What causes the burden of stroke in Scotland? A comparative risk assessment approach linking the Scottish Health Survey to administrative health data

Burden of disease attributable to risk factors in European countries: a scoping literature review

OBJECTIVES

Within the framework of the burden of disease (BoD) approach, disease and injury burden estimates attributable to risk factors are a useful guide for policy formulation and priority setting in disease prevention. Considering the important differences in methods, and their impact on burden estimates, we conducted a scoping literature review to: (1) map the BoD assessments including risk factors performed across Europe; and (2) identify the methodological choices in comparative risk assessment (CRA) and risk assessment methods.

METHODS

We searched multiple literature databases, including grey literature websites and targeted public health agencies websites.

RESULTS

A total of 113 studies were included in the synthesis and further divided into independent BoD assessments (54 studies) and studies linked to the Global Burden of Disease (59 papers). Our results showed that the methods used to perform CRA varied substantially across independent European BoD studies. While there were some methodological choices that were more common than others, we did not observe patterns in terms of country, year or risk factor. Each methodological choice can affect the comparability of estimates between and within countries and/or risk factors, since they might significantly influence the quantification of the attributable burden. From our analysis we observed that the use of CRA was less common for some types of risk factors and outcomes. These included environmental and occupational risk factors, which are more likely to use bottom-up approaches for health outcomes where disease envelopes may not be available.

CONCLUSIONS

Our review also highlighted misreporting, the lack of uncertainty analysis and the under-investigation of causal relationships in BoD studies. Development and use of guidelines for performing and reporting BoD studies will help understand differences, avoid misinterpretations thus improving comparability among estimates.

REGISTRATION

The study protocol has been registered on PROSPERO, CRD42020177477 (available at: https://www.crd.york.ac.uk/PROSPERO/ ).

Efficacy of meridian massage for motor function after a stroke: a systematic review and Meta-analysis

OBJECTIVE

To evaluate the efficacy of meridian massage on motor function after a stroke.

METHODS

This systematic review and Meta-analysis of randomised (RCTs) and quasi-randomised controlled trials (qRCTs) was performed to determine the effects of meridian massage on motor dysfunction following a stroke. Articles published until December 2020 related to stroke and meridian massage from National Library of Medicine, Cochrane Central Register of Controlled Trials, Embase, KoreaMed, Japan science and Technology Agency, China National Knowledge Infrastructure Database, Wanfang Database, Chinese Biomedical Literature Database and China Science and Technology Journal Database were searched. The primary outcomes included Fugl-Mayer Assessment (FMA), modified Barthel Index (mBI) and clinical efficiency, while the secondary outcomes included modified Ashworth (mAS) and Berg Balance Scale (BBS). Two authors independently selected the literature, extracted the data and assessed the risk of bias, after which Meta-analysis with subgroups and sensitivity analysis was conducted.

RESULTS

A total of 16 RCTs and 3 q-RCTs involved 1556 patients satisfied the inclusion. Meta-analysis showed that compared to conventional rehabilitation, meridian massage had significantly better FMA [mean difference () = 1.16, 95% confidence interval (): 0.43, 1.89, = 0.002], FMA-L ( = 3.21, 95% : 1.97, 4.45, = 0.000 01), mBI ( = 8.87, 95% : 4.24, 13.49, = 0.000 02), clinical efficiency [relative risk (RR) = 1.37,95% : 1.24, 1.51, < 0.000 01], mAS ( = -0.69, 95% : -1.26, -0.11, = 0.02) and BBS ( = 5.07, 95% : 2.22, 7.93, = 0.0005). Subgroup analysis indicated no significant difference between meridian massage and control group when the intervention duration was >8 weeks ( = 0.89, 95% : -0.64, 2.42, = 0.25) but improving motor function in the meridian massage when the intervention duration was ≤ 8 weeks (< 4 weeks intervention duration = 0.84, 95% : 0.59, 1.10, < 0.000 01; 4-8 weeks = 2.41, 95% : 0.80, 4.01, = 0.003).

CONCLUSIONS

Meridian massage as an alternative and complementary therapy seems to have short-term benefits in improving post-stroke motor function (particularly in the lower limbs), quality of life, clinical efficiency, and balance stability and muscle spasms. The high heterogeneity of the included studies and the low methodological quality certainly limits the confidence placed in this systematic review and Meta-analysis, warranting future well-designed studies.

Association between neighborhood disadvantage and fulfillment of desired postpartum sterilization

BACKGROUND

Adequacy of prenatal care is associated with fulfillment of postpartum sterilization requests, though it is unclear whether this relationship is indicative of broader social and structural determinants of health or reflects the mandatory Medicaid waiting period required before sterilization can occur. We evaluated the relationship between neighborhood disadvantage (operationalized by the Area Deprivation Index; ADI) and the likelihood of undergoing postpartum sterilization.

METHODS

Secondary analysis of a single-center retrospective cohort study examining 8654 postpartum patients from 2012 to 2014, of whom 1332 (15.4%) desired postpartum sterilization (as abstracted from the medical record at time of delivery hospitalization discharge) and for whom ADI could be calculated via geocoding their home address. We determined the association between ADI and sterilization completion, postpartum visit attendance, and subsequent pregnancy within 365 days of delivery via logistic regression and time to sterilization via Cox proportional hazards regression.

RESULTS

Of the 1332 patients included in the analysis, patients living in more disadvantaged neighborhoods were more likely to be younger, more parous, delivered vaginally, Black, unmarried, not college educated, and insured via Medicaid. Compared to patients living in less disadvantaged areas, patients living in more disadvantaged areas were less likely to obtain sterilization (44.8% vs. 53.5%, OR 0.84, 95% CI 0.75-0.93), experienced greater delays in the time to sterilization (HR 1.23, 95% CI 1.06-1.44), were less likely to attend postpartum care (58.9% vs 68.9%, OR 0.86, CI 0.79-0.93), and were more likely to have a subsequent pregnancy within a year of delivery (15.1% vs 10.4%, OR 1.56, 95% CI 1.10-1.94). In insurance-stratified analysis, for patients with Medicaid, but not private insurance, as neighborhood disadvantage increased, the rate of postpartum sterilization decreased. The rate of subsequent pregnancy was positively associated with neighborhood disadvantage for both Medicaid as well as privately insured patients.

CONCLUSION

Living in an area with increased neighborhood disadvantage is associated with worse outcomes in terms of desired postpartum sterilization, especially for patients with Medicaid insurance. While revising the Medicaid sterilization policy is important, addressing social determinants of health may also play a powerful role in reducing inequities in fulfillment of postpartum sterilization.

Social and physical environmental factors in daily stepping activity in those with chronic stroke

BACKGROUND, PURPOSE/OBJECTIVE

Walking behavior in the chronic stroke population is multi-factorial. Previous work focused on the role of physical and biopsychosocial factors in understanding daily stepping post stroke. However, qualitative evidence suggests that social and physical environmental factors also affect daily stepping in those with stroke. The purpose of this study was to understand the role of social and physical environmental factors in daily stepping after stroke.

METHODS

A total of 249 individuals ≥6 months post stroke were included in this cross-sectional analysis (129 females, mean age 62.98 years, SD 11.94). The social environment included living situation, work status, and marital status. The physical environment included the Area Deprivation Index (ADI) and Walk Score. At least 3 days of stepping was collected using an accelerometry-based device. Predictors were entered sequentially into a regression model: demographic characteristics, social environmental factors, and physical environmental factors.

RESULTS

After adjusting for demographic factors, social environmental factors explained 6.2% (p =.017) of the variance in post stroke daily stepping. The addition of physical environmental factors improved the model (ΔR² =.029, p =.024). The final model explained 9.2% (p =.003) of the variance in daily stepping. Lower area deprivation (ADI β = -0.178, p =.015) and working (working vs. retired β = -0.187, p = .029 and working vs. unemployed β = -0.227, p =.008) were associated with greater daily stepping.

DISCUSSION/CONCLUSION

Social and physical environmental factors predicted daily stepping and should be considered when setting expectations relative to the effects of rehabilitation on daily stepping in individuals poststroke.