers of community reintegration among individuals with stroke: a scoping review. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2023. [DOI: 10.1080/21679169.2022.2156599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Akshatha Nayak
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Aishwarya C. Bhave
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Zulkifli Misri
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Amreen Mahmood
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Abraham M. Joshua
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Suruliraj Karthikbabu
- KMCH College of Physiotherapy, Kovai Medical Center Research and Educational Trust, Coimbatore, The Tamil Nadu Dr. M.G.R. Medical University, Chennai
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12
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Tao C, Yuan Y, Xu Y, Zhang S, Wang Z, Wang S, Liang J, Wang Y. Role of cognitive reserve in ischemic stroke prognosis: A systematic review. Front Neurol 2023; 14:1100469. [PMID: 36908598 PMCID: PMC9992812 DOI: 10.3389/fneur.2023.1100469] [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: 11/20/2022] [Accepted: 01/26/2023] [Indexed: 02/24/2023] Open
Abstract
Objective This systematic review was performed to identify the role of cognitive reserve (CR) proxies in the functional outcome and mortality prognostication of patients after acute ischemic stroke. Methods PubMed, Embase, Web of Science, and Cochrane Library were comprehensively searched by two independent reviewers from their inception to 31 August 2022, with no restrictions on language. The reference lists of reviews or included articles were also searched. Cohort studies with a follow-up period of ≥3 months identifying the association between CR indicators and the post-stroke functional outcome and mortality were included. The outcome records for patients with hemorrhage and ischemic stroke not reported separately were excluded. The Quality In Prognosis Studies (QUIPS) tool was used to assess the quality of included studies. Results Our search yielded 28 studies (n = 1,14,212) between 2004 and 2022, of which 14 were prospective cohort studies and 14 were retrospective cohort studies. The follow-up period ranged from 3 months to 36 years, and the mean or median age varied from 39.6 to 77.2 years. Of the 28 studies, 15 studies used the functional outcome as their primary outcome interest, and 11 of the 28 studies included the end-point interest of mortality after ischemic stroke. In addition, two of the 28 studies focused on the interest of functional outcomes and mortality. Among the included studies, CR proxies were measured by education, income, occupation, premorbid intelligence quotient, bilingualism, and socioeconomic status, respectively. The quality of the review studies was affected by low to high risk of bias. Conclusion Based on the current literature, patients with ischemic stroke with higher CR proxies may have a lower risk of adverse outcomes. Further prospective studies involving a combination of CR proxies and residuals of fMRI measurements are warranted to determine the contribution of CR to the adverse outcome of ischemic stroke. Systematic review registration PROSPERO, identifier CRD42022332810, https://www.crd.york.ac.uk/PROSPERO/.
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Affiliation(s)
- Chunhua Tao
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China.,School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Yuan Yuan
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China.,Division of Satoyama Nursing and Telecare, Nagano College of Nursing, Komagane, Japan
| | - Yijun Xu
- Department of the Advanced Biomedical Research, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo, Japan
| | - Song Zhang
- Department of Biomedical Science and Institute of Bioscience and Biotechnology, Kangwon National University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Zheng Wang
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Sican Wang
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Jingyan Liang
- Department of Anatomy, Medical College, Yangzhou University, Yangzhou, China.,Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Yingge Wang
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
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13
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Hyldgård VB, Søgaard R, Valentin JB, Lange T, Damgaard D, Johnsen SP. Is the socioeconomic inequality in stroke prognosis changing over time and does quality of care play a role? Eur Stroke J 2022; 8:351-360. [PMID: 37021167 PMCID: PMC10069209 DOI: 10.1177/23969873221146591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 12/03/2022] [Indexed: 12/31/2022] Open
Abstract
Introduction: In a publicly financed healthcare system we aimed to study the development in socioeconomic disparity in ischemic stroke outcomes over time. In addition, we study whether the healthcare system affects these outcomes through the quality of early stroke care when adjustments are made for various patient characteristics incl. comorbidity and stroke severity. Patients and methods: Using nationwide, detailed individual-level register-data we analysed how income-related and education-related inequality in 30-day mortality and 30-day readmission risk developed between 2003 and 2018. In addition, focusing on income-related inequality, we applied mediation analyses to estimate the mediating role of quality of acute stroke care on 30-day mortality and 30-day readmission. Results: A total of 97,779 individual ischemic stroke patients were registered in Denmark with a first ever stroke in the study period. Three-point-seven percent died within 30 days of their index-admission and 11.5% were readmitted within 30 days of discharge. The income-related inequality in mortality remained virtually unchanged over time from an RR of 0.53 (95% CI: 0.38; 0.74) in 2003–06 to RR 0.69 (95% CI: 0.53; 0.89)) in 2015–18 when high income was compared to low income (Family income-time interaction: RR 1.00 (95% CI: 0.98–1.03)). A similar but less uniform trend was found for the education-related inequality in mortality (Education-time interaction: RR 1.00 (95% CI: 0.97–1.04)). The income-related disparity in 30-day readmission was smaller than in 30-day mortality and it diminished over time from 0.70 (95% CI: 0.58; 0.83) to 0.97 (95% CI: 0.87; 1.10). The mediation analysis showed no systematic mediating effect of quality of care on neither mortality nor readmission. However, it cannot be ruled out that residual confounding may have washed out some mediating effects. Discussion and Conclusion: The socioeconomic inequality in stroke mortality and re-admission risk has yet to be eliminated. Additional studies from different settings are warranted in order to clarify the impact of socioeconomic inequality of quality of acute stroke care.
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Affiliation(s)
| | - Rikke Søgaard
- Department of Clinical Research, University of Southern Denmark, Denmark
| | - Jan Brink Valentin
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Theis Lange
- Section of Biostatistics, University of Copenhagen, Denmark
| | - Dorte Damgaard
- Department of Neurology, Aarhus University Hospital, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
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14
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Wolf S, Holm SE, Ingwersen T, Bartling C, Bender G, Birke G, Meyer A, Nolte A, Ottes K, Pade O, Peller M, Steinmetz J, Gerloff C, Thomalla G. Pre-stroke socioeconomic status predicts upper limb motor recovery after inpatient neurorehabilitation. Ann Med 2022; 54:1265-1276. [PMID: 35510813 PMCID: PMC9090381 DOI: 10.1080/07853890.2022.2059557] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Lower socioeconomic status (SES) is associated with higher mortality rates and the likelihood of receiving less evidence-based treatment after stroke. In contrast, little is known about the impact of SES on recovery after discharge from inpatient rehabilitation. The aim of this study was to investigate the influence of SES on long-term recovery after stroke. PATIENTS AND METHODS In a prospective, observational, multicentre study, inpatients were recruited towards the end of rehabilitation. The 12-month follow-up focussed on upper limb motor recovery, measured by the Fugl-Meyer score. A clinically relevant improvement of ≥5.25 points was considered recovery. Patient-centric measures such as the Patient-reported Outcomes Measurement Information System-Physical Health (PROMIS-10 PH) provided secondary outcomes. Information on schooling, vocational training, income and occupational status pre-stroke entered a multidimensional SES index. Multivariate logistic regression models calculating odds ratios (ORs) and corresponding confidence intervals (CIs) were applied. SES was added to an initial model including age, sex and baseline neurological deficit. Additional exploratory analyses examined the association between SES and outpatient treatment. RESULTS One hundred and seventy-six patients were enrolled of whom 98 had SES and long-term recovery data. Model comparisons showed the SES-model superior to the initial model (Akaike information criterion (AIC): 123 vs. 120, Pseudo R2: 0.09 vs. 0.13). The likelihood of motor recovery (OR = 17.12, 95%CI = 1.31; 224.18) and PROMIS-10 PH improvement (OR = 20.76, 95%CI = 1.28; 337.11) were significantly increased with higher SES, along with more frequent use of outpatient therapy (p = .02). CONCLUSIONS Higher pre-stroke SES is associated with better long-term recovery after discharge from rehabilitation. Understanding these factors can improve outpatient long-term stroke care and lead to better recovery.KEY MESSAGEHigher pre-stroke socioeconomic status (SES) is associated with better long-term recovery after discharge from rehabilitation both in terms of motor function and self-reported health status.Higher SES is associated with significantly higher utilization of outpatient therapies.Discharge management of rehabilitation clinics should identify and address socioeconomic factors in order to detect individual needs and to improve outpatient recovery. Article registration: clinicaltrials.gov NCT04119479.
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Affiliation(s)
- S Wolf
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S E Holm
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - T Ingwersen
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Bartling
- Clinic for Neurological Rehabilitation, MEDICLIN Klinikum Soltau, Soltau, Germany
| | - G Bender
- Department Neurology, RehaCentrum Hamburg, Hamburg, Germany
| | - G Birke
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Meyer
- Clinic for Neurological Rehabilitation, MEDICLIN Klinikum Soltau, Soltau, Germany
| | - A Nolte
- Department Neurology, VAMED Klinik Geesthacht, Geesthacht, Germany
| | - K Ottes
- Department Neurology, RehaCentrum Hamburg, Hamburg, Germany
| | - O Pade
- Clinic for Neurological Rehabilitation, Klinikum Bad Bramstedt, Bad Bramstedt, Germany
| | - M Peller
- Department Neurology, VAMED Rehaklinik Damp, Damp, Germany
| | - J Steinmetz
- Clinic for Neurological Rehabilitation, Klinikum Bad Bramstedt, Bad Bramstedt, Germany
| | - C Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - G Thomalla
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Yadav RS, Chaudhary D, Avula V, Shahjouei S, Azarpazhooh MR, Abedi V, Li J, Zand R. Social Determinants of Stroke Hospitalization and Mortality in United States' Counties. J Clin Med 2022; 11:jcm11144101. [PMID: 35887865 PMCID: PMC9320068 DOI: 10.3390/jcm11144101] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/29/2022] [Accepted: 06/28/2022] [Indexed: 12/10/2022] Open
Abstract
(1) Background: Stroke incidence and outcomes are influenced by socioeconomic status. There is a paucity of reported population-level studies regarding these determinants. The goal of this ecological analysis was to determine the county-level associations of social determinants of stroke hospitalization and death rates in the United States. (2) Methods: Publicly available data as of 9 April 2021, for the socioeconomic factors and outcomes, was extracted from the Centers for Disease Control and Prevention. The outcomes of interest were “all stroke hospitalization rates per 1000 Medicare beneficiaries” (SHR) and “all stroke death rates per 100,000 population” (SDR). We used a multivariate binomial generalized linear mixed model after converting the outcomes to binary based on their median values. (3) Results: A total of 3226 counties/county-equivalents of the states and territories in the US were analyzed. Heart disease prevalence (odds ratio, OR = 2.03, p < 0.001), blood pressure medication nonadherence (OR = 2.02, p < 0.001), age-adjusted obesity (OR = 1.24, p = 0.006), presence of hospitals with neurological services (OR = 1.9, p < 0.001), and female head of household (OR = 1.32, p = 0.021) were associated with high SHR while cost of care per capita for Medicare patients with heart disease (OR = 0.5, p < 0.01) and presence of hospitals (OR = 0.69, p < 0.025) were associated with low SHR. Median household income (OR = 0.6, p < 0.001) and park access (OR = 0.84, p = 0.016) were associated with low SDR while no college degree (OR = 1.21, p = 0.049) was associated with high SDR. (4) Conclusions: Several socioeconomic factors (e.g., education, income, female head of household) were found to be associated with stroke outcomes. Additional research is needed to investigate intermediate and potentially modifiable factors that can serve as targeted interventions.
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Affiliation(s)
- Randhir Sagar Yadav
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (R.S.Y.); (D.C.); (S.S.)
- Department of Pediatrics, University of Florida College of Medicine, Jacksonville, FL 32207, USA
| | - Durgesh Chaudhary
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (R.S.Y.); (D.C.); (S.S.)
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Venkatesh Avula
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA; (V.A.); (J.L.)
| | - Shima Shahjouei
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (R.S.Y.); (D.C.); (S.S.)
| | - Mahmoud Reza Azarpazhooh
- Departments of Clinical Neurological Sciences and Epidemiology, University of Western Ontario, London, ON N6A 3K7, Canada;
| | - Vida Abedi
- Department of Public Health Sciences, College of Medicine, The Pennsylvania State University, Hershey, PA 17033, USA;
| | - Jiang Li
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA 17822, USA; (V.A.); (J.L.)
| | - Ramin Zand
- Geisinger Neuroscience Institute, Geisinger Health System, Danville, PA 17822, USA; (R.S.Y.); (D.C.); (S.S.)
- Department of Neurology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 17033, USA
- Neuroscience Institute, The Pennsylvania State University, Hershey, PA 17033, USA
- Correspondence:
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16
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Ghoneem A, Osborne MT, Abohashem S, Naddaf N, Patrich T, Dar T, Abdelbaky A, Al-Quthami A, Wasfy JH, Armstrong KA, Ay H, Tawakol A. Association of Socioeconomic Status and Infarct Volume With Functional Outcome in Patients With Ischemic Stroke. JAMA Netw Open 2022; 5:e229178. [PMID: 35476065 PMCID: PMC9047646 DOI: 10.1001/jamanetworkopen.2022.9178] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Long-term disability after stroke is associated with socioeconomic status (SES). However, the reasons for such disparities in outcomes remain unclear. OBJECTIVE To assess whether lower SES is associated with larger admission infarct volume and whether initial infarct volume accounts for the association between SES and long-term disability. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted in a prospective, consecutive population (n = 1256) presenting with acute ischemic stroke who underwent magnetic resonance imaging (MRI) within 24 hours of admission. Patients were recruited in Massachusetts General Hospital, Boston, from May 31, 2009, to December 31, 2011. Data were analyzed from May 1, 2019, until June 30, 2020. MAIN OUTCOMES AND MEASURES Initial stroke severity (within 24 hours of presentation) was determined using clinical (National Institutes of Health Stroke Scale [NIHSS]) and imaging (infarct volume by diffusion-weighted MRI) measures. Stroke etiologic subtypes were determined using the Causative Classification of Ischemic Stroke algorithm. Long-term stroke disability was measured using the modified Rankin Scale. Socioeconomic status was estimated using zip code-derived median household income and census block group-derived area deprivation index (ADI). Regression and mediation analyses were performed. RESULTS A total of 1098 patients had imaging and SES data available (mean [SD] age, 68.1 [15.7] years; 607 men [55.3%]). Income was inversely associated with initial infarct volume (standardized β, -0.074 [95% CI, -0.127 to -0.020]; P = .007), initial NIHSS (standardized β, -0.113 [95% CI, -0.171 to -0.054]; P < .001), and long-term disability (standardized β, -0.092 [95% CI, -0.149 to -0.035]; P = .001), which remained significant after multivariable adjustments. Initial stroke severity accounted for 64% of the association between SES and long-term disability (standardized β, -0.063 [95% CI, -0.095 to -0.029]; P < .05). Findings were similar when SES was alternatively assessed using ADI. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that lower SES is associated with larger infarct volumes on presentation. These SES-associated differences in initial stroke severity accounted for most of the subsequent disparities in long-term disability in this study. These findings shift the culpability for SES-associated disparities in poststroke disability from poststroke factors to those that precede presentation.
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Affiliation(s)
- Ahmed Ghoneem
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Michael T. Osborne
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Shady Abohashem
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Nicki Naddaf
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Tomas Patrich
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Tawseef Dar
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Amr Abdelbaky
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Adeeb Al-Quthami
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Jason H. Wasfy
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Katrina A. Armstrong
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Hakan Ay
- Anithoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston
- Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
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17
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Dharma KK, -Rahayu H. [The effective post-stroke adaptation behavior model requires a family support system]. ENFERMERIA CLINICA (ENGLISH EDITION) 2022; 32:123-130. [PMID: 35577409 DOI: 10.1016/j.enfcle.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/20/2020] [Indexed: 06/15/2023]
Abstract
PURPOSE This study aimed to explain the effective post-stroke adaptation behavior based on the Roy's adaptation model (RAM) through the patient experiences when undergoing the adaptation process after stroke. METHODS This study was qualitative used a phenomenological approach. The participants were patients undergoing post-stroke recovery at home with the following inclusion criteria: post-discharge from the hospital 2-3 months, and in stable medical condition. The data were collected through in-depth interviews. The data analysis was performed through content analysis. We used Lincoln and Guba's criteria to establish the trustworthiness of the study. RESULTS Three thematic categories structured the meaning of the stroke survivor's experience: (1) Problems after stroke; (2) Adaptive coping strategies and (3) Effective adaptation response. CONCLUSION A thematic analysis integrated with Roy's adaptation model generated an effective post-stroke adaptation model. We recommend the development of a family empowerment intervention framework to improve the adaptation behavior of stroke survivors.
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Affiliation(s)
- Kelana-Kusuma Dharma
- School of Nursing, Politeknik Kesehatan Kementerian Kesehatan Pontianak, Indonesia.
| | - Halina -Rahayu
- School of Nursing, Politeknik Kesehatan Kementerian Kesehatan Pontianak, Indonesia
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18
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Rakhimova I, Semenova Y, Khaibullin T, Kuanysheva A, Kovalchuk V, Abdrakhmanov A. Cryptogenic Stroke and Embolic Stroke of Undetermined Source: Risk Factors and Approaches for Detection of Atrial Fibrillation. Curr Cardiol Rev 2022; 18:e211221199213. [PMID: 34939547 PMCID: PMC9893140 DOI: 10.2174/1573403x18666211221145714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/17/2021] [Accepted: 11/03/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Stroke is a problem worldwide because of its high mortality and disability rates. Almost 90% of strokes are ischemic, and more than half of the deaths are caused by an ischemic stroke. Most risk factors for stroke are manageable so that it can be avoided with proper prevention. Despite the success in determining the causes of stroke in recent years, selectively, the "culprit" causing stroke remains unsolved. In such cases, a diagnosis of undetermined etiology (cryptogenic stroke) or embolic stroke of undetermined source (ESUS) is generated, resulting the prevention of a recurrent cerebrovascular occurrence impossible. Atrial fibrillation (AF) can be a cause of stroke by causing blood clots in the chambers of the heart. PURPOSE The aim was to determine the optimal method of heart rate monitoring in patients with ischemic stroke, as methods and approaches for detecting AF are very diverse, but there is still no single opinion, which would be universal. PROCEDURES In our review, we consider epidemiology, risk factors for the stroke of undetermined etiology, as well as analytical methods for detecting heart rhythm disturbances in this category of patients. FINDINGS Atrial fibrillation (AF) is detected by thorough monitoring of heart rate of patients with cryptogenic stroke and ESUS can be diagnosed in up to 46% of patients. . CONCLUSION After AF detection, consideration should be given to prescribing anticoagulants, instead of antiplatelet agents, for the secondary prevention of stroke.
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Affiliation(s)
- Idaliya Rakhimova
- Department of Cardiology and Interventional Arrhythmology, Semey State Medical University, Semey, Kazakhstan
| | - Yuliya Semenova
- Department of Cardiology and Interventional Arrhythmology, Semey State Medical University, Semey, Kazakhstan
| | - Talgat Khaibullin
- Department of Cardiology and Interventional Arrhythmology, Semey State Medical University, Semey, Kazakhstan
| | - Anargul Kuanysheva
- Department of Cardiology and Interventional Arrhythmology, Semey State Medical University, Semey, Kazakhstan
| | - Vitalii Kovalchuk
- Department of Semashko City Hospital, Saint Petersburg, Russian Federation
| | - Ayan Abdrakhmanov
- National Research Cardiac Surgery Center, Nur-Sultan 010000, Kazakhstan
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19
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Yu AYX, Smith EE, Krahn M, Austin PC, Rashid M, Fang J, Porter J, Vyas MV, Bronskill SE, Swartz RH, Kapral MK. Association of Neighborhood-Level Material Deprivation With Health Care Costs and Outcome After Stroke. Neurology 2021; 97:e1503-e1511. [PMID: 34408072 PMCID: PMC8575135 DOI: 10.1212/wnl.0000000000012676] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 07/26/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To determine the association between material deprivation and direct health care costs and clinical outcomes following stroke in the context of a publicly funded universal health care system. METHODS In this population-based cohort study of patients with ischemic and hemorrhagic stroke admitted to the hospital between 2008 and 2017 in Ontario, Canada, we used linked administrative data to identify the cohort, predictor variables, and outcomes. The exposure was a 5-level neighborhood material deprivation index. The primary outcome was direct health care costs incurred by the public payer in the first year. Secondary outcomes were death and admission to long-term care. RESULTS Among 90,289 patients with stroke, the mean (SD) per-person costs increased with increasing material deprivation, from $50,602 ($55,582) in the least deprived quintile to $56,292 ($59,721) in the most deprived quintile (unadjusted relative cost ratio and 95% confidence interval 1.11 [1.08, 1.13] and adjusted relative cost ratio 1.07 [1.05, 1.10] for least compared to most deprived quintile). People in the most deprived quintile had higher mortality within 1 year compared to the least deprived quintile (adjusted hazard ratio [HR] 1.07 [1.03, 1.12]) as well as within 3 years (adjusted HR 1.09 [1.05, 1.13]). Admission to long-term care increased incrementally with material deprivation and those in the most deprived quintile had an adjusted HR of 1.33 (1.24, 1.43) compared to those in the least deprived quintile. DISCUSSION Material deprivation is a risk factor for increased costs and poor outcomes after stroke. Interventions targeting health inequities due to social determinants of health are needed. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that the neighborhood-level material deprivation predicts direct health care costs.
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Affiliation(s)
- Amy Y X Yu
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada.
| | - Eric E Smith
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Murray Krahn
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Peter C Austin
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Mohammed Rashid
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Jiming Fang
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Joan Porter
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Manav V Vyas
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Susan E Bronskill
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Richard H Swartz
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
| | - Moira K Kapral
- From the Department of Medicine (Neurology), Sunnybrook Health Sciences Centre (A.Y.X.Y., M.V.V., R.H.S.), and Institute of Health Policy, Management, and Evaluation (A.Y.X.Y., M.K., P.C.A., M.V.V., S.E.B., M.K.K.), University of Toronto; ICES (A.Y.X.Y., M.K., P.C.A., M.R., J.F., J.P., M.V.V., S.E.B., R.H.S., M.K.K.), Toronto; Department of Clinical Neurosciences, Community Health Sciences, and Hotchkiss Brain Institute (E.E.S.), University of Calgary; Department of Medicine (General Internal Medicine) (M.K., M.K.K.), University of Toronto-University Health Network; and Toronto Health Economics and Technology Assessment (M.K.), Canada
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20
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Ehrlich ME, Han B, Lutz M, Ghorveh MG, Okeefe YA, Shah S, Kolls BJ, Graffagnino C. Socioeconomic Influence on Emergency Medical Services Utilization for Acute Stroke: Think Nationally, Act Locally. Neurohospitalist 2021; 11:317-325. [PMID: 34567392 DOI: 10.1177/19418744211010049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background and Purpose Rates of emergency medical services (EMS) utilization for acute stroke remain low nationwide, despite the time-sensitive nature of the disease. Prior research suggests several demographic and social factors are associated with EMS use. We sought to evaluate which demographic or socioeconomic factors are associated with EMS utilization in our region, thereby informing future education efforts. Methods We performed a retrospective analysis of patients for whom the stroke code system was activated at 2 hospitals in our region. Univariate and logistic regression analysis was performed to identify factors associated with use of EMS versus private vehicle. Results EMS use was lower in patients who were younger, had higher income, were married, more educated and in those who identified as Hispanic. Those arriving by EMS had significantly faster arrival to code, arrival to imaging, and arrival to thrombolytic treatment times. Conclusion Analysis of regional data can identify specific populations underutilizing EMS services for acute stroke symptoms. Factors effecting EMS utilization varies by region and this information may be useful for targeted education programs promoting EMS use for acute stroke symptoms. EMS use results in more rapid evaluation and treatment of stroke patients.
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Affiliation(s)
- Matthew E Ehrlich
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Bin Han
- Department of Statistical Science, Duke University, Durham, NC, USA
| | - Michael Lutz
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | | | - Yasmin Ali Okeefe
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Shreyansh Shah
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
| | - Brad J Kolls
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA.,Duke Clinical Research Institute, Durham, NC, USA
| | - Carmelo Graffagnino
- Department of Neurology, Duke University School of Medicine, Durham, NC, USA
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21
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Zang Y, Zhu Z, Shi M, Wang A, Xie X, Xu T, Peng Y, Yang P, Li Q, Ju Z, Geng D, Chen J, Liu L, Zhang Y, He J. Association between annual household income and adverse outcomes in patients who had ischaemic stroke. J Epidemiol Community Health 2021; 76:293-300. [PMID: 34493532 DOI: 10.1136/jech-2021-216481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 08/08/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE The association between annual household income and prognosis of ischaemic stroke remains debatable. We aimed to prospectively investigate the relationship between annual household income and prognosis at 3 months after ischaemic stroke. METHODS We included 3975 participants from the China Antihypertensive Trial in Acute Ischemic Stroke. All participants were categorised into three groups according to annual household income per capita: <¥10 000 (Chinese Yuan Renminbi (RMB)), ¥10 000-19 999 and ≥¥20 000. The primary outcome was a composite outcome of death and major disability (modified Rankin Scale score ≥3) at 3 months after stroke onset, and secondary outcomes included major disability, death, and vascular events. A meta-analysis was conducted to incorporate the results of the current study and previous studies on the association of income level with outcomes after stroke. RESULTS Within 3 months after ischaemic stroke, 1002 participants (25.20%) experienced primary outcome (880 major disabilities and 122 deaths). After multivariate adjustment, low annual household income level was associated with increased risk of the primary outcome (OR 1.60; 95% CI: 1.12 to 2.31; Ptrend=0.034) when two extreme groups were compared. The meta-analysis confirmed the significant association between income level and death or major disability after stroke (pooled relative risk for lowest vs highest income level, 1.31 (95% CI: 1.18 to 1.45)). CONCLUSIONS Low annual household income per capita was significantly associated with increased risks of adverse clinical outcomes at 3 months after ischaemic stroke, independently of established risk factors. Further studies from other samples are needed to replicate our findings due to a reason for excluding some patients who had a severe stroke in this study. TRIAL REGISTRATION NUMBER ClinicalTrials.gov (http://wwwclinicaltrialsgov) Registry (NCT01840072).
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Affiliation(s)
- Yuhan Zang
- Department of Epidemiology, Soochow University Medical College, Suzhou, Jiangsu, China
| | - Zhengbao Zhu
- Department of Epidemiology, Soochow University Medical College, Suzhou, Jiangsu, China
| | - Mengyao Shi
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Aili Wang
- Department of Epidemiology, Soochow University Medical College, Suzhou, Jiangsu, China
| | - Xuewei Xie
- Department of Neurology, Capital Medical University, Beijing, China
| | - Tan Xu
- Department of Epidemiology, Soochow University Medical College, Suzhou, Jiangsu, China
| | - Yanbo Peng
- Department of Neurology, Affiliated Hospital of North China University of Science and Technology, Tangshan, Hebei, China
| | - Pinni Yang
- Department of Epidemiology, Soochow University Medical College, Suzhou, Jiangsu, China
| | - Qunwei Li
- Department of Epidemiology, Shandong First Medical University, Jinan, China
| | - Zhong Ju
- Department of Neurology, Kerqin District First People's Hospital of Tongliao City, Inner Mongolia, China
| | - Deqin Geng
- Department of Neurology, Xuzhou Medical College Affiliated Hospital, Xuzhou, Jiangsu, China
| | - Jing Chen
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Liping Liu
- Department of Neurology, Capital Medical University, Beijing, China
| | - Yonghong Zhang
- Department of Epidemiology, Soochow University Medical College, Suzhou, Jiangsu, China
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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22
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Sanuade OA, Dodoo FNA, Koram K, de-Graft Aikins A. Explanatory models of stroke in Ghana: perspectives of stroke survivors and their caregivers. ETHNICITY & HEALTH 2021; 26:697-719. [PMID: 30922062 DOI: 10.1080/13557858.2018.1557116] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 12/01/2018] [Indexed: 06/09/2023]
Abstract
Objective: This study examines explanatory models (EMs) of stroke and its complications among people living with stroke, and their caregivers, in two urban poor communities in Accra (Ga Mashie) and Korle Bu Teaching Hospital (KBTH), Accra.Methods: Twenty-two stroke survivors and 29 caregivers were recruited from 2 urban poor communities in Accra and KBTH. Qualitative data were obtained using semi-structured interviews that lasted between 45 minutes and 2 hours. The interviews were audiotaped, transcribed and analysed thematically, informed by the concept of EMs of illness.Results: Participants referred to stroke as a sudden event and they expressed different emotional responses after the stroke onset. Stroke survivors and their caregivers attributed stroke with poor lifestyle practices, high blood pressure, unhealthy diet and dietary practices, supernatural causes, stress, family history, other chronic diseases, and delay in treatment of symptoms. While the stroke survivors associated stroke complications with physical disability and stigmatisation, the caregivers associated these with physical disability, behavioural and psychological changes, cognitive disability and death. These associations were mostly influenced by the biomedical model of stroke.Conclusion: The biomedical model of stroke is important for developing interventions that will be accepted by the stroke survivors and the caregivers. Nevertheless, sociocultural explanations of stroke need to be taken into consideration during delivery of medical information to the participants. This study proposes an integrated biopsychosociocultural approach for stroke intervention among the study participants.
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Affiliation(s)
| | | | - Kwadwo Koram
- The Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Ama de-Graft Aikins
- Regional Institute for Population Studies, University of Ghana, Accra, Ghana
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23
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Dharma KK, Halina-Rahayu. The effective post-stroke adaptation behavior model requires a family support system. ENFERMERIA CLINICA 2021; 32:S1130-8621(20)30550-7. [PMID: 33455844 DOI: 10.1016/j.enfcli.2020.11.001] [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] [Received: 05/27/2020] [Revised: 10/30/2020] [Accepted: 11/20/2020] [Indexed: 01/01/2023]
Abstract
PURPOSE This study aimed to explain the effective post-stroke adaptation behavior based on the Roy's adaptation model (RAM) through the patient experiences when undergoing the adaptation process after stroke. METHODS This study was qualitative used a phenomenological approach. The participants were patients undergoing post-stroke recovery at home with the following inclusion criteria: post-discharge from the hospital 2-3 months, and in stable medical condition. The data were collected through in-depth interviews. The data analysis was performed through content analysis. We used Lincoln and Guba's criteria to establish the trustworthiness of the study. RESULTS Three thematic categories structured the meaning of the stroke survivor's experience: (1) Problems after stroke; (2) Adaptive coping strategies and (3) Effective adaptation response. CONCLUSION A thematic analysis integrated with Roy's adaptation model generated an effective post-stroke adaptation model. We recommend the development of a family empowerment intervention framework to improve the adaptation behavior of stroke survivors.
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Affiliation(s)
- Kelana-Kusuma Dharma
- School of Nursing, Politeknik Kesehatan Kementerian Kesehatan Pontianak, Indonesia.
| | - Halina-Rahayu
- School of Nursing, Politeknik Kesehatan Kementerian Kesehatan Pontianak, Indonesia
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24
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Matos I, Fernandes A, Maso I, Oliveira-Filho J, de Jesus PA, Fraga-Maia H, Pinto EB. Investigating predictors of community integration in individuals after stroke in a residential setting: A longitutinal study. PLoS One 2020; 15:e0233015. [PMID: 32421731 PMCID: PMC7233578 DOI: 10.1371/journal.pone.0233015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/26/2020] [Indexed: 12/15/2022] Open
Abstract
Aim To identify potential predictors of community integration in individuals after stroke using a residential setting-based strategy. Method A prospective cohort of post-stroke individuals was recruited from the Stroke Unit of the Roberto Santos General Hospital (UAVC-HGRS). All included individuals were aged over 18 years, received a diagnosis of ischemic stroke confirmed by neuroimaging and resided in the city of Salvador (Bahia, Brazil). Following discharge from the stroke unit, the individuals themselves, or their responsible parties, were contacted by telephone to schedule a home visit no less than three months after discharge. All subjects were examined in their homes, at which time the Community Integration Questionnaire (CIQ) was also applied. A robust linear regression model was used to assess community reintegration using CIQ score as the outcome variable. Results A total of 124 individuals effectively fulfilled the eligibility criteria: 51.6% were females, the median (IQR) age was 63(53–69) years, 82.3% were non-white, 53.2% were married, the median (IQR) of years of schooling was 6 (4–12) and family income averaged two minimum monthly wages. Investigated individuals presented a median (IQR) NIH Stroke Scale (NIHSS) score of 7 (4–12). Multivariate linear regression identified the following independent predictors of community integration: age (β = -0.095; 95% CI = -0.165 to -0.025; p = 0.008), diabetes mellitus (β = -2.348; 95% CI = -4.125 to -0.571; p = 0.010), smoking habit (β = -2.951; 95% CI = -5.081 to -0.821; p = 0.007), functional capacity upon hospital discharge (β = 0.168; 95% CI = 0.093 to 0.242; p = <0.001) and stroke severity (β = -0.163; CI = -0.318 to -0.009); p = 0.038). Conclusions Regardless of length of time since stroke, individuals present restrictions that compromise their reintegration into their respective communities. The demographic, clinical and functional factors identified herein as potential predictors should be considered when conducting regular follow-up, as well as in the rehabilitation of individuals after stroke with the purpose to identify the interventions necessary to optimize their reintegration into the community.
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Affiliation(s)
- Isabela Matos
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Adriana Fernandes
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Iara Maso
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
- Roberto Santos General Hospital, Salvador, Brazil
| | | | - Pedro Antônio de Jesus
- Roberto Santos General Hospital, Salvador, Brazil
- Federal University of Bahia, Bahia, Brazil
| | | | - Elen Beatriz Pinto
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
- * E-mail:
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25
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Lowry CA, Jin AY. Improving the Social Relevance of Experimental Stroke Models: Social Isolation, Social Defeat Stress and Stroke Outcome in Animals and Humans. Front Neurol 2020; 11:427. [PMID: 32477259 PMCID: PMC7240068 DOI: 10.3389/fneur.2020.00427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023] Open
Abstract
The outcome of ischemic stroke varies across socioeconomic strata, even among countries with universal health care. Emerging evidence suggests that psychosocial aspects of low socioeconomic status such as social isolation and social defeat stress interact with, and contribute to, stroke pathophysiology. However, experimental investigations of stroke rarely account for such socioeconomic influences. Social isolation in stroke survivors is associated with increased infarction volume, increased risk of post-stroke depression, and worse long-term functional outcome. Social defeat is thought to contribute significantly to chronic stress in low socioeconomic status groups and is associated with poor health outcomes. Chronic stress is also associated with worse post-stroke functional outcome and greater disability even after accounting for stroke severity, vascular risk factors, and access to acute stroke care. Experimental stroke studies which incorporate social isolation or social defeat stress have shown that both tissue and functional stroke outcome is affected by the increased expression of TNF-α and IL-6, increased glucocorticoid production, and suppression of the protooncogene bcl-2. This review explores the consequences of social isolation and social defeat stress on stroke, preclinical stroke models that have been used to investigate these factors, and possible molecular mechanisms underlying the influence of socioeconomic disparities on stroke outcome.
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Affiliation(s)
- Chloe A Lowry
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Albert Y Jin
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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26
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Rosenich E, Hordacre B, Paquet C, Koblar SA, Hillier SL. Cognitive Reserve as an Emerging Concept in Stroke Recovery. Neurorehabil Neural Repair 2020; 34:187-199. [PMID: 32089097 DOI: 10.1177/1545968320907071] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Stroke is a leading cause of death and disability. It is a complex and largely heterogeneous condition. Prognosis for variations in impairment and recovery following stroke continues to be challenging and inaccurate, highlighting the need to examine the influence of other currently unknown variables to better predict and understand interindividual differences in stroke impairment and recovery. The concept of "cognitive reserve," a feature of brain function said to moderate the relationship between brain pathology and clinical outcomes, might provide a partial explanation. This review discusses the potential significance of cognitive reserve in the context of stroke, with reference to reduced burden of disability poststroke, health promotion, intervention and secondary prevention of cognitive impairment, ease and challenges of translation into clinical practice, prognosis and prediction of recovery, and clinical decisions and trial stratification. Discussions from the review aim to encourage stroke clinicians and researchers to better consider the role of premorbid, lifestyle-related variables, such as cognitive reserve, in facilitating successful neurological outcomes and recovery following stroke.
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Affiliation(s)
- Emily Rosenich
- University of South Australia, Adelaide, South Australia, Australia
| | - Brenton Hordacre
- University of South Australia, Adelaide, South Australia, Australia
| | - Catherine Paquet
- University of South Australia, Adelaide, South Australia, Australia
| | - Simon A Koblar
- University of Adelaide, Adelaide, South Australia, Australia
| | - Susan L Hillier
- University of South Australia, Adelaide, South Australia, Australia
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27
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Hyldgård VB, Johnsen SP, Støvring H, Søgaard R. Socioeconomic Status And Acute Stroke Care: Has The Inequality Gap Been Closed? Clin Epidemiol 2019; 11:933-941. [PMID: 31749635 PMCID: PMC6817766 DOI: 10.2147/clep.s218322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/27/2019] [Indexed: 11/23/2022] Open
Abstract
Purpose Socioeconomic inequality in stroke care occurs even in countries with free access to health care. We aimed to investigate the association between socioeconomic status and guideline-recommended acute care in Denmark during the last decade. Design We conducted a nationwide, population-based study. We used household income, employment status, and education as markers of socioeconomic status and adjusted the results for relevant clinical covariates. We used weighted linear regression models to analyse empirical log odds of performance measure fulfillment at patient level. Setting Public hospitals in Denmark. Participants A total of 110,848 consecutive stroke patients discharged between 2004 and 2014. Intervention(s) Acute stroke care according to clinical guidelines. Main outcome measure(s) Guideline-recommended care was defined in two ways based on clinical performance measures: the percentage of fulfilled measures used throughout the study period (m=8) (model 1) and the percentage of fulfilled measures used at the time of discharge (m=8 to 16) (model 2). Results Compared with high family income, low income was negatively associated with the guideline-recommended care; odds ratios (95% CI) were 0.89 (0.85–0.93) in model 1 and 0.81 (0.77–0.85) in model 2. Low family income was negatively associated with fulfillment of 14 of the 16 performance measures. In general, the percentage of performance measures fulfilled increased over time from 70% (95% CI 63–76) to 85% (95% CI 83–87). Conclusion Socioeconomic inequality in guideline-recommended stroke care remains despite overall improvements in a setting with free access to care and systematic monitoring of health care quality.
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Affiliation(s)
- Vibe Bolvig Hyldgård
- Department of Public Health, Aarhus University, Aarhus C 8000, Denmark.,Health Economics, DEFACTUM, Central Region Denmark, Aarhus N 8200, Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University Hospital, Aalborg 9000, Denmark
| | - Henrik Støvring
- Department of Public Health - Biostatistics, Aarhus University, Aarhus C 8000, Denmark
| | - Rikke Søgaard
- Department of Public Health, Aarhus University, Aarhus C 8000, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N 8200, Denmark
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28
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Wang S, Shen B, Wei L, Wu M, Wang J. Association between socioeconomic status and prognosis after ischemic stroke in South China. Neurol Res 2019; 41:916-922. [PMID: 31203766 DOI: 10.1080/01616412.2019.1630165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Previous studies have conflicting results on the association between socioeconomic status and stroke outcomes. Thus, this study aimed to investigate whether socioeconomic status is associated with the prognosis of ischemic stroke in Guangzhou, South China. Methods: A total of 622 patients with ischemic stroke who were admitted in the neurology department of five general hospitals in Guangzhou from May 2014 to October 2014 were included in the study. Socioeconomic status was measured based on education, income, caregiver, and insurance. The modified Rankin scale was used to evaluate the two years prognosis of patients with stroke. A multivariate logistic regression model was performed to determine the association between socioeconomic status and ischemic stroke prognosis. Results: In 2 years follow-up, 542 ischemic stroke patients were interviewed by telephone. Age ranged from 31 to 96 years, 65.5% of the patients were male. 33.9% of patients with ischemic stroke had a poor prognosis. After adjustment for age, sex, cardiovascular disease, behavior lifestyle, and severity of stroke, odds ratio for poor prognosis in patients with low income was 1.84 (95%CI 1.05-3.22), family caregiver 3.19 (95%CI 1.05-9.70), and no insurance 1.68 (95%CI 1.02-2.77). Conclusions: Patients with low income, family caregiver, and no insurance have a poorer prognosis after ischemic stroke that can be partly explained by intermediate variable in the patients' demographic characteristics, cardiovascular disease, behavior lifestyle, and stroke severity. Abbreviations: DALYs: disability-adjusted life years; SES: socioeconomic status; FMC: free medical care; MIUR: medical insurance for urban residents; MIUE: medical insurance for urban employees; NCMS: new rural cooperative medical scheme ; NIHSS: National Institute of Health Stroke Scale ; mRS: modified Rankin scale; OR: odds ratios; CI: confidence interval.
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Affiliation(s)
- Siping Wang
- School of Nursing, Guangdong Pharmaceutical University , Guangzhou , China
| | - Binyan Shen
- School of Nursing, Guangdong Pharmaceutical University , Guangzhou , China
| | - Lin Wei
- Department of nursing, Guangdong Province Hospital of Chinese Medicine , Guangzhou , China
| | - Meiting Wu
- School of Nursing, Guangdong Pharmaceutical University , Guangzhou , China
| | - Juan Wang
- School of Nursing, Guangdong Pharmaceutical University , Guangzhou , China
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Zimmermann BM, Koné I, Rost M, Leu A, Wangmo T, Elger BS. Factors associated with post-acute discharge location after hospital stay: a cross-sectional study from a Swiss hospital. BMC Health Serv Res 2019; 19:289. [PMID: 31068169 PMCID: PMC6505070 DOI: 10.1186/s12913-019-4101-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 04/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2012, Switzerland introduced the diagnosis-related group hospital payment system. Fearing that vulnerable patients may be discharged early, Acute and Transitional Care (ATC) was introduced to address the nursing care of patients who no longer needed an acute hospital stay. ATC is more costly for patients when compared to other discharge options like rehabilitation while providing less rehabilitative services. This study investigates factors associated with the place of discharge for patients in need of care. METHODS Data was collected from 660 medical records of inpatients 50 years and older of the municipal hospital Triemli in Zurich, Switzerland. We used stepwise logistic regression to identify factors associated with their discharge into ATC or rehabilitation. RESULTS Older patients with higher Delirium Observation Scale (DOS), lack of supplementary health insurance, resuscitation order and a lower social network were more likely to be discharged into ATC than rehabilitation. CONCLUSIONS The association of supplementary health insurance and social network with discharge into ATC or rehabilitation is problematic because patients that are already vulnerable from a financial and social perspective are potentially discharged into a more costly and less rehabilitative post-acute care facility.
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Affiliation(s)
- Bettina M Zimmermann
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.
| | - Insa Koné
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Michael Rost
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Agnes Leu
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland.,Careum Research, Department Health Sciences, Kalaidos University of Applied Sciences, Pestalozzistrasse 3, 8032, Zürich, Switzerland
| | - Tenzin Wangmo
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | - Bernice S Elger
- Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
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Dharma KK, Damhudi D, Yardes N, Haeriyanto S. Increase in the functional capacity and quality of life among stroke patients by family caregiver empowerment program based on adaptation model. Int J Nurs Sci 2018; 5:357-364. [PMID: 31406848 PMCID: PMC6626279 DOI: 10.1016/j.ijnss.2018.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 08/05/2018] [Accepted: 09/04/2018] [Indexed: 12/04/2022] Open
Abstract
Purpose The family caregiver's role is an important influence factor of patient's adaptation behaviour and quality of life after stroke. The purpose of this research was to identify the effect of caregiver empowerment program based on the adaptation model (CEP-BAM) on functional capacity and quality of life of patients after stroke. Methods This research was a quasi-experimental research with a pre- and post-test control group design. The total participants who completed the research were 80 patients and their families, 40 participants in the intervention group and 40 participants in the control group. We conducted home visits to perform the intervention. The measurement of functional capacity and quality of life performed four times (pre-test and three times post-test). Data analysis was performed using the repeated measurement ANOVA or general linear model repeated measure (GLM-RM). Results This research proves a significant difference in functional capacity and quality of life between the two groups and between pre-test and sixth months after intervention (P < 0.05). The quality of life of the intervention group in the sixth month after intervention was better than that of the control group (33.40 ± 3.65 vs 30.60 ± 2.78) with a significant difference (P < 0.05). Conclusion It is concluded that CEP-BAM effectively increased patients' functional capacity and quality of life after a stroke in the sixth month after intervention.
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Affiliation(s)
- Kelana Kusuma Dharma
- School of Nursing, Politeknik Kesehatan Kementerian Kesehatan Pontianak, Indonesia
| | - Dedi Damhudi
- School of Nursing, Politeknik Kesehatan Kementerian Kesehatan Pontianak, Indonesia
| | - Nelly Yardes
- School of Nursing, Politeknik Kesehatan Kementerian Kesehatan Jakarta III, Indonesia
| | - Suhana Haeriyanto
- School of Nursing, Politeknik Kesehatan Kementerian Kesehatan Jakarta III, Indonesia
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Kim J, Bushnell CD, Lee HS, Han SW. Effect of Adherence to Antihypertensive Medication on the Long-Term Outcome After Hemorrhagic Stroke in Korea. Hypertension 2018; 72:391-398. [DOI: 10.1161/hypertensionaha.118.11139] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 03/24/2018] [Accepted: 05/05/2018] [Indexed: 02/01/2023]
Affiliation(s)
- Jinkwon Kim
- From the Department of Neurology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea (J.K.)
| | - Cheryl D. Bushnell
- Wake Forest School of Medicine, Wake Forest University, Winston-Salem, NC (C.D.B.)
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea (H.S.L.)
| | - Sang Won Han
- Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Republic of Korea (S.W.H.)
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Jordan LC, Hills NK, Fox CK, Ichord RN, Pergami P, deVeber GA, Fullerton HJ, Lo W. Socioeconomic determinants of outcome after childhood arterial ischemic stroke. Neurology 2018; 91:e509-e516. [PMID: 29980641 DOI: 10.1212/wnl.0000000000005946] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 05/01/2018] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To determine whether lower socioeconomic status (SES) is associated with worse 1-year neurologic outcomes and reduced access to rehabilitation services in children with arterial ischemic stroke (AIS). METHODS From 2010 to 2014, the Vascular effects of Infection in Pediatric Stroke (VIPS) observational study prospectively enrolled and confirmed 355 children (age 29 days-18 years) with AIS at 37 international centers. SES markers measured via parental interview included annual household income (US dollars) at the time of enrollment, maternal education level, and rural/suburban/urban residence. Receipt of rehabilitation services was measured by parental report. Pediatric Stroke Outcome Measure scores were categorized as 0 to 1, 1.5 to 3, 3.5 to 6, and 6.5 to 10. Univariate and multivariable ordinal logistic regression models examined potential predictors of outcome. RESULTS At 12 ± 3 months after stroke, 320 children had documented outcome measurements, including 15 who had died. In univariate analysis, very low income (<US $10,000), but not other markers of SES, was associated with worse outcomes (odds ratio [OR] 3.13, 95% confidence interval [CI] 1.43-6.88, p = 0.004). In multivariable analysis, including adjustment for stroke etiology, this association persisted (OR 3.17, 95% CI 1.18-8.47, p = 0.02). Income did not correlate with receiving rehabilitation services at 1 year after stroke; however, quality and quantity of services were not assessed. CONCLUSIONS In a large, multinational, prospective cohort of children with AIS, low income was associated with worse neurologic outcomes compared to higher income levels. This difference was not explained by stroke type, neurologic comorbidities, or reported use of rehabilitation services. The root causes of this disparity are not clear and warrant further investigation.
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Affiliation(s)
- Lori C Jordan
- From the Department of Pediatrics (L.C.J.), Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN; Departments of Neurology (N.K.H., C.K.F., H.J.F.), Biostatistics and Epidemiology (N.K.H.), and Pediatrics (C.K.F., H.J.F.), University of California San Francisco; Department of Neurology (R.N.I.), The Children's Hospital of Philadelphia, PA; Department of Neurology (P.P.), Children's National Medical Center, Washington, DC; Department of Neurology (G.A.d.V.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Neurology (W.L.), Nationwide Children's Hospital, Columbus, OH.
| | - Nancy K Hills
- From the Department of Pediatrics (L.C.J.), Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN; Departments of Neurology (N.K.H., C.K.F., H.J.F.), Biostatistics and Epidemiology (N.K.H.), and Pediatrics (C.K.F., H.J.F.), University of California San Francisco; Department of Neurology (R.N.I.), The Children's Hospital of Philadelphia, PA; Department of Neurology (P.P.), Children's National Medical Center, Washington, DC; Department of Neurology (G.A.d.V.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Neurology (W.L.), Nationwide Children's Hospital, Columbus, OH
| | - Christine K Fox
- From the Department of Pediatrics (L.C.J.), Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN; Departments of Neurology (N.K.H., C.K.F., H.J.F.), Biostatistics and Epidemiology (N.K.H.), and Pediatrics (C.K.F., H.J.F.), University of California San Francisco; Department of Neurology (R.N.I.), The Children's Hospital of Philadelphia, PA; Department of Neurology (P.P.), Children's National Medical Center, Washington, DC; Department of Neurology (G.A.d.V.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Neurology (W.L.), Nationwide Children's Hospital, Columbus, OH
| | - Rebecca N Ichord
- From the Department of Pediatrics (L.C.J.), Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN; Departments of Neurology (N.K.H., C.K.F., H.J.F.), Biostatistics and Epidemiology (N.K.H.), and Pediatrics (C.K.F., H.J.F.), University of California San Francisco; Department of Neurology (R.N.I.), The Children's Hospital of Philadelphia, PA; Department of Neurology (P.P.), Children's National Medical Center, Washington, DC; Department of Neurology (G.A.d.V.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Neurology (W.L.), Nationwide Children's Hospital, Columbus, OH
| | - Paola Pergami
- From the Department of Pediatrics (L.C.J.), Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN; Departments of Neurology (N.K.H., C.K.F., H.J.F.), Biostatistics and Epidemiology (N.K.H.), and Pediatrics (C.K.F., H.J.F.), University of California San Francisco; Department of Neurology (R.N.I.), The Children's Hospital of Philadelphia, PA; Department of Neurology (P.P.), Children's National Medical Center, Washington, DC; Department of Neurology (G.A.d.V.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Neurology (W.L.), Nationwide Children's Hospital, Columbus, OH
| | - Gabrielle A deVeber
- From the Department of Pediatrics (L.C.J.), Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN; Departments of Neurology (N.K.H., C.K.F., H.J.F.), Biostatistics and Epidemiology (N.K.H.), and Pediatrics (C.K.F., H.J.F.), University of California San Francisco; Department of Neurology (R.N.I.), The Children's Hospital of Philadelphia, PA; Department of Neurology (P.P.), Children's National Medical Center, Washington, DC; Department of Neurology (G.A.d.V.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Neurology (W.L.), Nationwide Children's Hospital, Columbus, OH
| | - Heather J Fullerton
- From the Department of Pediatrics (L.C.J.), Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN; Departments of Neurology (N.K.H., C.K.F., H.J.F.), Biostatistics and Epidemiology (N.K.H.), and Pediatrics (C.K.F., H.J.F.), University of California San Francisco; Department of Neurology (R.N.I.), The Children's Hospital of Philadelphia, PA; Department of Neurology (P.P.), Children's National Medical Center, Washington, DC; Department of Neurology (G.A.d.V.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Neurology (W.L.), Nationwide Children's Hospital, Columbus, OH
| | - Warren Lo
- From the Department of Pediatrics (L.C.J.), Division of Pediatric Neurology, Vanderbilt University Medical Center, Nashville, TN; Departments of Neurology (N.K.H., C.K.F., H.J.F.), Biostatistics and Epidemiology (N.K.H.), and Pediatrics (C.K.F., H.J.F.), University of California San Francisco; Department of Neurology (R.N.I.), The Children's Hospital of Philadelphia, PA; Department of Neurology (P.P.), Children's National Medical Center, Washington, DC; Department of Neurology (G.A.d.V.), Hospital for Sick Children, Toronto, Ontario, Canada; and Department of Neurology (W.L.), Nationwide Children's Hospital, Columbus, OH
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Ouyang F, Wang Y, Huang W, Chen Y, Zhao Y, Dang G, Zhang C, Lin Y, Zeng J. Association between socioeconomic status and post-stroke functional outcome in deprived rural southern China: a population-based study. BMC Neurol 2018; 18:12. [PMID: 29370778 PMCID: PMC5785852 DOI: 10.1186/s12883-018-1017-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Data on the association between socioeconomic status and post-stroke functional outcome in developing countries is lacking. We aimed to evaluate the association in stroke survivors in deprived rural Southern China. METHODS We conducted door-to-door interviews and collected data using a structured questionnaire in stroke survivors from five fourth-class rural areas of Guangdong Province through a non-government initiated registry from August 2014 to March 2015. Descriptive statistics were used to provide information on the demographic, socioeconomic and clinical characteristics of the selected population. Univariate and multivariate logistic regression were used to examine the relationship of socioeconomic status indexed by self-reported average family income and functional impairment defined as a modified Rankin Scale of 3 to 5. RESULTS Among the 425 stroke survivors, 52.7% lived below the poverty line set by the local government. About 50% of patients suffered from functional impairment and required assistance in their daily life. Compared with their wealthier counterpart, stroke survivors with lower income were more likely to have functional impairment (OR 2.85, 95% CI 1.93-4.23). The effect size increased and remained significant after adjusting for possible confounding factors (OR 3.17, 95% CI 2.04-4.91). CONCLUSIONS Poorer patients tend to have poorer post-stroke functional outcome. Primary and secondary strategies targeting underprivileged populations in less-developed areas are thus urgently needed in China.
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Affiliation(s)
- Fubing Ouyang
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Ying Wang
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Weixian Huang
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Yicong Chen
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Yuhui Zhao
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Ge Dang
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhongshan Road 2, Guangzhou, 510080, China
| | - Chunbo Zhang
- Guangzhou Baiyunshan Qixing Pharmaceutical Co., Ltd, No.32 Yun Pu Road 1, Guangzhou, 510530, China
| | - Yang Lin
- Guangzhou Baiyunshan Qixing Pharmaceutical Co., Ltd, No.32 Yun Pu Road 1, Guangzhou, 510530, China
| | - Jinsheng Zeng
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Sun Yat-Sen University, No.58 Zhongshan Road 2, Guangzhou, 510080, China.
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Abstract
Purpose
Stroke is a leading cause of death and disability in the USA and worldwide. While stroke care has evolved dramatically, many new acute approaches to therapy focus only on the first 3-12 hours. Significant treatment opportunities beyond the first 12 hours can play a major role in improving outcomes for stroke patients. The purpose of this paper is to highlight the issues that affect stroke care delivery for patients and caregivers and describe an integrated care model that can improve care across the continuum.
Design/methodology/approach
This paper details evidence-based research that documents current stroke care and efforts to improve care delivery. Further, an innovative integrated care model is described, and its novel application to stroke care is highlighted.
Findings
Stroke patients and caregivers face fragmented and poorly coordinated care systems as they move through specific stroke nodes of care, from acute emergency and in-hospital stay through recovery post-discharge at a care facility or at home, and can be addressed by applying a comprehensive, technology-enabled Integrated Stroke Practice Unit (ISPU) Model of Care.
Originality/value
This paper documents specific issues that impact stroke care and the utilization of integrated care delivery models to address them. Evidence-based research results document difficulties of current care delivery methods for stroke and the impact of that care delivery on patients and caregivers across each node of care. It offers an innovative ISPU model and highlights specific tenets of that model for readers.
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Factors Mediating Outcome After Stroke: Gender, Thrombolysis, and Their Interaction. Transl Stroke Res 2017; 9:267-273. [DOI: 10.1007/s12975-017-0579-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 11/25/2022]
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Cho JS, Hu Z, Fell N, Heath GW, Qayyum R, Sartipi M. Hospital Discharge Disposition of Stroke Patients in Tennessee. South Med J 2017; 110:594-600. [PMID: 28863224 PMCID: PMC5774648 DOI: 10.14423/smj.0000000000000694] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Early determination of hospital discharge disposition status at an acute admission is extremely important for stroke management and the eventual outcomes of patients with stroke. We investigated the hospital discharge disposition of patients with stroke residing in Tennessee and developed a predictive tool for clinical adoption. Our investigational aims were to evaluate the association of selected patient characteristics with hospital discharge disposition status and predict such status at the time of an acute stroke admission. METHODS We analyzed 127,581 records of patients with stroke hospitalized between 2010 and 2014. Logistic regression was used to generate odds ratios with 95% confidence intervals to examine the factor outcome association. An easy-to-use clinical predictive tool was built by using integer-based risk scores derived from coefficients of multivariable logistic regression. RESULTS Among the 127,581 records of patients with stroke, 86,114 (67.5%) indicated home discharge and 41,467 (32.5%) corresponded to facility discharge. All considered patient characteristics had significant correlations with hospital discharge disposition status. Patients were at greater odds of being discharged to another facility if they were women; older; black; patients with a subarachnoid or intracerebral hemorrhage; those with the comorbidities of diabetes mellitus, heart disease, hypertension, chronic kidney disease, arrhythmia, or depression; those transferred from another hospital; or patients with Medicare as the primary payer. A predictive tool had a discriminatory capability with area under the curve estimates of 0.737 and 0.724 for derivation and validation cohorts, respectively. CONCLUSIONS Our investigation revealed that the hospital discharge disposition pattern of patients with stroke in Tennessee was associated with the key patient characteristics of selected demographics, clinical indicators, and insurance status. These analyses resulted in the development of an easy-to-use predictive tool for early determination of hospital discharge disposition status.
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Affiliation(s)
- Jin S Cho
- From the Departments of Computer Science and Engineering, Physical Therapy, Health and Human Performance, University of Tennessee, Chattanooga, and Erlanger Health System, Chattanooga, Tennessee
| | - Zhen Hu
- From the Departments of Computer Science and Engineering, Physical Therapy, Health and Human Performance, University of Tennessee, Chattanooga, and Erlanger Health System, Chattanooga, Tennessee
| | - Nancy Fell
- From the Departments of Computer Science and Engineering, Physical Therapy, Health and Human Performance, University of Tennessee, Chattanooga, and Erlanger Health System, Chattanooga, Tennessee
| | - Gregory W Heath
- From the Departments of Computer Science and Engineering, Physical Therapy, Health and Human Performance, University of Tennessee, Chattanooga, and Erlanger Health System, Chattanooga, Tennessee
| | - Rehan Qayyum
- From the Departments of Computer Science and Engineering, Physical Therapy, Health and Human Performance, University of Tennessee, Chattanooga, and Erlanger Health System, Chattanooga, Tennessee
| | - Mina Sartipi
- From the Departments of Computer Science and Engineering, Physical Therapy, Health and Human Performance, University of Tennessee, Chattanooga, and Erlanger Health System, Chattanooga, Tennessee
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Bettger JP, Thomas L, Liang L, Xian Y, Bushnell CD, Saver JL, Fonarow GC, Peterson ED. Hospital Variation in Functional Recovery After Stroke. Circ Cardiovasc Qual Outcomes 2017; 10:CIRCOUTCOMES.115.002391. [DOI: 10.1161/circoutcomes.115.002391] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 11/30/2016] [Indexed: 11/16/2022]
Abstract
Background—
Functional status is a key patient-centric outcome, but there are little data on whether functional recovery post-stroke varies among hospitals. This study examined the distribution of functional status 3 months after stroke, determined whether these outcomes vary among hospitals, and identified hospital characteristics associated with better (or worse) functional outcomes.
Methods and Results—
Observational analysis of the AVAIL study (Adherence Evaluation After Ischemic Stroke-Longitudinal) included 2083 ischemic stroke patients enrolled from 82 US hospitals participating in Get With The Guidelines-Stroke and AVAIL. The primary outcome was dependence or death at 3 months (modified Rankin Scale [mRS] score of 3–6). Secondary outcomes included functional dependence (mRS score of 3–5), disabled (mRS score of 2–5), and mRS evaluated as a continuous score. By 3 months post-discharge, 36.5% of patients were functionally dependent or dead. Rates of dependence or death varied widely by discharging hospitals (range: 0%–67%). After risk adjustment, patients had lower rates of 3-month dependence or death when treated at teaching hospitals (odds ratio, 0.72; 95% confidence interval, 0.54–0.96) and certified primary stroke centers (odds ratio, 0.69; 95% confidence interval, 0.53–0.91). In contrast, a composite measure of hospital-level adherence to acute stroke care performance metrics, stroke volume, and bed size was not associated with downstream patient functional status. Findings were robust across mRS end points and sensitivity analyses.
Conclusions—
One third of acute ischemic stroke patients were functionally dependent or dead 3 months postacute stroke; functional recovery rates varied considerably among hospitals, supporting the need to better determine which care processes can maximize functional outcomes.
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Affiliation(s)
- Janet Prvu Bettger
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.)
| | - Laine Thomas
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.)
| | - Li Liang
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.)
| | - Ying Xian
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.)
| | - Cheryl D. Bushnell
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.)
| | - Jeffrey L. Saver
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.)
| | - Gregg C. Fonarow
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.)
| | - Eric D. Peterson
- From the Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (J.P.B., L.T., L.L., Y.X., E.D.P.); Wake Forest Baptist Medical Center, Winston-Salem, NC (C.D.B.); and University of California at Los Angeles (J.L.S., G.C.F.)
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Carmo JFD, Oliveira ERA, Morelato RL. Functional disability and associated factors in elderly stroke survivors in Vitória, Brazil. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2016. [DOI: 10.1590/1809-98232016019.150215] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: The aim of the present study was to estimate the prevalence of disability and associated factors in elderly stroke survivors. Methods: A cross-sectional study of 230 elderly persons was conducted in the 22 territories of the Estratégia de Saúde da Família (the Family Health Strategy) of Vitória, in the state of Espirito Santo. Patients were assessed using the modified Rankin Scale. Poisson regression with robust variance in crude and adjusted analyses was employed. Results: The majority of subjects were men (52.1%) aged between 60 to 98 years, with a mean age of 75.8 (sd±9.2). The prevalence of disability was 66%. Age ≥80 years, self-perceived limitations in bodily function, considering the physical structure of the street to be a barrier to leaving home and believing street lighting to be insufficient were positively associated with functional disability. Possessing 12 or more years of schooling was inversely associated with the outcome. Conclusions: The high prevalence of disability and associated factors in elderly stroke survivors reinforce the need for a health system that operates continuously and proactively, promoting active aging.
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Brenner AB, Burke JF, Skolarus LE. Moving Toward an Understanding of Disability in Older U.S. Stroke Survivors. J Aging Health 2016; 30:75-104. [PMID: 27605555 DOI: 10.1177/0898264316666125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We test a comprehensive model of disability in older stroke survivors and determine the relative contribution of neighborhood, economic, psychological, and medical factors to disability. METHOD The sample consisted of 728 stroke survivors from the National Health and Aging Trends Study (NHATS), who were 65 years and older living in community settings or residential care. Confirmatory factor analysis and structural equation modeling were used to test relationships between neighborhood, socioeconomic, psychological, and medical factors, and disability. RESULTS Economic and medical context were associated with disability directly and indirectly through physical impairment. Neighborhood context was associated with disability, but was only marginally statistically significant ( p = .05). The effect of economic and neighborhood factors was small compared with that of medical factors. DISCUSSION Neighborhood and economic factors account for a portion of the variance in disability among older stroke survivors beyond that of medical factors.
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Post-stroke disability and its predictors among Nigerian stroke survivors. Disabil Health J 2016; 9:616-23. [PMID: 27387815 DOI: 10.1016/j.dhjo.2016.05.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/24/2016] [Accepted: 05/28/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite stroke is a major cause of disability, the predictors of the disability among stroke survivors has not been sufficiently delineated. OBJECTIVE To assess post-stroke disability and determine its predictors among Nigerian stroke survivors. METHODS This study involved 121 consecutive stroke survivors with at least 3 months of stroke from two tertiary health institutions in South-Western Nigeria. The World Health Organization Disability Assessment Schedule was used to assess their disability. Socio-demographic and clinical variables were obtained through interview and from their hospital records respectively. Poisson regression was used to examine the predictors. RESULTS Moderate disability level (44.1 ± 20.5) was observed among the participants. Prevalence of post-stroke disability was high in nine items with scores ranged between 62.0% and 90.1%. There was moderate prevalence of post-stroke disability in 3 items (44.6%-52.1%). When adjusted for sex, prevalence of post-stroke disability followed the same pattern. Being a male and having the affectation of dominant right limbs had 1.08 and 1.46 more likelihood of having disability while being gainfully employed after stroke had 0.81 less likelihood of having disability. Every additional unit of diastolic blood pressure and stroke duration were associated with estimated 0.4% and 0.2% less disability while every one year increased in age was associated with 0.5% increase in disability. CONCLUSION Disability in stroke survivors is determined by having right dominant limb affected, increase in blood pressure, longer stroke duration, increase in age and being a male. However, disability in stroke survivors decreases with the stroke survivors engaging in productive lifestyle.
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Vincent-Onabajo GO, Ihaza LO, Usman Ali M, Ali Masta M, Majidadi R, Modu A, Umeonwuka C. Impact of social support on participation after stroke in Nigeria. Top Stroke Rehabil 2016; 23:305-10. [DOI: 10.1080/10749357.2016.1155279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Marshall IJ, Wang Y, Crichton S, McKevitt C, Rudd AG, Wolfe CDA. The effects of socioeconomic status on stroke risk and outcomes. Lancet Neurol 2016; 14:1206-18. [PMID: 26581971 DOI: 10.1016/s1474-4422(15)00200-8] [Citation(s) in RCA: 220] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 07/23/2015] [Accepted: 07/29/2015] [Indexed: 11/19/2022]
Abstract
The latest evidence on socioeconomic status and stroke shows that stroke not only disproportionately affects low-income and middle-income countries, but also socioeconomically deprived populations within high-income countries. These disparities are reflected not only in risk of stroke but also in short-term and long-term outcomes after stroke. Increased average levels of conventional risk factors (eg, hypertension, hyperlipidaemia, excessive alcohol intake, smoking, obesity, and sedentary lifestyle) in populations with low socioeconomic status account for about half of these effects. In many countries, evidence shows that people with lower socioeconomic status are less likely to receive good-quality acute hospital and rehabilitation care than people with higher socioeconomic status. For clinical practice, better implementation of well established treatments, effective management of risk factors, and equity of access to high-quality acute stroke care and rehabilitation will probably reduce inequality substantially. Overcoming barriers and adapting evidence-based interventions to different countries and health-care settings remains a research priority.
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Affiliation(s)
- Iain J Marshall
- Division of Health and Social Care Research, King's College London, London, UK.
| | - Yanzhong Wang
- Division of Health and Social Care Research, King's College London, London, UK; NIHR Biomedical Research Centre, Guy's and Saint Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Siobhan Crichton
- Division of Health and Social Care Research, King's College London, London, UK
| | - Christopher McKevitt
- Division of Health and Social Care Research, King's College London, London, UK; NIHR Biomedical Research Centre, Guy's and Saint Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Anthony G Rudd
- Division of Health and Social Care Research, King's College London, London, UK; NIHR Biomedical Research Centre, Guy's and Saint Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Charles D A Wolfe
- Division of Health and Social Care Research, King's College London, London, UK; NIHR Biomedical Research Centre, Guy's and Saint Thomas' NHS Foundation Trust and King's College London, London, UK
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Factors associated with activities of daily living among the disabled elders with stroke. Int J Nurs Sci 2016. [DOI: 10.1016/j.ijnss.2016.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Capela NA, Lemaire ED, Baddour N, Rudolf M, Goljar N, Burger H. Evaluation of a smartphone human activity recognition application with able-bodied and stroke participants. J Neuroeng Rehabil 2016; 13:5. [PMID: 26792670 PMCID: PMC4719690 DOI: 10.1186/s12984-016-0114-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 01/12/2016] [Indexed: 11/11/2022] Open
Abstract
Background Mobile health monitoring using wearable sensors is a growing area of interest. As the world’s population ages and locomotor capabilities decrease, the ability to report on a person’s mobility activities outside a hospital setting becomes a valuable tool for clinical decision-making and evaluating healthcare interventions. Smartphones are omnipresent in society and offer convenient and suitable sensors for mobility monitoring applications. To enhance our understanding of human activity recognition (HAR) system performance for able-bodied and populations with gait deviations, this research evaluated a custom smartphone-based HAR classifier on fifteen able-bodied participants and fifteen participants who suffered a stroke. Methods Participants performed a consecutive series of mobility tasks and daily living activities while wearing a BlackBerry Z10 smartphone on their waist to collect accelerometer and gyroscope data. Five features were derived from the sensor data and used to classify participant activities (decision tree). Sensitivity, specificity and F-scores were calculated to evaluate HAR classifier performance. Results The classifier performed well for both populations when differentiating mobile from immobile states (F-score > 94 %). As activity recognition complexity increased, HAR system sensitivity and specificity decreased for the stroke population, particularly when using information derived from participant posture to make classification decisions. Conclusions Human activity recognition using a smartphone based system can be accomplished for both able-bodied and stroke populations; however, an increase in activity classification complexity leads to a decrease in HAR performance with a stroke population. The study results can be used to guide smartphone HAR system development for populations with differing movement characteristics.
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Affiliation(s)
- N A Capela
- Ottawa Hospital Research Institute, Ottawa, Canada. .,Mechanical Engineering, University of Ottawa, Ottawa, Canada.
| | - E D Lemaire
- Ottawa Hospital Research Institute, Ottawa, Canada. .,Faculty of Medicine, University of Ottawa, Ottawa, Canada.
| | - N Baddour
- Mechanical Engineering, University of Ottawa, Ottawa, Canada.
| | - M Rudolf
- University Rehabilitation Institute, Ljubljana, Slovenia.
| | - N Goljar
- University Rehabilitation Institute, Ljubljana, Slovenia.
| | - H Burger
- University Rehabilitation Institute, Ljubljana, Slovenia.
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Wolf SL, Sahu K, Bay RC, Buchanan S, Reiss A, Linder S, Rosenfeldt A, Alberts J. The HAAPI (Home Arm Assistance Progression Initiative) Trial: A Novel Robotics Delivery Approach in Stroke Rehabilitation. Neurorehabil Neural Repair 2015; 29:958-68. [PMID: 25782693 DOI: 10.1177/1545968315575612] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Geographical location, socioeconomic status, and logistics surrounding transportation impede access of poststroke individuals to comprehensive rehabilitative services. Robotic therapy may enhance telerehabilitation by delivering consistent and state-of-the art therapy while allowing remote monitoring and adjusting therapy for underserved populations. The Hand Mentor Pro (HMP) was incorporated within a home exercise program (HEP) to improve upper-extremity (UE) functional capabilities poststroke. OBJECTIVE To determine the efficacy of a home-based telemonitored robotic-assisted therapy as part of a HEP compared with a dose-matched HEP-only intervention among individuals less than 6 months poststroke and characterized as underserved. METHODS In this prospective, single-blinded, multisite, randomized controlled trial, 99 hemiparetic participants with limited access to UE rehabilitation were randomized to either (1) the experimental group, which received combined HEP and HMP for 3 h/d ×5 days ×8 weeks, or (2) the control group, which received HEP only at an identical dosage. Weekly communication between the supervising therapist and participant promoted compliance and progression of the HEP and HMP prescription. The Action Research Arm Test and Wolf Motor Function Test along with the Fugl-Meyer Assessment (UE) were primary and secondary outcome measures, respectively, undertaken before and after the interventions. RESULTS Both groups demonstrated improvement across all UE outcomes. CONCLUSIONS Robotic + HEP and HEP only were both effectively delivered remotely. There was no difference between groups in change in motor function over time. Additional research is necessary to determine the appropriate dosage of HMP and HEP.
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Affiliation(s)
- Steven L Wolf
- Emory University School of Medicine, Atlanta, GA, USA Atlanta VA Medical Center, Decatur, GA, USA
| | - Komal Sahu
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Aimee Reiss
- Emory University School of Medicine, Atlanta, GA, USA
| | | | | | - Jay Alberts
- Cleveland Clinic, OH, USA Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
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Sex, diastolic blood pressure, and outcome after thrombolysis for ischemic stroke. Stroke Res Treat 2014; 2014:747458. [PMID: 25302134 PMCID: PMC4181774 DOI: 10.1155/2014/747458] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 07/24/2014] [Accepted: 09/02/2014] [Indexed: 11/17/2022] Open
Abstract
Background. The goal of this study was to identify differences in risk factors and functional outcome between the two sexes in patients treated with thrombolysis for ischemic stroke. Methods. This cohort study audited data from patients treated with thrombolysis for ischemic stroke during a 3-year period at Södersjukhuset, Stockholm. Results. Of the 355 patients included in the study, 162 (45%) were women and 193 (54%) were men. Women were older with a median age of 76 years; median age for men was 69 years (P < 0.0001). Diastolic blood pressure was lower for women compared to men (P = 0.001). At admission fewer women had a favorable modified Rankin Scale score compared to men (93.8% versus 99%, P = 0.008). Three months after discharge functional status did not differ significantly between the two sexes. Diastolic blood pressure was associated to functional outcome only in men when sex specific odds ratios were calculated (OR, 5.7; 95% CI, 1.7–20). Conclusion. The study indicates that females appear to gain a relatively greater benefit from thrombolytic therapy than men due to a better functional recovery. A higher diastolic blood pressure increases the risk for a worse prospective functional status in men.
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Hartley T, Burger M, Inglis-Jassiem G. Post stroke health-related quality of life, stroke severity and function: A longitudinal cohort study. Afr J Disabil 1970; 11:947. [PMID: 35169551 PMCID: PMC8831922 DOI: 10.4102/ajod.v11i0.947] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 11/20/2021] [Indexed: 11/20/2022] Open
Abstract
Background Health related quality of life (HRQoL) is a determinant of physical, social and emotional well-being post-stroke. Objectives This study aimed to correlate self-reported HRQoL with activities of daily living (ADL) and stroke severity. Method A longitudinal observational study was conducted at a rehabilitation centre in the Western Cape, South Africa. Stroke inpatients were sampled over 6 months. The Euro-QoL Five Dimensions instrument (EQ5D-3L) for self-reported HRQoL, Barthel Index (BI) for function and independence in ADL, and modified Rankin Scale (mRS) for stroke severity were administered on admission and discharge. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25. Results Of the 54 potential participants, 49 met inclusion criteria and 41 completed reassessments (median age 48 years [interquartile range {IQR} 39–60]; median length of stay 53 days [IQR 46–60]). Most participants had infarctions (89.90%); with hypertension or diabetes risk factors (73.47% and 28.57%, respectively). The BI and mRS scores improved significantly (p < 0.001) with very strong correlation between scores (rs = -0.874, p < 0.001); indicating a trend of decreased stroke severity as function improved. The EQ5D Visual Analog Scale (VAS) scores (p < 0.001) and domains mobility, self-care, usual activities (p < 0.001) and pain/discomfort (p = 0.034) improved significantly. The anxiety/depression domain showed a non-significant change (p = 0.378). A weak negative significant correlation existed between EQ5D VAS and mRS scores (rs = -0.362; p = 0.02); indicating a trend that HRQoL was not improving to the degree stroke severity decreased. A weak positive significant correlation was seen between EQ5D VAS and BI scores (rs = 0.329; p = 0.036). Conclusion Although an improvement was noted in HRQoL, EQ5D VAS scores tended not to improve as strongly, despite significant improvements in function and stroke severity. These findings demonstrate the need for psychological support and pain management interventions for adjustment post-stroke.
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Affiliation(s)
- Tasneem Hartley
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
- Department of Physical Therapy and Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
| | - Marlette Burger
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gakeemah Inglis-Jassiem
- Division of Physiotherapy, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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