Frea, Simone; Bovolo, Virginia; Bergerone, Serena; D'Ascenzo, Fabrizio; Antolini, Marina; Capriolo, Michele; Canavosio, Federico Giovanni; Morello, Mara; Gaita, Fiorenzo
Right ventricular (RV) function plays a pivotal role in advanced heart failure patients, especially for screening those who may benefit from left ventricular assist device (LVAD) implantation. We introduce RV contraction pressure index (RVCPI) as a new echo-Doppler parameter of RV function. The accuracy of RVCPI in detecting RV failure was compared with the criterion standard, the RV stroke work index (RVSWI) obtained through right heart catheterization in advanced heart failure patients referred for heart transplantation or LVAD implantation. Right heart catheterization and echo-Doppler were simultaneously performed in 94 consecutive patients referred to our center for advanced heart failure (ejection fraction (EF) 24 ± 8.8%, 40% NYHA functional class IV). RV stroke volume and invasive pulmonary pressures were used to obtain RVSWI. Simplified RVCPI (sRVCPI) was derived as TAPSE × (RV - right atrial pressure gradient). Close positive correlation between sRVCPI and RVSWI was found (r = 0.68; P rights reserved.
Andersen, Klaus Kaae; Olsen, Tom Skyhøj
Although obesity is associated with excess mortality and morbidity, mortality is lower in obese than in normal weight stroke patients (the obesity paradox). Studies now indicate that obesity is not associated with increased risk of recurrent stroke in the years after first stroke. We studied the ...... the association between body mass index (BMI) and stroke patient's risk of having a history of previous stroke (recurrent stroke)....
Imamura, Teruhiko; Kinugawa, Koichiro; Kinoshita, Osamu; Nawata, Kan; Ono, Minoru
Although the right ventricular stroke work index (RVSWI) is a good index for RV function, a low RVSWI is not necessarily an indicator for the need for a right ventricular assist device at the time of left VAD implantation. We here aimed to determine a more precise indicator for the need for a biventricular assist device (BiVAD). In total, 116 patients (mean age, 38 ± 14 years), who underwent hemodynamic assessments preoperatively including 12 BiVAD patients, and had been followed at our institute from 2003 to 2015, were included. Multivariate logistic regression analysis indicated that RVSWI and pulmonary vascular resistance (PVR) were independent predictors of BiVAD requirement (P 5 g/m, PVR 5, PVR > 3.7), (3) RV failure (RVSWI 3.7), and examined. Most of the patients in Group 4 (75 %), with acutely depressed hemodynamics and inflammatory responses in the myocardium, required BiVAD. Overall, patients with BiVAD had a worse survival rate as compared with those with LVAD alone. In conclusion, high PVR in addition to low RVSWI effectively predicts BiVAD requirement.
Armstrong, Hilary F; Schulze, P Christian; Kato, Tomoko S; Bacchetta, Matthew; Thirapatarapong, Wilawan; Bartels, Matthew N
Studies have shown that patients with poor pre-lung transplant (LTx) right ventricular (RV) function have prolonged post-operative ventilation time and intensive care stay as well as a higher risk of in-hospital death. RV stroke work index (RVSWI) calculates RV workload and contractility. We hypothesized that patients with higher RV workload capacity, indicated by higher RVSWI, would have better outcomes after LTx. A retrospective record review was performed on all LTx patients between 2005 and 2011 who had right heart catheterizations (RHC) 1-year before LTx. In addition, results for echocardiograms and cardiopulmonary exercise testing within 1-year of RHCs were gathered. Mean RVSWI was 9.36 ± 3.59 for 115 patients. There was a significant relation between mean pulmonary artery pressure (mPAP), RVSWI, RV end-diastolic diameter (RVEDd), left atrial dimension (LAD), peak and resting pressure of end-tidal carbon dioxide, minute ventilation /volume of carbon dioxide production, and 1-year mortality after LTx. Contrary to our hypothesis, those who survived had lower RVSWI than those who died within 1 year (8.99 ± 3.38 vs 11.6 ± 4.1, p = 0.026). Hospital length of stay significantly correlated with mPAP, RVSWI, left ventricular ejection fraction, percentage of fractional shortening, RVEDd, RV fractional area change, LAD, and RV wall thickness in diastole. Intensive care length of stay also significantly correlated with these variables and with body mass index. RVSWI was significantly different between groups of different RV function, indicating that increased RVSWI is associated with impairment of RV structure and function in patients undergoing LTx evaluation. This study demonstrates an association between 1-year mortality, initial hospital and intensive care length of stay, and pre-LTx RVSWI. Increased mPAP is a known risk for outcomes in LTx patients. Our findings support this fact and also show increased mortality with elevation of RVSWI, demonstrating the value
König, Inke R; Ziegler, Andreas; Bluhmki, Erich; Hacke, Werner; Bath, Philip M W; Sacco, Ralph L; Diener, Hans C; Weimar, Christian
An early and reliable prognosis for recovery in stroke patients is important for initiation of individual treatment and for informing patients and relatives. We recently developed and validated models for predicting survival and functional independence within 3 months after acute stroke, based on age and the National Institutes of Health Stroke Scale score assessed within 6 hours after stroke. Herein we demonstrate the applicability of our models in an independent sample of patients from controlled clinical trials. The prognostic models were used to predict survival and functional recovery in 5419 patients from the Virtual International Stroke Trials Archive (VISTA). Furthermore, we tried to improve the accuracy by adapting intercepts and estimating new model parameters. The original models were able to correctly classify 70.4% (survival) and 72.9% (functional recovery) of patients. Because the prediction was slightly pessimistic for patients in the controlled trials, adapting the intercept improved the accuracy to 74.8% (survival) and 74.0% (functional recovery). Novel estimation of parameters, however, yielded no relevant further improvement. For acute ischemic stroke patients included in controlled trials, our easy-to-apply prognostic models based on age and National Institutes of Health Stroke Scale score correctly predicted survival and functional recovery after 3 months. Furthermore, a simple adaptation helps to adjust for a different prognosis and is recommended if a large data set is available.
Cameli, M; Bernazzali, S; Lisi, M; Tsioulpas, C; Croccia, M G; Lisi, G; Maccherini, M; Mondillo, S
Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and the success of using left ventricular assist devices in patients with refractory heart failure. RV deformation analysis by speckle tracking echocardiography (STE) has recently allowed the analysis of RV longitudinal function. Using cardiac catheterization as the reference standard, this study aimed to explore the correlation between RV longitudinal function by STE and RV stroke work index (RVSWI) among patients referred for cardiac transplantation. Right heart catheterization and transthoracic echo-Doppler were simultaneously performed in 47 patients referred for cardiac transplant assessment due to refractory heart failure (ejection fraction 25.1 ± 4.5%). Thermodilution RV stroke volume and invasive pulmonary pressures were used to obtain RVSWI. RV longitudinal strain (RVLS) by STE was assessed averaging RV free-wall segments (free-wall RVLS). We also calculated. Tricuspid S' and tricuspid annular plane systolic excursion (TAPSE). No significant correlation was observed for TAPSE on tricuspid S' with RV stroke volume (r = 0.14 and r = 0.06, respectively). A close negative correlation between free-wall RVLS and RVSWI was found (r = -0.82; P rights reserved.
Cameli, Matteo; Lisi, Matteo; Righini, Francesca Maria; Tsioulpas, Charilaos; Bernazzali, Sonia; Maccherini, Massimo; Sani, Guido; Ballo, Piercarlo; Galderisi, Maurizio; Mondillo, Sergio
Right ventricular (RV) systolic function has a critical role in determining the clinical outcome and success of using left ventricular assist devices (LVADs) in patients with refractory heart failure. Tissue Doppler and M-mode measurements of tricuspid systolic motion (tricuspid S' and tricuspid annular plane systolic excursion [TAPSE]) are the most currently used methods for the quantification of RV longitudinal function; RV deformation analysis by speckle-tracking echocardiography (STE) has recently allowed the analysis of global RV longitudinal function. Using cardiac catheterization as the reference standard, this study aimed at exploring the correlation between RV longitudinal function by STE and RV stroke work index (RVSWI) in patients referred for cardiac transplantation. Right-side heart catheterization and transthoracic echo Doppler were simultaneously performed in 41 patients referred for cardiac transplantation evaluation for advanced systolic heart failure. Thermodilution RV stroke volume and invasive pulmonary pressures were used to obtain RVSWI. RV longitudinal strain (RVLS) by STE was assessed averaging all segments in apical 4-chamber view (global RVLS) and by averaging RV free-wall segments (free-wall RVLS). Tricuspid S' and TAPSE were also calculated. No significant correlations were found for TAPSE or tricuspid S' with RVSWI (r = 0.14; r = 0.06; respectively). Close negative correlations between global RVLS and free-wall RVLS with the RVSWI were found (r = -0.75; r = -0.82; respectively; both P rights reserved.
Hachinski, Vladimir; Donnan, Geoffrey A.; Gorelick, Philip B.; Hacke, Werner; Cramer, Steven C.; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M.; Lo, Eng H.; Skolnick, Brett E.; Furie, Karen L.; Hankey, Graeme J.; Kivipelto, Miia; Morris, John; Rothwell, Peter M.; Sacco, Ralph L.; Smith, Jr., Sidney C.; Wang, Yulun; Bryer, Alan; Ford, Gary A.; Iadecola, Costantino; Martins, Sheila C.O.; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M.; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A.; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P.; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H.; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K.; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M.; Davis, Stephen M.; Goldstein, Larry B.; Leys, Didier; Tuomilehto, Jaakko
Background and Purpose The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Methods Preliminary work was performed by 7 working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Results Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent ‘silo’ mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (e.g., social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build
Hachinski, Vladimir; Donnan, Geoffrey A; Gorelick, Philip B; Hacke, Werner; Cramer, Steven C; Kaste, Markku; Fisher, Marc; Brainin, Michael; Buchan, Alastair M; Lo, Eng H; Skolnick, Brett E; Furie, Karen L; Hankey, Graeme J; Kivipelto, Miia; Morris, John; Rothwell, Peter M; Sacco, Ralph L; Smith, Sidney C; Wang, Yulun; Bryer, Alan; Ford, Gary A; Iadecola, Costantino; Martins, Sheila C O; Saver, Jeff; Skvortsova, Veronika; Bayley, Mark; Bednar, Martin M; Duncan, Pamela; Enney, Lori; Finklestein, Seth; Jones, Theresa A; Kalra, Lalit; Kleim, Jeff; Nitkin, Ralph; Teasell, Robert; Weiller, Cornelius; Desai, Bhupat; Goldberg, Mark P; Heiss, Wolf-Dieter; Saarelma, Osmo; Schwamm, Lee H; Shinohara, Yukito; Trivedi, Bhargava; Wahlgren, Nils; Wong, Lawrence K; Hakim, Antoine; Norrving, Bo; Prudhomme, Stephen; Bornstein, Natan M; Davis, Stephen M; Goldstein, Larry B; Leys, Didier; Tuomilehto, Jaakko
The aim of the Synergium was to devise and prioritize new ways of accelerating progress in reducing the risks, effects, and consequences of stroke. Preliminary work was performed by seven working groups of stroke leaders followed by a synergium (a forum for working synergistically together) with approximately 100 additional participants. The resulting draft document had further input from contributors outside the synergium. Recommendations of the Synergium are: Basic Science, Drug Development and Technology: There is a need to develop: (1) New systems of working together to break down the prevalent 'silo' mentality; (2) New models of vertically integrated basic, clinical, and epidemiological disciplines; and (3) Efficient methods of identifying other relevant areas of science. Stroke Prevention: (1) Establish a global chronic disease prevention initiative with stroke as a major focus. (2) Recognize not only abrupt clinical stroke, but subtle subclinical stroke, the commonest type of cerebrovascular disease, leading to impairments of executive function. (3) Develop, implement and evaluate a population approach for stroke prevention. (4) Develop public health communication strategies using traditional and novel (eg, social media/marketing) techniques. Acute Stroke Management: Continue the establishment of stroke centers, stroke units, regional systems of emergency stroke care and telestroke networks. Brain Recovery and Rehabilitation: (1) Translate best neuroscience, including animal and human studies, into poststroke recovery research and clinical care. (2) Standardize poststroke rehabilitation based on best evidence. (3) Develop consensus on, then implementation of, standardized clinical and surrogate assessments. (4) Carry out rigorous clinical research to advance stroke recovery. Into the 21st Century: Web, Technology and Communications: (1) Work toward global unrestricted access to stroke-related information. (2) Build centralized electronic archives and
Quinn, Terence J; Langhorne, Peter; Stott, David J
Robust measures of functional outcome are required to determine treatment effects in stroke trials. Of the various measures available, the Barthel index (BI) is one of the more prevalent. We aimed to describe validity, reliability, and responsiveness (clinimetric properties) of the BI in stroke trials. Narrative review of published articles describing clinimetric properties or use of the BI as a stroke trial end point. Definitive statements on properties of BI are limited by heterogeneity in methodology of assessment and in the content of "BI" scales. Accepting these caveats, evidence suggests that BI is a valid measure of activities of daily living; sensitivity to change is limited at extremes of disability (floor and ceiling effects), and reliability of standard BI assessment is acceptable. However, these data may not be applicable to contemporary multicenter stroke trials. Substantial literature describing BI clinimetrics in stroke is available; however, questions remain regarding certain properties. The "BI" label is used for a number of instruments and we urge greater consistency in methods, content, and scoring. A 10-item scale, scoring 0 to 100 with 5-point increments, has been used in several multicenter stroke trials and it seems reasonable that this should become the uniform stroke trial BI.
Engberg, A; Bentzen, L; Garde, B
The aim of the present study was to investigate the predictive power of ratings of Barthel Index at Day 40 post stroke, compared with and/or combined with simultaneous ratings from a mobility scale (EG motor index) and a rather simple cognitive test scale (CT50). The parameter to be individually ...
Engberg, A; Bentzen, L; Garde, B
The aim of the present study was to investigate the predictive power of ratings of Barthel Index at Day 40 post stroke, compared with and/or combined with simultaneous ratings from a mobility scale (EG motor index) and a rather simple cognitive test scale (CT50). The parameter to be individually...... predicted was the need for special living facilities and support at discharge from a rehabilitation hospital, as well as six months later; 53 stroke patients with age median 68 years were included in this prospective study. It was shown that a combination of Barthel Index and CT50 had a stronger predictive...
van der Kemp, Jet; Kruithof, Willeke J.; Nijboer, Tanja C. W.; van Bennekom, Coen A. M.; van Heugten, Caroline; Visser-Meily, Johanna M. A.
A large proportion of stroke patients are unable to return to work (RTW), although figures vary greatly. A total of 121 mild-to-moderate stroke patients, who had a paid job at the time of their stroke were included (a) to quantify RTW and work satisfaction one-year post-stroke (using the Utrecht
Full Text Available Objective To investigate the influence of body mass index (BMI and abdominal girth index (AGI on the location and etiology of ischemic stroke in order to determine whether they can predict the etiology and pathogenesis of ischemic stroke. Methods A total of 185 patients with acute ischemic stroke and 155 cases of normal controls matched in sex, age and past medical history were enrolled in this study. Their height and weight were measured to calculate BMI, and abdominal circumference was measured to calculate AGI. Oxfordshire Community Stroke Project (OCSP and TOAST classification were carried out. Results BMI of overweight (BMI 24.00-27.90 kg/m2 subgroup (t = 2.060, P = 0.000 and obesity (BMI ≥ 28 kg/m2 subgroup (t = 2.315, P = 0.000 in patients with ischemic stroke was significantly higher than that in control group. AGI of abnomaly (AGI > 1 cm/kg subgroup in patients with ischemic stroke was significantly higher than that in control group (t = 1.021, P = 0.000. Based on OCSP classification, 185 patients with ischemic stroke were classified into 10 (5.41% of total anterior circulation infarct (TACI, 81 (43.78% of partial anterior circulation infarct (PACI, 56 (30.27% of lacunar infarct (LACI and 38 (20.54% of posterior circulation infarct (POCI. Only the PACI ratio among different BMI subgroups had statistical significance (H = 7.041, P = 0.011. PACI ratio in BMI 24.00-27.90 kg/m2 subgroup was significantly higher than that in BMI 1 cm/kg subgroup was significantly higher (χ2 = 11.461, P = 0.001, while SOE ratio was significantly lower ( χ2 = 4.558, P = 0.033 than that in AGI ≤ 1 cm/kg subgroup. Conclusions BMI and AGI can influence the location and etiology of ischemic stroke, which can be used to predict the etiology and pathogenesis of ischemic stroke. DOI: 10.3969/j.issn.1672-6731.2017.11.011
Padberg, Inken; Knispel, Petra; Zöllner, Susanne; Sieveking, Meike; Schneider, Alice; Steinbrink, Jens; Heuschmann, Peter U; Wellwood, Ian; Meisel, Andreas
Previous studies examining social work interventions in stroke often lack information on content, methods and timing over different phases of care including acute hospital, rehabilitation and out-patient care. This limits our ability to evaluate the impact of social work in multidisciplinary stroke care. We aimed to quantify social-work-related support in stroke patients and their carers in terms of timing and content, depending on the different phases of stroke care. We prospectively collected and evaluated data derived from a specialized "Stroke-Service-Point" (SSP); a "drop in" center and non-medical stroke assistance service, staffed by social workers and available to all stroke patients, their carers and members of the public in the metropolitan region of Berlin, Germany. Enquiries from 257 consenting participants consulting the SSP between March 2010 and April 2012 related to out-patient and in-patient services, therapeutic services, medical questions, medical rehabilitation, self-help groups and questions around obtaining benefits. Frequency of enquiries for different topics depended on whether patients were located in an in-patient or out-patient setting. The majority of contacts involved information provision. While the proportion of male and female patients with stroke was similar, about two thirds of the carers contacting the SSP were female. The social-work-related services provided by a specialized center in a German metropolitan area were diverse in terms of topic and timing depending on the phase of stroke care. Targeting the timing of interventions might be important to increase the impact of social work on patient's outcome.
As a support service manager in the stroke and rehabilitation unit at Addenbrooke's Hospital, Cambridge, I manage a team of band 3 nutrition assistants working effectively to meet the nutritional needs of all our patients (letters July 1).
Krebs, Hermano Igo; Volpe, Bruce; Hogan, Neville
We reviewed some of our initial insights about the process of upper-limb behavioral recovery following stroke. Evidence to date indicates that intensity, task specificity, active engagement, and focusing training on motor coordination are key factors enabling efficacious recovery. On modeling, experience with over 400 stroke patients has suggested a working model of recovery similar to implicit motor learning. Ultimately, we plan to apply these insights in the development of customized training paradigms to enhance recovery.
Tibaek, Sigrid; Dehlendorff, Christian
distinguished between types of UI (38% urge UI, 28% stress UI, and 14% other UI). There were significantly fewer stroke patients who reported UI by the Barthel Index compared to the DAN‐PSS questionnaire in term of urge UI (P stress UI (P PSS......To compare the prevalence of urinary incontinence (UI) measured by Barthel Index and the Danish Prostate Symptom Score (DAN‐PSS‐1) questionnaire in stroke patients. A cross‐sectional, hospital based survey was initiated whereby 407 stroke patients, average age 67 (SD 12) years with a mean interval...... of 101 days since onset of last stroke at inclusion. The stroke patients self‐reported the prevalence of UI by Barthel Index and the DAN‐PSS‐1 questionnaire. The prevalence of UI was 10.5% measured by the Barthel Index and 49% by the DAN‐PSS‐1 questionnaire. Furthermore, the DAN‐PSS‐1 questionnaire...
Wang, Ying-Chih; Kapellusch, Jay; Garg, Arun
As the field of rehabilitation shifts its focus towards improving functional capacity instead of managing disability, return to work (RTW) and return to the community emerge as key goals in a person's recovery from major disabling illness such as stroke. To compile important factors believed to influence RTW after a stroke. Based on a comprehensive literature review, we clustered similar factors and organized these factors based on the International Classification of Function, Disability and Health (ICF) framework: body functions or structure, activity participation, environmental factors and personal and psychosocial factors. Overall, stroke severity, as assessed by the degree of residual disability such as weakness, neurological deficit or impairments (speech, cognition, apraxia, agnosia), has been shown to be the most consistent negative predictor of RTW. Many factors such as the number of working years remaining until retirement, depression, medical history, and occupation need to be taken into consideration for stroke survivors, as they can influence RTW decision making. Stroke survivors who are flexible and realistic in their vocational goal and emotionally accept their disability appear more likely to return to work. There are many barriers to employment for stroke survivors ranging from physical and cognitive impairments to psychosocial and environmental factors.
... adjust your treatment as needed. Rehabilitation After a stroke, you may need rehabilitation (rehab) to help you recover. Rehab may include working with speech, physical, and occupational therapists. Language, ... may have trouble communicating after a stroke. You may not be able to find the ...
Gjærde, Line K.; Gamborg, Michael; Ängquist, Lars
IMPORTANCE: The incidence of ischemic stroke among young adults is rising and is potentially due to an increase in stroke risk factors occurring at younger ages, such as obesity. OBJECTIVES: To investigate whether childhood body mass index (BMI) and change in BMI are associated with adult ischemic....... Participants were 307 677 individuals (8899 ischemic stroke cases) with measured weight and height at ages 7 to 13 years. The dates of the analysis were September 1, 2015, to May 27, 2016. MAIN OUTCOMES AND MEASURES: Childhood BMI, change in BMI, and birth weight. Ischemic stroke events were divided into early...... (55 years) or late (>55 years) age at diagnosis. RESULTS: The study cohort comprised 307 677 participants (approximately 49% female and 51% male). During the study period, 3529 women and 5370 men experienced an ischemic stroke. At all ages from 7 to 13 years, an above-average BMI z score...
Steen, C; De Keyser, J; Sulter, G.
Background and Purpose-The Barthel Index (BI) and the Modified Rankin Scale (MRS) are commonly used scales that: measure disability or dependence in activities of daily living in stroke victims. The objective of this study was to investigate how these scales were used and interpreted in acute stroke
Method: One hundred and twelve participants with a diagnosis of stroke were prospectively enrolled. Fifteen clinical variables, the National Institutes of Health Stroke Scale (NIHSS) score on admission, and the barthel index at 7th day were the independent variables. The modified Rankin scale at 6 weeks was the outcome ...
Introduction: Stroke survivors (SSs) are largely inactive despite the benefits of exercise. Community-based exercise professionals (EPs) skilled in exercise prescription and personal motivation may have a role to play in promoting exercise for SSs. However, little is known about EPs’ opinions towards working with SSs. Aims: To investigate EPs’ opinions towards working with SSs. Objectives: To identify EPs’ barriers and facilitators towards working with SSs and to investigate their re...
Full Text Available In adult life, many of the social determinants of health are connected to working life. Yet, our knowledge of the role of work-related factors for the risk of stroke is fairly limited. In contemporary occupational health research, the Demand-Control Model (DCM is frequently used to measure work stress. Previous literature reviews of the association of work stress and cardiovascular disease (CVD do not include stroke as a specific outcome. Results regarding work stress and the risk of CVD are less evident in working women. With the focus on working women, the purpose of the present paper was to review the current research into the DCM in relation to stroke and to scrutinize potential gender differences. A literature search was performed and eight studies from three countries were identified. Based on the reviewed studies, there is some evidence that high psychological demands, low job control, and job strain are associated with increased stroke risk in women as well as in men. Any major reduction in deaths and disability from stroke is likely to come from decreasing social inequalities in health, and reducing work stress has a potential to contribute to a reduced risk of stroke in working populations.
Hannerz, Harald; Ferm, Linnea; Poulsen, Otto M; Pedersen, Betina Holbæk; Andersen, Lars L
It has been hypothesised that return to work rates among sick-listed workers increases with enterprise size. The aim of the present study was to estimate the effect of enterprise size on the odds of returning to work among previously employed stroke patients in Denmark, 2000-2006. We used a prospective design with a 2 year follow-up period. The study population consisted of 13,178 stroke patients divided into four enterprise sizes categories, according to the place of their employment prior to the stroke: micro (1-9 employees), small (10-49 employees), medium (50-249 employees) and large (>250 employees). The analysis was based on nationwide data on enterprise size from Statistics Denmark merged with data from the Danish occupational hospitalisation register. We found a statistically significant association (p = 0.034); each increase in enterprise size category was followed by an increase in the estimated odds of returning to work. The chances of returning to work after stroke increases as the size of enterprise increases. Preventive efforts and research aimed at finding ways of mitigating the effect are warranted.
Hartke, Robert J; Trierweiler, Robert
To describe the development and results of a detailed survey on return to work (RTW) after stroke completed by survivors at various stages of recovery. This study used a multi-method qualitative and quantitative research strategy to design and implement a 39-item survey for stroke survivors. Individual interviews, focus groups, and working committees were used to conceptualize the issues and translate them into a survey format. Surveys were distributed in regular and electronic mail. Groups of rehabilitation professionals, employers, and stroke survivors were assembled to review findings and obtain feedback to aide in interpretation. Overall 715 surveys were completed. The respondents were on average 54 years of age, mostly white, well-educated, urban dwelling, and in skilled occupations. Results are described in seven areas: financial, stroke impairments, organizational, work and psychological issues, interpersonal support, and therapy. Several salient findings are described including the role of fatigue, under utilization of vocational rehabilitation (VR) services, and motivational factors related to finances, self-esteem, work, and workplace relationships. Although earning an income is a strong motivation to RTW, salary decreases in importance when compared with other psychological benefits. Fatigue was rated as the second highest impairment barrier to RTW and persisted as a relevant impediment over time. Attitudes of co-workers and flexibility in work schedule were viewed as most helpful to the RTW process, whereas work stress was viewed as the greatest impediment to return. Only 24% of the sample received VR counseling with more respondents receiving counseling if they returned 6 months or longer after their stroke. Other trends and clinical and research implications are discussed.
Full Text Available Stroke is one of the most common and resource intensive diseases for society. Stroke in the working age population is increasing in different parts of the world. An incomplete return to work (RTW after sick leave post stroke entails negative consequences for the affected person and an economical burden for society. The aim of this study was to explore the RTW rate and factors associated with RTW in a six-year follow up post stroke.Data from 174 persons 63 years or younger, with first ever stroke in 2009-2010 in Gothenburg were analyzed. Baseline characteristics were collected through medical records and the Swedish Health Insurance Office provided information on sick leave up to 6 years post stroke. Time-to-event was presented and cox regression as well as logistic regression were used to analyze risk factors for no-RTW.The RTW rate was 74.7%, at the end of follow up. Participants continued to RTW until just over 3 years post stroke. Dependency at discharge (in the modified Rankin Scale and sick leave prior to the stroke were significant risk factors for no-RTW after 1 year with odds ratio 4.595 and 3.585, respectively. The same factors were significant in time-to-event within six years post stroke with hazard ratio 2.651 and 1.929, respectively.RTW after a stroke is incomplete, however RTW is possible over a longer period of time than previously thought. More severe disability at discharge from hospital and sick leave prior to the stroke were shown to be risk factors for no-RTW. This knowledge can contribute to more individualized vocational rehabilitation.
Suadicani, Poul; Andersen, Lars; Holtermann, Andreas
Investigate if the association between perceived psychological work pressure and risk of stroke is modified by socioeconomic status.......Investigate if the association between perceived psychological work pressure and risk of stroke is modified by socioeconomic status....
Ye, Xiao-qin; Xie, Yan-ming; Zou, Yi-huai; Zhao, Xin-quan; Han, Jian-hua; Wang, Xin-zhi; Ma, Yun-zhi; Bi, Qi; Xie, Qin-fan; Zhao, Jian-jun; Cao, Xiao-lan; Chen, Hong-xia; Wang Shi-zhong; Yan, Yong-mei; Han, Zu-cheng; Yi, Dan-hui; Wang, Yong-yan
To evaluate the effect of Naoshuantong capsule on the life quality of patients with ischemic stroke in six months of follow-up studies, and observe the adverse events. The results would provide reference for the secondary prevention on the recovery stage of ischemic stroke. 696 patients from 12 Class III Grade I hospitals nationwide were divided into 2 groups by central randomization system. The study group, 344 cases, were treated with Naoshuantong capsule plus Aspirin, and the control group, 352 cases, were treated with Aspirin. The patients were treated for 6 months. At the end of treatment, SS-QOL used for evaluating the quality of life was observed. The safety index was defined by adverse observation event. The incidence of adverse events and laboratory tests results were observed before and after treatment at the same time. The results indicated that compared to the control group, the treatment group had significant statistical difference in the impact of effort, self-care ability and the the work or labor ability of patients (P Asprin on improving the quality of life on patients with ischemic stroke, and it could be used in secondary prevention on the recovery stage of ischemic stroke. Naoshuantong capsule is safe and effective in the treatment of convalescence ischemic stroke.
Gjærde, Line K; Gamborg, Michael; Ängquist, Lars; Truelsen, Thomas C; Sørensen, Thorkild I A; Baker, Jennifer L
The incidence of ischemic stroke among young adults is rising and is potentially due to an increase in stroke risk factors occurring at younger ages, such as obesity. To investigate whether childhood body mass index (BMI) and change in BMI are associated with adult ischemic stroke and to assess whether the associations are age dependent or influenced by birth weight. This investigation was a population-based cohort study of schoolchildren born from 1930 to 1987, with follow-up through national health registers from 1977 to 2012 in Denmark. Participants were 307 677 individuals (8899 ischemic stroke cases) with measured weight and height at ages 7 to 13 years. The dates of the analysis were September 1, 2015, to May 27, 2016. Childhood BMI, change in BMI, and birth weight. Ischemic stroke events were divided into early (≤55 years) or late (>55 years) age at diagnosis. The study cohort comprised 307 677 participants (approximately 49% female and 51% male). During the study period, 3529 women and 5370 men experienced an ischemic stroke. At all ages from 7 to 13 years, an above-average BMI z score was positively associated with early ischemic stroke. At age 13 years, a BMI z score of 1 was associated with hazard ratios (HRs) of 1.26 (95% CI, 1.11-1.43) in women and 1.21 (95% CI, 1.10-1.33) in men. No significant associations were found for below-average BMI z scores. Among children with above-average BMI z scores at age 7 years, a score increase of 0.5 from ages 7 to 13 years was positively associated with early ischemic stroke in women (HR, 1.10; 95% CI, 1.01-1.20) and in men (HR, 1.08; 95% CI, 1.00-1.16). Similarly, among children with below-average BMI z scores at age 7 years, a score increase of 0.5 from ages 7 to 13 years was positively associated with early ischemic stroke in women (HR, 1.14; 95% CI, 1.06-1.23) and in men (HR, 1.10; 95% CI, 1.04-1.18). Adjusting for birth weight minimally affected the associations. Independent of birth weight, above
Saito, Yoko; Mineo, Mai; Yaeda, Jun
The number of Japanese working age persons who have experienced a stroke is significantly increasing. In such cases work support is an urgent issue. Although an active cooperation between medical institutions and work support agencies is critical, it has been insufficient, due to an absence of key coordinators with sufficient knowledge in both occupational therapy and work support or vocational rehabilitation. The present paper introduced two case studies to illustrate the importance of the cooperation between medical institutions and work support agencies and discussed reasons why medical institutions have difficulties in supporting persons who have experienced a stroke in their return to work.
Braun, Tobias; Marks, Detlef; Thiel, Christian; Grüneberg, Christian
To establish the validity and reliability of the de Morton Mobility Index (DEMMI) in patients with sub-acute stroke. This cross-sectional study was performed in a neurological rehabilitation hospital. We assessed unidimensionality, construct validity, internal consistency reliability, inter-rater reliability, minimal detectable change and possible floor and ceiling effects of the DEMMI in adult patients with sub-acute stroke. The study included a total sample of 121 patients with sub-acute stroke. We analysed validity (n = 109) and reliability (n = 51) in two sub-samples. Rasch analysis indicated unidimensionality with an overall fit to the model (chi-square = 12.37, p = 0.577). All hypotheses on construct validity were confirmed. Internal consistency reliability (Cronbach's alpha = 0.94) and inter-rater reliability (intraclass correlation coefficient = 0.95; 95% confidence interval: 0.92-0.97) were excellent. The minimal detectable change with 90% confidence was 13 points. No floor or ceiling effects were evident. These results indicate unidimensionality, sufficient internal consistency reliability, inter-rater reliability, and construct validity of the DEMMI in patients with a sub-acute stroke. Advantages of the DEMMI in clinical application are the short administration time, no need for special equipment and interval level data. The de Morton Mobility Index, therefore, may be a useful performance-based bedside test to measure mobility in individuals with a sub-acute stroke across the whole mobility spectrum. Implications for Rehabilitation The de Morton Mobility Index (DEMMI) is an unidimensional measurement instrument of mobility in individuals with sub-acute stroke. The DEMMI has excellent internal consistency and inter-rater reliability, and sufficient construct validity. The minimal detectable change of the DEMMI with 90% confidence in stroke rehabilitation is 13 points. The lack of any floor or ceiling effects on hospital admission indicates
Uyttenboogaart, M; Luijckx, G-J; Vroomen, P C A J; Stewart, R E; De Keyser, J
The effectiveness of therapeutic interventions in acute stroke trials is traditionally measured with the modified Rankin scale (mRs) and the Barthel index (BI). The mRs is a global disability scale divided into six steps from total independence to total dependence. The BI assesses ten basal
Fuglsang, S; Bendtsen, F; Christensen, E
Arterial function may be altered in patients with cirrhosis. We determined compliance of the arterial tree (C(1)) in relation to systemic and splanchnic hemodynamic derangement and clinical variables. C(1) and the stroke volume-pulse pressure index (SV/PP) were significantly higher (+62% and +40%...... predictors of SV/PP (P abnormalities in the arterial compliance of these patients....
Viosca, Enrique; Lafuente, Rubén; Martínez, José L; Almagro, Pedro L; Gracia, Antonio; González, Carmen
To investigate walking recovery after an acute stroke by using both a new functional classification and the Barthel Index, and to identify factors associated with good recovery. A 1-year inception cohort study. In- and outpatient setting in a district hospital. Twenty-six patients with a prognosis of intermediate walking recovery. Conventional physical rehabilitation under professional supervision. Walking capacity was assessed with a new classification scale and the Barthel Index during 5 patient evolution stages (admission to the hospital, hospital and physiotherapy discharge, clinical review, end of study). We also assessed the severity of the paresis of the affected lower limb, the time lapse between the stroke until the recovery of the weight-bearing capacity of the affected leg, and finally the time until standing balance was regained. We detected improvement in walking capacity throughout the follow-up process with our new classification scale, but not with the Barthel Index. Significant improvements were observed from the initial assessment, from 1 month onward, and from 3 to 12 months. The functional level of the final ambulation correlated negatively and significantly with the initial time to achieve weight-bearing capacity on the affected leg and also with the standing balance. There was also a significant correlation with the severity of lower-extremity paresis. Patients experienced an improvement in walking recovery throughout the first year after their stroke. The early weight-bearing capacity of the affected leg and standing balance were associated with higher walking levels 1 year after the stroke.
Martinsson, Louise; Eksborg, Staffan
It was the aim of this study to compare the Barthel Index (BI) and the activities of daily living (ADL) component of the Activity Index [AI(ADL)] regarding floor and ceiling effects, responsiveness and the predictive value for survival during the first week until 3 months after stroke onset. Basic ADL were assessed in 75 patients with ischaemic stroke. There was a strong concordance between BI and AI(ADL) scores at all time points (Kendall's taub = 0.7878, p scales had a substantial ceiling effect at 3 months. At 1 week, the baseline BI score was significantly higher in patients being alive as compared with those who had died, while their AI(ADL) score did not differ significantly. At 3 months, baseline BI and AI(ADL) scores were significantly higher in patients being alive as compared with those who had died. The predictive value of being alive at 1 week and 3 months did not differ between BI and AI(ADL). AI(ADL) is recommended to be used in addition as a complement to BI in patients with severe stroke since the floor effect with BI in the acute stage is significantly more pronounced than with AI(ADL), thus hampering the responsiveness. Copyright 2006 S. Karger AG, Basel.
Thanh G. Phan
Full Text Available Background and aimThe availability and access of hospital administrative data [coding for Charlson comorbidity index (CCI] in large data form has resulted in a surge of interest in using this information to predict mortality from stroke. The aims of this study were to determine the minimum clinical data set to be included in models for predicting disability after ischemic stroke adjusting for CCI and clinical variables and to evaluate the impact of CCI on prediction of outcome.MethodWe leverage anonymized clinical trial data in the Virtual International Stroke Trials Archive. This repository contains prospective data on stroke severity and outcome. The inclusion criteria were patients with available stroke severity score such as National Institutes of Health Stroke Scale (NIHSS, imaging data, and outcome disability score such as 90-day Rankin Scale. We calculate CCI based on comorbidity data in this data set. For logistic regression, we used these calibration statistics: Nagelkerke generalised R2 and Brier score; and for discrimination we used: area under the receiver operating characteristics curve (AUC and integrated discrimination improvement (IDI. The IDI was used to evaluate improvement in disability prediction above baseline model containing age, sex, and CCI.ResultsThe clinical data among 5,206 patients (55% males were as follows: mean age 69 ± 13 years, CCI 4.2 ± 0.8, and median NIHSS of 12 (IQR 8, 17 on admission and 9 (IQR 5, 15 at 24 h. In Model 2, adding admission NIHSS to the baseline model improved AUC from 0.67 (95% CI 0.65–0.68 to 0.79 (95% CI 0.78–0.81. In Model 3, adding 24-h NIHSS to the baseline model resulted in substantial improvement in AUC to 0.90 (95% CI 0.89–0.91 and increased IDI by 0.23 (95% CI 0.22–0.24. Adding the variable recombinant tissue plasminogen activator did not result in a further change in AUC or IDI to this regression model. In Model 3, the variable NIHSS at 24 h explains 87.3% of
A. N. Sumin
Full Text Available Aim. To study the factors associated with a poor annual prognosis in patients with acute stroke and prognostic role of pathological ankle-brachial index (ABI.Material and methods. The study included 345 patients (age 63.6±7.8 years, 181 males and 164 females with ischemic stroke that were observed for 1 year. All patients were divided into 2 groups: Group 1 included patients with favorable annual outcome of stroke; Group 2 included patients that during a year had any clinical events including death. All patients underwent a standard neurological and instrumental examination including assessment of peripheral arteries status by sphygmomanometry.Results. Both groups did not differ by age and sex. The frequency of unfavorable outcomes (death, re-stroke, cardiovascular events 1 year after ischemic stroke was 29.5%. Chronic heart failure, atrial fibrillation, previous cardiovascular events, presence of peripheral atherosclerosis, overweight were identified most commonly in Group 2. Patients of Group 2 initially had a rough neurological deficit. The pathological ABI was detected in 70.7% of patients in Group 2 vs 33.8% of patients in Group 1 (p=0.000001. A strong relationship of pathological ABI with a poor outcome of stroke was found by regression analysis.Conclusions. Detection of pathological ABI in patients with ischemic stroke makes it possible to reveal peripheral atherosclerosis and to carry out the targeted preventive measures in these patients. Risk stratification can contribute to more individual and effective secondary prevention in patients with cerebrovascular disease.
Full Text Available Background: Stroke is a disease with a high mortality rate and common cause of disability. Nutritional factors are strongly associated with this disease. Malnutrition in hospitalized patients increases the incidence of complications, prolonged the length of stay and also the cost of hospitalization. Furthermore, nutritional status of stroke patients can deteriorate during hospitalization. The prevalence of malnutrition in hospitalized stroke patients is about 6% to 62%. The objective of this study was to identify the nutritional status of hospitalized stroke patient. Methods: This was a descriptive cross-sectional study. Population of the study was hospitalized stroke patients at Neurology Ward, Kemuning Building Dr. Hasan Sadikin General Hospital Bandung, Indonesia from August until October 2014 who meet the inclusion criteria. Nutritional status was measured objectively using Body Mass Index (BMI and subjectively using Subjective Global Assessment (SGA method. The collected data were processed using frequency tabulation and percentage. Results: Twenty six hospitalized stroke patients were included in this study. The hospitalized patients with normal BMI were about 12 people (46.15%, 8 people were overweight (30.77%, 4 people were undernourished (15.39% and 2 people (7.69% were obese. According to SGA measurement, approximately 18 people (69.22% were moderately malnourished, and as much as 4 people (15.39% were in good nutrition, whereas 4 people (15.39% were severely malnourished. Conclusions: Majority of the hospitalized stroke patients has normal BMI and moderately malnourished based on SGA. DOI: 10.15850/amj.v4n2.1090
Merz, Zachary C; Van Patten, Ryan; Mulhauser, Kyler; Fucetola, Robert
The reintegration to normal living index (RNLI) is a global assessment of patient quality of life often utilized in stroke populations. Previous studies in various general disability samples have consistently reported a two-factor solution for the RNLI. Despite its common use with stroke patients, the RNLI has not been psychometrically evaluated in an exclusively stroke sample. This study is believed to represent the first factor analysis of the RNLI using a sample comprised exclusively of individuals who have survived cerebral infarct. The aim of this study is to evaluate the psychometric properties of the RNLI in assessing quality of life of stroke survivors. We retrospectively examined RNLI scores of 928 adults with strokes of varying severities as part of a multidisciplinary, interinstitutional collaboration across an academic medical center, acute care hospital, and rehabilitation center. We utilized a principal component factor analysis to evaluate the factor structure of the RNLI. Mean RNLI scores ±SD for the sample were 75.26 ± 19.85, ranging between 20 and 100. The Cronbach α was .94. A scree test for factor retention strongly suggested a single factor solution, explaining 64.50% of the total variance. Previous factor analyses on the RNLI utilizing general disability samples commonly report a two-factor solution. Our data support the presence of a single factor solution across the RNLI within a large sample comprised exclusively of stroke survivors. This suggests that the RNLI acts as more of a unitary measure of quality of life within a stroke sample relative to other disabled samples.
Jansa, Jelka; Pogacnik, Tomaz; Gompertz, Patrick
To evaluate the Extended Barthel Index with acute ischemic stroke patients. This prospective 1- to 6-week poststroke follow-up study was carried out using 33 newly diagnosed acute ischemic stroke patients who were admitted to the University Medical Centre Ljubljana, Department of Neurology. Measures used were Barthel Index (BI), Extended Barthel Index (EBI), Fugl-Meyer Motor Impairment Scale, 1-5 Self-Assessment scale, Rivermead Behavioural Memory Test. The EBI is a reliable scale in terms of internal consistency. The cognitive part is less reliable than the physical part of the EBI. It is a 3-dimensional scale as calculated by factor analysis (factor 1 with eigen value 8.2, factor 2 with eigen value 2.7 and factor 3 with eigen value 0.9). Criterion validity to the BI and the Fugl-Meyer Motor Impairment Scale was supported (P=0.1-0.001). External validity to the Self-Assessment scale was also supported (P<0.001). It is more sensitive to the changes in functional status that occur in the 1st 6 weeks poststroke than the original BI, although the ceiling effect was not really explained in this follow-up period. The EBI is a valid, reliable, 2- to 3-dimensional outcome measure of disability/activity for stroke patients. To some extent, it also reveals the level of patients' perception of their functional status.
Ryu, Wi-Sun; Lee, Seung-Hoon; Kim, Chi Kyung; Kim, Beom Joon; Yoon, Byung-Woo
Obesity is believed to increase the risks of ischemic stroke or coronary heart disease; however, regarding outcome after established vascular diseases, recent unexpected evidence has suggested that an increased body mass index (BMI) might have beneficial effects (obesity paradox). The aim of this study was to evaluate the independent association between BMI and long-term mortality after ischemic stroke. A total of 1,592 consecutive patients with ischemic stroke were prospectively included through our stroke cohort. In this study, the levels of BMI were classified based on guidelines for the Asian-Pacific population. Initial neurological severity was estimated by the National Institutes of Health Stroke Scale (NIHSS) score. Information on mortality was collected until the end of 2009, and the median follow-up period was 4 years. To examine the association between BMI and long-term mortality, we used Cox's proportional regression analysis. During follow-up, 23% of patients died. Linear regression analysis showed that the level of BMI was inversely related to initial neurological severity (p = 0.002). In the model of adjustment of age and gender using Cox's proportional regression analysis, this inverse trend was also significant (reference, normal weight; hazard ratio of underweight, 2.45; overweight, 0.77; obesity, 0.60). However, after adjustment of all covariates, including initial neurological severity, only the harmful effect of underweight remained significant (2.79; 95% CI, 1.92-4.05); however, beneficial effects of overweight and obesity did not. Our study showed that an independent association between BMI and long-term mortality after ischemic stroke was found only in underweight patients. The obesity paradox phenomenon seems to be limited, and might not be interpreted as a direct causal relationship due to a strong association with initial neurological severity. Copyright © 2011 S. Karger AG, Basel.
Al-Ali, Firas; Elias, John J.; Filipkowski, Danielle E.; Faber, James E.
The current strategy for intra-arterial treatment (IAT) of acute ischemic stroke focuses on minimizing time from ictus to revascularization and maximizing revascularization. Employing this strategy has yet to lead to improved rates of successful outcomes. However, the collateral blood supply likely plays a significant role in maintaining viable brain tissue during ischemia. Based on our prior work, we believe that only approximately 50% of patients are genetically predisposed to have sufficient collaterals for a good outcome following treatment, a concept we call the 50% barrier. The Capillary Index Score (CIS) has been developed as a tool to identify patients with a sufficient collateral blood supply to maintain tissue viability prior to treatment. Patients with a favorable CIS (f CIS) may be able to achieve a good outcome with IAT beyond an arbitrary time window. The CIS is incorporated into a proposed patient treatment algorithm. For patients suffering from a large stroke without aphasia, a non-enhanced head CT should be followed by CT angiography (CTA). For patients without signs of stroke mimics or visible signs of structural changes due to large irreversible ischemia, CTA can help confirm the vascular occlusion and location. The CIS can be obtained from a diagnostic cerebral angiogram, with IAT offered to patients categorized as f CIS. PMID:25954243
Hsieh, Yu-Wei; Wang, Chun-Hou; Wu, Shwu-Chong; Chen, Pau-Chung; Sheu, Ching-Fan; Hsieh, Ching-Lin
The interpretation of the change scores of the Barthel Index (BI) in follow-up or outcome studies has been hampered by the fact that its minimal clinically important difference (MCID) has not been determined. This article was written to establish the MCID of the BI in stroke patients. Both anchor-based and distribution-based methods were used to establish the MCID. In the anchor-based method, 43 stroke inpatients participated in a follow-up study designed to determine the MCID of the BI using patients' global ratings of the activities of daily living function on a 15-point Likert-type scale. The mean change scores on the 20-point scale of the BI of the MCID group, based on the patients' ratings on the Likert-type scale, served as the first estimate of the MCID. In the distribution-based method, 56 chronic stroke patients participated in the test-retest reliability study to determine the MCID of the BI. One standard error of measurement (SEM) served as the second estimate for the MCID. The larger MCID value of the 2 estimates was chosen as the MCID of the BI. In the anchor-based study, there were 20 patients in the MCID group, with a mean change score of 1.85 points (ie, the first MCID estimate). In the distribution-based study, the SEM based on test-retest agreement was 1.45 points (ie, the second MCID estimate). The MCID of the BI in stroke patients was estimated to be 1.85 points. The authors' results, within the limitations of their design, suggest that if the mean BI change score within a stroke group has reached 1.85 points in a study, the change score on the BI can be perceived by patients as important and beyond measurement error (ie, such a change score is clinically important).
Noaparast, M.; Delavarian, M.
Work index is a measure to define ores/minerals grind ability which is significantly used in Bond (1952) to calculate the required energy of ores' comminution. Work index for any material is experimentally calculated under specific conditions and it is a certain value. To understand the effect of changing control screen in work index calculation, three different ores Alam-Kuh Pb-Zn ore, Sarcheshmeh Cu Ore, and Abe-Garm Region Dolomite were tested, using 425, 212,150 and 100 micron screens (totally 12 sets of tests). Results showed that the work index values increase with the increases of screen size. The relation between root of screen size and fines produced per revolution of mill and also, screen size and size of products out of which 80% passes through this size appeared to be linear for all three different ores. The constants of these linear equations were estimated using regression technique
Chemla, Denis; Castelain, Vincent; Zhu, Kaixian; Papelier, Yves; Creuzé, Nicolas; Hoette, Susana; Parent, Florence; Simonneau, Gérald; Humbert, Marc; Herve, Philippe
The mean pulmonary artery pressure (mPAP) replaces mean systolic ejection pressure (msePAP) in the classic formula of right ventricular stroke work (RVSW) = (mPAP - RAP) × stroke volume, where RAP is mean right atrial pressure. Only the steady work is thus taken into account, not the pulsatile work, whereas pulmonary circulation is highly pulsatile. Our retrospective, high-fidelity pressure study tested the hypothesis that msePAP was proportional to mPAP, and looked at the implications for RVSW. Eleven patients with severe, precapillary pulmonary hypertension (PH) (six patients with idiopathic pulmonary arterial hypertension and five with chronic thromboembolic PH; mPAP = 57 ± 10 mm Hg) were studied at rest and during mild to moderate exercise. Eight non-PH control subjects were also studied at rest (mPAP = 16 ± 2 mm Hg). The msePAP was averaged from end diastole to dicrotic notch. In the full data set (53 pressure-flow points), mPAP ranged from 14 to 99.5 mm Hg, cardiac output from 2.38 to 11.1 L/min, and heart rate from 53 to 163 beats/min. There was a linear relationship between msePAP and mPAP (r² = 0.99). The msePAP matched 1.25 mPAP (bias, -0.5 ± 2.6 mm Hg). Results were similar in the resting non-PH group and in resting and the exercising PH group. This implies that the classic formula markedly underestimates RVSW and that the pulsatile work may be a variable 20% to 55% fraction of RVSW, depending on RAP and mPAP. At rest, RVSW in patients with PH was twice as high as that of the non-PH group (P work fraction was similar between the two groups (26 ± 4% vs 24 ± 1%) because of the counterbalancing effects of high RAP (11 ± 5 mm Hg vs 4 ± 2 mm Hg), which increases the fraction, and high mPAP, which decreases the fraction. Our study favored the use of an improved formula that takes into account the variable pulsatile work fraction: RVSW = (1.25 mPAP - RAP) × stroke volume. Increased RAP and increased mPAP have opposite effects on the pulsatile work
Fuglsang, S; Bendtsen, F; Christensen, E
Arterial function may be altered in patients with cirrhosis. We determined compliance of the arterial tree (C(1)) in relation to systemic and splanchnic hemodynamic derangement and clinical variables. C(1) and the stroke volume-pulse pressure index (SV/PP) were significantly higher (+62% and +40....../PP on one side and age, sex, body weight, portal pressure, systemic hemodynamics, biochemical variables, and severity of disease on the other. In the multiple-regression analysis, sex, age, mean arterial blood pressure, systemic vascular resistance, and biochemical variables were significant independent...
Tuttolomondo, Antonino; Casuccio, Alessandra; Buttà, Carmelo; Pecoraro, Rosaria; Di Raimondo, Domenico; Della Corte, Vittoriano; Arnao, Valentina; Clemente, Giuseppe; Maida, Carlo; Simonetta, Irene; Miceli, Giuseppe; Lucifora, Benedetto; Cirrincione, Anna; Di Bona, Danilo; Corpora, Francesca; Maugeri, Rosario; Iacopino, Domenico Gerardo; Pinto, Antonio
Adherence to a Mediterranean Diet appears to reduce the risk of cardiovascular disease, cancer, Alzheimer's disease, and Parkinson's disease, as well as the risk of death due to cardiovascular disease. No study has addressed the association between diagnostic subtype of stroke and its severity and adherence to a Mediterranean Diet in subjects with acute ischemic stroke. To evaluate the association between Mediterranean Diet adherence, TOAST subtype, and stroke severity by means of a retrospective study. The type of acute ischemic stroke was classified according to the TOAST criteria. All patients admitted to our ward with acute ischemic stroke completed a 137-item validated food-frequency questionnaire adapted to the Sicilian population. A scale indicating the degree of adherence to the traditional Mediterranean Diet was used (Me-Di score: range 0-9). 198 subjects with acute ischemic stroke and 100 control subjects without stroke. Stroke subjects had a lower mean Mediterranean Diet score compared to 100 controls without stroke. We observed a significant positive correlation between Me-Di score and SSS score, whereas we observed a negative relationship between Me-Di score and NIHSS and Rankin scores. Subjects with atherosclerotic (LAAS) stroke subtype had a lower mean Me-Di score compared to subjects with other subtypes. Multinomial logistic regression analysis in a simple model showed a negative relationship between MeDi score and LAAS subtype vs. lacunar subtype (and LAAS vs. cardio-embolic subtype). Patients with lower adherence to a Mediterranean Diet are more likely to have an atherosclerotic (LAAS) stroke, a worse clinical presentation of ischemic stroke at admission and a higher Rankin score at discharge. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
de Zwart, B. C. H.; Frings-Dresen, M. H. W.; Van Duivenbooden, J. C.
The goal of the study was to assess the test-retest reliability of the Work Ability Index (WAI) questionnaire. Reliability was tested using a test-retest design with a 4 week interval between measurements. Valid data were collected among 97 elderly construction workers aged 40 years and older. We
Uyttenboogaart, Maarten; Stewart, Roy E; Vroomen, Patrick C A J; De Keyser, Jacques; Luijckx, Gert-Jan
Background and Purpose - There is little agreement on how to assess outcome in acute stroke trials. Cutoff scores for the Barthel Index (BI) and modified Rankin Scale (mRS) are frequently arbitrarily chosen to dichotomize favorable and unfavorable outcome. We investigated sensitivity and specificity
Kusumaningsih, W.; Rachmayanti, S.; Werdhani, R. A.
Hypertension and diabetes mellitus are the most common risk factors of stroke. The study aimed to determine the relationship between hypertension and diabetes mellitus risk factors and dependence on assistance with activities of daily living in chronic stroke patients. The study used an analytical observational cross-sectional design. The study’s sample included 44 stroke patients selected using the quota sampling method. The relationship between the variables was analyzed using the bivariate chi-squared test and multivariate logistic regression. Based on the chi-squared test, the relationship between the Modified Shah Barthel Index (MSBI) score and hypertension and diabetes mellitus as stroke risk factors, were p = 0.122 and p = 0.002, respectively. The logistic regression results suggest that hypertension and diabetes mellitus are stroke risk factors related to the MSBI score: p = 0.076 (OR 4.076; CI 95% 0.861-19.297) and p = 0.007 (OR 22.690; CI 95% 2.332-220.722), respectively. Diabetes mellitus is the most prominent risk factor of severe dependency on assistance with activities of daily living in chronic stroke patients.
Parvataneni, Krishnaji; Olney, Sandra J; Brouwer, Brenda
Knowledge of associations between changes in muscle work with changes in gait speed could assist gait training in persons with stroke. The purpose of the study was to determine changes in the work of major muscle groups during gait that were associated with increases in walking speed of persons with stroke following training. The gait of 28 subjects (14 males, 14 females) with mean age of 64.2 (SD 11.7) years, at 4.8 (SD 6.9) years post stroke was studied using two-dimensional motion analysis before and after a strength training program. Outcome variables were changes in gait speed and changes in work associated with the hip flexors and extensors, knee flexors and extensors and ankle plantar flexors bilaterally. A stepwise linear regression analysis determined best positive work predictors of changes in gait speed. Hip extension work in early stance and ankle plantarflexion work in late stance of the affected side accounted for 74.9% of the variance in change of gait speed; a second model showed that hip extension work in early stance of the affected and less-affected sides accounted for 74.3%, a similar amount of variance. This work is the first to explore the changes in muscle work during gait that are associated with speed increases in persons with stroke. Augmenting hip extensor work in early stance on both sides, as well as ankle plantarflexion thrust on the affected side may be particularly beneficial in increasing the speed of walking of persons with stroke.
Lee, Ya-Chen; Chen, Sheng-Shiung; Koh, Chia-Lin; Hsueh, I-Ping; Yao, Kai-Ping; Hsieh, Ching-Lin
The Barthel Index (BI) assesses actual performance of activities of daily living (ADL). However, comprehensive assessment of ADL functions should include two other constructs: self-perceived difficulty and ability. The aims of this study were to develop two BI-based Supplementary Scales (BI-SS), namely, the Self-perceived Difficulty Scale and the Ability Scale, and to examine the construct validity of the BI-SS in patients with stroke. The BI-SS was first developed by consultation with experts and then tested on patients to confirm the clarity and feasibility of administration. A total of 306 participants participated in the construct validity study. Construct validity was investigated using Mokken scale analysis and analyzing associations between scales. The agreement between each pair of the scales' scores was further examined. The Self-perceived Difficulty Scale consisted of 10 items, and the Ability Scale included 8 items (excluding both bladder and bowel control items). Items in each individual scale were unidimensional (H ≥ 0.5). The scores of the Self-perceived Difficulty and Ability Scales were highly correlated with those of the BI (rho = 0.78 and 0.90, respectively). The scores of the two BI-SS scales and BI were significantly different from each other (pscales assessed unique constructs. The BI-SS had overall good construct validity in patients with stroke. The BI-SS can be used as supplementary scales for the BI to comprehensively assess patients' ADL functions in order to identify patients' difficulties in performing ADL tasks, plan intervention strategies, and assess outcomes.
Uyttenboogaart, M; Luijckx, G-J; Vroomen, P C A J; Stewart, R E; De Keyser, J
The effectiveness of therapeutic interventions in acute stroke trials is traditionally measured with the modified Rankin scale (mRs) and the Barthel index (BI). The mRs is a global disability scale divided into six steps from total independence to total dependence. The BI assesses ten basal activities of daily living, of which eight assess level of dependence (bathing, grooming, using stairs, dressing, feeding, toilet use, transfers and walking). The aim of this study was to investigate the relationship between the mRs and the total scores and item-scores of the BI. During a period of 3 months mRs and BI scores were collected from two multicentre randomised, placebo-controlled trials with lubeluzole (515 and 519 patients). In each patient we compared the mRs grades with the total BI score and the scores on the ten subitems. For both trials there was extensive overlap of BI scores between mRs grades and a wide range in BI scores among patients with mRs grades 3 and 4. We also found discrepancies between the BI item-scores and mRs grades. About 40% of patients with mRs grades 1 (able to carry out all usual activities) and 2 (able to look after own affairs without assistance) were not independent on at least one activity of the BI. In both studies, about 30% of the patients needed help or supervision for walking, although they were classified as mRs 3 (requiring some help but able to walk without assistance). Investigators in stroke trials use the mRs as a subjective global disability scale, and they do not strictly take into account limitations in performing specific basal activities of daily living, as assessed by the BI, to assign mRs grades.
Full Text Available Due to recent results from clinical intra-arterial treatment for acute ischemic stroke (IAT-AIS trials such as the Interventional Management of Stroke (IMS III, IAT-AIS and the merit of revascularization have been contested. Even though intra-arterial treatment (IAT has been shown to improve revascularization rates, a corresponding increase in good outcomes has only recently been noted. Even though a significant percentage of patients achieve good revascularization in a timely manner, results do not translate into good clinical outcomes (GCOs. Based on a review of the literature, the authors suspect limited good clinical outcomes following timely and successful revascularization are due to poor patient selection that led to futile and possibly even harmful revascularization. The Capillary Index Score (CIS is a simple angiography-based scale that can potentially be used to improve patient selection to prevent revascularization being performed on patients who are unlikely to benefit from treatment. The CIS characterizes presence of capillary blush related to collateral flow as a marker of residual viable tissue, with absence of blush indicating the tissue is no longer viable due to ischemia. By only selecting patients with a favorable CIS for IAT, the rate of GCOs should consistently approach 80-90%. Current methods of patient selection are primarily dependent on time from ischemia. Time from cerebral ischemia to irreversible tissue damage seems to vary from patient to patient, however, so focusing on viable tissue based on the CIS rather than relying on an artificial time window seems to be a more appropriate approach to patient selection.
Glozier, Nick; Hackett, Maree L; Parag, Varsha; Anderson, Craig S
Few data exist on the determinants of return to paid work after stroke, yet participation in employment is vital to a person's mental well-being and role in society. This study aimed to determine the frequency and determinants of return to work, in particular the effect of early psychiatric morbidity, in a population-based study of stroke survivors. The third Auckland Regional Community Stroke (ARCOS) study was a prospective, population-based, stroke incidence study undertaken in Auckland, New Zealand during 2002 to 2003. After a baseline assessment early after stroke, data were collected on all survivors at 1 and 6 months follow-up. Multiple variable logistic regression was used to determine predictors of return to paid work. Data are reported with odds ratios (OR) and 95% confidence intervals (CI). Among 1423 patients registered with first-ever strokes, there were 210 previously in paid employment who survived to 6 months, of whom 155 (74%) completed the GHQ-28 and 112 (53%) had returned to paid work. Among those cognitively competent, psychiatric morbidity at 28 days was a strong independent predictor of not returning to work (Odds Ratio 0.39; 95% CI 0.22 to 0.80). Non-New Zealand European ethnicity (OR 0.40; 95% CI 0.17 to 0.91), prior part-time, as opposed to full-time, employment 0.36 (0.15 to 0.89), and not being functionally independent soon after the stroke 0.28 (0.13 to 0.59) were the other independent age- and gender-adjusted predictors of not successfully returning to paid work. About half of previously employed people return to paid employment after stroke, with psychiatric morbidity and physical disability being independent, yet potentially treatable, determinants of this outcome. Appropriate management of both emotional and physical sequelae would appear necessary for optimizing recovery and return to work in younger adults after stroke.
Moriya, M; Aoki, C; Sakatani, K
Physical exercise enhances prefrontal cortex activity and improves working memory performance in healthy older adults, but it is not clear whether this remains the case in post-stroke patients. Therefore, the aim of this study was to examine the acute effect of physical exercise on prefrontal cortex activity in post-stroke patients using near-infrared spectroscopy (NIRS). We studied 11 post-stroke patients. The patients performed Sternberg-type working memory tasks before and after moderate intensity aerobic exercise (40 % of maximal oxygen uptake) with a cycling ergometer for 15 min. We measured the NIRS response at the prefrontal cortex during the working memory task. We evaluated behavioral performance (response time and accuracy) of the working memory task. It was found that physical exercise improved behavioral performance of the working memory task compared with the control condition (p prefrontal cortex activation, particularly in the right prefrontal cortex (p prefrontal cortex activity and improves working memory performance in post-stroke patients.
Viola, Fiorella; Larese Filon, Francesca
Job satisfaction and work ability are important in the nursing profession to ensure good working conditions and to reduce work-related diseases and illness. Psychosocial factors such as social support and decision latitude (autonomy) could have a role in cardiovascular diseases, low back pain, injuries and sick leave. To evaluate work ability, job satisfaction, psychosocial factors and diseases in 10 departments of the Monfalcone Hospital. The Work Ability Index (WAI) questionnaire and Karasek Job Content Questionnaire with other questions related to working conditions and diseases were administered to 160 nurses working in 10 departments. The response rate was 90%. SPSS Statistic packaging was used for statistical analysis. The study population had a mean age of 41.1 ± 7 years and the majority were female (81.25%). WAI gave a rating of over 37 points (good and excellent) for 86.4%, with an average of 39.9 ± 5.9 in women and 40.6 ± 6.4 in men. The WAI differences between the departments were significant with Medicine and Surgery showing lower values (p=0.012). WAI was significantly lower in subjects with sick leave higher than 10 days per year (p=0.000) and in subjects with cardiovascular diseases (p=0.031). Our study showed very good working conditions for nurses. A follow-up of the analyzed population over time will add further information on this aspect.
Wang, Haoyu; Chen, Yintao; Guo, Xiaofan; Chang, Ye; Sun, Yingxian
Cardiometabolic index (CMI) has been recognized as a novel and practical marker for the assessment of cardiometabolic risk as it is independently related to diabetes and atherosclerotic progression. This study tested the hypothesis that CMI represents a risk of ischemic stroke in a general population of rural China. From July 2012 to August 2013, we examined data from a large cross-sectional study of 11,345 participants (mean age 53.8 years; 60.8% females) who underwent biochemical determinations and anthropometric measurements in rural areas of northeast China. Ischemic stroke was documented as a history of cerebrovascular events and verified by medical record review. The prevalence of ischemic stroke was given to 3.1% of females and 3.2% of males. The cardio-metabolic profile was notably more adverse in ischemic stroke groups, irrespective of gender. A dose-response manner was detected for the prevalence of ischemic stroke, exhibiting a significant increase from the lowest to the highest quartiles of CMI (1.2% to 6.4% in females, P for trend<0.001; 2.3% to 4.3% in males, P for trend = 0.017). In multivariable analysis, for every 1 SD increment in CMI, the probability of ischemic stroke increased by 18% in females and 14% in males, respectively. The odds ratios for ischemic stroke comparing the top versus bottom quartiles of CMI were 2.047 (95%CI: 1.168-3.587) for females and 1.722 (95%CI: 1.019-2.910) for males. According to the area under receiver operating characteristic (AUC), the discrimination power of CMI in predicting ischemic stroke was relatively higher for females (AUC: 0.685) than males (AUC: 0.573). The strong and independent association of CMI with ischemic stroke in females, in comparison with the much lesser degree in males, provides further insight to better stratify by sex in investigations of ischemic stroke and solidly corroborates the potential role of ischemic stroke prevention targeted at CMI.
Abramov, Dmitry; Haglund, Nicholas A; Di Salvo, Thomas G
Although milrinone infusion is reported to benefit left ventricular function in chronic left heart failure, few insights exist regarding its effects on pulmonary circulation and right ventricular function. We retrospectively reviewed right heart catheterization data at baseline and during continuous infusion of milrinone in 69 patients with advanced heart failure and analyzed the effects on ventricular stroke work indices, pulmonary vascular resistance and pulmonary arterial compliance. Compared to baseline, milrinone infusion after a mean 58 ± 61 days improved mean left ventricular stroke work index (1540 ± 656 vs. 2079 ± 919 mmHg·mL/m 2 , p = 0.0007) to a much greater extent than right ventricular stroke work index (616 ± 346 vs. 654 ± 332, p = 0.053); however, patients with below median stroke work indices experienced a significant improvement in both left and right ventricular stroke work performance. Overall, milrinone reduced left and right ventricular filling pressures and pulmonary and systemic vascular resistance by approximately 20%. Despite an increase in pulmonary artery capacitance (2.3 ± 1.6 to 3.0 ± 2.0, p = 0.013) and a reduction in pulmonary vascular resistance (3.8 ± 2.3 to 3.0 ± 1.7 Wood units), milrinone did not reduce the transpulmonary gradient (13 ± 7 vs. 12 ± 6 mmHg, p = 0.252), the pulmonary artery pulse pressure (25 ± 10 vs. 24 ± 10, p = 0.64) or the pulmonary artery diastolic to pulmonary capillary wedge gradient (2.0 ± 6.5 vs. 2.4 ± 6.0, p = 0.353). Milrinone improved left ventricular stroke work indices to a greater extent than right ventricular stroke work indices and had beneficial effects on right ventricular net input impedance, predominantly via augmentation of left ventricular stroke volume and passive unloading of the pulmonary circuit. Patients who had the worst biventricular performance benefited the most from chronic milrinone infusion.
Ghandehari, Kavian; Ghandehari, Kosar; Saffarian-Toosi, Ghazaleh; Masoudinezhad, Shahram; Yazdani, Siamak; Nooraddin, Ali; Ebrahimzadeh, Saeed; Ahmadi, Fahimeh; Abrishamchi, Fatemeh
This study tried to develop an Asian Stroke Disability Scale (ASDS) and compared its interrater reliability with modified Rankin Scale (mRS) and Barthel Index (BI). Three items including self-care, mobility, and daily activities were selected as variables for development of the ASDS. The variables were provisionally graded on a 2- to 4-point scale based on the importance of each item. Each of the variables was categorized into 3 categories. Afterward, 125 rater-patient assessments for each scale (mRS, BI, and ASDS) were performed on 25 stroke patients by 5 raters. For categorization of functional impairment as minor or major, the scores of mRS, BI and ASDS were categorized as ≤ 2 and > 2, 0.05). The ASDS is easy to use, requires less than 1 minute to complete and is as valid as mRS and BI in assessment of functional impairment of patients with stroke.
Hannerz, Harald; Mortensen, Ole S; Poulsen, Otto M
In the period 1997-2005, the Danish government initiated a series of legislative changes aimed at facilitating RTW (return to work) in the Danish population. In the present study, we investigated the odds of being gainfully occupied ca. two years after stroke as a function of onset calendar year...
Safari, Shahram; Akbari, Jafar; Kazemi, Meghdad; Mououdi, Mohammad Amin; Mahaki, Behzad
Two great changes in developed countries are taking place: populations are ageing and becoming increasingly overweight. Combination of these factors with shift work is a risk factor for work ability and mental workload that are dynamic processes which change greatly throughout an individual's work life. The aim of this study was to investigate mental workload and work ability in textile workers and to identify factors which affect work ability and mental workload. This cross-sectional study was carried out among 194 male workers in textile industry. Employees based on their job group and work conditions have been divided into 6 categories. They completed work ability index and mental workload questionnaires during three work shifts. Body mass index (BMI) and demographic details were recorded. All of the participants rated their work ability as moderate with high mental workload. The mean WAI and mental workload in age group were significant. The mean BMI was 25.5 kg/m(2) (standard deviation 4.1) and the mean age was 40.22 years. There was a statistically significant correlation between work ability index and shift work. Unlike the previous study, a decrease point in WAI started in early age that may be due to life-style work and another psychological factor; on the other hand, NASA-TLX revealed high score in six subscales that can be another reason for low WAI.
Lim, Ji-Hye; Cheon, Song-Hee
[Purpose] The purpose of this study was to understand factors present at baseline that affect outcome and healthcare utilization post-stroke. We investigated the association between the Charlson Comorbidity Index (CCI) score and functional outcome (length of stay) after hemorrhagic and ischemic stroke. [Subjects and Methods] Data from the Korean National Hospital Discharge In-depth Injury Survey for 6 years, from 2005 to 2010, were used. The t-test and analysis of variance were carried out to compare average differences in the length of stay with the general characteristics in accordance with CCI. Multiple regression analysis was carried out using dummy variables to look at factors affecting stroke patients' length of stay. [Results] Independent variables with significant relationships with the log-transformed length of stay included gender, type of insurance, the size of city of residence, the number of beds in the hospital, the location of the medical institution, hospitalization path, receipt of physical therapy, treatment involving brain surgery, death, the type of stroke, and CCI. [Conclusion] The results of the present study suggests that CCI independently influences the length of stay after ischemic and hemorrhagic stroke and that variables with significant relationships with the log-transformed length of stay need to be continuously managed.
Jenkinson, Crispin; Fitzpatrick, Ray; Crocker, Helen; Peters, Michele
The Stroke Impact Scale (SIS) covers 8 dimensions and a composite disability score. This study evaluates the SIS in the UK context, and develops a single index and an 8-item short form. Patients with a diagnosis of stroke were recruited through general practices in London and the North-West of England. Patients completed the SIS and the EQ-5D. Internal consistency of the SIS dimensions and the disability score ranged from α 0.86 to 0.95. Complete data were available on 73 questionnaires (48.34%). Factor analysis suggested the 8 domains could be aggregated into a single index. A short-form SIS (SF-SIS) index was created by summing 1 item per dimension. Selected items were those that most highly correlated with their respective domain score (ρ ranged from 0.77-0.94, PSIS index scores were highly correlated with those gained from the parent form (ρ=0.98; PSIS index and SF-SIS index with the EQ-5D was identical (ρ=0.83; PSIS, or relevant items on the SF-SIS, were highly correlated (ρ=0.97; PSIS covers aspects of health, which are of importance to stroke patients, and the dimensions were found to have high levels of internal consistency in the UK context. The amount of incomplete data suggests that the length of the questionnaire may present a substantial patient burden. In comparison to the parent form the SF-SIS can accurately provide the disability score and overall index score with considerable brevity.
Condon, Marie; Guidon, Marie
Stroke survivors (SSs) are largely inactive despite the benefits of exercise. Exercise professionals (EPs), skilled in exercise prescription and motivation, may have a role in promoting exercise among SSs. However, the number of EPs working with SSs is estimated to be low. This study aimed to investigate EPs' opinions on working with SSs by rating their agreement of barriers and facilitators to working with SSs. The study also investigated EPs skills, interest and experience working with SSs and the relationship between EPs' barriers and facilitators with their training on stroke. A descriptive cross-sectional study was conducted using a researcher-designed online survey between October and December 2015. Purposive sampling was used to survey EPs on the Register of Exercise Professionals in Ireland (n = 277). The response rate was 31% (87/277). Only 22% (19/86) of EPs had experience working with SSs. The primary barriers rated by EPs included insufficient training on psychological problems post-stroke (84%; 61/73), unsuitable equipment for SSs (69%; 50/73) and the level of supervision SSs require (56%; 41/73). The primary facilitators rated included access to suitable equipment (97%; 69/71), practical (100%; 71/71) and theoretical training (93%; 66/71) on stroke. Respondents with no training on stroke were significantly more likely to agree that insufficient training on psychological problems post-stroke and lack of experience were barriers. Seventy-six per cent of EPs (58/76) were interested in one-to-one exercise sessions with SSs but only 53% (40/76) were interested in group sessions. Eighty-two per cent of EPs (62/76) rated their motivational skills as good or very good but 42% (32/76) indicated having only acceptable skills dealing with psychological problems. Results indicate that EPs are interested in working with SSs despite limited experience and practical barriers. Training opportunities on stroke need to be developed; taking into account EPs' barriers
Full Text Available The purpose of this research was to preliminarily study the Mae Moh lignite grindability tests emphasizing onHardgrove grindability and approximate work index determination respectively. Firstly, the lignite samples were collected,prepared and analyzed for calorific value, total sulfur content, and proximate analysis. After that the Hardgrove grindabilitytest using ball-race test mill was performed. Knowing the Hardgrove indices, the Bond work indices of some samples wereestimated using the Aplan’s formula. The approximate work indices were determined by running a batch dry-grinding testusing a laboratory ball mill. Finally, the work indices obtained from both methods were compared. It was found that allsamples could be ranked as lignite B, using the heating value as criteria, if the content of mineral matter is neglected. Similarly,all samples can be classified as lignite with the Hargrove grindability indices ranging from about 40 to 50. However, there isa significant difference in the work indices derived from Hardgrove and simplified Bond grindability tests. This may be due todifference in variability of lignite properties and the test procedures. To obtain more accurate values of the lignite workindex, the time-consuming Bond procedure should be performed with a number of corrections for different milling conditions.With Hardgrove grindability indices and the work indices calculated from Aplan’s formula, capacity of the roller-racepulverizer and grindability of the Mae Moh lignite should be investigated in detail further.
Cioncoloni, D; Piu, P; Tassi, R; Acampa, M; Guideri, F; Taddei, S; Bielli, S; Martini, G; Mazzocchio, R
The modified Rankin Scale (mRS) and the Barthel Index (BI) are the most common clinimetrical instruments for measuring disability after stroke. This study investigated the relationship between the BI and the mRS at multiple time points after stroke. The BI, which is a widely used instrument for longitudinal follow-up post-stroke, was used as reference to determine the effect of time on the sensitivity of the mRS in differentiating functional recovery. Ninety-two patients with first stroke and hemispheric brain lesion were evaluated using the BI and mRS at 10 days, 3 and 6 months. The Kruskal-Wallis test was applied to examine median differences in BI among the mRS levels at 10 days, 3 and 6 months with Dunn's correction for multigroup comparison. The Mann and Whitney test was used to compare median differences in BI scores between two aggregations of mRS grades (mRS=0-2, mRS=3-5) at the same time periods after stroke. BI score distribution amongst mRS grades overlapped at 10 days, differentiating only between extreme grades (no disability vs severe disability). At 3 months, independent patients with slight disability could be distinguished from dependent patients with marked disability. At 6 months, grade 2 and 3 overlapped no more, differentiating independence (class 0-2) from dependence (class 3-5). The largest transition to an independent functional status occurred from grade 4, at 3 months. Maximum sensitivity of mRS in differentiating functional recovery is reached at six months post-stroke.
Di Maria, Michael V; Burkett, Dale A; Younoszai, Adel K; Landeck, Bruce F; Mertens, Luc; Ivy, D Dunbar; Friedberg, Mark K; Hunter, Kendall S
Right ventricular (RV) failure is a key determinant of mortality in children with pulmonary arterial hypertension (PAH). RV stroke work (RVSW) can be estimated as the product of RV systolic pressure and stroke volume. The authors have shown that RVSW predicts adverse outcomes in this population when derived from hemodynamic data; noninvasive assessment of RVSW may be advantageous but has not been assessed. There are few data validating noninvasive versus invasive measurements in children with PAH. The aim of this study was to compare echocardiographically derived RVSW with RVSW determined from hemodynamic data. This was a retrospective study, including subjects with idiopathic PAH and minor or repaired congenital heart disease. Forty-nine subjects were included, in whom cardiac catheterization and echocardiography were performed within 1 month. Fourteen additional patients were included in a separate cohort, in whom catheterization and echocardiography were performed simultaneously. Catheterization-derived RVSW was calculated as RV systolic pressure × (cardiac output/heart rate). Echocardiographically derived RVSW was calculated as 4 × (peak tricuspid regurgitant jet velocity)(2) × (pulmonary valve area × velocity-time integral). Statistics included the intraclass correlation coefficient and Bland-Altman analysis. Echocardiographically derived RVSW was linearly correlated with invasively derived RVSW (r = 0.74, P work was related to indexed pulmonary vascular resistance (r = 0.43, P = .002), tricuspid annular plane systolic excursion (r = 0.41, P = .004), and RV wall thickness (r = 0.62, P work, a potential novel index of RV function, can be estimated noninvasively and is related to pulmonary hemodynamics and other indices of RV performance. Copyright © 2015 American Society of Echocardiography. Published by Elsevier Inc. All rights reserved.
Lee, Namheon; Das, Ashish; Banerjee, Rupak K; Gottliebson, William M
Adult patients who underwent tetralogy of Fallot repair surgery (rTOF) confront life-threatening ailments due to right ventricular (RV) myocardial dysfunction. Pulmonary valve replacement (PVR) needs to be performed to restore the deteriorating RV function. Determination of correct timing to perform PVR in an rTOF patient remains subjective, due to the unavailability of quantifiable clinical diagnostic parameters. The objective of this study is to evaluate the possibility of using RV body surface area (BSA)-indexed stroke work (SW(I)) to quantify RV inefficiency in TOF patients. We hypothesized that RV SW(I) required to push blood to the lungs in rTOF patients is significantly higher than that of normal subjects. Seven patients with rTOF pathophysiology and eight controls with normal RV physiology were registered for this study. Right ventricular volume and pressure were measured using cardiac magnetic resonance imaging and catheterization, respectively. Statistical analysis was performed to quantify the difference in SW(I) between the RV of the rTOF and control groups. Right ventricular SW(I) in rTOF patients (0.176 ± 0.055 J/m(2)) was significantly higher by 93.4% (P = 0.0026) than that of controls (0.091 ± 0.030 J/m(2)). Further, rTOF patients were found to have significantly higher (P < 0.05) BSA normalized RV end-systolic volume, end-systolic pressure, and regurgitation fraction than control subjects. Ejection fraction and peak ejection rate of rTOF patients were significantly lower (P < 0.05) than those of controls. Patients with rTOF pathophysiology had significantly higher RV SW(I) compared with subjects with normal RV physiology. Therefore, RV SW(I) may be useful to quantify RV inefficiency in rTOF patients along with currently used clinical end points such as RV volume, pressure, regurgitation fraction, and ejection fraction.
Kivimäki, Mika; Jokela, Markus; Nyberg, Solja T
-response association for stroke, with RR estimates of 1·10 (95% CI 0·94-1·28; p=0·24) for 41-48 working hours, 1·27 (1·03-1·56; p=0·03) for 49-54 working hours, and 1·33 (1·11-1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (ptrendEmployees who work......, Economic and Social Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working......BACKGROUND: Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. METHODS: We...
Schiller, Petter; Vikholm, Per; Hellgren, Laila
Right ventricular (RV) failure is a major cause of morbidity and mortality after left ventricular assist device (LVAD) placement and remains hard to predict. We hypothesized that partial surgical exclusion of the RV with a modified Glenn shunt during LVAD treatment would reduce RV stroke work. An LVAD was implanted in eight pigs and a modified Glenn shunt was constructed. A conductance pressure-volume catheter was placed in the right ventricle through the apex. Haemodynamic data and pressure-volume loops were obtained at the following time periods: (i) baseline, (ii) open shunt, (iii) LVAD with closed shunt and (iii) LVAD and open shunt. During LVAD therapy, the right atrial (RA) pressure increased from 9 mmHg (9-9) to 15 mmHg (12-15), P = 0.01. RV stroke volume increased from 30 ml (29-40) to 51 ml (42-53), P < 0.01. Also, RV stroke work increased to 708 mmHg ml (654-1193) from 535 mmHg ml (424-717), P = 0.04, compared with baseline. During LVAD therapy in combination with a Glenn shunt, the RA pressure decreased from 15 mmHg (12-15) to 10 mmHg (7-11) when compared with LVAD therapy only, P = 0.01. A decrease in RV stroke work from 708 mmHg ml (654-1193) to 465 mmHg ml (366-711), P = 0.04, was seen when the LVAD was combined with a shunt, not significantly different from the baseline value (535 mmHg ml). The developed pressure in the right ventricle decreased from 29 mmHg (26-32) to 21 mmHg (20-24), P < 0.01. The pressure-volume loops of the RV show a significant reduction of RV stroke work during the use of the shunt with LVAD treatment. A modified Glenn shunt reduced RV volumes, RV stroke work and RA pressure during LVAD therapy in an experimental model of heart failure in pigs. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
Fuentes, Amanda; Westmacott, Robyn; Deotto, Angela; deVeber, Gabrielle; Desrocher, Mary
There is a dearth of research examining working memory (WM) following pediatric arterial ischemic stroke (AIS). This study assesses the WM patterns of 32 children, aged 6 to 14 years, with a history of unilateral AIS and 32 controls using a paradigm based on Baddeley and Hitch's multi-component WM model. The results indicate compromised WM in children with AIS relative to controls and parent reports confirm higher rates of dysfunction. Supplementary analyses of impairment confirm higher rates in children with AIS, ranging from 31.25% to 38.70% on performance-based measures and 50.00% on parent reports, compared to 0.00% to 21.88% on performance-based measures in controls and 15.63% on parent reports. Continual follow-up is recommended given that a subset of children with stroke appear to be at risk for WM impairment. Moreover, the subtle nature of WM challenges experienced by many children who have experienced a stroke increases the likelihood that WM impairment could go undetected. The long-term trajectories of WM in the pediatric stroke population remains unknown and future studies are needed to track changes in WM functioning over time.
Gibbon, Bernard; Watkins, Caroline; Barer, David; Waters, Karen; Davies, Steve; Lightbody, Liz; Leathley, Michael
Teamwork is regarded as the cornerstone of rehabilitation. It is recognized that the skills of a multiprofessional team are required to provide the care and interventions necessary to maximize the patient's potential to recover from his/her stroke. Critical evaluation of team working is lacking in the literature. Indeed, there is no consensus on a precise definition of teamwork or on the best way of implementing it, beyond a general exhortation to members to work to the same therapeutic plan in a cohesive manner. The literature has highlighted many problems in team working, including petty jealousies, ignorance and a perceived loss of autonomy and threat to professional status. To determine if the use of team co-ordinated approaches to stroke care and rehabilitation would improve staff attitudes to team working. A pre-post design was adopted using 'The Team Climate Inventory' to explore attitudes to team working before and after introducing the interventions. Local Research Ethics Committee approval was obtained. Improvements in attitudes towards team working suggest that the introduction of team co-ordinated approaches (integrated care pathways and team notes) did not result in greater team working. The introduction of an integrated care pathway and team notes is based on an assumption that they would enhance team working. The results suggest that the introduction of team co-ordinated approaches (team notes and care pathways) do not improve attitudes to team working, teams appear to take a long time to establish cohesion and develop shared values.
Ervasti, Jenni; Virtanen, Marianna; Lallukka, Tea; Friberg, Emilie; Mittendorfer-Rutz, Ellenor; Lundström, Erik; Alexanderson, Kristina
We examined the risk of disability pension before and after ischaemic heart disease (IHD) or stroke event, the burden of stroke compared with IHD and which factors predicted disability pension after either event. A population-based cohort study with follow-up 5 years before and after the event. Register data were analysed with general linear modelling with binary and Poisson distributions including interaction tests for event type (IHD/stroke). All people living in Sweden, aged 25‒60 years at the first event year, who had been living in Sweden for 5 years before the event and had no indication of IHD or stroke prior to the index event in 2006‒2008 were included, except for cases in which death occurred within 30 days of the event. People with both IHD and stroke were excluded, resulting in 18 480 cases of IHD (65%) and 9750 stroke cases (35%). Disability pension. Of those going to suffer IHD or stroke event, 25% were already on disability pension a year before the event. The adjusted OR for disability pension at first postevent year was 2.64-fold (95% CI 2.25 to 3.11) for people with stroke compared with IHD. Economic inactivity predicted disability pension regardless of event type (OR=3.40; 95% CI 2.85 to 4.04). Comorbid mental disorder was associated with the greatest risk (OR=3.60; 95% CI 2.69 to 4.83) after an IHD event. Regarding stroke, medical procedure, a proxy for event severity, was the largest contributor (OR=2.27, 95% CI 1.43 to 3.60). While IHD event was more common, stroke involved more permanent work disability. Demographic, socioeconomic and comorbidity-related factors were associated with disability pension both before and after the event. The results help occupational and other healthcare professionals to identify vulnerable groups at risk for permanent labour market exclusion after such an event. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial
Full Text Available Objectives: To explore the diagnostic performance of 25-hydroxyvitamin D (25(OHD, parathyroid hormone (PTH, bone alkaline phosphatase (BALP, and osteocalcin (OC in predicting stroke. Methods: This retrospective survey was conducted in The Second Affiliated Hospital to Nanchang University, Nanchang, Jiangxi Province, China. involved 121 cerebral infarction patients and 103 cerebral hemorrhage patients as the experimental groups, 100 volunteers as the healthy control group and 80 brain trauma patients as the disease control group. The 25(OHD, PTH, BALP, and OC levels of all participants were measured by electrochemiluminescence immunoassay. Results: The serum concentration of 25(OHD in stroke patients was appreciably lower than that of the control groups (p<0.05, and subsequently, the deficiency level of 25(OHD in the stroke population was considerably higher than that of the control groups (p<0.05. The serum concentrations of PTH and OC in stroke patients exceeded those found in the control groups (p<0.05, and the abnormal level in the stroke patients was also higher than that of the control. Compared with the control group, BALP concentrations in cerebral infarction patients were increased significantly. Additionally, abnormal levels of BALP in stroke patients were found to be higher than those in the control groups. However, concentrations and abnormal levels of BALP in cerebral hemorrhage patients were not found to be significantly different than those found in cerebral infarction and the control groups, There were no substantial differences between the 2 control groups. Conclusion: Lack of 25(OHD and excessive PTH, BALP, and OC could indicate a high risk of stroke.
Burau, Viola; Carstensen, Kathrine; Lou, Stina; Kuhlmann, Ellen
Patient-centred care based on needs has been gaining momentum in health policy and the workforce. This creates new demand for interprofessional teams and redefining roles and tasks of professionals, yet little is known on how to implement new health policies more effectively. Our aim was to analyse the role and capacity of health professions in driving organisational change in interprofessional working and patient-centred care. A case study of the introduction of interprofessional, early discharge teams in stroke rehabilitation in Denmark was conducted with focus on day-to-day coordination of care tasks and the professional groups' interests and strategies. The study included 5 stroke teams and 17 interviews with different health professionals conducted in 2015. Professional groups expressed highly positive professional interest in reorganised stroke rehabilitation concerning patients, professional practice and intersectoral relations; individual professional and collective interprofessional interests strongly coincided. The corresponding strategies were driven by a shared goal of providing needs-based care for patients. Individual professionals worked independently and on behalf of the team. There was also a degree of skills transfer as individual team members screened patients on behalf of other professional groups. The study identified supportive factors and contexts of patient-centred care. This highlights capacity to improve health workforce governance through professional participation, which should be explored more systematically in a wider range of healthcare services.
Green, J; Forster, A; Young, J
To assess the test-retest reliability of a range of outcome measures in stroke patients. Twenty-two patients > 1 year post-stroke were tested twice at an interval of 1 week using the Barthel Index (BI); the Rivermead Mobility Index (RMI); the Nottingham Extended Activities of Daily Living Scale (NEADL); and the Frenchay Activities Index (FAI). The mean difference (bias) and reliability coefficient (random error) were calculated for the total scores. Percentage agreement and the kappa coefficient were used to analyse individual items. The mean differences and reliability coefficients were BI 0.4 +/- 2.0, RMI 0.3 +/- 2.2, the NEADL 0.6 +/- 5.6, FAI -0.6 +/- 7.1. There was little bias between assessments. The performance of the BI and RMI were better with lower random error. The NEADL and FAI did not perform as well having larger random error components. Percentage agreements were generally high especially for the BI (>75%) and RMI (>85%), but there was considerable variation in the kappa coefficients. Measurement of basic activities of daily living and mobility as measured by the BI and RMI is reliable post-stroke. Measurements used to assess extended activities of daily living were less reliable in this study.
Mauss, Daniel; Li, Jian; Angerer, Peter
The aim of this study was to test the psychometric properties of a short questionnaire for work-related stress entitled Work Well index (WWi) and its interaction with different variables of self-reported health. An online survey was conducted in a sample of 1,218 employees (51% female) in four countries of an international insurance company. Internal consistency reliability, factorial validity, convergent validity and criterion validity of the 10-item WWi were analyzed. Good internal consistency reliability of the WWi was obtained (Cronbach's α coefficient = 0.85). Confirmatory factor analysis showed a satisfactory model fit of the data (AGFI = 0.92). The WWi was highly correlated to conceptually close constructs such as demand-control, effort-reward imbalance and workplace social capital (p instrument measuring psychosocial stress at work. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Monaghan, J; Channell, K; McDowell, D; Sharma, A K
To determine the extent to which three forms of multidisciplinary team (MDT) care in stroke rehabilitation meet the standards set by the United Kingdom National Service Framework (NSF). Consecutive assessment of the three forms of care was completed. The study included three groups of 25 stroke inpatients on the stroke rehabilitation ward. (1) A standard weekly MDT meeting using a standard form for documentation; (2) a standard MDT meeting using a newly devised form; and (3) a novel MDT ward round using the new form, and attended by doctors. MDT ward rounds result in significantly better consideration of patients' needs (median 7 per patient compared with 0 and 5 in phases one and two), enhanced SMART (specific, measurable, achievable, realistic and time framed) goal-setting (median 3 per patient compared to 1 in phases one and two); greater patient involvement (12 patients compared to 0 and 4 in phases one and two); and improved team working (measured using the team climate inventory) than do MDT meetings. In the present study, standard weekly MDT meetings did not meet the standards set for MDT care by the NSF. The use of a MDT ward round allows these standards to be achieved.
Uyttenboogaart, Maarten; Stewart, Roy E; Vroomen, Patrick C A J; De Keyser, Jacques; Luijckx, Gert-Jan
There is little agreement on how to assess outcome in acute stroke trials. Cutoff scores for the Barthel Index (BI) and modified Rankin Scale (mRS) are frequently arbitrarily chosen to dichotomize favorable and unfavorable outcome. We investigated sensitivity and specificity of BI cutoff scores in relation to the mRS to obtain the optimal corresponding BI and mRS scores. BI and mRS scores were collected from 1034 ischemic stroke patients. Sensitivity and specificity were calculated for BI cutoff scores from 45 to 100 in mRS score 1, 2, and 3 and were plotted in receiver operator characteristic (ROC) curves. The cutoff scores for the BI with the highest sum of sensitivity and specificity were 95 (sensitivity 85.6%; specificity 91.7%), 90 (sensitivity 90.7%; specificity 88.1%), and 75 (sensitivity 95.7%; specificity, 88.5%) for, respectively, mRS 1, 2, and 3. The area under the ROC curve was 0.933 in mRS 1, 0.960 in mRS 2, and 0.979 in mRS 3. The optimal cutoff scores for the BI were 95 for mRS 1, 90 for mRS 2, and 75 for mRS 3. For future acute stroke trials that assess stroke outcome with the BI and mRS, we recommend the use of these BI cutoff score(s) with the corresponding mRS cutoff score(s), to ensure the use of consistent and uniform end points.
Lallukka, Tea; Ervasti, Jenni; Lundström, Erik; Mittendorfer-Rutz, Ellenor; Friberg, Emilie; Virtanen, Marianna; Alexanderson, Kristina
Although a stroke event often leads to work disability, diagnoses behind work disability before and after stroke are largely unknown. We examined the pre-event and postevent trends in diagnosis-specific work disability among patients of working age. We included all new nonfatal stroke events in 2006-2008 from population-based hospital registers in Sweden among women and men aged 25 to 60 years (n=12 972). Annual days of diagnosis-specific work disability were followed for 4 years before and after stroke. Repeated measures negative binomial regression models using the generalized estimating equations method were fitted to examine trends in diagnosis-specific work disability before and after the event. Already during the 4 pre-event years, work disability attributed to circulatory diseases increased among women (rate ratio, 1.99; 95% confidence interval, 1.68-2.36) and men (rate ratio, 2.20; 95% confidence interval, 1.88-2.57). Increasing trends before stroke were also found for work disability attributed to mental disorders, musculoskeletal diseases, neoplasms, diseases of the nervous, respiratory, and digestive systems, injuries, and diabetes mellitus. As expected, a sharp increase in work disability days attributed to circulatory diseases was found during the first year after the event among both sexes. Overall, during 4 years after the stroke, there was a decreasing trend for circulatory diseases and injuries, whereas the trend was increasing for nervous diseases and diabetes mellitus. Work disability attributed to several mental and somatic diagnoses is higher already before a stroke event. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Noly, Pierre-Emmanuel; Haddad, François; Arthur-Ataam, Jennifer; Langer, Nathaniel; Dorfmüller, Peter; Loisel, Fanny; Guihaire, Julien; Decante, Benoit; Lamrani, Lilia; Fadel, Elie; Mercier, Olaf
Mechanisms of right ventricular (RV) adaptation to chronic pressure overload are not well understood. We hypothesized that a lower capillary density (CD) to stroke work ratio would be associated with more fibrosis and RV maladaptive remodeling. We induced RV chronic pressure overload over a 20-week period in 2 piglet models of pulmonary hypertension; that is, a shunt model (n = 5) and a chronic thromboembolic pulmonary hypertension model (n = 5). We assessed hemodynamic parameters and RV remodeling as well as RV CD, fibrosis, and angiogenic factors expression. Although RV was similarly hypertrophied in both models, maladapted RV remodeling with impaired systolic function was only seen in chronic thromboembolic pulmonary hypertension group members who had lower CD (484 ± 99 vs 1213 ± 74 cap/mm 2 ; P work ratio (0.29 ± 0.07 vs 0.82 ± 0.16; P = .02), higher myocardial fibrosis (15.4% ± 3.8% vs 8.0% ± 2.5%; P work ratio) was associated with greater degree of myocardial fibrosis and RV dysfunction and could be a promising index of RV maladaptation. Further studies are needed to understand the underlying mechanisms. Copyright © 2017 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
Marcinkiewicz, Andrzej; Walusiak-Skorupa, Jolanta
The classification of an acute vascular episode, both heart infarct and stroke, as an accident at work poses difficulties not only for post accidental teams, but also to occupational health professionals, experts and judges at labor and social insurance courts. This article presents the case of a 41-year-old office worker, whose job involved client services. While attending a very aggressive customer she developed solid stress that resulted in symptoms of the central nervous system (headache, speech disturbances). During her hospitalisation at the neurological unit ischemic stroke with transient mixed type aphasia was diagnosed. Magnetic resonance imaging (MRI) scan of the head revealed subacute ischemia. After an analysis of the accident circumstances, the employer's post accidental team decided that ischemic stroke had been an accident at work, because it was a sudden incident due to an external cause inducing work-related traumatic stroke. As a primary cause tough stress and emotional strain due to the situation developed while attending the customer were acknowledged. During control medical check up after 5 months the patient was found to be fit for work, so she could return to work. However, it should be noted that such a check up examination of subjects returning to work after stroke must be holistic, including the evaluation of job predispositions and health education aimed at secondary prevention of heart and vascular diseases with special reference to their risk factors. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.
Full Text Available The classification of an acute vascular episode, both heart infarct and stroke, as an accident at work poses difficulties not only for post accidental teams, but also to occupational health professionals, experts and judges at labor and social insurance courts. This article presents the case of a 41-year-old office worker, whose job involved client services. While attending a very aggressive customer she developed solid stress that resulted in symptoms of the central nervous system (headache, speech disturbances. During her hospitalisation at the neurological unit ischemic stroke with transient mixed type aphasia was diagnosed. Magnetic resonance imaging (MRI scan of the head revealed subacute ischemia. After an analysis of the accident circumstances, the employer’s post accidental team decided that ischemic stroke had been an accident at work, because it was a sudden incident due to an external cause inducing work-related traumatic stroke. As a primary cause tough stress and emotional strain due to the situation developed while attending the customer were acknowledged. During control medical check up after 5 months the patient was found to be fit for work, so she could return to work. However, it should be noted that such a check up examination of subjects returning to work after stroke must be holistic, including the evaluation of job predispositions and health education aimed at secondary prevention of heart and vascular diseases with special reference to their risk factors. Med Pr 2015;66(4:595–599
Al-Ali, Firas; Elias, John J.; Tomsick, Thomas A.; Liebeskind, David S; Broderick, Joseph P.
Background and Purpose Until recently, acute ischemic stroke (AIS) trials have failed to show a benefit of endovascular therapy (EVT) compared to standard therapy, leading some authors to recommend decreasing the time from ictus to revascularization (TIR) to improve outcomes. We hypothesize that improving patient selection using the capillary index score (CIS) may also be a useful strategy. Methods CIS was calculated, blinded to outcome, from pre-treatment diagnostic cerebral angiograms for 78 subjects in the Interventional Management of Stroke (IMS) III database with internal carotid artery (ICA) and middle cerebral artery trunk (M1) occlusion. The CIS was dichotomized into favorable (fCIS = 2 or 3) and poor (pCIS = 0 or 1). Outcomes were categorized based on the modified Rankin Scale (mRS) score at 90-days (0 to 2 considered a good outcome). Modified thrombolysis in cerebral infarction (mTICI) score 2b or 3 was considered good revascularization. Multivariable logistic regression was performed to relate CIS, TIR, mTICI score, and NIH Stroke Scale score to good outcomes. Results Only CIS and mTICI score were correlated with good outcomes (p < 0.01). Patients with fCIS and good revascularization achieved 71% mRS ≤ 2, compared to 13% for patients with pCIS and good revascularization. Conclusions In this subset of patients from the IMS III Trial, CIS and mTICI were strong predictors of outcome after endovascular reperfusion. Using the CIS to improve patient selection could be a powerful strategy to improve rate of good outcomes in EVT. A randomized trial is needed. Clinical Trial Registration: www.clinicaltrials.gov. Unique identifier: NCT00359424 PMID:25953374
Full Text Available Stroke scales can be classified as clinicometric scales and functional impairment, handicap scales. All studies describing stroke scales were reviewed by internet searching engines with the final search performed on January 1, 2013. The following string of keywords was entered into search engines; stroke, scale, score and disability. Despite advantages of modified National Institute of Health Stroke Scale and Scandinavian stroke scale comparing to the NIHSS, including their simplification and less inter-rater variability; most of the stroke neurologists around the world continue using the NIHSS. The modified Rankin scale (mRS and Barthel index (BI are widely used functional impairment and disability scales. Distinction between grades of mRS is poorly defined. The Asian stroke disability scale is a simplified functional impairment, handicap scale which is as valid as mRS and BI. At the present time, the NIHSS, mRS and BI are routine stroke scales because physicians have used to work with these scales for more than two decades, although it could not be an acceptable reason. On the other side, results of previous stroke trials, which are the basis of stroke management guidelines are driven using these scales.
Bok, Tae Hoon; Kong, Qi; Nam, Kweon Ho; Choi, Jay Chol; Paeng, Dong Guk
In the present paper, the ultrasound blood images were measured at both the human radial artery(RA) and common carotid artery(CCA), depending on the age, and the pulsatility index of blood echogenicity(PIBE) was analyzed. In addition, the ultrasound blood images were measured at both RA and CCA of both the stroke patients and the control group, and PIBE was compared. PIBE of RA for the young group was similar with that for the old group (0.13±0.21 and 0.16±0.03). PIBE of CCA for the young group, however, was larger than that for the old group (0.70±0.21 and 0.32±0.01), and was more variable depending on the subject. Similarly, the fibrinogen concentrations of the patients (336±61 and 340±126 mg/dl) were more than that of the control group (264±38 and 43 mg/dl), for both RA and CCA. The results indicate the possibility of the ultrasonic test on the correlation between erythrocyte aggregation and stroke, and it is expected that the in-vivo EA measurement would be clinically useful.
Naghdi, S; Ansari, N N; Mansouri, K; Olyaei, G R; Asgari, A; Kazemnejad, A
The Modified Ashworth Scale (MAS) is currently a widely used clinical scale to evaluate muscle spasticity. However, it lacks reliability and the validity, of the MAS as a clinical measure of muscle spasticity has been challenged. The aim of the present study was to examine the validity of the MAS in patients with wrist flexor spasticity after stroke by using the Hslope/Mslope (Hslp/Mslp) ratio as the new index of alpha motoneuron excitability. Twenty-seven adult patients (14 women and 13 men) with first ever stroke resulting in hemiplegia with a mean (SD, range) age of 57.9 (11.6, 37-75) were included in the study. The main outcome measures were the MAS for the clinical assessment of spasticity, and the Hslp/Mslp for the neurophysiological evaluation. There was not a significant correlation between the MAS scores and Hslp/Mslp ratio (r = 0.38, p > 0.05). The mean of the Hslp/Mslp did not show a hierarchical increase with the MAS scores. The findings indicate that the MAS is not a valid and ordinal level measure of muscle spasticity.
Sangha, Harpreet; Lipson, David; Foley, Norine; Salter, Katherine; Bhogal, Sanjit; Pohani, Gina; Teasell, Robert W
In order to compare the frequency and patterns of use of the Barthel Index (BI) and Functional Independence Measure (FIM) in stroke rehabilitation trials, all randomized controlled trials (RCTs) of stroke rehabilitation published between 1968 and 2002 were identified and reviewed to determine the frequency with which the BI and FIM measures were used relative to other measures of disability. The date and location of each study citing either the FIM or the BI were also recorded. Studies were assigned ratings of methodological quality based on the physiotherapy evidence database (PEDro) scoring system. Comparisons of the age, frequency and continents of origin and methodological quality of the studies were explored. Results indicate that the BI and FIM were the most common measures of disability used in RCTs examining stroke rehabilitation. However, the BI was used more often than the FIM (n=86, Pscale use in stroke rehabilitation research.
Review published clinical trial studies on pharmacological treatment of stroke using both the Barthel Index (BI) and Modified Rankin Scale (MRS) as outcome measures, and to highlight the differences in psychometric properties and cut-off scores through a systematic review. A systematic literature search on stroke studies involving a pharmacological treatment was conducted between 1955-2008. Key words included Barthel index, Rankin, modified Rankin, pharmacotherapy, validity, reliability, responsiveness, sensitivity, specificity, outcomes, psychometrics, prediction, randomized clinical trials, analysis, and stroke. All search terms were limited to Medical Subjects Headings (MESH) terms, English-language abstracts, and human subjects. Overall, 44 studies were identified, six studies comparing the psychometric properties of the BI and the MRS, 24 studies on use of both the BI and the MRS in clinical stroke trials involving a pharmacological treatment, and 14 studies reviewed the cut-off scores and statistical issues related to scale selection. Most studies measured outcomes at 90 days after initiating therapy although differences were observed in this lag time. There was inconsistency in cut-off points used for both scales in the studies. There was no apparent relation between time to initiation of stroke therapy and outcomes measured by the BI and the MRS. The time window ranged from 3 hours to 72 hours although most of the studies reported outcomes after therapy initiation within 3-6 hours of stroke onset. BI may not be an appropriate scale to measure treatment effects due to the inherent ceiling and floor effects. Use of total distribution scores on the scales rather that dichotomizing or trichotomizing the scales has been favored recently. In mild to moderate stroke patients, the MRS seems to detect small and significant treatment effect changes as compared to the BI. Since most stroke studies try to exhibit the effects of treatment within 3 hours after symptom
Hughes, Anne K; Woodward, Amanda T; Fritz, Michele C; Reeves, Mathew J
Strokes impact over 800,000 people every year. Stroke care typically begins with inpatient care and then continues across an array of healthcare settings. These transitions are difficult for patients and caregivers, with psychosocial needs going unmet. Our team developed a case management intervention for acute stroke patients and their caregivers aimed at improving stroke transitions. The intervention focusses on four aspects of a successful care transition: support, preparedness, identifying and addressing unmet needs, and stroke education. This paper describes the development and implementation of this program, and is an example of the synergy created between neuroscience and clinical practice.
Full Text Available Abstract Background The Barthel Index (BI is a measure of independence in activities of daily living (ADL. In the modified Barthel Index (MBI, a five-point system replaced the original two or three or four point rating system. Based on this modified measure, the performance evaluation tool MBI (PET-MBI was developed in Japan. Although the reliability and validity of PET-MBI have been verified for older people, the use of this tool in stroke patients has not been evaluated. This study investigated the validity and reliability of PET-MBI for stroke patients. Methods Ten raters independently determined the BI and PET-MBI scores of stroke patients by direct observation. These patients’ ADL were videotaped, and 10 other raters then evaluated the videos privately and assigned PET-MBI scores twice, one month apart. The criterion-related validity of the PET-MBI against the BI was evaluated using the correlation coefficients for their total scores. Furthermore, to assess inter- and intra-rater reliabilities from the results of the first and second sessions, Fleiss’ intraclass correlation coefficients (ICCs were calculated for the total scores, with the lower limits of the 95% confidence interval (95%CI, along with weighted kappa (κw coefficients for agreement in individual tasks of this evaluation tool. ICC and κw coefficients of 0.81–1.00 were considered to be “almost perfect” agreement. Results The mean age of the 30 patients (23 men, 7 women was 71.9 (standard deviation 10.5 years. One patient had diplegia, 14 had right hemiplegia, and 15 had left hemiplegia. For the total scores obtained by direct evaluation, Pearson’s and Spearman’s correlation coefficients of the BI versus the PET-MBI were both 0.95 (lower limit of the 95%CI, 0.90. The ICC representing inter-rater reliability for the first session was 0.99 (lower limit of the 95%CI, 0.98]. For intra-rater reliability, the mean value of the ICCs was 0.99 (range, 0.99–1.00. For
Kwakkel, Gert; Veerbeek, Janne M.; Harmeling-van der Wel, Barbara C.; van Wegen, Erwin; Kollen, Boudewijn J.; Harmeling-van der Wel, BC
Background and Purpose-This study investigated the diagnostic accuracy of the Barthel Index (BI) in 206 stroke patients, measured within 72 hours, for activities of daily living at 6 months and determined whether the timing of BI assessment during the first days affects the accuracy of predicting
Masic, Izet; Begic, Edin
H-index is an index that attempts to measure the productivity and impact of published work of scientists. H-index has several advantages – it combines productivity with echo, is not sensitive to extreme values in terms of articles without citation or to articles with above-average number of citations and directly enables the identification of the most relevant articles with regard to the number of citations received. H-index has great potential in the academic community, but it still has not realistic indicator of the quality of work of one author. Authors described most used indices for scientific assessment. PMID:27708482
Kwon, Sooyeon; Hartzema, Abraham G; Duncan, Pamela W; Min-Lai, Sue
Residual disability after stroke presents a major economic and humanistic burden. To quantify disability in patients, activities of daily living (ADL; Barthel Index [BI], and motor component of Functional Independence Measure [M-FIM]) and categorical disability measures (Modified Rankin Scale [MRS]) are used. The purpose of this study is to examine the predicting ability of ADL measures to global disability scale. Kansas City Stroke Study data were used for the present study. Correlation coefficient, Kruskal-Wallis test, and polytomous logistic regression analysis were applied to examine the relationship between the ADL measure and global disability scale. Model fit statistics were examined to verify logistic regression appropriateness. A categorization scheme, which minimized the false-positive response rate, was selected as the optimal categorizing system. The 3 measures were highly correlated. Both BI and M-FIM differentiated disability better in lower than higher disability. In logistic regression, BI differentiated 4 disability levels; M-FIM differentiated 3 levels in MRS. However, on the basis of results of the Kruskal-Wallis and multiple comparison tests, we suspect that M-FIM may have the potential to predict MRS categories better with a different model. The proposed categorization scheme can serve as a translation between measures. However, because of the ceiling effect of BI and M-FIM, the translation could not be completed for all 6 levels of MRS. No apparent variation over time in the categorization scheme was observed. Further research needs to be conducted to develop better prediction models explaining the relationship between M-FIM and MRS.
Salis, Christos; Kelly, Helen; Code, Chris
Background: Aphasia following stroke refers to impairments that affect the comprehension and expression of spoken and/or written language, and co-occurring cognitive deficits are common. In this paper we focus on short-term and working memory impairments that impact on the ability to retain and manipulate auditory-verbal information. Evidence from…
Roelen, C.A.M.; Rhenen, van W.; Groothoff, J.W.; Klink, van der J.J.L.; Twisk, W.R.; Heymans, M.W.
Work ability predicts future disability pension (DP). A single-item work ability score (WAS) is emerging as a measure for work ability. This study compared single-item WAS with the multi-item work ability index (WAI) in its ability to identify workers at risk of DP.
Hu, Yuxuan; Gurev, Viatcheslav; Constantino, Jason; Trayanova, Natalia
Background The acute response to cardiac resynchronization therapy (CRT) has been shown to be due to three mechanisms: resynchronization of ventricular contraction, efficient preloading of the ventricles by a properly timed atrial contraction, and mitral regurgitation reduction. However, the contribution of each of the three mechanisms to the acute response of CRT, specifically stroke work improvement, has not been quantified. Objective The goal of this study was to use an MRI-based anatomically accurate 3D model of failing canine ventricular electromechanics to quantify the contribution of each of the three mechanisms to stroke work improvement and identify the predominant mechanisms. Methods An MRI-based electromechanical model of the failing canine ventricles assembled previously by our group was further developed and modified. Three different protocols were used to dissect the contribution of each of the three mechanisms to stroke work improvement. Results Resynchronization of ventricular contraction did not lead to significant stroke work improvement. Efficient preloading of the ventricles by a properly timed atrial contraction was the predominant mechanism underlying stroke work improvement. Stroke work improvement peaked at an intermediate AV delay, as it allowed ventricular filling by atrial contraction to occur at a low diastolic LV pressure but also provided adequate time for ventricular filling before ventricular contraction. Diminution of mitral regurgitation by CRT led to stroke work worsening instead of improvement. Conclusion Efficient preloading of the ventricles by a properly timed atrial contraction is responsible for significant stroke work improvement in the acute CRT response. PMID:23928177
Enhancing the Alignment of the Preclinical and Clinical Stroke Recovery Research Pipeline: Consensus-Based Core Recommendations From the Stroke Recovery and Rehabilitation Roundtable Translational Working Group.
Corbett, Dale; Carmichael, S Thomas; Murphy, Timothy H; Jones, Theresa A; Schwab, Martin E; Jolkkonen, Jukka; Clarkson, Andrew N; Dancause, Numa; Weiloch, Tadeusz; Johansen-Berg, Heidi; Nilsson, Michael; McCullough, Louise D; Joy, Mary T
Stroke recovery research involves distinct biological and clinical targets compared to the study of acute stroke. Guidelines are proposed for the pre-clinical modeling of stroke recovery and for the alignment of pre-clinical studies to clinical trials in stroke recovery.
Grosdemange, Antoine; Monfort, Vincent; Richard, Sébastien; Toniolo, Anne-Marie; Ducrocq, Xavier; Bolmont, Benoît
Working memory is the most impaired cognitive domain in the acute phase of stroke. In a context where anxiety is highly prevalent, close attention must be paid to anxiety which could mimic mild to moderate working memory impairments. This is the first study to assess the contribution of state anxiety (the currently experienced level of anxiety) to the working memory (verbal, visuospatial) in patients with first-ever acute stroke without severe cognitive impairment. 28 patients with first-ever acute stroke and 41 matched control subjects were exposed to a neutral condition and an anxiogenic condition in which verbal (VWM) and visuospatial working memory (VSWM) performance and state anxiety were assessed. State anxiety was assessed before the beginning of the experiment (baseline), after the neutral condition and after the anxiogenic condition. The mean state anxiety score was higher in patients than in controls in the neutral (z = 1.9, p<0.05) and anxiogenic (z = 2, p<0.05) conditions despite a similar level at baseline. Multiple regression analyses with a dummy variable 'group' (patients vs controls) showed that increased state anxiety in patients contributed significantly more to both reduced VWM (β = -0.93, p<0.05) and VSWM (β = -1, p<0.05) performance between the neutral and anxiogenic conditions compared to controls. In a stressful context, the contribution of state anxiety to reduced working memory performance is more pronounced in patients with acute stroke than in controls. These results are of particular relevance for clinicians assessing patients in the acute phase of stroke in which anxiety is highly prevalent. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Dale, C. R.
Discussed is the biotic indexing of water quality and its application to A-level field work with reference to the Trent Biotic Index and Chandler Score system. These indices are related to the classification of water quality used by the Department of the Environment. Interpretations and limitations of the indices are discussed. (Author/DS)
Full Text Available Introduction: Maintenance of work ability and continuous effort to improve reduced work ability of employees is a major concern for managers. This study aimed to determine the level of work ability index and relation with life style in mechanics of thermal power plant. Method: A total of 60 mechanics from selected thermal power plant were included in this cross sectional study. Health promoting behaviors was tested by Promoting lifestyle questionnaire walker. Work ability was assessed by the Work Ability Index (WAI and the final score was calculated from answers to its seven dimensions. Data was analyzed using SPSS 21 software. Results: The mean value of work ability index in this study was 34.80 ± 5.76. The WAI categories were 16.66% in "excellent", 36.6% in "good", 30 % in "moderate", and 16.66% in "poor" levels. Association between life style factors and WAI was statistically significant (P<.0.05. Lower WAI was associated with increasing the age, high work experience and lower education (p<.0.05. Conclusions: Average of work ability index in mechanics was at average level. Also there is a significant relationship between work ability indexes with life style.
Newman, M F; Wolman, R; Kanchuger, M; Marschall, K; Mora-Mangano, C; Roach, G; Smith, L R; Aggarwal, A; Nussmeier, N; Herskowitz, A; Mangano, D T
The paradox of present cardiac surgery is that the more elderly and debilitated patients benefit most from cardiac surgery compared with medical therapy, yet they sustain greater overall risk for morbidity and mortality after cardiac surgery. The goal of the present study was to develop a preoperative index predicting major perioperative neurological events in patients undergoing coronary artery bypass graft surgery. As part of a prospective, multicenter, observational study (McSPI Research Group), we enrolled 2417 patients at 24 academic medical centers in the United States. Patients who died intraoperatively or had concomitant open-heart procedures were excluded from analysis, resulting in a total of 2107 for analysis. Sixty-eight patients (3.2%) developed adverse neurological events, defined as cerebrovascular accident, transient ischemic attack (TIA), or persistent coma. Bivariate analysis was applied to determine associations between preoperative variables and neurological events. Significant bivariate predictors were identified then logically grouped, and for each cluster, a score was calculated based on principal components. Key predictor variables were age, history of previous neurological disease, diabetes, history of vascular disease, previous coronary artery surgery, unstable angina, and history of pulmonary disease, the coefficients for which were used to develop a preoperative stroke risk index that was validated by bootstrap (c-index = 0.778). Stroke risk could then be determined for each patient, calculating a patient's risk for stroke within 95% confidence intervals. With the McSPI stroke risk index developed in this study, neurological risk can be estimated, and the most appropriate group for perioperative therapy can be identified. Further refinement and validation of this index, however, are necessary and are under way in current studies.
Full Text Available The incidence of ischemic stroke in patients with diabetes is increasing. While brachial-ankle pulse wave velocity (BaPWV and ankle-brachial index (ABI are known to be associated with ischemic cardiovascular and cerebrovascular diseases, whether these measures predict the risk of ischemic cerebrovascular disease in diabetic patients remains unclear. 117 patients with type 2 diabetes were enrolled in this study. According to the results of head magnetic resonance imaging, the patients were divided into a diabetes-only group (n = 55 and a diabetes and ischemic stroke group (n = 62. We then performed ABI and BaPWV examinations for all patients. Compared with the diabetes-only group, we found decreased ABI and increased BaPWV in the diabetes and ischemic stroke group. Multivariate logistic regression analyses revealed that BaPWV and ABI were risk factors for ischemic stroke in patients with type 2 diabetes. Our findings indicate that decreased ABI and increased BaPWV are objective indicators of increased risk of ischemic stroke in patients with type 2 diabetes.
Van Dongen, Isabella; Josephsson, Staffan; Ekstam, Lisa
This qualitative study explored how some working Austrians experienced and coped with changes in their daily occupations after becoming informal carers of persons who had had a stroke. The study provides insights into the working carers' occupational experiences and strategies during a period of pronounced life changes. Three participants, who were employed in full- or part-time work, as well as being informal carers of persons who had had a stroke, were interviewed on two occasions. The data from these interviews were analysed using Interpretative Phenomenological Analyses. Carers found themselves in an ongoing process, ranging from the disruption of daily occupations to their eventual restructure. First, the stroke led to involuntary changes in the carers' daily life, which resulted in challenges in their own, and in shared, occupations. Second, carers actively changed their values and performance of occupations, which appeared to be a strategy to shape their well-being. Paid work was found to be a stabilizing and balancing occupation, which contributed to coping and the well-being of carers. The authors' findings demonstrate the benefits of paid work and engagement in meaningful occupation for the carers' well-being. These results should encourage occupational therapists to be sensitive to the complexity of the lives of working informal carers.
Oliveira,Roberta de; Cacho,Enio Walker Azevedo; Borges,Guilherme
Stroke is one of the major causes of morbidity and mortality. Sequels deriving from this event may lead to motor disability and from mild to severe deficits. In order to better classify sensory-motor dysfunction, balance and ability to perform activities of daily living, quantitative and qualitative evaluation scales have been used. Objective: To correlate the scales Fugl-Meyer assessment scale, Berg balance scale and Barthel index. Twenty subjects with sequel after a single, unilateral strok...
Suadicani, Poul; Andersen, Lars L; Holtermann, Andreas; Mortensen, Ole S; Gyntelberg, Finn
Investigate if the association between perceived psychological work pressure and risk of stroke is modified by socioeconomic status. Thirty-year follow-up of 4943 middle-aged men without cardiovascular disease. In the higher social classes (I, II, and III), perceived regular exposure to psychological work pressure was common and a significant predictor of stroke; almost 10% of the stroke events could be attributed to this exposure in the higher social classes; among lower social classes (IV and V), perceived psychological pressure was no predictor at all. Regular psychological work pressure is a highly prevalent and independent risk factor for stroke among men in higher social classes. In contrast, no association to stroke risk was found among low social class men.
Owen, Christopher G; Kapetanakis, Venediktos V; Rudnicka, Alicja R; Wathern, Andrea K; Lennon, Lucy; Papacosta, Olia; Cook, Derek G; Wannamethee, S Goya; Whincup, Peter H
Adiposity in middle age is an established risk factor for cardiovascular disease and type 2 diabetes; less is known about the impact of adiposity from early adult life. We examined the effects of high body mass index (BMI) in early and middle adulthood on myocardial infarction (MI), stroke and diabetes risks. A prospective cohort study. 7735 men with BMI measured in middle age (40-59 years) and BMI ascertained at 21 years from military records or participant recall. 30-year follow-up data for type 2 diabetes, MI and stroke incidence; Cox proportional hazards models were used to examine the effect of BMI at both ages on these outcomes, adjusted for age and smoking status. Among 4846 (63%) men (with complete data), a 1 kg/m(2) higher BMI at 21 years was associated with a 6% (95% CI 4% to 9%) higher type 2 diabetes risk, compared with a 21% (95% CI 18% to 24%) higher diabetes risk for a 1 kg/m(2) higher BMI in middle age (hazard ratio (HR) 1.21, 95% CI 1.18 to 1.24). Higher BMI in middle age was associated with a 6% (95% CI 4% to 8%) increase in MI and a 4% (95% CI 1% to 7%) increase in stroke; BMI at 21 years showed no associations with MI or stroke risk. Higher BMI at 21 years of age is associated with later diabetes incidence but not MI or stroke, while higher BMI in middle age is strongly associated with all outcomes. Early obesity prevention may reduce later type 2 diabetes risk, more than MI and stroke. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Andrzej Marcinkiewicz; Jolanta Walusiak-Skorupa
The classification of an acute vascular episode, both heart infarct and stroke, as an accident at work poses difficulties not only for post accidental teams, but also to occupational health professionals, experts and judges at labor and social insurance courts. This article presents the case of a 41-year-old office worker, whose job involved client services. While attending a very aggressive customer she developed solid stress that resulted in symptoms of the central nervous system (headache,...
Full Text Available With the help of 3-D modeling of the workflow of a two-stroke engine with spark ignition, crank-chamber scavenging and a carburetor feeding system in the modes of external speed characteristic the indices of gas exchange were evaluated. The simulation results are consistent with the experimental data and 3D simulation results in the AVL FIRE and MTFS® software complexes. The model allows performing optimized calculations of multiphase flow in ICE during experimental design work.
van Bennekom, C. A.; Jelles, F.; Lankhorst, G. J.; Bouter, L. M.
This study evaluates the criterion, content, and construct validity of the Rehabilitation Activities Profile (RAP) in patients with stroke. This instrument is constructed for screening, monitoring, and prognosis purposes to assist clinical rehabilitation. It consists of 21 activities, covering the
Cross-sectional survey of workload and burnout among Japanese physicians working in stroke care: the nationwide survey of acute stroke care capacity for proper designation of comprehensive stroke center in Japan (J-ASPECT) study.
Nishimura, Kunihiro; Nakamura, Fumiaki; Takegami, Misa; Fukuhara, Schunichi; Nakagawara, Jyoji; Ogasawara, Kuniaki; Ono, Junichi; Shiokawa, Yoshiaki; Miyachi, Shigeru; Nagata, Izumi; Toyoda, Kazunori; Matsuda, Shinya; Kataoka, Hiroharu; Miyamoto, Yoshihiro; Kitaoka, Kazuyo; Kada, Akiko; Iihara, Koji
Burnout is common among physicians and affects the quality of care. We aimed to determine the prevalence of burnout among Japanese physicians working in stroke care and evaluate personal and professional characteristics associated with burnout. A cross-sectional design was used to develop and distribute a survey to 11 211 physicians. Physician burnout was assessed using the Maslach Burnout Inventory General Survey. The predictors of burnout and the relationships among them were identified by multivariable logistic regression analysis. A total of 2724 (25.3%) physicians returned the surveys. After excluding those who were not working in stroke care or did not complete the survey appropriately, 2564 surveys were analyzed. Analysis of the participants' scores revealed that 41.1% were burned out. Multivariable analysis indicated that number of hours worked per week is positively associated with burnout. Hours slept per night, day-offs per week, years of experience, as well as income, are inversely associated with burnout. Short Form 36 mental health subscale was also inversely associated with burnout. The primary risk factors for burnout are heavy workload, short sleep duration, relatively little experience, and low mental quality of life. Prospective research is required to confirm these findings and develop programs for preventing burnout. © 2014 American Heart Association, Inc.
Sarker, Shah-Jalal; Rudd, Anthony G; Douiri, Abdel; Wolfe, Charles D A
Basic activities of daily living measures are often supplemented by extended activities of daily living. We compared the Frenchay Activities Index (FAI) and Nottingham Extended Activities of Daily Living (NEADL) with the Barthel Index (BI) in terms of distribution of scores, concurrent validity, reliability, and their agreement and investigated the predictors of scales outcomes. Two hundred thirty-eight patients from the population-based South London Stroke Register were assessed with the BI, FAI, and NEADL 3 months after a first-ever stroke. The pairwise relationship was studied using correlations, fractional polynomial regression, and Bland and Altman plot; the baseline predictors, for example, sociodemography, case severity: National Institutes of Health Stroke Scale, and 7-day Abbreviated Memory Test, comorbidities, and acute treatments by negative binomial regression. The BI was highly affected by a ceiling effect (33% had the highest score), FAI was only affected by floor effect (19%), but NEADL was symmetrical with only 4% highest and lowest score. Despite high concurrent validity of the scales (r ≥0.80, PScale >13) had 28% lower BI (79% lower FAI and 62% lower NEADL) score than nonsevere patients (P≤0.001). Cognitively intact patients (Abbreviated Memory Test: 8-10) had 2.3 times greater FAI values (65% higher NEADL) compared with impaired patients (Pscale was symmetrical, concurrently valid with no floor and ceiling effects. It corresponded better with BI than FAI did confirming its basic activities of daily living properties, yet it is a more sensitive tool for extended activities of daily living without the floor and ceiling effects. Future functional status could be predicted by the acute stage National Institutes of Health Stroke Scale score, whereas only extended activities of daily living status could be predicted by the Abbreviated Memory Test score. Predicting future functional status at the acute stage may decrease unnecessary length of stay
Pranjic, Nurka; Males-Bilic, Ljiljana
Goal: The aim of this study is to estimate the association of burnout syndrome and depression; burnout syndrome and sick leave; and burnout syndrome with Work Ability Index in patients who suffer from stress at work. Material and methods: The control clinical study was conducted in the Teaching Department for Professional Pathology and Toxicology at the Primary Health Care Center Tuzla in the period from 2009 to 2014. The study included 140 patients exposed to different levels of stress at wo...
Delavega, Elena; Kindle, Peter A.; Peterson, Susan; Schwartz, Charles
This study reports the development of a new Blame Index to determine attributions of the causes of poverty along a single structural-to-individual dimension. A multisite pre-/post-group design tested the degree of change in social work students' (N = 177) perception of poverty as a result of taking a single BSW social policy course or an MSW…
Pranjic, Nurka; Males-Bilic, Ljiljana
The aim of this study is to estimate the association of burnout syndrome and depression; burnout syndrome and sick leave; and burnout syndrome with Work Ability Index in patients who suffer from stress at work. The control clinical study was conducted in the Teaching Department for Professional Pathology and Toxicology at the Primary Health Care Center Tuzla in the period from 2009 to 2014. The study included 140 patients exposed to different levels of stress at work. Besides conducted interviews and anamnesis with working anamnesis, physical examination, all patients were subjected to diagnostic package of questionnaires for assessing exposure to stress at work and its effects on health and work ability and Hamilton Rating Scale for screening depression. All patients were referred to the Department with suspected distress and burnout syndrome. For this study we used a questionnaire for measuring intensity of burnout (two categories exclude suffering from burnout syndrome: successfully overcome stress at work and sometimes feel stress at work and the other two reveal the initial and very high burn-out syndrome. Studied group was consisted of patients categorized with burnout syndrome (n=88). The questionnaire on the Work Ability Index (WAI) estimated characteristics of sick leave and prognostic factors with current work ability index. Lack of support at work with poor personal relations is the most common factor with the mobbing in burnout syndrome. Significantly more patients with the burnout syndrome suffered very severe depression 49%:37%; more use long sick leaves 53%:21%; several of them have poor WAI 51%:31% compared to those who are only exposed to stress at work (p=0.001). We found that the burn-out syndrome is predictor for developing depression (β=0.312, 95% CI, 0.114-0.353, p=0.001); absenteeism (β=0.285, 95% CI, 0.093-0.334, p=0.001); and a decline in working ability (β=0.413, 95% CI, 0.297-0.648). All the patients in whom it is found burnout
Alaszewski, Andy; Wilkinson, Iain
This article draws on data from a Stroke Association-funded longitudinal study in South East England (2003-2006) that explored the experiences and recovery of 43 stroke survivors under 60 years. Participants were invited to take part in four interviews over an 18-month period and to complete a diary for 1 week each month during this period. Here, we chart their shifting attitudes towards the process of their recovery. We bring a focus to how this transformed their views on the possible futures before them. We underline how hope was experienced as a deeply paradoxical and risk-laden notion. With energies concentrated upon the effort to live positively in the here and now, the very idea of hope for the future was met as an unwelcome distraction and in some cases even as a source of distress. © The Author(s) 2014.
Palmieri, V.; Bella, J.N.; Gerdts, E.
in hypertension (LIFE) study, we evaluated the impact of antihypertensive treatment on change of PP/SVi as raw indicator of systemic arterial stiffness, and further explored the impact of the change in PP/SVi on the change in LV mass and RWT. RESULTS: Compared to baseline, mean PP/SVi reduction was -13% at year 1......BACKGROUND: In cross-sectional data in hypertensive subjects, brachial pulse pressure (PP)/Doppler stroke index (SVi), (PP/SVi) correlates weakly but significantly with left ventricular (LV) mass and relative wall thickness (RWT). METHODS: In the Losartan Intervention For End-point reduction...
Jessica Hagy is a different kind of thinker. She has an astonishing talent for visualizing relationships, capturing in pictures what is difficult for most of us to express in words. At indexed.blogspot.com, she posts charts, graphs, and Venn diagrams drawn on index cards that reveal in a simple and intuitive way the large and small truths of modern life. Praised throughout the blogosphere as “brilliant,” “incredibly creative,” and “comic genius,” Jessica turns her incisive, deadpan sense of humor on everything from office politics to relationships to religion. With new material along with some of Jessica’s greatest hits, this utterly unique book will thrill readers who demand humor that makes them both laugh and think.
Fred Stephen Sarfo
Conclusion: Persistence of secondary preventive medications among stroke survivors in this resource-limited setting is excellent and comparable to those in resource-replete countries. There is however the need to investigate the causes of high attrition rates from care.
Mohammad, Ashiru Hamza; Al-Sadat, Nabilla; Siew Yim, Loh; Chinna, Karuthan
This study aims to test the translated Hausa version of the stroke impact scale SIS (3.0) and further evaluate its psychometric properties. The SIS 3.0 was translated from English into Hausa and was tested for its reliability and validity on a stratified random sample adult stroke survivors attending rehabilitation services at stroke referral hospitals in Kano, Nigeria. Psychometric analysis of the Hausa-SIS 3.0 involved face, content, criterion, and construct validity tests as well as internal and test-retest reliability. In reliability analyses, the Cronbach's alpha values for the items in Strength, Hand function, Mobility, ADL/IADL, Memory and thinking, Communication, Emotion, and Social participation domains were 0.80, 0.92, 0.90, 0.78, 0.84, 0.89, 0.58, and 0.74, respectively. There are 8 domains in stroke impact scale 3.0 in confirmatory factory analysis; some of the items in the Hausa-SIS questionnaire have to be dropped due to lack of discriminate validity. In the final analysis, a parsimonious model was obtained with two items per construct for the 8 constructs (Chi-square/df 0.9, and RMSEA SIS seems to measure adequately the QOL outcomes in the 8 domains.
Koert N J Burger
Full Text Available BACKGROUND: The associations of glycemic load (GL and glycemic index (GI with the risk of cardiovascular diseases (CVD are not well-established, particularly in men, and may be modified by gender. OBJECTIVE: To assess whether high dietary GL and GI increase the risk of CVD in men and women. METHODS: A large prospective cohort study (EPIC-MORGEN was conducted within the general Dutch population among 8,855 men and 10,753 women, aged 21-64 years at baseline (1993-1997 and free of diabetes and CVD. Dietary intake was assessed with a validated food-frequency questionnaire and GI and GL were calculated using Foster-Powell's international table of GI. Information on morbidity and mortality was obtained through linkage with national registries. Cox proportional hazards analysis was performed to estimate hazard ratios (HRs for incident coronary heart disease (CHD and stroke, while adjusting for age, CVD risk factors, and dietary factors. RESULTS: During a mean follow-up of 11.9 years, 581 CHD cases and 120 stroke cases occurred among men, and 300 CHD cases and 109 stroke cases occurred among women. In men, GL was associated with an increased CHD risk (adjusted HR per SD increase, 1.17 [95% CI, 1.02-1.35], while no significant association was found in women (1.09 [0.89-1.33]. GI was not associated with CHD risk in both genders, while it was associated with increased stroke risk in men (1.27 [1.02-1.58] but not in women (0.96 [0.75-1.22]. Similarly, total carbohydrate intake and starch intake were associated with a higher CHD risk in men (1.23 [1.04-1.46]; and 1.24 [1.07-1.45], but not in women. CONCLUSION: Among men, high GL and GI, and high carbohydrate and starch intake, were associated with increased risk of CVD.
Lee, Ya-Chen; Yu, Wan-Hui; Hsueh, I-Ping; Chen, Sheng-Shiung; Hsieh, Ching-Lin
A lack of evidence on the test-retest reliability and responsiveness limits the utility of the BI-based Supplementary Scales (BI-SS) in both clinical and research settings. To examine the test-retest reliability and responsiveness of the BI-based Supplementary Scales (BI-SS) in patients with stroke. A repeated-assessments design (1 week apart) was used to examine the test-retest reliability of the BI-SS. For the responsiveness study, the participants were assessed with the BI-SS and BI (treated as an external criterion) at admission to and discharge from rehabilitation wards. Seven outpatient rehabilitation units and one inpatient rehabilitation unit. Outpatients with chronic stroke. Eighty-four outpatients with chronic stroke participated in the test-retest reliability study. Fifty-seven inpatients completed baseline and follow-up assessments in the responsiveness study. For the test-retest reliability study, the values of the intra-class correlation coefficient and the overall percentage of minimal detectable change for the Ability Scale and Self-perceived Difficulty Scale were 0.97, 12.8%, and 0.78, 35.8%, respectively. For the responsiveness study, the standardized effect size and standardized response mean (representing internal responsiveness) of the Ability Scale and Self-perceived Difficulty Scale were 1.17 and 1.56, and 0.78 and 0.89, respectively. Regarding external responsiveness, the change in score of the Ability Scale had significant and moderate association with that of the BI (r=0.61, Preliability and sufficient responsiveness for patients with stroke. However, the Self-perceived Difficulty Scale of the BI-SS has substantial random measurement error and insufficient external responsiveness, which may affect its utility in clinical settings. The findings of this study provide empirical evidence of psychometric properties of the BI-SS for assessing ability and self-perceived difficulty of ADL in patients with stroke.
Bethge, Matthias; Gutenbrunner, Christoph; Neuderth, Silke
To determine whether the Work Ability Index (WAI), a short 7-item self-report questionnaire addressing issues of perceived disability, impairment, and expectations for resuming work, predicts application for disability pension, recommendations for further treatment, and other adverse work-related criteria in patients with chronic back pain after rehabilitation. Cohort study with 3-month follow-up. Seven inpatient rehabilitation centers. Patients (N=294; 168 women; mean age, 49.9y) with chronic back pain. The WAI was completed at the beginning of rehabilitation. All patients were treated according to the German rehabilitation guidelines for chronic back pain and work-related medical rehabilitation. Application for disability pension, as assessed by a postal questionnaire 3 months after discharge. Receiver operating characteristic curve analysis of the association between the WAI at baseline and subsequent application for disability pension revealed an area under the curve of .80 (95% confidence interval [CI], .62-.97). Youden index was highest when the WAI cutoff value was ≤20 points (sensitivity, 72.7%; specificity, 82.2%; total correct classification, 81.7%). After adjusting for age and sex, persons with a baseline WAI score of ≤20 points had 15.6 times (95% CI, 3.6-68.2) higher odds of subsequent application for disability pension, 4.9 times (95% CI, 1.5-16.8) higher odds of unemployment, and 6 times (95% CI, 2.4-15.2) higher odds of long-term sick leave at follow-up. The WAI could help rehabilitation professionals identify patients with back pain with a high risk of a subsequent application for disability pension. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
Tamburini, P; Mazzoli, D; Stagni, R
The assessment of walking function alterations is a key issue to design effective rehabilitative interventions in sub-acute stroke patients. Nevertheless, the objective quantification of these alterations remains a challenge. Clinical rating scales are commonly used in clinical practice, but have been proven prone to errors associated to the evaluator subjective perception. On the other hand, instrumental measurement of trunk acceleration can be exploited for an objective quantitative characterization of gait function, but it is not applied in routine clinical practice, because the resulting quantitative indexes have not been related to the clinically information, conventionally provided by the rating scales. To overcome this limitation, the relationship between the indexes, in specific clinical conditions, and rating scale must be better investigated, to support their exploitability in the clinical practice as a fast and reliable screening tool. Thirty-one sub-acute stroke patients (17 with and 14 without cane) participated in the study. All were assessed with 6 rating scales (MI, TCT, MRI, FAC, WHS, CIRS) and 2 functional tests (2MWT and TUG). Sample Entropy (SEN) and Recurrence Quantification Analysis (RQA) in AP, ML and V directions were calculated over 2MWT and walking section of TUG. The influence of assessment task and cane was analysed, as well as correlation of SEN and RQA indexes with clinical rating scales. SEN and RQA on the medio-lateral plane resulted influenced by the use of the cane, while the correlations between indexes and clinical scales showed that SEN and RQA for antero-posterior direction correlate positively with WHS. Copyright © 2017 Elsevier B.V. All rights reserved.
de Oliveira, Roberta; Cacho, Enio Walker Azevedo; Borges, Guilherme
Stroke is one of the major causes of morbidity and mortality. Sequels deriving from this event may lead to motor disability and from mild to severe deficits. In order to better classify sensory-motor dysfunction, balance and ability to perform activities of daily living, quantitative and qualitative evaluation scales have been used. To correlate the scales Fugl-Meyer assessment scale, Berg balance scale and Barthel index. Twenty subjects with sequel after a single, unilateral stroke in chronic phase (>6 months post ictus) were evaluated for about one hour. Barthel scale was statistically related to the total motor score of Fugl-Meyer assessment (r=0.597, p=0.005). The lower limb section at Fugl-Meyer had positive correlation with Berg scale (r=0.653, p=0.002) and with the balance section of Fugl-Meyer own scale (r=0.449, p=0.047). Both balance scales were correlated one with other (r=0.555, p=0.011). Statistical divergence appeared when Barthel's Index was correlated with Berg's Scale (r=0.425, p=0.062), and it is not statistically significant. The use of both quantitative and qualitative scales was shown to be a good measuring instrument for the classification of the general clinical performance of the patient, especially when positively related joint evaluations are applied.
Full Text Available It is always attempted to reduce the costs of comminution in mineral processing plants. One of thedifficulties in size reduction section is not to be designed properly. The key factor to design size reductionunits such as crushers and grinding mills, is ore’s work index. The work index, wi, presents the oregrindability, and is used in Bond formula to calculate the required energy. Bond has defined a specificrelationship between some parameters which is applied to calculate wi, which are control screen, fineparticles produced, feed and product d80.In this research work, a high grade copper sample from Miduk copper concentrator was prepared, and itswork index values were experimentally estimated, using different control screens, 600, 425, 212, 150, 106and 75 microns. The obtained results from the tests showed two different behaviors in fine production.According to these two trends the required models were then defined to present the fine mass calculationusing control screen. In next step, an equation was presented in order to calculate Miduk copper ore workindex for any size. In addition to verify the model creditability, a test using 300 microns control screenwas performed and its result was compared with calculated ones using defined model, which showed agood fit. Finally the experimental and calculated values were compared and their relative error was equalto 4.11% which is an indication of good fit for the results.
Pranjić, Nurka; Males-Bilić, Ljiljana; Beganlić, Azijada; Mustajbegović, Jadranka
To assess the frequency of reported mobbing and the association among mobbing, working environment factors, stress, health outcome, personality type, and work ability index in a sample of physicians in Bosnia and Herzegovina. We conducted a questionnaire survey using a validated self-reported questionnaire among 511 physicians in national health sector of Bosnia and Herzegovina. The questions covered five major categories of mobbing behavior. Characteristics of the work, perceived work environment and its effects, stress, health, and satisfaction with work and life were assessed by the standardized abridged form of Occupational Stress Questionnaire (OSQ). A standardized questionnaire Work Ability Index (WAI) was used to determine the relation between mobbing and work ability. Of 511 surveyed physicians, 387 (76%) physicians self-reported mobbing behavior in the working environment and 136 (26%) was exposed to persistent mobbing. More than a half of the physicians experienced threats to their professional status and almost a half felt isolated. Logistic regression analysis showed that lack of motivation, loss of self-esteem, loss of confidence, fatigue, and depressiveness were significantly associated with lack of support from colleagues. Intention to leave work was associated with lack of support from colleagues (OR 2.3, 95% CI, 1.065-3.535; t =4.296, P =0.003) and lack of support from superiors (OR 1.526, 95% CI, 0.976-2.076; t =5.753; P =0.001). Isolation or exclusion and threats to professional status were predictors for mental health symptoms. Persistent mobbing experience was a significant predictor for sick leave. Exposure to persistent threat to professional status and isolation or exclusion as forms of mobbing are associated with mental health disturbances and lack of self-esteem and confidence. Setting up a system of support for physicians exposed to mobbing may have important benefits.
Antunes, Luciana da Conceição; Jornada, Manoela Neves da; Ramalho, Letícia; Hidalgo, Maria Paz Loayza
Correlate shift work with body mass index (BMI), waist circumference, chronotype and depressive symptoms. This study comprising 14 shift workers and 13 day workers. Subjects were workers from the health area aged 25 to 60 years. Minor psychiatric disorders were accessed by Self Report Questionnaire (SRQ-20) and depressive symptoms by Beck Depression Inventory (BDI). Chronotype was accessed using Morningness-Eveningness Questionnaire (MEQ). Anthropometric measures were taken. Shift workers presented higher BMI (P = 0.03) and waist circumference (P = 0.004) than day workers. Years on shift work were significantly correlated to waist circumference (r = 0.43; P = 0.03) and age (r = 0.47; P = 0.02). Shift work was not correlated with depressive symptoms and chronotype. These results may suggest a role played by shift work on the development and/or the early clinic manifestations of metabolic disturbances, becoming a risk factor to metabolic syndrome.
Full Text Available Stroke is the third leading cause of morbidity and mortality in Thailand accounting for a significant and increasing share of hospital costs. The purpose of this project is to study the epidemiology of the prevalence and its predicting factors of working aged hemorrhagic stroke (HS patients admitted at a tertiary teaching hospital in Chiang Mai, Thailand. We conducted a five-year retrospective descriptive study. The subjects in this study were patients diagnosed with HS, between 15-59 years of age, and admitted to a tertiary teaching hospital in Chiang Mai, Thailand from January 2009 to December 2013. A total of 404 working aged adults who had HS were admitted to the hospital during this review period; 60.9% males and 39.1% females. Nearly 70% of patients were between 46-59 years of age (M = 47.5, SD = 9.8. Of the patients admitted to the hospital, 76.7% were transferred there from other hospitals. Intracerebral hemorrhage was present in 59.7% of patients. Severe HS occurred in 35.9% of the patients with a Glasgow Coma Score from 3-8. Approximately 69% of the working aged HS patients required surgery. The top five identified risk factors for HS were hypertension (83.4%, hyperlipidemia (38.9%, alcohol consumption (21.5%, smoking (15.3 %, and drug non-adherence (14.9%. We found significantly associated risk factors in working-aged HS by multivariate analysis among male gender (p < .001, drug non-adherence (p = .047, and hypertension (p = .048. Raising awareness to reduce risk behavior and health promotion in the community are the keynotes for health care providers in working-aged HS prevention.
Esteves, William A M; Lodi-Junqueira, Lucas; Neto, Cirilo P Fonseca; Tan, Timothy C; Nascimento, Bruno R; Mehrotra, Praveen; Barbosa, Marcia M; Ribeiro, Antonio Luiz P; Nunes, Maria Carmo P
We aimed to explore the relationship between brain natriuretic peptide (BNP) levels and right ventricular (RV) function in patients with mitral stenosis (MS), and to investigate the hemodynamic parameters that predict reduction of BNP levels after percutaneous mitral valvuloplasty (PMV). Few studies have evaluated BNP in the context of MS, specifically the impact of the RV stroke work (RVSW) on serum BNP levels has not been defined. Thirty patients with symptomatic rheumatic MS in sinus rhythm who were referred for a PMV were enrolled. Right and left heart pressures were obtained before and after valvuloplasty. RVSW index (RVSWI) was calculated by cardiac catheterization. Basal BNP levels were elevated in MS patients and correlated with several hemodynamic parameters including pulmonary pressure, pulmonary vascular resistance index, cardiac index (CI), and RVSWI. In multivariate analysis, CI and RVSWI were independent predictors of raised basal BNP levels. PMV resulted in a significant decrease in the RVSWI with a concurrent increase in CI (2.4 ± 0.43 to 2.9 ± 0.8 L/min/m(2), P = 0.010). Overall, plasma BNP levels significantly decreased from 124 (63/234) to 73 (48/148) pg/ml postvalvuloplasty. Multivariate analysis revealed that the reduction of left atrial (LA) pressure post-PMV was an independent predictor of change in BNP levels. Elevated baseline BNP level in MS patients was independently associated with CI and RVSWI. Plasma BNP levels were reduced after successful PMV, which was associated with the reduction of the LA pressure. © 2013, Wiley Periodicals, Inc.
Wideman, Timothy H; Sullivan, Michael J L
Psychosocial variables such as fear of movement, depression, and pain catastrophizing have been shown to be important prognostic factors for a wide range of pain-related outcomes. The potential for a cumulative relationship between different elevated psychosocial factors and problematic recovery following physical therapy has not been fully explored. The purpose of this study was to determine whether the level of risk for problematic recovery following work-related injuries is associated with the number of elevated psychosocial factors. This was a prospective cohort study. Two hundred two individuals with subacute, work-related musculoskeletal injuries completed a 7-week physical therapy intervention and participated in testing at treatment onset and 1 year later. An index of psychosocial risk was created from measures of fear of movement, depression, and pain catastrophizing. This index was used to predict the likelihood of experiencing problematic recovery in reference to pain intensity and return-to-work status at the 1-year follow-up. Logistic regression analysis revealed that the number of prognostic factors was a significant predictor of persistent pain and work disability at the 1-year follow-up. Chi-square analysis revealed that the risk for problematic recovery increased for patients with elevated levels on at least 1 psychosocial factor and was highest when patients had elevated scores on all 3 psychosocial factors. The physical therapy interventions used in this study were not standardized. This study did not include a specific measure for physical function. The number of elevated psychosocial factors present in the subacute phase of recovery has a cumulative effect on the level of risk for problematic recovery 1 year later. This research suggests that a cumulative prognostic factor index could be used in clinical settings to improve prognostic accuracy and to facilitate clinical decision making.
Dehlendorff, Christian; Andersen, Klaus Kaae; Olsen, Tom Skyhøj
between 2003 and 2012 (N=79 617), and the Danish Register of Causes of Death. Information was available on age, sex, marital status, stroke severity, stroke subtype, socioeconomic status, and cardiovascular risk profile. We studied only deaths due to the index stroke, with the assumption that death.......5%) or 1 month (6.9%), respectively. After the age of 60 years, women had more severe strokes than men. Up to ages in the mid-60s, no difference in the risk of death from stroke was seen between the 2 sexes. For people aged >65 years, however, the risk gradually became greater in men than in women...
... Month Infographic Stroke Hero F.A.S.T. Quiz Stroke Treatment Stroke used to rank fourth in leading causes of ... type of treatment depends on the type of stroke. Ischemic stroke happens when a clot blocks a ...
Full Text Available OBJECTIVES: This pilot study was designed to utilize stroke volume variation and cardiac index to ensure fluid optimization during one-lung ventilation in patients undergoing thoracoscopic lobectomies. METHODS: Eighty patients undergoing thoracoscopic lobectomy were randomized into either a goal-directed therapy group or a control group. In the goal-directed therapy group, the stroke volume variation was controlled at 10%±1%, and the cardiac index was controlled at a minimum of 2.5 L.min-1.m-2. In the control group, the MAP was maintained at between 65 mm Hg and 90 mm Hg, heart rate was maintained at between 60 BPM and 100 BPM, and urinary output was greater than 0.5 mL/kg-1/h-1. The hemodynamic variables, arterial blood gas analyses, total administered fluid volume and side effects were recorded. RESULTS: The PaO2/FiO2-ratio before the end of one-lung ventilation in the goal-directed therapy group was significantly higher than that of the control group, but there were no differences between the goal-directed therapy group and the control group for the PaO2/FiO2-ratio or other arterial blood gas analysis indices prior to anesthesia. The extubation time was significantly earlier in the goal-directed therapy group, but there was no difference in the length of hospital stay. Patients in the control group had greater urine volumes, and they were given greater colloid and overall fluid volumes. Nausea and vomiting were significantly reduced in the goal-directed therapy group. CONCLUSION: The results of this study demonstrated that an optimization protocol, based on stroke volume variation and cardiac index obtained with a FloTrac/Vigileo device, increased the PaO2/FiO2-ratio and reduced the overall fluid volume, intubation time and postoperative complications (nausea and vomiting in thoracic surgery patients requiring one-lung ventilation.
Antonio Juan SÁNCHEZ
Full Text Available The Advances in Distributed Computing and Artificial Intelligence Journal (ADCAIJ is an open access journal that publishes articles which contribute new results associated with distributed computing and artificial intelligence,and their application in different areas. The artificial intelligence is changing our society. Its application in distributed environments, such as the Internet, electronic commerce, mobile communications, wireless devices, distributed computing and so on, is increasing and becoming and element of high added value and economic potential in industry and research. These technologies are changing constantly as a result of the large research and technical effort being undertaken in both universities and businesses. The exchange of ideas between scientists and technicians from both academic and business areas is essential to facilitate the development of systems that meet the demands of today's society. We would like to thank all the contributing authors for their hard and highly valuable work. Their work has helped to contribute to the success of this special issue. Finally, the Editors wish to thank Scientific Committee of Advances in Distributed Computing and Artificial Intelligence Journal for the collaboration of this special issue, that notably contributes to improve the quality of the journal. We hope the reader will share our joy and find this special issue very useful.
Antonio Juan SÁNCHEZ
Full Text Available The Advances in Distributed Computing and Artificial Intelligence Journal (ADCAIJ is an open access journal that publishes articles which contribute new results associated with distributed computing and artificial intelligence,and their application in different areas.The artificial intelligence is changing our society. Its application in distributed environments, such as the Internet, electronic commerce, mobile communications, wireless devices, distributed computing and so on, is increasing and becoming and element of high added value and economic potential in industry and research. These technologies are changing constantly as a result of the large research and technical effort being undertaken in both universities and businesses. The exchange of ideas between scientists and technicians from both academic and business areas is essential to facilitate the development of systems that meet the demands of today's society.We would like to thank all the contributing authors for their hard and highly valuable work. Their work has helped to contribute to the success of this special issue. Finally, the Editors wish to thank Scientific Committee of Advances in Distributed Computing and Artificial Intelligence Journal for the collaboration of this special issue, that notably contributes to improve the quality of the journal. We hope the reader will share our joy and find this special issue very useful.
Antonio Juan Sánchez
Full Text Available The Advances in Distributed Computing and Artificial Intelligence Journal (ADCAIJ is an open access journal that publishes articles which contribute new results associated with distributed computing and artificial intelligence,and their application in different areas.The artificial intelligence is changing our society. Its application in distributed environments, such as the Internet, electronic commerce, mobile communications, wireless devices, distributed computing and so on, is increasing and becoming and element of high added value and economic potential in industry and research. These technologies are changing constantly as a result of the large research and technical effort being undertaken in both universities and businesses. The exchange of ideas between scientists and technicians from both academic and business areas is essential to facilitate the development of systems that meet the demands of today's society.We would like to thank all the contributing authors for their hard and highly valuable work. Their work has helped to contribute to the success of this special issue. Finally, the Editors wish to thank Scientific Committee of Advances in Distributed Computing and Artificial Intelligence Journal for the collaboration of this special issue, that notably contributes to improve the quality of the journal. We hope the reader will share our joy and find this special issue very useful.
Cincura, Carolina; Pontes-Neto, Octavio M; Neville, Iuri S; Mendes, Henrique F; Menezes, Daniela F; Mariano, Débora C; Pereira, Issana F; Teixeira, Larissa A; Jesus, Pedro A P; de Queiroz, Danilo C L; Pereira, Davidson F; Pinto, Elen; Leite, João P; Lopes, Antonio A; Oliveira-Filho, Jamary
We aimed to validate three widely used scales in stroke research in a multiethnic Brazilian population. The National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS) and Barthel Index (BI) were translated, culturally adapted and applied by two independent investigators. The mRS was applied with or without a previously validated structured interview. Interobserver agreement (kappa statistics) and intraclass correlation coefficients were calculated. 84 patients underwent mRS (56 with and 28 without a structured interview), 57 BI and 62 NIHSS scoring. Intraclass correlation coefficient was 0.902 for NIHSS and 0.967 for BI. For BI, interobserver agreement was good (kappa = 0.70). For mRS, the structured interview improved interobserver agreement (kappa = 0.34 without a structured interview; 0.75 with a structured interview). The NIHSS, BI and mRS show good validity when translated and culturally adapted. Using a structured interview for the mRS improves interobserver concordance rates. Copyright (c) 2008 S. Karger AG, Basel.
Andersen, Klaus Kaae; Olsen, Tom Skyhøj
. Data include age, gender, civil status, stroke severity, computed tomography, and cardiovascular risk factors. Patients were followed up to 9·8 years (median 2·6 years). We used Cox regression models to compare risk of death and readmission for recurrent stroke in the four body mass index groups......BACKGROUND: Although associated with excess mortality and morbidity, obesity is associated with lower mortality after stroke. The association between obesity and risk of recurrent stroke is unclear. AIMS: The study aims to investigate the association in stroke patients between body mass index...... and risk of death and readmission for recurrent stroke. METHODS: An administrative Danish quality-control registry designed to collect a predefined dataset on all hospitalized stroke patients in Denmark 2000–2010 includes 45 615 acute first-ever stroke patients with information on body mass index in 29 326...
Fujishiro, Kaori; Lividoti Hibert, Eileen; Schernhammer, Eva; Rich-Edwards, Janet W
The effects of job strain and shift work on weight gain have not been studied jointly. Cross-sectional and longitudinal studies on shift work and weight gain have reported different results. This study examines potential effect modification by job strain on the link between shift work and weight gain, and concurrent and delayed effects of shift work on weight gain. Data came from 52 622 women who participated in the Nurses' Health Study II, a prospective cohort study. Using linear regression, we modelled change in body mass index (BMI) over 4 years as a function of change in job strain, cumulative exposure to rotating night shift previously and during the 4 years (ie, previous and concurrent exposures) and the interaction between job strain and concurrent shift work exposure. Age, race/ethnicity, pregnancy history, baseline BMI, job types and health behaviours at baseline were controlled for. Job strain and rotating shift work, concurrent and previous, all had independent associations with BMI change during the 4-year period. There was no evidence for effect modification by job strain. Concurrent and previous exposures to rotating night shift had different associations with BMI change: an inverted U-shape for concurrent exposure (ranging from 0.01 to 0.14 kg/m 2 increase), a dose-response for previous exposure (-0.02 to 0.09 kg/m 2 ). Job strain and rotating night shift work have independent contributions to weight gain. Reducing job strain and supporting night shift workers are both important intervention goals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.
Nag, Deb Sanjay; Chatterjee, Abhishek; Samaddar, Devi Prasad; Agarwal, Ajay
We report a case of a 72 year old hypertensive male who developed severe hypertension followed by neurological deterioration in the immediate postoperative period after transurethral resection of prostate. While arterial blood gas and laboratory tests excluded transurethral resection of prostate syndrome or any other metabolic cause, reduction of blood pressure failed to ameliorate the symptoms. A cranial CT done 4hours after the onset of neurological symptoms revealed bilateral gangliocapsular and right thalamic infarcts. Oral aspirin was advised to prevent early recurrent stroke. Supportive treatment and mechanical ventilation ensured physiological stability and the patient recovered completely over the next few days without any residual neurological deficit. Copyright © 2016. Publicado por Elsevier Editora Ltda.
Kromhout, D.; Soedamah-Muthu, S.S.; Groot, de C.P.G.M.; Hollander, de E.L.; Geleijnse, J.M.; Feskens, E.J.M.
Background - Body-mass index (BMI) and diabetes have increased worldwide, whereas global average blood pressure and cholesterol have decreased or remained unchanged in the past three decades. We quantified how much of the effects of BMI on coronary heart disease and stroke are mediated through blood
Kivimäki, Mika; Jokela, Markus; Nyberg, Solja T; Singh-Manoux, Archana; Fransson, Eleonor I; Alfredsson, Lars; Bjorner, Jakob B; Borritz, Marianne; Burr, Hermann; Casini, Annalisa; Clays, Els; De Bacquer, Dirk; Dragano, Nico; Erbel, Raimund; Geuskens, Goedele A; Hamer, Mark; Hooftman, Wendela E; Houtman, Irene L; Jöckel, Karl-Heinz; Kittel, France; Knutsson, Anders; Koskenvuo, Markku; Lunau, Thorsten; Madsen, Ida E H; Nielsen, Martin L; Nordin, Maria; Oksanen, Tuula; Pejtersen, Jan H; Pentti, Jaana; Rugulies, Reiner; Salo, Paula; Shipley, Martin J; Siegrist, Johannes; Steptoe, Andrew; Suominen, Sakari B; Theorell, Töres; Vahtera, Jussi; Westerholm, Peter J M; Westerlund, Hugo; O'Reilly, Dermot; Kumari, Meena; Batty, G David; Ferrie, Jane E; Virtanen, Marianna
Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data. We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603,838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528,908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02-1·26; p=0·02) and incident stroke (1·33, 1·11-1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30-1·42). We recorded a dose-response association for stroke, with RR estimates of 1·10 (95% CI 0·94-1·28; p=0·24) for 41-48 working hours, 1·27 (1·03-1·56; p=0·03) for 49-54 working hours, and 1·33 (1·11-1·61; p
Association of body mass index and obesity measured in early childhood with risk of coronary heart disease and stroke in middle age: findings from the aberdeen children of the 1950s prospective cohort study.
Lawlor, Debbie A; Leon, David A
There is concern that the childhood epidemic of obesity will result in increases in the risk of cardiovascular disease in the future; however, there is currently little direct evidence on this issue. We assessed the association of body mass index, measured when subjects were a mean age of 4.9 years old, with the future risk of coronary heart disease (CHD) and stroke in a large Scottish birth cohort (born in the 1950s) who have been linked to hospital admissions and mortality data. At the start of the follow-up period (1981), there were 11,106 (91%) members of the cohort alive and believed to be resident in Scotland. Over the follow-up period, they contributed 245,000 person-years of risk. Among these subjects, there were 302 (53 fatal) cases of CHD, 109 (4 fatal) cases of stroke, and 397 (57 fatal) cases of either a CHD or stroke. There was no association between childhood body mass index and CHD risk. There was no linear association between childhood body mass index and stroke risk, but those who were obese in childhood (top 2.5% of the body mass index distribution) compared with all others had an increased risk of stroke; the adjusted (for gender, father's occupational social class at birth, number of siblings, and birth weight) hazards ratio was 2.41 (95% CI 1.00 to 5.86). Body mass index in early childhood does not appear to be associated with increased CHD risk in later life.
Lim, Chun; Alexander, Michael P.
Memory impairments are common after stroke, and the anatomical basis for impairments may be quite variable. To determine the range of stroke-related memory impairment, we identified all case reports and group studies through the Medline database and the Science Citation Index. There is no hypothesis about memory that is unique to stroke, but there…
Greubel, Jana; Nachreiner, Friedhelm
Although it is known that there is an association between working hours and occupational accidents, there are only few tools which allow for an assessment of the risk associated with different working time arrangements, none of them validated yet by independent samples. Promising tools like the risk index (RI), assessed via the fatigue and risk index calculator, thus need to be validated. Since analyses on the validity of the RI based on individual data found only moderate associations between the RI and the actual accident risk, the question arises, whether a validation based on grouped data yields more promising results. Thus, the validity of the RI was re-examined, using aggregated data, i.e. pooling several individuals into groups of respondents according to their RI-score and performing calculations on the group level in order to control for individual and random variation. The study sample (n=337) was derived from an Internet survey on working hours and health, which contained information on working hours over four weeks and on the occurrence of an occupational accident during the last 12 months. Two models of aggregation were used: a distribution based and a criterion based classification, resulting in four RI groups each. Accident rates for each group were calculated and compared via χ(2)-analyses and fitting trends to the data. Results show, for both models of aggregation, that the accident rate increased exponentially with an increasing RI. Risk was 3.7 times (distribution based aggregation) and 6.5 times (criterion based aggregation) higher in the highest compared to the lowest RI-groups. The exponential trend explained 92% (distribution based aggregation) and 98% (criterion based aggregation) of the variance, respectively. Analyses for homogeneous subgroups (e.g., service sector, and workers with high workload) showed similar trends. Thus the analyses based on aggregated data indicated a considerable and consistently higher validity of the RI than the
Kerstin G Reeuwijk
Full Text Available The work ability index (WAI is a frequently used tool in occupational health to identify workers at risk for a reduced work performance and for work-related disability. However, information about the prognostic value of the WAI to identify workers at risk for sickness absence is scarce.To investigate the prognostic value of the WAI for sickness absence, and whether the discriminative ability differs across demographic subgroups.At baseline, the WAI (score 7-49 was assessed among 1,331 office workers from a Dutch financial service company. Sickness absence was registered during 12-months follow-up and categorised as 0 days, 0
Kaewboonchoo, Orawan; Ratanasiripong, Paul
The purpose of this research was to develop and test the psychometric properties of the Thai version of the Work Ability Index (WAI). Forward translation and back-translation of the WAI were performed by seven bilingual professionals to ensure that the Thai WAI was culturally relevant and conceptually accurate. To ensure generalizability of the Thai WAI, a sample of 2,744 Thai workers from 19 different enterprises in five regions of Thailand completed the Thai version of the WAI along with the General Health Questionnaire. The 19 enterprises were from the following industries: canned food, snack food, cooking oil, footwear, pharmaceutical, ceramics, toy, steel, petrochemical, and auto parts. The results from exploratory factor analysis supported a 3-factor model, accounting for 53.49% of the total variance. The results also provided evidence for adequate test-retest reliability and internal consistency of the Thai WAI. The internal consistency of the Thai WAI was found to be slightly low due to the newness of the concept of work ability, which is not a common term used in the Thai language; therefore, explanation of the meaning of work ability is needed to increase understanding of workers. By providing early recognition of workers' health risks as well as risks of early termination, the WAI can help Thai human resources managers respond better to the needs of workers and be proactive in their efforts to retain workers in their organizations. Occupational health professionals could also utilize the WAI to evaluate the work ability of Thai workers in order to help organizations recognize early signs of their workers' health risks and possible early terminations and respond appropriately.
MacIsaac, Rachael L; Ali, Myzoon; Taylor-Rowan, Martin; Rodgers, Helen; Lees, Kennedy R; Quinn, Terence J
There may be a potential to reduce the number of items assessed in the Barthel Index (BI), and shortened versions of the BI have been described. We sought to collate all existing short-form BI (SF-BI) and perform a comparative validation using clinical trial data. We performed a systematic review across multidisciplinary electronic databases to find all published SF-BI. Our validation used the VISTA (Virtual International Stroke Trials Archive) resource. We describe concurrent validity (agreement of each SF-BI with BI), convergent and divergent validity (agreement of each SF-BI with other outcome measures available in the data set), predictive validity (association of prognostic factors with SF-BI outcomes), and content validity (item correlation and exploratory factor analyses). From 3546 titles, we found 8 articles describing 6 differing SF-BI. Using acute trial data (n=8852), internal reliability suggested redundancy in BI (Cronbach α, 0.96). Each SF-BI demonstrated a strong correlation with BI, modified Rankin Scale, National Institutes of Health Stroke Scale (all ρ≥0.83; P Scale and 5 domain EuroQOL (ρ≥0.50, P <0.001). Prespecified prognostic factors were associated with SF-BI outcomes (all P <0.001). Our factor analysis described a 3 factor structure, and item reduction suggested an optimal 3-item SF-BI comprising bladder control, transfer, and mobility items in keeping with 1 of the 3-item SF-BI previously described in the literature. There is redundancy in the original BI; we have demonstrated internal and external validity of a 3-item SF-BI that should be simple to use. © 2017 American Heart Association, Inc.
Huybrechts, Krista F; Caro, J Jaime
Providing a quantitative prognosis after a stroke is important to clinicians and patients as well as to researchers interested in projecting the results of clinical trials and other studies. Thus, we critically reviewed the evidence supporting the prognostic value of two frequently-used measures, the Barthel Index (BI) and modified Rankin Scale (mRS) for long-term outcomes. A narrative review of the peer-reviewed medical literature obtained by searching Medline 1966 to January 2004--using the phrase '[stroke] AND [Barthel OR Rankin]'--was conducted to assess the strength of the evidence for these measures and answer three main questions: How good are the BI and mRS at predicting (1) the level of care required, (2) the time-course of recovery, and (3) mortality. Abstracts were screened for the presence of actual data on the prognostic impact of BI and mRS on these endpoints, and selected articles were fully reviewed and abstracted. Additional articles were identified from bibliographies of the retrieved papers. Of 753 abstracts screened, 89 articles were selected for detailed assessment. Early disability and global outcome (< or = 7 days) were shown in 21 studies to be strong predictors of care needs. This relation appears to be mainly biological, not country-specific. Recovery was shown in 18 studies to be strongly related to early BI. In contrast, the 11 studies examining mortality provided insufficient information to directly support the prognostic value of either measure. Key limitations of this review include heterogeneity of available studies (e.g., time-points, outcome, parameterization) and relative lack of information on the mRS. Despite the lack of uniformity in existing studies, the evidence overall is quite strong, supporting the use of BI and mRS as prognostic tools. External non-treatment modifiable factors which also determine long-term outcome (e.g., social support) have to be taken into account.
Full Text Available Background: The practice environment pivotal role in patients and nurses better outcomes is evident. Practice Environment Scale of Nursing Work Index (PES-NWI is widely utilized to assess nursing work environments. The present study was conducted to demonstrate the validity and reliability of the Persian version of PES-NWI. Materials and Methods: The instrument was translated and its psychometrics were investigated by content, construct validity (factor analysis, and homogeneity (internal consistency and intraclass correlation on a sample of 350 nurses at educational hospitals in East Azerbaijan, Iran. Results: The 30 items loaded onto 4 factors explained 34.95–50.06% of the variance. The items across the factors differed slightly from those reported by the original author of the PES-NWI. Cronbach's alpha and Pearson coefficient for the entire instrument and also for extracted factors was 0.70–0.96. Conclusions: The Persian version of PES-NWI has an appropriate level of validity and reliability in the Iranian setting for nurses. The subscale of Nursing Foundations for quality care needs modification.
Burau, Viola; Carstensen, Kathrine; Lou, Stina; Kuhlmann, Ellen
Background Patient-centred care based on needs has been gaining momentum in health policy and the workforce. This creates new demand for interprofessional teams and redefining roles and tasks of professionals, yet little is known on how to implement new health policies more effectively. Our aim was to analyse the role and capacity of health professions in driving organisational change in interprofessional working and patient-centred care. Methods A case study of the introduction of interprofe...
Eaton, Jennifer L; Mohr, David C; Hodgson, Michael J; McPhaul, Kathleen M
To describe development and validation of the work-related well-being (WRWB) index. Principal components analysis was performed using Federal Employee Viewpoint Survey (FEVS) data (N = 392,752) to extract variables representing worker well-being constructs. Confirmatory factor analysis was performed to verify factor structure. To validate the WRWB index, we used multiple regression analysis to examine relationships with burnout associated outcomes. Principal Components Analysis identified three positive psychology constructs: "Work Positivity", "Co-worker Relationships", and "Work Mastery". An 11 item index explaining 63.5% of variance was achieved. The structural equation model provided a very good fit to the data. Higher WRWB scores were positively associated with all three employee experience measures examined in regression models. The new WRWB index shows promise as a valid and widely accessible instrument to assess worker well-being.
Eaton, Jennifer L; Mohr, David C; Hodgson, Michael J; McPhaul, Kathleen M
To describe development and validation of the Work-Related Well-Being (WRWB) Index. Principal Components Analysis was performed using Federal Employee Viewpoint Survey (FEVS) data (N = 392,752) to extract variables representing worker well-being constructs. Confirmatory factor analysis was performed to verify factor structure. To validate the WRWB index, we used multiple regression analysis to examine relationships with burnout associated outcomes. PCA identified three positive psychology constructs: "Work Positivity", "Co-worker Relationships", and "Work Mastery". An 11 item index explaining 63.5% of variance was achieved. The structural equation model provided a very good fit to the data. Higher WRWB scores were positively associated with all 3 employee experience measures examined in regression models. The new WRWB index shows promise as a valid and widely accessible instrument to assess worker well-being.
Sujatha; Ramalingam; Vinodkumar; Vasumathi; Valarmathi; Anu
BACKGROUND Ischemic strokes account for >80% of total stroke events. Biochemical modalities like serum uric acid, ESR, CRP, Serum Fibrinogen will be a low cost and useful way to predict functional outcome after ischemic stroke. The Barthel ADL index it is an ordinal scale helping us to measure performances in ADL-activities in daily living. The present study aims to study the Biochemical parameters Uric Acid, CRP, ESR and Fibrinogen in Ischemic Stroke patients and to assess fu...
Jamjoom, Aimun A B; Wiggins, A N; Loan, J J M; Emelifeoneu, J; Fouyas, I P; Brennan, P M
Academic metrics can be used to compare the productivity of researchers. We aimed to use a variety of bibliometric parameters to assess the productivity of neurosurgeons working in the United Kingdom. Neurosurgical consultants working in the United Kingdom were identified using the Society of British Neurosurgeons' Audit Programme website. Baseline data collected included year of entry to specialist register, academic position and award of higher degree. Google Scholar was used to compute a range of academic metrics for each consultant including the h-index, hi-norm, e-index and g-index. Non-parametric tests were used to compare median results. Median metrics for the whole cohort were: h-index (5), hi-norm (3), g-index (10.4) and e-index (9). The top 3 units based on h-index were Addenbrookes (13), Great Ormond Street (12.5) and Queen's Square (11.5). The h-index correlated with academic position [Prof (17.5), Senior Lecturer (10.5) and non-academic (5); P 10 year (7), citation metrics. It provides a benchmark bibliometric profile and we advocate future comparative assessments as a means to assess impact of and guide academic policy. Copyright © 2016 Elsevier Inc. All rights reserved.
Gopal K. Singh, PhD
Full Text Available Objectives: We examined the extent to which area- and individual-level socioeconomic inequalities in cardiovascular-disease (CVD, heart disease, and stroke mortality among United States men and women aged 25-64 years changed between 1969 and 2011. Methods: National vital statistics data and the National Longitudinal Mortality Study were used to estimate area- and individual-level socioeconomic gradients in mortality over time. Rate ratios and log-linear and Cox regression were used to model mortality trends and differentials. Results: Area socioeconomic gradients in mortality from CVD, heart disease, and stroke increased substantially during the study period. Compared to those in the most affluent group, individuals in the most deprived area group had, respectively 35%, 29%, and 73% higher CVD, heart disease, and stroke mortality in 1969, but 120-121% higher mortality in 2007-2011. Gradients were steeper for women than for men. Education, income, and occupation were inversely associated with CVD, heart disease, and stroke mortality, with individual-level socioeconomic gradients being steeper during 1990-2002 than in 1979-1989. Individuals with low education and incomes had 2.7 to 3.7 times higher CVD, heart disease, and stroke mortality risks than their counterparts with high education and income levels. Conclusions and Global Health Implications: Although mortality declined for all US groups during 1969-2011, socioeconomic disparities in mortality from CVD, heart disease and stroke remained marked and increased over time because of faster declines in mortality among higher socioeconomic groups. Widening disparities in mortality may reflect increasing temporal areal inequalities in living conditions, behavioral risk factors such as smoking, obesity and physical inactivity, and access to and use of health services. With social inequalities and prevalence of smoking, obesity, and physical inactivity on the rise, most segments of the working
Singh, Gopal K; Siahpush, Mohammad; Azuine, Romuladus E; Williams, Shanita D
We examined the extent to which area- and individual-level socioeconomic inequalities in cardiovascular-disease (CVD), heart disease, and stroke mortality among United States men and women aged 25-64 years changed between 1969 and 2011. National vital statistics data and the National Longitudinal Mortality Study were used to estimate area- and individual-level socioeconomic gradients in mortality over time. Rate ratios and log-linear and Cox regression were used to model mortality trends and differentials. Area socioeconomic gradients in mortality from CVD, heart disease, and stroke increased substantially during the study period. Compared to those in the most affluent group, individuals in the most deprived area group had, respectively 35%, 29%, and 73% higher CVD, heart disease, and stroke mortality in 1969, but 120-121% higher mortality in 2007-2011. Gradients were steeper for women than for men. Education, income, and occupation were inversely associated with CVD, heart disease, and stroke mortality, with individual-level socioeconomic gradients being steeper during 1990-2002 than in 1979-1989. Individuals with low education and incomes had 2.7 to 3.7 times higher CVD, heart disease, and stroke mortality risks than their counterparts with high education and income levels. Although mortality declined for all US groups during 1969-2011, socioeconomic disparities in mortality from CVD, heart disease and stroke remained marked and increased over time because of faster declines in mortality among higher socioeconomic groups. Widening disparities in mortality may reflect increasing temporal areal inequalities in living conditions, behavioral risk factors such as smoking, obesity and physical inactivity, and access to and use of health services. With social inequalities and prevalence of smoking, obesity, and physical inactivity on the rise, most segments of the working-age population in low- and middle-income countries will likely experience increased cardiovascular
Full Text Available Background and aims : The ability of work is the basis of well-being for all of us. Many factors affect the work ability such as work and work condition, work organization and human resource. The aim of this study was to assess the work ability among car manufacturing workers and determine the relationship between the work ability index with individual characteristics and life style factors. Methods : The study was a descriptive cross-sectional investigation. The subjects comprised of 271 workers with mean age of 35 years who occupied by a car manufacturing Company. They completed the Work Ability Index Questionnaire during semi interview sessions. The job groups of Painting Shop, assembling line, office department, and technical section were studied. Statistical tests including one-way ANOVA, t-test, Kruskal wallis were used for analyzing the relationship between work ability index and individual characteristic as well as life style factors. To test the distribution of work ability index score categories, a chi-square test was used and finally, Spearman correlation coefficient was used in order to determine correlation between the final of work ability index score with any of questionnaire items. Results : The mean value of work ability index in this study was (37.67 with SD=5.87. The WAI categories were 17.71% in "excellent", 38.75% in "good", 36.16% in "moderate", and 7.4% in "poor" levels. Association between life style factors (obesity, smoking, exercise and WAI was statistically significant (P< .0.001 . Lower WAI was associated with increasing the age, high work experience and lower education (P<.0.001. Meanwhile, physical demand of the jobs was strongly associated with the WAI score (P<.0.001. Conclusion : On the basis of Finnish Institute of Occupational Health, the value of work ability in current study was in good category(37-43; but, concerning the mean age (35 years of the studied population the mean value of work
Yong, Mei; Fischer, Dorothee; Germann, Christina; Lang, Stefan; Vetter, Céline; Oberlinner, Christoph
The present study investigates the impact of chronotype, social jetlag and sleep duration on self-perceived health, measured by Work Ability Index (WAI), within an industrial setting. Between 2011 and 2013, 2474 day and shift workers participated in a health check offered by an occupational health promotion program and filled out the Munich ChronoType Questionnaire (adapted to the rotational 12-h schedule for shift workers) and the WAI. We computed sleep duration on work and free days, chronotype, and social jetlag. We used linear regression models to examine chronotype, sleep duration and social jetlag for association with the WAI sum score, and proportional odds models to estimate the combined effect of social jetlag and sleep duration. Participants reported an average daily sleep duration of 7.35 h (SD: 1.2 h), had an average chronotype of 3:08 a.m. (SD: 1 h), and the average social jetlag corresponded to 1.96 h (SD: 2.05 h). Increasing social jetlag and shorter sleep duration were independently associated with a decreasing WAI, while chronotype per se was not associated with WAI. Short sleep duration combined with high social jetlag significantly increased the risk of poor WAI (OR = 1.36; 95% CI: 1.09-1.72), while long sleep duration and high social jetlag were not associated with poor WAI (OR = 1.09; 95% CI: 0.88-1.35). Our results add to a growing body of literature, suggesting that circadian misalignment, but not chronotype per se, may be critical for health. Our results indicate that longer sleep may override the adverse effects of social jetlag on WAI.
Zhao, Y; Tang, D; Hu, L; Zhang, L; Hitchman, G; Wang, L; Chen, A
Working memory (WM) tasks may increase or decrease the interference effect of concurrently performed cognitive control tasks. However, the neural oscillatory correlates of this modulation effect of WM on the Stroop task are still largely unknown. In the present study, behavioral and electroencephalographic (EEG) data were recorded from 32 healthy participants during their performance of the single Stroop task and the same task with a concurrent WM task. We observed that the Stroop interference effect represented in both response times (RTs) and theta-band event-related spectral perturbation (ERSP) magnitude reduced under the dual-task condition compared with the single-task condition. The reduction of interference in theta-band ERSP was further positively correlated with interference reduction in RTs, and was mainly explained by the source in the left middle frontal gyrus. In conclusion, the present study suggests that the effect of concurrent WM tasks on the reduction of the Stroop interference effect can be indexed by EEG oscillations in theta-band rhythm in the centro-frontal regions and this modulation was mediated by the reduced cognitive control under the concurrent WM task. Copyright © 2014 IBRO. Published by Elsevier Ltd. All rights reserved.
Slater, Paul; McCormack, Brendan
The nurse shortage is increasing in the developed world. Organisational context is important in determining issues associated with nurse shortages, such as retention, recruitment, and job satisfaction. Recent research has utilised the Nursing Work Index-Revised (NWI-R) as a measure of organisational context traits. Within the NWI-R a four-factor model has been reported as being important in determining good organisational context, yet researchers have recently questioned the stability of the four-factor structure. No known study has attempted to replicate the four-factor structure reported in the NWI-R. The aim of this research is to examine the factor structure of the 15 items that comprise the four factors of the NWI-R. The NWI-R is an instrument that is focused on capturing organisational attributes that characterise professional nursing environments. A random sample of 172 (50%) acute care hospital nurses completed the NWI-R as part of a larger research project. The sample was diverse concerning nursing grade and specialty. Data were analysed using SPSS.11.0 to extract factors' structures (principal component and maximum likelihood), measures of homogeneity and descriptive statistics were generated from the findings. The four-factor structure of the NWI-R was not replicated in the data analysis. Instead a modified three-factor structure was identified accounting for 57% of the variance. Measures of internal consistency were acceptable. Previous research utilised the four factors of the NWI-R as a method to identify supportive organisational context and practice. The three-factor model raises questions regarding the stability of the findings using the NWI-R. This research shows the synthesis of the two models in light of previous findings. The findings might have far reaching implications for research that has utilised the NWI-R as a measure of organisational context. Further research is required to examine this study's findings and literature.
C S Mohanty
Conclusion: Our study has demonstrated that stroke functional outcome can be predicted from the baseline BI and mRS scales. It is concluded thatBI and mRS Stroke scale can be used to prognosticate functional outcome at admission and at follow up.
Bembenek, Jan Paweł; Karlinski, Michał; Niewada, Maciej; Kurkowska-Jastrzębska, Iwona; Członkowska, Anna
We aimed to investigate whether increased waist-to-hip ratio (WHR), waist circumference (WC), or improper body mass index (BMI) may differently predict short-term outcomes in females and males with first-ever acute ischemic stroke. This was a retrospective study of consecutive patients (1109 females and 939 males) admitted for first-ever ischemic stroke between 2003 and 2015. Data were collected in a detailed hospital stroke registry. BMI of 18.5-24.9 kg/m 2 and gender-specific normal values of WHC and WC were used as references for comparisons. Logistic regression was used to calculate the odds of in-hospital death or being dead or dependent at discharge, adjusted for patients' age and prestroke disability. In both sexes a high WHR increased the odds of death or dependency at discharge (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.05-3.08 for females and 1.43; 95% CI, 1.00-2.04 for males), but not in-hospital death alone. Increased WC was significantly associated with lower odds of either death or death and dependency at discharge in females only (OR, .36; 95% CI, .22-.58 and .69; 95% CI, .48-.97, respectively). BMI did not show any clear predictive value in either sex. Our findings suggest that being overweight measured with WC is a strong predictor of good outcome in women but not in men. The WHR less consistently predicts stroke outcome, as it is not associated with death at discharge alone; however, the WHR seems to be of similar clinical relevance in both genders. BMI seems to have the least clinical value in predicting stroke outcome in both genders. Copyright © 2018 National Stroke Association. Published by Elsevier Inc. All rights reserved.
... A.M. Editorial team. Related MedlinePlus Health Topics Hemorrhagic Stroke Ischemic Stroke Stroke Browse the Encyclopedia A.D. ... any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should ...
A stroke can cause lasting brain damage. People who survive a stroke need to relearn skills they lost because of ... them relearn those skills. The effects of a stroke depend on which area of the brain was ...
Impact of cigarette smoking on the relationship between body mass index and coronary heart disease: a pooled analysis of 3264 stroke and 2706 CHD events in 378579 individuals in the Asia Pacific region
Full Text Available Abstract Background Elevated levels of body mass index (BMI and smoking are well established lifestyle risk factors for coronary heart disease (CHD and stroke. If these two risk factors have a synergistic relationship, rigorous lifestyle modification may contribute to greater reduction in cardiovascular burden than previously expected. Methods A pooled analysis of individual participant data from 38 cohorts, involving 378,579 participants. Hazards ratios (HRs and 95% confidence intervals (CIs for BMI by cigarette smoking status were estimated using Cox proportional hazard models. Results During a mean follow-up of 3.8 years, 2706 CHD and 3264 strokes were recorded. There was a log-linear, positive relationship of BMI with CHD and stroke in both smokers and non-smokers with evidence of a synergistic effect of smoking on the association between BMI and CHD only: HRs (95% CIs associated with a 2 kg/m2 higher BMI were 1.13 (1.10 – 1.17 in current smokers and 1.09 (1.06 – 1.11 in non-smokers (p-value for interaction = 0.04. Conclusion Smoking amplifies the positive association between BMI and CHD but not stroke. If confirmed, these results suggest that effective strategies that target smoking cessation and weight loss are likely to have a greater impact than anticipated on reducing the burden of CHD.
Claudio R. M. Baigún
Full Text Available The pejerrey Odontesthes bonariensis is the most important target species in temperate freshwater fisheries of Argentina, and assessment of condition has been a regular practice and common diagnostic tool. Most pejerrey fishery studies have used Fulton's (K index, without testing whether underlying assumptions or requirements were met. We analyzed and contrasted the applicability of K, Kn and Wr indices to assess condition status in several pejerrey populations inhabiting Pampean lakes. Our results showed that whereas Wr and Kn displayed significant condition changes across length at some study lakes, Kn portrayed a small range of variation. We also noted that pejerrey maximum length and size structure strongly varied among populations probably due to the characteristics of trophic niche changes through lifespan, depending on lake limnological characteristics and zooplankton availability. We conclude that the K index should be disregarded in those cases where populations show allometric growth and size ranges strongly vary. In turn, the Kn index appears to be only appropriate for regular within population assessment, being difficult to apply when comparisons between populations are needed and when they exhibit different weight-length relationship slopes. Finally, the Wr index should be strongly preferred if the objective is to perform comparisons between pejerrey populations, particularly when population structure is not well known, stocking has been used for population recovery, lakes are strongly supported by limnological changes, data are limited to only one or few samplings and metaphoetesis is suspected in pejerrey populations.
Randa Aly Soliman
Conclusions: Baseline stroke volume variation ⩾8.15% predicted fluid responsiveness in mechanically ventilated patients with acute circulatory failure. The study also confirmed the ability of pulse pressure variation to predict fluid responsiveness.
Louie Amber M
Full Text Available Abstract Background The aim of the study was to examine the relationship between psychosocial and other working conditions and body-mass index (BMI in a working population. This study contributes to the approximately dozen investigations of job stress, which have demonstrated mixed positive and negative results in relation to obesity, overweight and BMI. Methods A cross-sectional population-based survey was conducted among working Australians in the state of Victoria. Participants were contacted by telephone from a random sample of phone book listings. Information on body mass index was self-reported as were psychosocial work conditions assessed using the demand/control and effort/reward imbalance models. Other working conditions measured included working hours, shift work, and physical demand. Separate linear regression analyses were undertaken for males and females, with adjustment for potential confounders. Results A total of 1101 interviews (526 men and 575 women were completed. Multivariate models (adjusted for socio-demographics demonstrated no associations between job strain, as measured using the demand/control model, or ERI using the effort/reward imbalance model (after further adjustment for over commitment and BMI among men and women. Multivariate models demonstrated a negative association between low reward and BMI among women. Among men, multivariate models demonstrated positive associations between high effort, high psychological demand, long working hours and BMI and a negative association between high physical demand and BMI. After controlling for the effort/reward imbalance or the demand/control model, the association between physical demand and working longer hours and BMI remained. Conclusion Among men and women the were differing patterns of both exposures to psychosocial working conditions and associations with BMI. Among men, working long hours was positively associated with higher BMI and this association was partly
Costa, Ana Filipa; Puga-Leal, Rogério; Nunes, Isabel L
The objective of this paper is to present a study on the assessment of the work ability of a group of aged computers workers. The study was developed with the goal of creating a decision making framework oriented towards the maintenance of the health and working ability of aged workers. Fifty computer workers participated in this study. They were administrative secretaries and computer technicians working mainly with office computers. The method used to assess the work ability was the Work Ability Index (WAI). 78% of the participants had good or excellent work ability and only 2% a poor one. The average WAI score was 40.5 (SD=5.761; min=27; max=49). This study confirms the decrease in work ability of workers while aging. The group overall work ability was slightly higher than the reference values develop by the Finnish Institute of Occupational Health. The assessment of work ability is fundamental to make age-friendly workplaces. WAI is one tool designed to perform such assessment. The results obtained could assist the early identification of situations where employees are struggling with their work ability, thus helping to prioritize ergonomic interventions devoted to improve the working conditions, and allowing the continued employment of aging workers on their current job.
Apr 2, 2011 ... Ischemic Stroke Registry yielded an incidence of 3.3 cases per 100 000 children per year, of ... Neonatal stroke. The newborn period confers the highest risk period for childhood ischaemic stroke. Focal patterns of ischaemic brain injury to the perinatal brain are .... family history of young stroke/ thrombosis.
Hackam, Daniel G
An increasing number of case reports link cannabis consumption to cerebrovascular events. Yet these case reports have not been scrutinized using criteria for causal inference. All case reports on cannabis and cerebrovascular events were retrieved. Four causality criteria were addressed: temporality, adequacy of stroke work-up, effects of rechallenge, and concomitant risk factors that could account for the cerebrovascular event. There were 34 case reports on 64 patients. Most cases (81%) exhibited a temporal relationship between cannabis exposure and the index event. In 70%, the evaluation was sufficiently comprehensive to exclude other sources for stroke. About a quarter (22%) of patients had another stroke after subsequent re-exposure to cannabis. Finally, half of patients (50%) had concomitant stroke risk factors, most commonly tobacco (34%) and alcohol (11%) consumption. Many case reports support a causal link between cannabis and cerebrovascular events. This accords well with epidemiological and mechanistic research on the cerebrovascular effects of cannabis. © 2015 American Heart Association, Inc.
Mazloumi, Adel; Rostamabadi, Akbar; Nasl Saraji, Gabraeil; Rahimi Foroushani, Abbas
In recent decades, work ability index (WAI) has been a common practical tool to measure individuals' work ability in many European, Asian and South American countries. However, there is no study concerning work ability in Iran. The aim of this study was to determine the work ability index in an Iranian petrochemical job setting and to examine its relationship with psychosocial factors. A cross-sectional study was conducted among 420 male workers in various occupations. Work ability was evaluated using the WAI questionnaire developed by FIOH; the Job content questionnaire (JCQ) was used to assess psychosocial factors. The mean WAI score was 39.1 (SD=5.7) among workers in the studied petrochemical industry. Multiple linear regression analysis revealed a significant association between mean WAI score and age, job tenure, educational level, rest and sleep status and vocational education. Moreover, the results showed that skill discretion, coworker support and supervisor support were positively associated with the mean WAI score. On the other hand, it was inversely associated with job demands, job strain and job insecurity. This study was the first research to determine WAI in an important industry in Iran. Overall, work ability was in the "Good" category among the workers in the studied field. On the basis of the WAI guidelines, this level should be maintained and promoted to excellent level by providing supportive countermeasures. The WAI score was significantly associated with psychosocial factors. The results showed that even in heavy physical work, factors such as job insecurity, skill discretion, job strain and social support play an important role in maintaining work ability. A positive combination of "psychosocial characteristics" of the job with "individual resources" can promote work ability in such occupations.
Liu, Shimin; Zhen, Gehua; Meloni, Bruno P.; Campbell, Kym; Winn, H Richard
Translational stroke research is a challenging task that needs long term team work of the stroke research community. Highly reproducible stroke models with excellent outcome consistence are essential for obtaining useful data from preclinical stroke trials as well as for improving inter-lab comparability. However, our review of literature shows that the infarct variation coefficient of commonly performed stroke models ranges from 5% to 200%. An overall improvement of the commonly used stroke ...
Raza, L.; Ali, T.M.; Hasnain, A.
BMI is considered as a major determinant of health. The objective of study was to find out differences between dietary practices, as well as BMI in educated housewives and working woman. It is supposed that both study groups may have difference in work pressures with resultant diverse preferences for food. This can affect health status particularly in relation to obesity in women. Furthermore, we selected participants with 14 years education expecting basic awareness of healthful diet. Methods: This cross sectional study had a convenient sampling method and sample size of 600 with 300 house wives and 300 working women, aged 35-45 years. Dietary habits were recorded by interview. BMI was calculated by standard formula, and results obtained by Chi-Square using SPSS 17. Results: Working women had healthier dietary practices. Number of meals, fruits, fish/ poultry and water consumption was better in working mothers with significant p value < 0.00.1. Intake of vegetables and fast food was found similar. BMI comparison showed that majority of housewives were noted as overweight whereas working women showed normal weight, p-value=< 0.001. Most housewives responded that they have a sedentary life style as opposed to working women p- value < 0.001. Self- assessment of diet quality was comparable as it was mentioned moderate by most of the participants, however more working females accepted that they need to improve their diet and would need expert advice. Conclusion:Healthier BMI, active life style and better dietary habits were witnessed in working women as compared to housewives. (author)
[Functional electrical stimulation based on a working pattern influences function of lower extremity in subjects with early stroke and effects on diffusion tensor imaging: a randomized controlled trial].
Chen, Danfeng; Yan, Tiebin; Li, Guandong; Li, Fangming; Liang, Qitang
To explore the possible mechanisms for improving lower extremity motor function in patients with early stroke through combining magnetic resonance diffusion tensor imaging (DTI) technology and functional electrical stimulation (FES) based on human walking patterns. From August 2012 to September 2013, a total of 48 eligible patients were stratified according to age, gender, disease course, Brunnstrom staging and types of stroke. And the Minimize software was used to divided them randomly into four-channel FES group (n = 18), dual-channel FES group (n = 15) and comfort stimulation group (n = 15). For all three groups, general medication and standard rehabilitation were provided. Based on normal walking pattern design of FES treatment, four-channel FES groups received the stimulations of quadriceps, hamstring, anterior tibialis and medial gastrocnemius. For the dual-channel FES group, the stimulations of tibialis anterior, peroneus longus and peroneus brevis muscles were applied. In comfort electrical stimulation group, the electrode positions were identical to the stimulation group, but there was no current output during stimulation. Before and after 3-week treatment, three groups received weekly rehabilitation evaluations of Fugl-Meyer assessment (FMA), posture assessment of stroke scale (PASS), Brunel balance assessment (BBA), Berg balance scale (BBS) and modified Barthel index (MBI). Before and after treatment, DTI examination was performed for some patients. Among three groups, general patient profiles and pre-treatment evaluations showed no significant difference. For intra-group comparisons versus pre-treatment, at week 1, 2 and 3, the scores of PASS, BBA, BBS, FMA and MBI had statistically significant differences (P stimulation group. When dual-channel FES and comfort stimulation groups were compared, MBI had significant statistical difference [(60 ± 17) vs (47 ± 20), P stimulation group respectively. When dual-channel FES and comfort stimulation groups were
Chatzikonstantinou, A; Förster, A; Hennerici, M G; Bäzner, H
The introduction of the diagnosis related groups (DRG) system in Germany has radically influenced the organization of in-hospital patient treatment. Case-mix-index and duration of treatment in a stroke unit (SU) play a central role. Our SU started in 1998 and was gradually extended to the current "Stroke Competence Center" (SCC), with a total capacity of 29 patients. The SCC combines acute treatment, work-up and post-stroke management by the same specialized team. We aimed primarily at demonstrating the financial effects of this concept. Data from stroke patients treated in our SU/SCC between 2004 and 2009 were analyzed. We analyzed the number of treated stroke patients, number of thrombolytic treatments, the number of cases coded with procedure codes OPS 8-981.x and the ratio of OPS 8-981.0 (24-72 h on SU) to the higher remunerated OPS 8-981.1 (>72 h on SU). The number of treated patients increased by 118.3% (from 469 in 2004 to 1024 in 2009). The number of thrombolyses per year has more than quadrupled (2004: 46, 2009: 253, i.e. 25% of SU patients). The introduction of the stroke center concept lead to a great increase in the ratio of the higher rewarded OPS 8-981.1 to OPS 8-981.0 (from 1.5 in 2005 to 5.21 in 2009). Our data demonstrates that the SCC concept leads to a greater financial potential, while offering considerable medical advantages concerning more effective stroke treatment and work-up as well as improved flow of information and enhanced individual patient-physician relationship.
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Renal dysfunction as a predictor of stroke and systemic embolism in patients with nonvalvular atrial fibrillation: validation of the R(2)CHADS(2) index in the ROCKET AF (Rivaroxaban Once-daily, oral, direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation) and ATRIA (AnTicoagulation and Risk factors In Atrial fibrillation) study cohorts.
Piccini, Jonathan P; Stevens, Susanna R; Chang, YuChiao; Singer, Daniel E; Lokhnygina, Yuliya; Go, Alan S; Patel, Manesh R; Mahaffey, Kenneth W; Halperin, Jonathan L; Breithardt, Günter; Hankey, Graeme J; Hacke, Werner; Becker, Richard C; Nessel, Christopher C; Fox, Keith A A; Califf, Robert M
We sought to define the factors associated with the occurrence of stroke and systemic embolism in a large, international atrial fibrillation (AF) trial. In ROCKET AF (Rivaroxaban Once-daily, oral, direct factor Xa inhibition Compared with vitamin K antagonism for prevention of stroke and Embolism Trial in Atrial Fibrillation), 14 264 patients with nonvalvular AF and creatinine clearance ≥30 mL/min were randomized to rivaroxaban or dose-adjusted warfarin. Cox proportional hazards modeling was used to identify factors at randomization independently associated with the occurrence of stroke or non-central nervous system embolism based on intention-to-treat analysis. A risk score was developed in ROCKET AF and validated in ATRIA (AnTicoagulation and Risk factors In Atrial fibrillation), an independent AF patient cohort. Over a median follow-up of 1.94 years, 575 patients (4.0%) experienced primary end-point events. Reduced creatinine clearance was a strong, independent predictor of stroke and systemic embolism, second only to prior stroke or transient ischemic attack. Additional factors associated with stroke and systemic embolism included elevated diastolic blood pressure and heart rate, as well as vascular disease of the heart and limbs (C-index 0.635). A model that included creatinine clearance (R(2)CHADS(2)) improved net reclassification index by 6.2% compared with CHA(2)DS(2)VASc (C statistic=0.578) and by 8.2% compared with CHADS(2) (C statistic=0.575). The inclusion of creatinine clearance <60 mL/min and prior stroke or transient ischemic attack in a model with no other covariates led to a C statistic of 0.590.Validation of R(2)CHADS(2) in an external, separate population improved net reclassification index by 17.4% (95% confidence interval, 12.1%-22.5%) relative to CHADS(2). In patients with nonvalvular AF at moderate to high risk of stroke, impaired renal function is a potent predictor of stroke and systemic embolism. Stroke risk stratification in patients
Tradução e adaptação para a cultura brasileira do "Nursing Work Index - Revised" Traducción y adaptación a la cultura brasileña del "Nursing Work Index - Revised" Translation and cross-cultural adaptation of the "Nursing Work Index - Revised" into Brazilian Portuguese
Renata Cristina Gasparino
Full Text Available OBJETIVO: Traduzir e adaptar o "Nursing Work Index - Revised", para a cultura brasileira. MÉTODOS: Para o procedimento metodológico seguiram-se as etapas recomendadas internacionalmente: tradução; retro-tradução; avaliação por um grupo de juízes e pré-teste. RESULTADOS: As etapas de tradução e retro-tradução foram realizadas satisfatoriamente e a avaliação da versão síntese pelo comitê de juízes resultou em alteração na maioria dos itens assegurando as equivalências entre as versões original e traduzida. Durante o pré-teste, verificou-se a necessidade de reformulações de alguns itens tornando-os mais claros e de fácil compreensão. CONCLUSÃO: Destaca-se que apesar da complexidade do instrumento, o processo de tradução e adaptação cultural do Nursing Work Index - Revised, para a cultura brasileira, foi concluído com sucesso.OBJETIVO: Traducir y adaptar el "Nursing Work Index - Revised", a la cultura brasileña. MÉTODOS: Para el procedimiento metodológico se siguieron las etapas recomendadas internacionalmente: traducción; retrotraducción; evaluación por un grupo de jueces y pre-test. RESULTADOS: Las etapas de traducción y retrotraducción fueron realizadas satisfactoriamente, la evaluación de la versión síntesis por el comité de jueces resultó en alteración en la mayoría de los ítems, garantizando las equivalencias entre las versiones original y traducida. Durante el pre-test, se verificó la necesidad de reformulaciones de algunos ítems, tornándolos más claros y de fácil comprensión. CONCLUSION: Se destaca que, a pesar de la complejidad del instrumento, el proceso de traducción y adaptación cultural del Nursing Work Index - Revised, a la cultura brasileña fue concluido con êxito.OBJECTIVE: To translate and establish the cross-cultural validation of the "Nursing Work Index - Revised" into Brazilian Portuguese. METHODS: Internationally recommended methodological procedures were followed
Uzdin, Raam; Kosloff, Ronnie
A multilevel four-stroke engine where the thermalization strokes are generated by unitary collisions with thermal bath particles is analyzed. Our model is solvable even when the engine operates far from thermal equilibrium and in the strong system–bath coupling. Necessary operation conditions for the heat machine to perform as an engine or a refrigerator are derived. We relate the work and efficiency of the device to local and non-local statistical properties of the baths (purity, index of coincidence, etc) and put upper bounds on these quantities. Finally, in the ultra-hot regime, we analytically optimize the work and find a striking similarity to results obtained for efficiency at maximal power of classical engines. The complete swap limit of our results holds for any four-stroke quantum Otto engine that is coupled to the baths for periods that are significantly longer than the thermal relaxation time. (paper)
Uzdin, Raam; Kosloff, Ronnie
A multilevel four-stroke engine where the thermalization strokes are generated by unitary collisions with thermal bath particles is analyzed. Our model is solvable even when the engine operates far from thermal equilibrium and in the strong system-bath coupling. Necessary operation conditions for the heat machine to perform as an engine or a refrigerator are derived. We relate the work and efficiency of the device to local and non-local statistical properties of the baths (purity, index of coincidence, etc) and put upper bounds on these quantities. Finally, in the ultra-hot regime, we analytically optimize the work and find a striking similarity to results obtained for efficiency at maximal power of classical engines. The complete swap limit of our results holds for any four-stroke quantum Otto engine that is coupled to the baths for periods that are significantly longer than the thermal relaxation time.
Baldwin, Kathleen; Orr, Sean; Briand, Mary; Piazza, Carolyn; Veydt, Annita; McCoy, Stacey
Stroke is the third most common cause of death in the United States and is the number one cause of long-term disability. Legislative mandates, largely the result of the American Heart Association, American Stroke Association, and Brain Attack Coalition working cooperatively, have resulted in nationwide standardization of care for patients who experience a stroke. Transport to a skilled facility that can provide optimal care, including immediate treatment to halt or reverse the damage caused by stroke, must occur swiftly. Admission to a certified stroke center is recommended for improving outcomes. Most strokes are ischemic in nature. Acute ischemic stroke is a heterogeneous group of vascular diseases, which makes targeted treatment challenging. To provide a thorough review of the literature since the 2007 acute ischemic stroke guidelines were developed, we performed a search of the MEDLINE database (January 1, 2004-July 1, 2009) for relevant English-language studies. Results (through July 1, 2009) from clinical trials included in the Internet Stroke Center registry were also accessed. Results from several pivotal studies have contributed to our knowledge of stroke. Additional data support the efficacy and safety of intravenous alteplase, the standard of care for acute ischemic stroke since 1995. Due to these study results, the American Stroke Association changed its recommendation to extend the time window for administration of intravenous alteplase from within 3 hours to 4.5 hours of symptom onset; this recommendation enables many more patients to receive the drug. Other findings included clinically useful biomarkers, the role of inflammation and infection, an expanded role for placement of intracranial stents, a reduced role for urgent carotid endarterectomy, alternative treatments for large-vessel disease, identification of nontraditional risk factors, including risk factors for women, and newly published pediatric stroke guidelines. In addition, new devices for
Full Text Available Cryptogenic stroke is defined as brain infarction that is not attributable to a source of definite embolism, large artery atherosclerosis, or small artery disease despite a thorough vascular, cardiac, and serologic evaluation. Despite many advances in our understanding of ischemic stroke, cryptogenic strokes remain a diagnostic and therapeutic challenge. The pathophysiology of cryptogenic stroke is likely various. Probable mechanisms include cardiac embolism secondary to occult paroxysmal atrial fibrillation, aortic atheromatous disease or other cardiac sources, paradoxical embolism from atrial septal abnormalities such as patent foramen ovale, hypercoagulable states, and preclinical or subclinical cerebrovascular disease. Cryptogenic stroke is one-fourth among cerebral infarction, but most of them could be ascribed to embolic stroke. A significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging and improvement in our ability to detect paroxysmal atrial fibrillation in patients with cryptogenic stroke has strengthened the idea that these strokes are embolic in nature. a significant proportion of cryptogenic strokes adhere to embolic infarct topography on brain imaging.embolic stroke of undetermined sources(ESUS was planned for unifying embolic stroke of undetermined source. The etiologies underlying ESUS included minor-risk potential cardioembolic sources, covert paroxysmal atrial fibrillation, cancer-associated coagulopathy and embolism, arteriogenic emboli, and paroxysmal embolism. Extensive evaluation including transesophageal echocardiography and cardiac monitoring for long time could identify the etiology of these patients. Therefore cryptogenic stroke is a diagnosis of exclusion. Compared with other stroke subtypes, cryptogenic stroke tends to have a better prognosis and lower long-term risk of recurrence.
Amarenco, Pierre; Benavente, Oscar; Goldstein, Larry B
BACKGROUND AND PURPOSE: The SPARCL trial showed that atorvastatin 80 mg/d reduces the risk of stroke and other cardiovascular events in patients with recent stroke or transient ischemic attack (TIA). We tested the hypothesis that the benefit of treatment varies according to index event stroke sub...
Kalaria, Raj N.; Akinyemi, Rufus; Ihara, Masafumi
The global burden of ischaemic strokes is almost 4-fold greater than haemorrhagic strokes. Current evidence suggests that 25–30% of ischaemic stroke survivors develop immediate or delayed vascular cognitive impairment (VCI) or vascular dementia (VaD). Dementia after stroke injury may encompass all types of cognitive disorders. States of cognitive dysfunction before the index stroke are described under the umbrella of pre-stroke dementia, which may entail vascular changes as well as insidious neurodegenerative processes. Risk factors for cognitive impairment and dementia after stroke are multifactorial including older age, family history, genetic variants, low educational status, vascular comorbidities, prior transient ischaemic attack or recurrent stroke and depressive illness. Neuroimaging determinants of dementia after stroke comprise silent brain infarcts, white matter changes, lacunar infarcts and medial temporal lobe atrophy. Until recently, the neuropathology of dementia after stroke was poorly defined. Most of post-stroke dementia is consistent with VaD involving multiple substrates. Microinfarction, microvascular changes related to blood–brain barrier damage, focal neuronal atrophy and low burden of co-existing neurodegenerative pathology appear key substrates of dementia after stroke injury. The elucidation of mechanisms of dementia after stroke injury will enable establishment of effective strategy for symptomatic relief and prevention. Controlling vascular disease risk factors is essential to reduce the burden of cognitive dysfunction after stroke. This article is part of a Special Issue entitled: Vascular Contributions to Cognitive Impairment and Dementia edited by M. Paul Murphy, Roderick A. Corriveau and Donna M. Wilcock. PMID:26806700
Ahmed, R.; Zuberi, F.Z.; Afsar, S.
Objective: To evaluate the baseline National Institute of Health Stroke Scale (NIHSS) score as a predictor of functional outcome after ischemic stroke. Subjects and Methods: The study included 50 patients who presented to Civil Hospital, Karachi, during the study period with acute stroke and were evaluated with CT scan of brain. Only those patients were enrolled in the study that had acute ischemic stroke. The enrolled subjects were then evaluated for the neurological impairment using National Institute of Health Stroke Scale (NIHSS). The subjects were followed-up and their functional outcome was assessed using Barthel index (BI) on the 7th day of their admission. Results: Of the fifty patients enrolled in the study, 31 (62%) were males and 19 (38%) were females, with age ranging from 45 years to 95 years and a mean age of 59.9 years. Neurological impairment at presentation was assessed by NIHSS. The score ranged between 2 and 28. The functional outcome was evaluated on the 7th day using Barthel index (BI), which ranged from 0 to 80. NIHSS score was found to be a good predictor of functional outcome in patients with ischemic stroke (p<0.001). Other factors like gender, hypertension and heart disease did not affect the functional recovery in such patients. Various factors were found to be significant for early prediction of stroke recovery. The NIHSS score was the strongest predictor of outcome after ischemic stroke. Age at the time of the event was also found to be an important predictor for stroke recovery. Conclusion: The NIHSS score is a good predictor of patient's recovery after stroke. Assessing the patient's neurological impairment at first presentation of ischemic stroke can guide the physician regarding the prognosis and management plan. (author)
J.M. Cramm (Jane); A.P. Nieboer (Anna)
markdownabstractIntroduction: The quality of integrated stroke care depends on smooth team functioning but professionals may not always work well together. Professionals’ perspectives on the factors that influence stroke team functioning remain largely unexamined. Understanding their
Vanni, Simone; Polidori, Gianluca; Pepe, Giuseppe; Chiarlone, Melisenda; Albani, Alberto; Pagnanelli, Adolfo; Grifoni, Stefano
The absence of a rapidly available and sensitive diagnostic test represents an important limitation in the triage of patients with suspected stroke. The aim of the present study was to investigate the triage accuracy of a novel test that measures blood-borne biomarkers (triage stroke panel, TSP) and to compare its accuracy with that of the Cincinnati Prehospital Stroke Scale (CPSS). Consecutive patients with suspected stroke presenting to the Emergency Departments of three Italian hospitals underwent triage by a trained nurse according to the CPSS and had blood drawn for TSP testing. The TSP simultaneously measures four markers (B-type natriuretic peptide, D-dimer, matrix metalloproteinase-9, and S100β) presenting a single composite result, the Multimarker Index (MMX). Stroke diagnosis was established by an expert committee blinded to MMX and CPSS results. There were 155 patients enrolled, 87 (56%) of whom had a final diagnosis of stroke. The area under the receiver operating characteristic (ROC) curve for CPSS was 0.77 (95% confidence interval [CI] 0.70-0.84) and that of MMX was 0.74 (95% CI 0.66-0.82) (p = 0.285). Thus, both tests, when used alone, failed to recognize approximately 25% of strokes. The area under the ROC curve of the combination of the two tests (0.86, 95% CI 0.79-0.91) was significantly greater than that of either single test (p = 0.01 vs. CPSS and p vs. TSP). In an emergency care setting, a panel test using multiple biochemical markers showed triage accuracy similar to that of CPSS. Further studies are needed before biomarkers can be introduced in the clinical work-up of patients with suspected stroke. Copyright © 2011 Elsevier Inc. All rights reserved.
Stroke rehabilitation; Cerebrovascular accident - rehabilitation; Recovery from stroke; Stroke - recovery; CVA - recovery ... LIVE AFTER A STROKE Most people will need stroke rehabilitation (rehab) to help them recover after they leave ...
Rowat, Anne; Lawrence, Maggie; Horsburgh, Dorothy; Legg, Lynn; Smith, Lorraine N
stroke is a national research priority. However, in the literature there is still minimal systematic investigation of stroke nursing - especially practice. The aim of this study was to explore stroke nurses' research priorities through a series of focus groups. the study was qualitative and involved focus groups (n = 7) with registered nurses working in stroke care settings and who were members of the Scottish Stroke Nurses Forum. Data were analysed to identify conceptual categories, which were found to relate to the categories defined by Kirkevold (1997) and Booth (2001). five priority areas for stroke nursing were described: preventive/conserving; supporting/consoling; restorative; integrative; and service structure/systems. by consulting stroke nurses it can be ensured that future research truly reflects the nature of nursing care and is of particular relevance to stroke nursing practice. The development of research evidence-base in stroke nursing will lead to increased knowledge, a better quality of care and ultimately better outcomes for patients.
... unique for each person. Although a majority of functional abilities may be restored soon after a stroke, recovery is an ongoing process. Effects of a Stroke Weakness (hemiparesis) or paralysis (hemiplegia) on one side of the body that may affect the whole ...
... of 3 and 10. In those with SCD, ischemic strokes most often occur in children under the age of 15 and adults over the age of 30, while hemorrhagic strokes most often occur in young adults between the ages of 20 and 30. ...
Ossama Y. Mansour
Nov 20, 2014 ... or predict all dimensions of recovery and disability after acute stroke. Several scales have proven reliability and validity in stroke trials. Objectives: The aim of the work was to evaluate the FOUR score predictability for outcome of patients with acute ischemic stroke in comparison with the NIHSS and the GCS ...
Stroke; Acute Stroke; Acute Brain Injury; Ischemic Stroke; Hemorrhagic Stroke; Transient Ischemic Attack; Subarachnoid Hemorrhage; Cerebral Ischemia; Cerebral Infarction; Cerebral Stroke; Venous Sinus Thrombosis, Cranial
This review provides a synthesis of the work done by our laboratory that demonstrates the presence of cellular immune responses directed towards brain antigens in animals following experimental stroke as well as in patients following ischemic stroke. These responses include both antigenspecific Th1(+) responses, which are associated with worse stroke outcome, and antigen-specific Treg responses, which are associated with better stroke outcome. The likelihood of developing a detrimental Th1(+)...
Manenschijn, Laura; van Kruysbergen, Rulanda G P M; de Jong, Frank H; Koper, Jan W; van Rossum, Elisabeth F C
The incidence of obesity and other features of the metabolic syndrome is increased in shift workers. This may be due to a misalignment between the internal circadian rhythm and the behavioral rhythm. The stress hormone cortisol could play a role in this phenomenon because it is secreted in a circadian rhythm, and long-term elevated cortisol leads to components of the metabolic syndrome. We compared cortisol levels in scalp hair of shift and day workers to study changes in long-term cortisol due to shift work. Hair samples were collected from 33 shift workers and 89 day workers. Cortisol was extracted from the hair samples with methanol, and cortisol levels were measured using ELISA. Height and weight were measured, and body mass index (BMI) was calculated. Shift workers had higher hair cortisol levels than day workers: 47.32 pg/mg hair [95% confidence interval (CI) = 38.37-58.21] vs. 29.72 pg/mg hair (95% CI = 26.18-33.73) (P cortisol levels were present only in younger shift workers: 48.53 pg/mg hair (95% CI = 36.56-64.29) vs. 26.42 pg/mg hair (95% CI = 22.91-30.55) (P cortisol and BMI were positively correlated (β = 0.262; P = 0.005). Shift work at a young adult age is associated with elevated long-term cortisol levels and increased BMI. Elevated cortisol levels and BMI may contribute to the increased cardiovascular risk found in shift workers.
Lochhead, Lois E; MacMillan, Peter D
The Oswestry disability index (ODI) is the most widely used measure of perceived disability for low back conditions. It has been adopted without adaptation in functional capacity evaluation (FCE). Rigorous testing of the ODI with modern psychometric methods, in this setting, is warranted. To determine the psychometric properties of the ODI in FCE: unidimensionality; differential item functioning; item coverage and to identify poorly functioning items, allowing for improvement of these items and recalibration of the scale. Rasch analysis, specifically Masters' partial credit model, was conducted on data. 133 work-disabled individuals presenting for FCE in northern British Columbia, Canada. All items had one poorly functioning option. Items were rescaled from six categories to five, improving the psychometric properties of the ODI as a unidimensional (disability due to back pain) scale. Item difficulty range is sufficient for a population with mild to severe disability. Although two of the ten ODI items functioned marginally unsatisfactorily in the unrevised state, the 5-option revised ODI appears superior. Use in clinical settings across a broad spectrum of disability levels could help establish its psychometric properties. Health professionals should be aware that the ODI may perform differently depending on client population.
Azadimanesh, Farzaneh; Mohammadi, Naser
Cellulose triacetate (CTA) plasticization with 25 wt% glycerin (GLY), triethyl citrate (TEC) or dioctyl phthalate (DOP) enhanced its crystalline content as much as 55%, while only 10% crystalline content increase noticed using poly (ethylene glycol) (PEG). In addition, GLY and PEG did not cause any sensible Tg depression regarding CTA, whereas DOP and TEC decreased it as much as 46°C and 16°C, respectively. Furthermore, the work of fracture (WoF) of CTA was deteriorated by PEG, did not change using GLY and magnified as much as 6.5 and 15 times by TEC and DOP, respectively. The elastic modulus (EM) of the plasticized CTAs, however, were 1.07, 1.06, 0.42 and 0.3 GPa using GLY, PEG, TEC and DOP, respectively. Finally, the normalized WoF and EM of the plasticized CTAs by their Tg depression (ΔTg) and crystalline content (Xc) showed a universal correlation with a plasticizer index containing its molar volume, concentration and polymer/plasticizer Painter-Coleman interaction parameter. Copyright © 2015 Elsevier Ltd. All rights reserved.
Langhorne, P.; Bernhardt, J.; Kwakkel, G.
Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially
Full Text Available Robotic therapy devices have been an important part of clinical neurological rehabilitation for several years. Until now such devices are only available for patients receiving therapy inside rehabilitation hospitals. Since patients should continue rehabilitation training after hospital discharge at home, intelligent robotic rehab devices could help to achieve this goal. This paper presents therapeutic requirements and early phases of the user-centered design process of the patient’s work station as part of a novel robot-based system for motor telerehabilitation.
Larsen, Ulrik; Wronski, Jorrit; Andreasen, Jesper Graa
presents the thermodynamic analysis of a concept that aims at reducing the cost of an organic Rankine cycle unit by using one of the cylinders in a large diesel engine as expansion device. Numerical models were used to optimise the process parameters and thereby determine the power potential...... for this concept. The evaluation of 104 working fluids points to cyclopropane, R245fa and R1234ze(z) as the most promising. The results suggest that the power produced by the organic Rankine cycle cylinder is at least equivalent to that of the cylinders operating with the diesel process. This enables potential...
Roorda, L.D.; Green, J.; Kluis, K.R. de; Molenaar, I.W.; Bagley, P.; Smith, J.; Geurts, A.C.H.
OBJECTIVE: To investigate the cross-cultural validity of international Dutch-English comparisons when using the Dutch Rivermead Mobility Index (RMI), and the intra-test reliability and construct validity of the Dutch RMI. METHODS: Cross-cultural validity was studied in a combined data-set of Dutch
Roorda, Leo D.; Green, John; De Kluis, Kiki R. A.; Molenaar, Ivo W.; Bagley, Pam; Smith, Jane; Geurts, Alexander C. H.
Objective: To investigate the cross-cultural validity of international Dutch-English comparisons when using the Dutch Rivermead Mobility Index (RMI), and the intra-test reliability and construct validity of the Dutch RMI. Methods: Cross-cultural validity was studied in a combined data-set of Dutch
Weiss, Steven J; Ernst, Amy A; Nick, Todd G
Emergency department (ED) crowding is just beginning to be quantified. The only two scales presently available are the National Emergency Department Overcrowding Scale (NEDOCS) and the Emergency Department Work Index (EDWIN). To assess the value of the NEDOCS and the EDWIN in predicting overcrowding. The hypothesis of this study was that the NEDOCS and the EDWIN would be equally sensitive and specific for overcrowding. The NEDOCS, the EDWIN, and an overcrowding measure (OV) were determined every two hours for a ten-day period in December 2004. The NEDOCS is a statistically derived calculation, and the EDWIN is a formula-based calculation. The overcrowding measure is a composite of physician and charge nurse expert opinion on the degree of overcrowding as measured on a 100-mm visual analogue scale (VAS). The primary outcome, overcrowding, was based on the dichotomized OV VAS score at the midpoint of 50 mm (> or =50, overcrowded; overcrowded). The area under the receiver operator characteristic curve (AUC) and an index of adequacy (relative prognostic content) of each measure, on the basis of the likelihood ratio chi-square statistic, were computed to evaluate the performance of NEDOCS and EDWIN. There were 130 completed sampling times over ten days. The OV indicated that the ED was overcrowded 62% of the time. The AUC for the NEDOCS was 0.83 (95% CI = 0.75 to 0.90), and the AUC for the EDWIN was 0.80 (95% CI = 0.73 to 0.88). The NEDOCS score accounts for 97% of the prognostic information provided by combining all variables used in each model into one combined model. The EDWIN score accounts for only 86% (chi2 test for difference, p = 0.02). Both scales had high AUCs, correlated well with each other, and showed good discrimination for predicting ED overcrowding. This establishes construct validity for these scales as measures of overcrowding. Which scale is used in an ED is dependent on which set of data is most readily available, with the favored scale being the
Stroke in childhood has gained increasingly more attention and is accepted as an important disease in childhood. The reasons for this severe event and the consequences for the rest of the life are totally different than for adults. This is also true for the diagnosis and therapy. This paper gives a comprehensive overview on the characteristics of pediatric stroke to assist radiologists in making a rapid and safe diagnosis in order to identify the underlying disease. (orig.) [de
Erdur, Hebun; Scheitz, Jan F; Ebinger, Martin; Rocco, Andrea; Grittner, Ulrike; Meisel, Andreas; Rothwell, Peter M; Endres, Matthias; Nolte, Christian H
We aimed to assess the risk of recurrent ischemic events during hospitalization for stroke or transient ischemic attack (TIA) with optimal current management and to identify associated risk factors. We performed a retrospective analysis of all patients treated for acute ischemic stroke or TIA in 3 stroke units between 2010 and 2013. Recurrent stroke was defined as new persisting (≥24 hours) neurological deficit occurring >24 hours after the index event and not attributable to other causes of neurological deterioration. Cox proportional hazard regression identified risk factors associated with recurrent stroke. The study included 5106 patients. During a median length of stay of 5 days (interquartile range, 4-8), stroke recurrence (or stroke after TIA) occurred in 40 patients (0.8%) and was independently associated with history of TIA, symptomatic carotid stenosis (≥70%), or other determined etiology. Patients with recurrent stroke and other determined etiology had cervical arterial dissection (n=2), primary angiitis of the central nervous system (n=1), giant cell arteritis (n=1), and lung cancer with nonbacterial thrombotic endocarditis (n=1). In patients with initial TIA or minor stroke (National Institutes of Health Stroke Scale ≤5) recurrence was associated additionally with pneumonia after the inciting ischemic event but before stroke recurrence. Patients with initial stroke and aphasia had a lower stroke recurrence rate and there were no recurrences in patients with lacunar stroke. Recurrence was associated with significantly higher in-hospital mortality (17.5% versus 3.1%; Pstroke recurrence was low with optimal current management. Patients with a history of TIA, severe symptomatic carotid stenosis, or uncommon causes of stroke were at higher risk. Pneumonia was associated with a higher risk of stroke recurrence in patients with initial TIA or minor stroke but not in the overall population studied. Aphasia may bias the detection rate by concealing new
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Kalowska, E.; Rostrup, E.; Rosenbaum, S.
aimed to assess if acute MRI findings could be used for the prediction of stroke in progression (SIP). METHODS: Prospectively 41 patients, 13 with lacunar infarcts and 28 with territorial infarcts, were admitted to an acute stroke unit within 24 h of stroke onset (median 11 h, range 3- 22). Diffusion...... the modified Rankin Scale, Barthel Index and SSS score. Patients with and without SIP were compared using both clinical and MRI data obtained on admission, on day 7 and after 3 months. RESULTS: Fifteen patients (37%) developed SIP. Increased DWI lesion volume on day 7 in all strokes was associated with SIP...
Eriksson, Karin; Forsgren, Emma; Hartelius, Lena; Saldert, Charlotta
To evaluate the effect of a communication partner training programme directed to enrolled nurses working with people with communication disorders in nursing homes, using an individualised approach. Five dyads consisting of a person with stroke-induced aphasia (n = 4) or Parkinson's disease (PD) (n = 1) living in different nursing homes and his/her enrolled nurse participated in the study, which had a replicated single-subject design with multiple baselines across individuals. The main element of the intervention was supervised analysis of video-recorded natural interaction in everyday nursing situations and the formulation of individual goals to change particular communicative strategies. Outcome was measured via blinded assessments of filmed natural interaction obtained at baseline, intervention and follow-up and showed an increased use of the target communicative strategies. Subjective measures of goal attainment by the enrolled nurses were consistent with these results. Measures of perceived functional communication on behalf of the persons with communication disorders were mostly positive; four of five participants with communication disorders and two of five enrolled nurses reported improved functional communication after intervention. The use of an individualised communication partner training programme led to significant changes in natural interaction, which contributes importantly to a growing body of knowledge regarding communication partner training. Communication partner training can improve the communicative environment of people with communication disorders. For people with communication disorders who live in institutions, the main conversation partner is likely to be a professional caretaker. An individualised approach for communication partner training that focussed on specific communication patterns was successful in increasing the use of supportive strategies that enrolled nurses used in natural interaction with persons with communication disorders
Full Text Available Background: The need to obtain efficiency gains and to focus practice on obtaining value has influenced research in the area of nursing environment and nursing outcomes. The conclusions reached in those studies highlight the need for better nurse/patient ratios, better qualified nurses, and greater involvement of nurses in decision-making and in clinical management, which will lead to increased levels of productivity and satisfaction and, consequently,better patient outcomes and better organization. The study and creation of favourable practice environments may play a fundamental role on that. Practice environments have been studied since the 1980s (Lake, 2002 with the aim of better understanding their effect on nursing professionals and on patient outcomes. More recently, focus has also been put on their connection to patient safety.Aim: To translate and validate the Practice Environment Scale of the Nursing Work Index (PES-NWI for producing a Portuguese version of the scale ready to be used for the assessment of nursing practice environments in Portugal.Methodology: Translation, cultural validation and back-translation were achieved with the collaboration of a group of nurses and nursing teachers. The psychometric validation of the Portuguese version was reached by extracting the principal components using a varimax rotation (construct validity. The analysis of the criterionvalidity was carried out through correlation using Barton’s Job Satisfaction Scale and scale reliability was assessed through the analysis of internal consistency using Cronbach’s Alpha. An electronic version of the instrument was created and given to a sample of nurses who were members of the National Board for Nursing and who were invited to fill out the scale via email. A total of 418 responses were received.Results: The analysis identified an eight-factor solution which, following a deeper semantic analysis resulted in seven subscales. The scale’s global internal
Angela Michelle Auriat
Full Text Available Following stroke, the brain undergoes various stages of recovery where the central nervous system can reorganize neural circuitry (neuroplasticity both spontaneously and with the aid of behavioural rehabilitation and non-invasive brain stimulation. Multiple neuroimaging techniques can characterize common structural and functional stroke-related deficits, and importantly, help predict recovery of function. Diffusion tensor imaging (DTI typically reveals increased overall diffusivity throughout the brain following stroke, and is capable of indexing the extent of white matter damage. Magnetic resonance spectroscopy (MRS provides an index of metabolic changes in surviving neural tissue after stroke, serving as a marker of brain function. The neural correlates of altered brain activity after stroke have been demonstrated by abnormal activation of sensorimotor cortices during task performance, and at rest, using functional magnetic resonance imaging (fMRI. Electroencephalography (EEG has been used to characterize motor dysfunction in terms of increased cortical amplitude in the sensorimotor regions when performing upper-limb movement, indicating abnormally increased cognitive effort and planning in individuals with stroke. Transcranial magnetic stimulation (TMS work reveals changes in ipsilesional and contralesional cortical excitability in the sensorimotor cortices. The severity of motor deficits indexed using TMS has been linked to the magnitude of activity imbalance between the sensorimotor cortices. In this paper we will provide a narrative review of data from studies utilizing DTI, MRS, fMRI, EEG and brain stimulation techniques focusing on TMS and its combination with uni and multi-modal neuroimaging methods to assess recovery after stroke. Approaches that delineate the best measures with which to predict or positively alter outcomes will be highlighted.
Comparison of Expert Adjudicated Coronary Heart Disease and Cardiovascular Disease Mortality With the National Death Index: Results From the REasons for Geographic And Racial Differences in Stroke (REGARDS) Study.
Olubowale, Olusola Tope; Safford, Monika M; Brown, Todd M; Durant, Raegan W; Howard, Virginia J; Gamboa, Christopher; Glasser, Stephen P; Rhodes, J David; Levitan, Emily B
The National Death Index (NDI) is widely used to detect coronary heart disease (CHD) and cardiovascular disease (CVD) deaths, but its reliability has not been examined recently. We compared CHD and CVD deaths detected by NDI with expert adjudication of 4010 deaths that occurred between 2003 and 2013 among participants in the REGARDS (REasons for Geographic And Racial Differences in Stroke) cohort of black and white adults in the United States. NDI derived CHD mortality had sensitivity 53.6%, specificity 90.3%, positive predictive value 54.2%, and negative predictive value 90.1%. NDI-derived CVD mortality had sensitivity 73.4%, specificity 84.5%, positive predictive value 70.6%, and negative predictive value 86.2%. Among NDI-derived CHD and CVD deaths, older age (odds ratios, 1.06 and 1.04 per 1-year increase) was associated with a higher probability of disagreement with the adjudicated cause of death, whereas among REGARDS adjudicated CHD and CVD deaths a history of CHD or CVD was associated with a lower probability of disagreement with the NDI-derived causes of death (odds ratios, 0.59 and 0.67, respectively). The modest accuracy and differential performance of NDI-derived cause of death may impact CHD and CVD mortality statistics. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
Willey, Joshua Z; Disla, Norbelina; Moon, Yeseon Park; Paik, Myunghee C; Sacco, Ralph L; Boden-Albala, Bernadette; Elkind, Mitchell S V; Wright, Clinton B
Depression is highly prevalent after stroke and may influence recovery. We aimed to determine whether depressed mood acutely after stroke predicts subsequent disability and mortality. As part of the Northern Manhattan Stroke Study, a population-based incident stroke case follow-up study performed in a multiethnic urban population, participants were asked about depressed mood within 7 to 10 days after stroke. Participants were followed every 6 months the first 2 years and yearly thereafter for 5 years for death and disability measured by the Barthel Index. We fitted polytomous logistic regression models using a canonical link to examine the association between depressed mood after stroke and disability comparing moderate (Barthel Index 60 to 95) and severe (Barthel Index or=95). Cox proportional hazards models were created to examine the association between depressed mood and mortality. A question about depressed mood within 7 to 10 days after stroke was asked in 340 of 655 patients with ischemic stroke enrolled, and 139 reported that they felt depressed. In multivariate analyses controlling for sociodemographic factors, stroke severity, and medical conditions, depressed mood was associated with a greater odds of severe disability compared with no disability at 1 (OR 2.91, 95% CI 1.07 to 7.91) and 2 years (OR 3.72, 95% CI 1.29 to 10.71) after stroke. Depressed mood was not associated with all-cause mortality or vascular death. Depressed mood after stroke is associated with disability but not mortality after stroke. Early screening and intervention for mood disorders after stroke may improve outcomes and requires further research.
Marshall, Isiah, Jr.; Smith, Belinda Davis; Green, Makeba T.; Anderson, Brian; Harry, Sonja V.; Byrd, Yolanda M.; Pratt-Harris, Natasha C.; Bolden, Errol S.; Hill, Solomon
Faculty scholarship at historically Black colleges and universities (HBCU) has in the past served as a blueprint for the Black masses. Even today, HBCU faculty scholarship continues to be an informative source to communicate accurate information regarding marginalized groups. This study examines h-index scores of 65 faculty members at five…
Perloff, Michael D; Patel, Nimesh S; Kase, Carlos S; Oza, Anuja U; Voetsch, Barbara; Romero, Jose R
To evaluate occurrence of cerebellar stroke in Emergency Department (ED) presentations of isolated dizziness (dizziness with a normal exam and negative neurological review of systems). A 5-year retrospective study of ED patients presenting with a chief complaint of "dizziness or vertigo", without other symptoms or signs in narrative history or on exam to suggest a central nervous system lesion, and work-up included a brain MRI within 48h. Patients with symptoms commonly peripheral in etiology (nystagmus, tinnitus, gait instability, etc.) were included in the study. Patient demographics, stroke risk factors, and gait assessments were recorded. One hundred and thirty-six patients, who had a brain MRI for isolated dizziness, were included. There was a low correlation of gait assessment between ED physician and Neurologist (49 patients, Spearman's correlation r 2 =0.17). Based on MRI DWI sequence, 3.7% (5/136 patients) had acute cerebellar strokes, limited to or including, the medial posterior inferior cerebellar artery vascular territory. In the 5 cerebellar stroke patients, mean age, body mass index (BMI), hemoglobin A1c, gender distribution, and prevalence of hypertension were similar to the non-cerebellar stroke patient group. Mean LDL/HDL ratio was 3.63±0.80 and smoking prevalence was 80% in the cerebellar stroke group compared to 2.43±0.79 and 22% (respectively, p values<0.01) in the non-cerebellar stroke group. Though there was preselection bias for stroke risk factors, our study suggests an important proportion of cerebellar stroke among ED patients with isolated dizziness, considering how common this complaint is. Copyright © 2017 Elsevier Inc. All rights reserved.
Mørch, Sofie Søndergaard; Andersen, Johnny Dohn Holmgren; Bestle, Morten Heiberg
and mortality. This case report describes two Danish patients diagnosed with heat stroke syndrome during a heat wave in the summer of 2014. Both patients were morbidly obese and had several predisposing illnesses. However since heat stroke is a rare condition in areas with temperate climate, they were...... not diagnosed until several days after admittance; hence treatment with cooling was delayed. Both patients were admitted to the intensive care unit, where they were treated with an external cooling device and received treatment for complications. Both cases ended fatally. As global warming continues, more heat...
Huon, Leh-Kiong; Wang, Ting-Chuan; Fang, Te-Yung; Chuang, Li-Ju; Wang, Pa-Chun
To investigate the association between vertigo and stroke in Taiwan using the Bureau of National Health Insurance research database. Information on adult patients with an index vertigo attack in 2006 was retrieved from Bureau of National Health Insurance research database. All patients with specific diagnostic codes for vertigo were included. Occurrence of stroke during a 1-year follow-up period was identified. Risk factors for stroke were examined. Using χ test, t test, and a multilevel logistic regression model, patients with vertigo were categorized into stroke and nonstroke groups for comparative analyses. An age- and sex- matched control cohort was prepared for comparison. Patients with vertigo (n = 527,807) (mean age, 55.1 yr) accounted for 3.1% of the general Taiwanese adult population. The prevalence of stroke among vertigo patients of 0.5% (mean age, 67.8 yr) was slightly higher than that of the control group (0.3%; mean age, 72.3 yr; p vertigo had higher prevalence of comorbid conditions (p diabetes mellitus, hypertension, dyslipidemia, coronary artery disease, or atrial fibrillation had a higher prevalence of stroke (p vertigo had higher chance to develop stroke than the control group. Some strokes may initially manifest as peripheral vertigo, and some central vertigo may eventually evolve into a stroke. Middle aged male, diabetes, hypertension, dyslipidemia, coronary artery disease, and atrial fibrillation are risk factors for subsequent stroke in vertigo patients.
DuBose, Lyndsey E; Voss, Michelle W; Weng, Timothy B; Kent, James D; Dubishar, Kaitlyn M; Lane-Cordova, Abbi; Sigurdsson, Gardar; Schmid, Phillip; Barlow, Patrick B; Pierce, Gary L
Aging is associated with increased carotid artery stiffness, a predictor of incident stroke, and reduced cognitive performance and brain white matter integrity (WMI) in humans. Therefore, we hypothesized that higher carotid stiffness/lower compliance would be independently associated with slower processing speed, higher working memory cost, and lower WMI in healthy middle-aged/older (MA/O) adults. Carotid β-stiffness ( P working memory cost (-15.4 ± 0.14 vs. -2.2 ± 0.05%, P working memory cost or WMI. Among MA/O adults, higher β-stiffness (B = -0.60 ± 0.18, P = 0.002) and lower compliance (B = 0.93 ± 0.26, P = 0.002) were associated with slower processing speed but not working memory cost or WMI. These data suggest that greater carotid artery stiffness is independently and selectively associated with slower processing speed but not working memory among MA/O adults. Carotid artery stiffening may modulate reductions in processing speed earlier than working memory with healthy aging in humans. NEW & NOTEWORTHY Previously, studies investigating the relation between large elastic artery stiffness, cognition, and brain structure have focused mainly on aortic stiffness in aged individuals with cardiovascular disease risk factors and other comorbidities. This study adds to the field by demonstrating that the age-related increases in carotid artery stiffness, but not aortic stiffness, is independently and selectively associated with slower processing speed but not working memory among middle-aged/older adults with low cardiovascular disease risk factor burden. Copyright © 2017 the American Physiological Society.
Office work-related upper extremity symptoms and disorders have been associated with static work posture, repetition, and inadequate recovery in the anatomic structures of the neck and upper extremities...
Wade, D T; Hewer, R L
Actual functional performance of 976 acute stroke patients was assessed using the Barthel index: the data were analysed to determine the frequency of disability after stroke, the validity of the Barthel index, and the recovery seen. At 6 months, over 45% of survivors were functionally independent. Validity of the Barthel index was confirmed: it related as expected with motor loss and factor analysis showed a single major factor. The items of the Barthel index form an hierarchical scale. There...
Ali, Myzoon; Atula, Sari; Bath, Philip M W; Grotta, James; Hacke, Werner; Lyden, Patrick; Marler, John R; Sacco, Ralph L; Lees, Kennedy R
Stroke incidence and outcome vary widely within and across geographical locations. We examined whether differences in index stroke severity, stroke risk factors, mortality, and stroke outcome across geographical locations remain after adjusting for case mix. We analyzed 3284 patients from the Virtual International Stroke Trials Archive (VISTA). We used logistic regression to examine the incidence of mild index stroke, functional, and neurological outcomes after accounting for age, medical history, year of trial recruitment, and initial stroke severity in the functional and neurological outcome analyses. We examined mortality between geographical regions using a Cox proportional hazards model, accounting for age, initial stroke severity, medical history, and year of trial recruitment. Patients enrolled in the USA and Canada had the most severe index strokes. Those recruited in Austria and Switzerland had the best functional and neurological outcomes at 90 days (P<0.05), whereas those enrolled in Germany had the worst functional outcome at 90 days (P=0.013). Patients enrolled in Austria, Switzerland, Belgium, Netherlands, Finland, Germany, Greece, Israel, Spain, and Portugal had a significantly better survival rate when compared with those enrolled in USA and Canada. Patients enrolled in trials after 1998 had more severe index strokes, with no significant difference in outcome compared with those enrolled before 1998. We identified regional variations in index stroke severity, outcome, and mortality for patients enrolled in ischemic stroke clinical trials over the past 13 years that were not fully explained by case mix. Index stroke severity was greater in patients enrolled after 1998, with no significant improvement in outcomes compared to those enrolled before 1998.
Sethi, Jasobanta; Sandhu, Jaspal Singh; Imbanathan, Vijay
Work urgency, accuracy and demands compel the computer professionals to spend longer hours before computers without giving importance to their health, especially body weight. Increase of body weight leads to improper Body Mass Index (BMI) may aggravate work related musculoskeletal discomfort and occupational-psychosocial stress. The objective of the study was to find out the effect of BMI on work related musculoskeletal discomforts and occupational stress of computer workers in a developed ergonomic setup. A descriptive inferential study has been taken to analyze the effect of BMI on work related musculoskeletal discomfort and occupational-psychosocial stress. A total of 100 computer workers, aged 25-35 years randomly selected on convenience from software and BPO companies in Bangalore city, India for the participation in this study. BMI was calculated by taking the ratio of the subject's height (in meter) and weight (in kilogram). Work related musculoskeletal discomfort and occupational stress of the subjects was assessed by Cornell University's musculoskeletal discomfort questionnaire (CMDQ) and occupational stress index (OSI) respectively as well as a relationship was checked with their BMI. A significant association (p stress. From this study, it has been concluded that, there is a significant effect of BMI in increasing of work related musculoskeletal discomfort and occupational-psychosocial stress among computer workers in a developed ergonomic setup.
Han, Shi-You; Hong, Zhi-You; Xie, Yu-Hua; Zhao, Yong; Xu, Xiao
Stroke is a condition with high morbidity and mortality, and 75% of stroke survivors lose their ability to work. Stroke is a burden to the family and society. The purpose of this study was to evaluate the effectiveness of Chinese herbal patent medicines in the treatment of patients after the acute phase of a stroke. We searched the following databases through August 2016: PubMed, Embase, Cochrane library, China Knowledge Resource Integrated Database (CNKI), China Science Periodical Database (CSPD), and China Biology Medicine disc (CBMdisc) for studies that evaluated Chinese herbal patent medicines for post stroke recovery. A random-effect model was used to pool therapeutic effects of Chinese herbal patent medicines on stroke recovery. Network meta-analysis was used to rank the treatment for each Chinese herbal patent medicine. In our meta-analysis, we evaluated 28 trials that included 2780 patients. Chinese herbal patent medicines were effective in promoting recovery after stroke (OR, 3.03; 95% CI: 2.53-3.64; P herbal patent medicines significantly improved neurological function defect scores when compared with the controls (standard mean difference [SMD], -0.89; 95% CI, -1.44 to -0.35; P = .001). Chinese herbal patent medicines significantly improved the Barthel index (SMD, 0.73; 95% CI, 0.53-0.94; P herbal medicines most likely to improve stroke recovery when combined with acupuncture. Our research suggests that the Chinese herbal patent medicines were effective for stroke recovery. The most effective treatments for stroke recovery were MLC601, Shuxuetong, and BuchangNaoxintong. However, to clarify the specific effective ingredients of Chinese herbal medicines, a well-designed study is warranted.
Dean, Jesse C; Kautz, Steven A
Gait instability is a common problem following stroke, as evidenced by increases in fall risk and fear of falling. However, the mechanism underlying gait instability is currently unclear. We recently found that young, healthy humans use a consistent gait stabilization strategy of actively controlling their mediolateral foot placement based on the concurrent mechanical state of the stance limb. In the present work, we tested whether people with stroke (n = 16) and age-matched controls (n = 19) used this neuromechanical strategy. Specifically, we used multiple linear regressions to test whether (1) swing phase gluteus medius (GM) activity was influenced by the simultaneous state of the stance limb and (2) mediolateral foot placement location was influenced by swing phase GM activity and the mechanical state of the swing limb at the start of the step. We found that both age-matched controls and people with stroke classified as having a low fall risk (Dynamic Gait Index [DGI] score >19) essentially used the stabilization strategy previously described in young controls. In contrast, this strategy was disrupted for people with stroke classified as higher fall risk (DGI foot placement may contribute to poststroke instability.
Christoffersen, Peter; Heston, Steven; Jacobs, Kris
State-of-the-art stochastic volatility models generate a "volatility smirk" that explains why out-of-the-money index puts have high prices relative to the Black-Scholes benchmark. These models also adequately explain how the volatility smirk moves up and down in response to changes in risk. However...... using a two-factor stochastic volatility model. Because the factors have distinct correlations with market returns, and because the weights of the factors vary over time, the model generates stochastic correlation between volatility and stock returns. Besides providing more flexible modeling of the time...
Truelsen, Thomas; Krarup, Lars-Henrik
This is the first study to examine the awareness of major stroke symptoms and stroke risk factors among the general population in Denmark. Early recognition of stroke warning signs and means of reducing stroke occurrence could improve the treatment and prevention of stroke....
Goldstein, L.B.; Amarenco, P.; Zivin, J.
BACKGROUND AND PURPOSE: Laboratory experiments suggest statins reduce stroke severity and improve outcomes. The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) trial was a placebo-controlled, randomized trial designed to determine whether treatment with atorvastatin reduces...... strokes in subjects with recent stroke or transient ischemic attack (n=4731). We analyzed SPARCL trial data to determine whether treatment favorably shifts the distribution of severities of ischemic cerebrovascular outcomes. METHODS: Severity was assessed with the National Institutes of Health Stroke...... Scale, Barthel Index, and modified Rankin Scale score at enrollment (1 to 6 months after the index event) and 90 days poststroke in subjects having a stroke during the trial. RESULTS: Over 4.9 years, strokes occurred in 576 subjects. There were reductions in fatal, severe (modified Rankin Scale score 5...
Loughborough, W.; Mahady, K.; Bradley, M.D.; Renowden, S.A.; Mortimer, A.M.
Recent trial evidence suggests that for patients suffering large-vessel occlusive stroke, endovascular therapy based on the stent-retriever technique is associated with superior clinical outcomes when compared to intravenous thrombolysis alone. The challenge now is how this service is to be delivered. This may involve both centralisation of services around large cities and development of robust networks to receive patients from district general hospitals situated further afield. Both diagnostic and interventional neuroradiology will need to expand. Furthermore, we suggest that it would be advantageous for radiology departments in those hospitals receiving hyperacute stroke patients to perform computed tomography (CT) angiography in addition to non-contrast CT, which also has implications for service delivery in these units. This could swiftly aid identification of patients who might benefit from thrombectomy and improve decision-making through demonstration of occlusive thrombus and of collateral status.
Langhorne, Peter; Bernhardt, Julie; Kwakkel, Gert
Stroke is a common, serious, and disabling global health-care problem, and rehabilitation is a major part of patient care. There is evidence to support rehabilitation in well coordinated multidisciplinary stroke units or through provision of early supported provision of discharge teams. Potentially beneficial treatment options for motor recovery of the arm include constraint-induced movement therapy and robotics. Promising interventions that could be beneficial to improve aspects of gait include fitness training, high-intensity therapy, and repetitive-task training. Repetitive-task training might also improve transfer functions. Occupational therapy can improve activities of daily living; however, information about the clinical effect of various strategies of cognitive rehabilitation and strategies for aphasia and dysarthria is scarce. Several large trials of rehabilitation practice and of novel therapies (eg, stem-cell therapy, repetitive transcranial magnetic stimulation, virtual reality, robotic therapies, and drug augmentation) are underway to inform future practice. Copyright © 2011 Elsevier Ltd. All rights reserved.
Full Text Available This poem playfully addresses the slippery nature of linguistic signification, employing humour and sarcasm in presenting a wide range of human experience. It ironical twists -- and "strokes" (read ambiguously as both a giving a punishment and erotic pleasuring -- move from the naming of location through international discourse of capital to the crumbling relationships between nation states. It reading of the signs of language is tied to the unease and fracture in cultural and political experience.
... die within minutes. Strokes happen more in some populations and geographic areas. Stroke death declines have stalled in 3 out of every 4 states. Blacks have the highest stroke death rates among all ...
... Issue Past Issues Special Section Two Kinds of Stroke Past Issues / Summer 2007 Table of Contents For ... are often a warning sign for future strokes. Stroke Can Affect Anyone Award-winning actress Julie Harris ...
... Stories Stroke Heroes Among Us Healthy Living After Stroke Nutrition Good nutrition is one way to reduce ... the hospital. Thank goodness, she did. Subscribe to Stroke Connection Get quarterly digital issues plus our monthly ...
Stroke is an acute, neurological dysfunction of vascular origin with sudden occurrence and it influences physical, cognitive and psychological functions. Initial treatment aims at eliminating or reducing the brain damage. Soon, however, the influence of the stroke on the entire life of stroke survivors has to be considered. This thesis explores the meaning of life after stroke to 19 elderly stroke survivors during the first year post stroke. Survivors were interviewed twice and the interviews...
... Simple Techniques Can Help Memory after a Stroke Self-Esteem after Stroke Cognitive Challenges After Stroke Depression Trumps ... spasticity), fatigue and more. Let's Talk About Stroke Fact Sheets Our stroke fact sheets cover treatments, recovery, ...
Vyas, Manav V; Hackam, Daniel G; Silver, Frank L; Laporte, Audrey; Kapral, Moira K
Stroke leads to a substantial societal economic burden. Loss of productivity among stroke survivors is a significant contributor to the indirect costs associated with stroke. We aimed to characterize productivity and factors associated with employability in stroke survivors. We used the Canadian Community Health Survey 2011-2012 to identify stroke survivors and employment status. We used multivariable logistic models to determine the impact of stroke on employment and on factors associated with employability, and used Heckman models to estimate the effect of stroke on productivity (number of hours worked/week and hourly wages). We included data from 91,633 respondents between 18 and 70 years and identified 923 (1%) stroke survivors. Stroke survivors were less likely to be employed (adjusted OR 0.39, 95% CI 0.33-0.46) and had hourly wages 17.5% (95% CI 7.7-23.7) lower compared to the general population, although there was no association between work hours and being a stroke survivor. We found that factors like older age, not being married, and having medical comorbidities were associated with lower odds of employment in stroke survivors in our sample. Stroke survivors are less likely to be employed and they earn a lower hourly wage than the general population. Interventions such as dedicated vocational rehabilitation and policies targeting return to work could be considered to address this lost productivity among stroke survivors. © 2016 S. Karger AG, Basel.
Ryan, Alice S; Ivey, Frederick M; Serra, Monica C; Hartstein, Joseph; Hafer-Macko, Charlene E
To determine the prevalence of sarcopenia in stroke survivors using different methodologies, and compare a subset of the stroke group to age-, sex-, and body mass index (BMI)-matched nonstroke control counterparts. Cohort study. A Veterans Affairs medical center and a university hospital. Mild to moderately disabled participants >6 months after onset of stroke aged 40 to 84 years (N=190, 61% men, 57% African American; mean BMI ± SEM, 29±1kg/m 2 ). Not applicable. Dual-energy x-ray absorptiometry scans to assess appendicular lean mass (ALM). Rates of sarcopenia were determined using 4 established methods: (1) ALM/height 2 (ALM/ht 2 ); (2) European Working Group on Sarcopenia in Older Persons; (3) International Working Group on Sarcopenia; and (4) ALM/BMI. Sarcopenia prevalence in our stroke cohort ranged between 14% and 18%. The stroke survivor subset (n=38) matched one-for-one with control counterparts for race, sex, age ±4 years and BMI ±2.5kg/m 2 had higher prevalence rates compared with their nonstroke counterparts (13.2% vs 5.3%, Psarcopenia when considering age, sex, and race compared with nonstroke individuals. Published by Elsevier Inc.
Fransson, Eleonor I; Nyberg, Solja T; Heikkilä, Katriina
studies to investigate the association between job strain, a measure of work-related stress, and incident stroke. RESULTS: In 1.8 million person-years at risk (mean follow-up 9.2 years), 2023 first-time stroke events were recorded. The age- and sex-adjusted hazard ratio for job strain relative to no job....... CONCLUSION: Job strain may be associated with an increased risk of ischemic stroke, but further research is needed to determine whether interventions targeting job strain would reduce stroke risk beyond existing preventive strategies....
Albawardi, Nada M; Jradi, Hoda; Al-Hazzaa, Hazzaa M
Physical inactivity is among the leading risk factors for non-communicable diseases. Saudi Arabia has just begun to address physical inactivity as recent studies have shown an alarming prevalence of insufficiently physically active adults. Saudi women are identified as among the most overweight/obese and least active worldwide. With an increase in the number of women in office based jobs, the risk of physical inactivity is likely to increase. Identifying the level and correlates for high BMI and physical inactivity in Saudi women will help to plan more effective public health strategies. The aim of this study is to assess the level of physical activity, inactivity and body mass index among Saudi women working in office based jobs in Riyadh city and identify the correlates for overweight, obesity and low physical activity. A cross- sectional study was conducted on 420 Saudi women aged 18 to 58 years working in office based jobs in eight worksites in Riyadh, Saudi Arabia. Body mass index was determined using weight and height measurements and physical activity was assessed based on a validated self-administered questionnaire. The majority of the subjects were overweight or obese (58.3 %). Overweight/obesity was associated with increased age, lower income and with those working in the public versus private sector. More than half of the sample (52.1 %) were insufficiently physically active. Participants working seven or more hours per day and those working in private versus public sector were significantly associated with low physical activity. This study identified Saudi women working in office based jobs as a high risk group for overweight, obesity and physical inactivity. As sedentary jobs may compound the risk for obesity and physical inactivity, this may support the use of workplace health programs to reduce sitting time and promote physical activity as a viable public health initiative.
Full Text Available Stroke is an important cause for neurological morbidity and mortality. Prevention of ischemic stroke involves identification and prevention of risk factors and optimal use of pharmacotherapy. Risk factors have been classified as modifiable and non-modifiable; control of modifiable factors should prevent stroke occurrence. Stroke prevention has been described at three levels: primary, secondary and tertiary. Prolonged hypertension increases an individual′s risk for developing fatal or nonfatal stroke by three times and its control has been shown to prevent stroke. Diabetes mellitus is an important cause for microangiopathy and predisposes to stroke. Statin trials have shown significant reduction in stroke in those who were treated with statins. Stroke risk can be reduced by avoiding tobacco use, control of obesity and avoiding sedentary life style. Anti platelet medications are effective for secondary prevention of stroke. Educating society regarding modifiable risk factors and optimal use of pharmacotherapy form the cornerstone for the prevention of stroke.
Trudel, Xavier; Brisson, Chantal; Milot, Alain; Masse, Benoit; Vézina, Michel
A number of prospective studies have documented the effect of adverse psychosocial work factors (work stress) on high blood pressure (BP). Weight gain could be an important pathway by which work stress exerts its effect on BP. No previous prospective study has examined this mediating effect. The aim of the present study was to examine the mediating effect of body mass index (BMI) in the association between psychosocial work factors from Siegrist's effort-reward imbalance model (ERI) and ambulatory BP (ABP). A prospective study was conducted among 1436 white-collar workers. Data were collected three times during a 5-year period. ERI was measured using validated scales, at each time. BMI was measured by a trained assistant. ABP was measured every 15 min during a working day. ERI exposure onset over 3 years was indirectly associated with ABP changes (0.49 mmHg; 95 % CI 0.05, 1.22), through BMI changes, in women with baseline BMI ≥25 kg/m 2 . An effect of similar magnitude and of borderline significance was observed for ERI chronic exposure. No mediating effect was observed among men, and using ERI exposure over 5 years. The mediating effect of BMI was of small magnitude and observed in certain subgroups and time frame only. Subgroup-specific mediating pathways might be involved to explain the effect of work stress on cardiovascular diseases risk.
Kantermann, Thomas; Meisel, Andreas; Fitzthum, Katharina; Penzel, Thomas; Fietze, Ingo; Ulm, Lena
This study aimed to elucidate associations between stroke onset and severity as well as chronotype (phase of entrainment) and internal time of stroke. Fifty-six first-ever ischemic stroke patients participated in a cross-sectional study assessing chronotype (mid-sleep on work-free days corrected for
Kantermann, Thomas; Meisel, Andreas; Fitzthum, Katharina; Penzel, Thomas; Fietze, Ingo; Ulm, Lena
This study aimed to elucidate associations between stroke onset and severity as well as chronotype (phase of entrainment) and internal time of stroke. Fifty-six first-ever ischemic stroke patients participated in a cross-sectional study assessing chronotype (mid-sleep on work-free days corrected for
Olsen, Tom Skyhøj; Dehlendorff, Christian; Petersen, Hans Gregers
Background: Obesity is an established cardiovascular risk factor. We studied the association between body mass index (BMI) and all-cause mortality after stroke. Methods: A registry started in 2001 with the aim to register all hospitalized stroke patients in Denmark now includes 21,884 patients...
Ali, Myzoon; Bath, Philip; Brady, Marian; Davis, Stephen; Diener, Hans-Christoph; Donnan, Geoffrey; Fisher, Marc; Hacke, Werner; Hanley, Daniel F; Luby, Marie; Tsivgoulis, G; Wahlgren, Nils; Warach, Steven; Lees, Kennedy R
Analysis of reliable registry data can direct future research to influence clinical care. Data from the Virtual International Stroke Trials Archive have been used to test hypotheses and inform trial design. We sought to expand Virtual International Stroke Trials Archive into a broader stroke resource with new opportunities for research and international collaboration. Using procedures initially developed for an acute stroke trial archive, we invited trialists to lodge data on rehabilitation, secondary prevention, intracerebral haemorrhage, imaging, and observational stroke studies. We have extended Virtual International Stroke Trials Archive into six subsections: Virtual International Stroke Trials Archive-Acute (n = 28 190 patients' data), Virtual International Stroke Trials Archive-Rehab (n = 10 194), Virtual International Stroke Trials Archive-intracerebral haemorrhage (n = 1829), Virtual International Stroke Trials Archive-Prevention, Virtual International Stroke Trials Archive-Imaging (n = 1300), and Virtual International Stroke Trials Archive-Plus (n = 6573). Enrollment continues, with commitments for the contribution of six further trials to Virtual International Stroke Trials Archive-Prevention, 13 trials to Virtual International Stroke Trials Archive-Rehab, and one registry to Virtual International Stroke Trials Archive-Plus. Data on age, type of stroke, medical history, outcomes by modified Rankin scale and Barthel Index (BI), mortality, and adverse events are available for analyses. The Virtual International Stroke Trials Archive network encourages the development of young investigators and provides opportunities for international peer review and collaboration. Application of the original Virtual International Stroke Trials Archive concepts beyond acute stroke trials can extend the value of clinical research at low cost, without threatening commercial or intellectual property interests. This delivers valuable research output to inform
Ischemic stroke is not rare in young adults since one in ten stroke patients are less than 50 years old. This incidence increased over the past last years, mainly due to the rise in the prevalence of traditional vascular risk factors in this sub-group of age but also of illegal drug use. Even though both survival and functional outcome of young stroke patients are better than those observed in older patients, socio-economic and quality of life consequences make this disease a main objective in terms of primary and secondary prevention. Identifying the cause of ischemic stroke in young adults is of major importance to prevent stroke recurrence. However, given the wide variety of potential underlying causes, the etiologic work-up of stroke in young adults requires a different approach from that in the elderly. In this context, a sequential diagnostic work-up is needed in order to optimize the yield of diagnostic tests, to reduce their cost and risks for the patient. Arterial dissection is the most frequent cause of stroke in young adults but other less frequent causes are numerous. Despite a comprehensive work-up, about one third of cases remains unexplained leading to the diagnosis of cryptogenic ischemic stroke. Copyright © 2015 Société nationale française de médecine interne (SNFMI). Published by Elsevier SAS. All rights reserved.
Zhang, Li; Sun, Dong-Mei; Li, Chang-Bing; Tao, Min-Fang
The aim of this study was to identify influencing factors for sleep quality among shift-working nurses based on a three-factor scoring model that included sleep efficacy, sleep quality and daily dysfunction. A cross-sectional survey of 513 nurses in a hospital in Shanghai, China, was conducted using a self-reported questionnaire. Sleep quality was measured by the Pittsburgh Sleep Quality Index (PSQI). Data were analyzed based on the three-factor PSQI model: Factor 1, sleep efficacy; Factor 2, sleep quality; Factor 3, daily disturbances. After adjusting for age, marital status, and having children, multivariate logistic regression analysis showed that participants who had previous shift work experience which was at least 6 months ago, or were currently performing shift work were significantly more likely to have poor sleep quality (PSQI > 5) than those who had never done shift work (adjusted odds ratios of 3.943 and 3.975, respectively, both p sleep quality. An appropriate arrangement and intervention strategies are needed in Chinese hospitals in order to improve sleep quality among shift-working nurses. Copyright © 2016. Published by Elsevier B.V.
Kammersgaard, L P; Jørgensen, H S; Nakayama, H
Leukocytosis is a common finding in the acute phase of stroke. A detrimental effect of leukocytosis on stroke outcome has been suggested, and trials aiming at reducing the leukocyte response in acute stroke are currently being conducted. However, the influence of leukocytosis on stroke outcome has...
First aid Stroke: First aid Stroke: First aid By Mayo Clinic Staff A stroke occurs when there's bleeding into your brain or when blood flow to your ... cells start dying. Seek immediate medical assistance. A stroke is a true emergency. The sooner treatment is ...
This extensively revised and updated 5th Edition features contributions by 3000 distinguished experts - including 16 Nobel Prize winners - working with an international advisory board and 60 consulting editors. Thorough coverage is devoted to 75 separate disciplines in science and technology, from acoustics and biochemistry through fluid mechanics and geophysics to thermodynamics and vertebrate zoology. Detailed entries examine not only the physical and natural sciences, but also all engineering disciplines, discussing both the basic and the most recent theories, concepts, terminology, discoveries, materials, methods, and techniques. All of the new developments and technical advances that have occurred during the last five years - in each of the 75 disciplines - have been added to the encyclopedia and are explored in depth. Completely new material deals with such timely and newsworthy subjects as genetic engineering, artificial intelligence, nuclear medicine, desertification, psycholinguistics, industrial robots, and immunoassay. Also covered in extensive entries are such current topics as video disk recording, metallic glasses, acoustic levitation, magnetic bubble memory, gluons, and computerized tomography. The encyclopedia includes more than 15,000 photographs, drawings, maps, charts, and diagrams, shown in full-color, two-color, or black-and-white reproductions.
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Kruithof, WJ; Post, MWM; Meily, JMA
Objective: To compare the psychometric properties of the Caregiver Strain Index Expanded with those of the original Caregiver Strain Index among partners of stroke patients. Design and subjects: Cross-sectional validation study among 173 caregivers of stroke patients six months post-stroke. Main
Ricci, Stefano; Celani, Maria Grazia; Cantisani, Teresa Anna; Righetti, Enrico
Piracetam has neuroprotective and antithrombotic effects that may help to reduce death and disability in people with acute stroke. This is an update of a Cochrane Review first published in 1999, and previously updated in 2006 and 2009. To assess the effects of piracetam in acute, presumed ischaemic stroke. We searched the Cochrane Stroke Group Trials Register (last searched 15 May 2011), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 2), MEDLINE (1966 to May 2011), EMBASE (1980 to May 2011), and ISI Science Citation Index (1981 to May 2011). We also contacted the manufacturer of piracetam to identify further published and unpublished studies. Randomised trials comparing piracetam with control, with at least mortality reported and entry to the trial within three days of stroke onset. Two review authors extracted data and assessed trial quality and this was checked by the other two review authors. We contacted study authors for missing information. We included three trials involving 1002 patients, with one trial contributing 93% of the data. Participants' ages ranged from 40 to 85 years, and both sexes were equally represented. Piracetam was associated with a statistically non-significant increase in death at one month (approximately 31% increase, 95% confidence interval 81% increase to 5% reduction). This trend was no longer apparent in the large trial after correction for imbalance in stroke severity. Limited data showed no difference between the treatment and control groups for functional outcome, dependence or proportion of patients dead or dependent. Adverse effects were not reported. There is some suggestion (but no statistically significant result) of an unfavourable effect of piracetam on early death, but this may have been caused by baseline differences in stroke severity in the trials. There is not enough evidence to assess the effect of piracetam on dependence.
Morgunov, L Iu; Denisova, I A; Rozhkova, T I; Stakhovskaia, L V; Skvortsova, V I
We have studied 154 men (mean age 61,4+/-4,1 years) with the first hemispheric ischemic stroke. Clinical and laboratory studies have revealed the androgenic deficit in 66,3%, with its frequency higher in patients with diabetes mellitus type II (50 and 26,3%, respectively). Forty-two men with diabetes mellitus type II and acquired androgenic deficit received replacing treatment with testosterone undecanoate in dose 1000 mg intramuscular. The treatment was started one week after the development of stroke, the next injections were given after 6 weeks and then every 12 weeks during 2 years. The control group included 30 males who did not receive androgens. After 2 years from the beginning of treatment, there were the decrease in clinical severity of androgenic deficit, the increase of total and free testosterone levels, and muscle power in the main group compared to the controls. Body mass index, glicated hemoglobin, cholesterol, triglycerides, low density lipoproteins have decreased as well. Secondary stroke has developed in 3 (7,1%) patients of the main group and in 5 (16,6%) controls; 12 (28,6%) patients returned to work in the main group compared to 2 (6,6%) in the control group. The treatment with androgens has a positive effect on risk factors of secondary ischemic stroke. It is an effective method for improvement of social adaptation of men survived after the stroke.
Fitriah, N.; Wijaya, S. K.; Fanany, M. I.; Badri, C.; Rezal, M.
In Indonesia, based on the result of Basic Health Research 2013, the number of stroke patients had increased from 8.3 ‰ (2007) to 12.1 ‰ (2013). These days, some researchers are using electroencephalography (EEG) result as another option to detect the stroke disease besides CT Scan image as the gold standard. A previous study on the data of stroke and healthy patients in National Brain Center Hospital (RS PON) used Brain Symmetry Index (BSI), Delta-Alpha Ratio (DAR), and Delta-Theta-Alpha-Beta Ratio (DTABR) as the features for classification by an Extreme Learning Machine (ELM). The study got 85% accuracy with sensitivity above 86 % for acute ischemic stroke detection. Using EEG data means dealing with many data dimensions, and it can reduce the accuracy of classifier (the curse of dimensionality). Principal Component Analysis (PCA) could reduce dimensionality and computation cost without decreasing classification accuracy. XGBoost, as the scalable tree boosting classifier, can solve real-world scale problems (Higgs Boson and Allstate dataset) with using a minimal amount of resources. This paper reuses the same data from RS PON and features from previous research, preprocessed with PCA and classified with XGBoost, to increase the accuracy with fewer electrodes. The specific fewer electrodes improved the accuracy of stroke detection. Our future work will examine the other algorithm besides PCA to get higher accuracy with less number of channels.
Mitchell, Andrew B; Cole, John W; McArdle, Patrick F; Cheng, Yu-Ching; Ryan, Kathleen A; Sparks, Mary J; Mitchell, Braxton D; Kittner, Steven J
Body mass index has been associated with ischemic stroke in older populations, but its association with stroke in younger populations is not known. In light of the current obesity epidemic in the United States, the potential impact of obesity on stroke risk in young adults deserves attention. A population-based case-control study design with 1201 cases and 1154 controls was used to investigate the relationship of obesity and young onset ischemic stroke. Stroke cases were between the ages of 15 and 49 years. Logistic regression analysis was used to evaluate the association between body mass index and ischemic stroke with and without adjustment for comorbid conditions associated with stroke. In analyses adjusted for age, sex, and ethnicity, obesity (body mass index >30 kg/m(2)) was associated with an increased stroke risk (odds ratio, 1.57; 95% confidence interval, 1.28-1.94) although this increased risk was highly attenuated and not statistically significant after adjustment for smoking, hypertension, and diabetes mellitus. These results indicate that obesity is a risk factor for young onset ischemic stroke and suggest that this association may be partially mediated through hypertension, diabetes mellitus, or other variables associated with these conditions. © 2015 American Heart Association, Inc.
Aarnio, Karoliina; Joensuu, Heikki; Haapaniemi, Elena; Melkas, Susanna; Kaste, Markku; Tatlisumak, Turgut; Putaala, Jukka
Cancer is a risk factor for ischemic stroke. Little is known about cancer among young adults with ischemic stroke. We studied the frequency of cancer and its association with long-term risk of death among young patients with first-ever ischemic stroke. 1002 patients aged 15 to 49 years, registered in the Helsinki Young Stroke Registry, and with a median follow-up of 10.0 years (interquartile range 6.5-13.8) after stroke were included. Historical and follow-up data were derived from the Finnish Care Register and Statistics Finland. Survival between groups was compared with the Kaplan-Meier life-table method, and Cox proportional hazard models were used to identify factors associated with mortality. One or more cancer diagnosis was made in 77 (7.7%) patients, of whom 39 (3.9%) had cancer diagnosed prestroke. During the poststroke follow-up, 41 (53.2%) of the cancer patients died. Median time from prestroke cancer to stroke was 4.9 (1.0-9.5) years and from stroke to poststroke cancer was 6.7 (2.7-10.9) years. Poststroke cancer was associated with age>40 years, heavy drinking, and cigarette smoking. The cumulative mortality was significantly higher among the cancer patients (68.6%, 95% confidence interval 52.0%-85.3%) compared with patients without cancer (19.7%, 95% confidence interval 16.3%-23.2%). Active cancer at index stroke, melanoma, and lung/respiratory tract cancer had the strongest independent association with death during the follow-up when adjusted for known poststroke mortality prognosticators. Cancer, and especially active cancer and no other apparent cause for stroke, is associated with unfavorable survival among young stroke patients. © 2015 American Heart Association, Inc.
Salih, Mustafa A.; Al-Jarallah, Ahmed A.; Al-Salman, Mussaad M.; Alorainy, Ibrahim A.; Hassan, Hamdy H.
Cercocephalic arterial dissecting (CCAD) is an important, but rarely recognized, cause of stroke in children. We describe 3 cases of CCAD who were diagnosed during a study on childhood stroke which included 104 patients. A high index of suspicion and targeted investigations are needed for the diagnosis and management of CCAD in childhood. (author)
Full Text Available Milija D Mijajlović,1,* Vuk M Aleksić,2,* Nadežda M Šternić,1 Mihailo M Mirković,3 Natan M Bornstein4,5 1Neurology Clinic, Clinical Center of Serbia, School of Medicine University of Belgrade, 2Department of Neurosurgery, Clinical Hospital Center Zemun, Belgrade, 3Department of Neurology, General Hospital Valjevo, Valjevo, Serbia; 4Department of Neurology, Tel-Aviv Sourasky Medical Center, Tel-Aviv University, Tel-Aviv, 5Shaare Zedek Medical Center, Jerusalem, Israel *These authors contributed equally to this work Abstract: Stroke is one of the leading causes of death and probably the greatest cause of adult disability worldwide. Diabetes mellitus (DM is a state of accelerated aging of blood vessels. Patients with diabetes have increased risk of stroke. Hyperglycemia represents a risk factor for poor outcome following stroke, and probably is just a marker of poor outcome rather than a cause. Lowering of blood glucose levels has not been shown to improve prognosis. Also, prevention of stroke risk among patients with DM is not improved with therapy for reduction of glucose levels. On the other hand, prediabetes, a metabolic state between normal glucose metabolism and diabetes, is a risk factor for the development of DM type 2 and subsequently for stroke. Several methods are known to identify prediabetes patients, including fasting plasma glucose levels, 2-hour post load glucose levels, and glycosylated hemoglobin levels. In this text, we tried to summarize known data about diagnosis, epidemiology, risk factors, pathophysiology, and prevention of prediabetes in relation to DM and stroke. Keywords: diabetes mellitus, insulin, metabolic syndrome, prediabetes, risk factors, stroke
Taouk, Yamna; Milner, Allison; LaMontagne, Anthony D
The study investigated the association between psychosocial job quality and body mass index (BMI) by sex. Regression models examining potential differences in the job stressor-BMI relationship between men and women were conducted using longitudinal data from working Australians and a psychosocial job stressor index. There was strong evidence of an association between psychosocial job stressors and BMI for females but not males. Compared with no psychosocial job stressors, 1 adversity was associated with 0.13 kg/m2 (95% CI: -0.42-0.67); 2 adversities were associated with 0.53 kg/m2 (-0.00-1.07); and 3 or more adversities were associated with 0.87 kg/m2 (0.30-1.45) increase in mean BMI for females. Females were found to have on average 0.32 kg/m2 (0.16-0.49) increase in BMI per increase in psychosocial job stressor. Psychosocial job stressors appear to have an adverse effect on women's weight.
Humaidan, Hani; Yassi, Nawaf; Weir, Louise; Davis, Stephen M; Meretoja, Atte
Only 37 cases of stroke during or soon after long-haul flights have been published to our knowledge. In this retrospective observational study, we searched the Royal Melbourne Hospital prospective stroke database and all discharge summaries from 1 September 2003 to 30 September 2014 for flight-related strokes, defined as patients presenting with stroke within 14days of air travel. We hypothesised that a patent foramen ovale (PFO) is an important, but not the only mechanism, of flight-related stroke. We describe the patient, stroke, and flight characteristics. Over the study period, 131 million passengers arrived at Melbourne airport. Our centre admitted 5727 stroke patients, of whom 42 (0.73%) had flight-related strokes. Flight-related stroke patients were younger (median age 65 versus 73, p<0.001), had similar stroke severity, and received intravenous thrombolysis more often than non-flight-related stroke patients. Seven patients had flight-related intracerebral haemorrhage. The aetiology of the ischaemic strokes was cardioembolic in 14/35 (40%), including seven patients with confirmed PFO, one with atrial septal defect, four with atrial fibrillation, one with endocarditis, and one with aortic arch atheroma. Paradoxical embolism was confirmed in six patients. Stroke related to air travel is a rare occurrence, less than one in a million. Although 20% of patients had a PFO, distribution of stroke aetiologies was diverse and was not limited to PFO and paradoxical embolism. Copyright © 2016 Elsevier Ltd. All rights reserved.
Meijering, Louise; Klaassens, Mirjam; Nanninga, Christa; Lettinga, Ant T.
Older adults who have survived a stroke may suffer from physical effects such as paralysis, fatigue, and pain, as well as cognitive/emotional effects such as loss of cognitive function, aphasia, depression, and memory loss. After experiencing a stroke, most survivors work on their recovery in a
... Risks for Heart Disease & Stroke Risks for Heart Disease & Stroke About 1.5 million heart attacks and strokes ... the Centers for Disease Control and Prevention: Heart Disease Stroke High Blood Pressure Cholesterol Salt Video: Know Your ...
Alonso, Inmaculada; Valdivielso, Pedro; Josefa Zamudio, María; Sánchez Chaparro, Miguel Angel; Pérez, Francisca; Ramos, Heliodoro; González Santos, Pedro
Detection of asymptomatic peripheral arterial disease increases the risk of vascular morbibity and mortality. We aimed to estimate the prevalence of clinical and subclinical peripheral arterial disease using the ankle-arm index (AAI) as diagnostic tool in a working population. We included 450 workers, older than 50 years old, attending voluntary regular health check-up at Centro de Prevención de Riesgos Laborales de la Junta de Andalucía in Málaga (Spain). We recorded clinical and anthopometrical data. Blood samples were taken after an overnight fast. Vascular risk was calculated using Framinghan and SCORE scales. Every participant was asked for symptoms of intermittent claudicatio and AAI was measured. AAI was considered normal within 0.9-1.3 values. Most of our workers were at low- or moderate vascular risk. Only 48 (10.6%) of individuals had an abnormal AAI: 9 (2%) showed an AAI1.3. An AAI or = 5%, and in 11% of those having a Framinghan risk > or = 20%. Intermittent claudication was present in 4 out of 9 (44%) of those having an AAI<0.9 and in 7 out of 402 (1.7%) with a normal AAI. Systematic screening of peripheral arterial disease using the AAI is not recommended in active working population over 50 years-old of age. Thus, AAI measurement is indicated only for those individuals suffering from intermitent claudicatio and those who are at moderate- or high vascular risk.
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Van Bogaert, Peter; Clarke, Sean; Vermeyen, Karel; Meulemans, Herman; Van de Heyning, Paul
To study the relationship between nurse work environment, job outcomes and nurse-assessed quality of care in the Belgian context. Work environment characteristics are important for attracting and retaining professional nurses in hospitals. The Revised Nursing Work Index (NWI-R) was originally designed to describe the professional nurse work environment in U.S. Magnet Hospitals and subsequently has been extensively used in research internationally. The NWI-R was translated into Dutch to measure the nurse work environment in 155 nurses across 13 units in three Belgian hospitals. Factor analysis was used to identify a set of coherent subscales. The relationship between work environments and job outcomes and nurse-assessed quality of care was investigated using logistic and linear regression analyses. Three reliable, consistent and meaningful subscales of the NWI-R were identified: nurse-physician relations, nurse management at the unit level and hospital management and organizational support. All three subscales had significant associations with several outcome variables. Nurse-physician relations had a significant positive association with nurse job satisfaction, intention to stay the hospital, the nurse-assessed unit level quality of care and personal accomplishment. Nurse management at the unit level had a significant positive association with the nurse job satisfaction, nurse-assessed quality of care on the unit and in the hospital, and personal accomplishment. Hospital management and organizational support had a significant positive association with the nurse-assessed quality of care in the hospital and personal accomplishment. Higher ratings of nurse-physician relations and nurse management at the unit level had significant negative associations with both the Maslach Burnout Inventory emotional exhaustion and depersonalization dimensions, whereas hospital management and organizational support was inversely associated only with depersonalization scores. A Dutch
Gschwendtner, A; Dichgans, M
Stroke is one of the most widespread causes of mortality und disability worldwide. Around 80 % of strokes are ischemic and different forms of intracranial bleeding account for the remaining cases. Monogenic stroke disorders are rare but the diagnosis may lead to specific therapeutic consequences for the affected patients who are predominantly young. In common sporadic stroke, genetic factors play a role in the form of susceptibility genes. Their discovery may give rise to new therapeutic options in the future.
Jordan M.D., Lori C.; Hillis M.D., Argye E.
Hemorrhagic stroke accounts for approximately half of stroke in childhood. Unlike arterial ischemic stroke, there are no consensus guidelines to assist in the evaluation and treatment of these children. We review the literature on the evaluation, treatment, etiology and neurologic outcome of hemorrhagic stroke in children. Important differences between pediatric and adult hemorrhage are highlighted, as treatment guidelines for adults may not be applicable in all cases. Needed future research ...
Community reintegration (CR) was assessed three months post-admission discharge using the Reintegration to Normal Living Index (RNLI). Demographic and stroke-specific characteristics were obtained using a data form. Data were analysed using descriptive statistics, the Mann-Whitney U test and the chi-square test.
Langhorne, P.; Jepsen, Birgitte G.; Larsen, Torben
This report is a brief practical problem-based guide to support clinical management in the implementation of early home-supported discharge as an integrated part of stroke care. However, it is clear that skilled members of a multidisciplinary team are needed and they need to work in a coordinated...... benefit most are likely to have moderate stroke severity and may be able to cooperate with rehabilitation in the home setting. Staffing requirements will vary according to several factors. These will include (a) the severity and complexity of stroke impairments, (b) the current level of community support...
Full Text Available Objectives: To evaluate (1 the prevalence of operationally defined depressive disorder (ICD-10 in chronic stroke subjects and (2 the relationship of post-stroke depression (PSD with disability. Design: Cross-sectional, descriptive study. Setting: Neurological rehabilitation unit of a tertiary care university research center. Materials and Methods: Participants were those with first episode of supratentorial stroke of more than 3 months′ duration with impaired balance and gait who had been referred for rehabilitation. Data were collected on demographic data, stroke data (side and type of lesion and post-stroke duration, cognition (mini mental state examination, depressive ideation (Hamilton Depression Rating Scale - HRDS, impairment (Scandinavian Stroke Scale, balance (Berg Balance Scale, ambulatory status (Functional Ambulation Category, walking ability (speed, and independence in activities of daily living (Barthel Index. Statistical analysis was done using SPSS 13.0. We carried out the chi-square test for ordinal variables and the independent t test for continuous variables. Results: Fifty-one patients (M:F: 41:10 of mean age 46.06 ± 11.19 years and mean post-stroke duration of 467.33 ± 436.39 days were included in the study. Eighteen of the 51 participants (35.29% met the criteria for depression. Demographic variables like male gender, being married, living in a nuclear family, urban background, and higher HRDS score were significantly correlated with PSD (P < 0.05. Depression was related to functional disability after stroke but to a statistically insignificant level (P > 0.05 and was unrelated to lesion-related parameters. Conclusion: Depression occurs in one-third of chronic stroke survivors and is prevalent in subjects referred for rehabilitation. PSD is related primarily to demographic variables and only to a lesser extent to functional disability following stroke.
Pedersen, P M; Jørgensen, H S; Kammersgaard, L P; Nakayama, H; Raaschou, H O; Olsen, T S
To determine the frequency of manual and oral apraxia in acute stroke and to examine the influence of these symptoms on functional outcome. Seven hundred seventy six unselected, acute stroke patients who were admitted within seven days of stroke onset with unimpaired consciousness were included. If possible, the patients were assessed for manual and oral apraxia on acute admission. Neurologic stroke severity including aphasia was assessed with the Scandinavian Stroke Scale, and activities of daily living function was assessed with the Barthel Index. All patients completed their rehabilitation in the same large stroke unit. Six hundred eighteen patients could cooperate with the apraxia assessments. Manual apraxia was found in 7% of subjects (10% in left and 4% in right hemispheric stroke; chi2 = 9.0; P = 0.003). Oral apraxia was found in 6% (9% in left and 4% in right hemispheric stroke; chi2 = 5.4; P = 0.02). Both manual and oral apraxia were related to increasing stroke severity, and manual, but not oral, apraxia was associated with increasing age. There was no gender difference in frequency of apraxia. Patients with either type of apraxia had temporal lobe involvement more often than patients without. When analyzed with multiple linear and logistic regression analyses, neither manual nor oral apraxia had any independent influence on functional outcome. Apraxia is significantly less frequent in unselected patients with acute stroke than has previously been assumed and has no independent negative influence on functional outcome.
Full Text Available OBJECTIVE: To investigate the prevalence of obstructive sleep apnea in patients with ischemic stroke and to evaluate the effectiveness of nasal continuous positive airway pressure treatment. METHODS: Overnight polysomnography was performed by a computerized system in 19 subjects with ischemic stroke. Patients with an apnea-hypopnea index > 5 were considered to have obstructive sleep apnea. The appropriate level of continuous positive airway pressure for each patient was determined during an all-night continuous positive airway pressure determination study. Attended continuous positive airway pressure titration was performed with a continuous positive airway pressure auto-titrating device. RESULTS: Obstructive sleep apnea prevalence among patients with ischemic stroke was 73.7%. The minimum SaO2 was significantly lower, and the percent of total sleep time in the wake stage and stage 1 sleep was significantly longer in patients with obstructive sleep apnea. In two patients with severe obstructive sleep apnea, we observed a decrease in the apnea-hypopnea index, an increase in mean wake time, mean SaO2, and minimum SaO2, and alterations in sleep structures with continuous positive airway pressure treatment. CONCLUSION: As the diagnosis and treatment of obstructive sleep apnea is of particular importance in secondary stroke prevention, we suggest that the clinical assessment of obstructive sleep apnea be part of the evaluation of stroke patients in rehabilitation units, and early treatment should be started.
Welmer, Anna-Karin; Holmqvist, Lotta Widén; Sommerfeld, Disa K
To describe the extent to which the voluntary movements of hemiparetic stroke patients are restricted to the hemiplegic limb synergies (which are marked by the inability to master individual joint movements) described by Brunnström. The study also aimed to describe the extent to which the synergies are related to functioning. In a prospective observational study design, 64 consecutive hemiparetic stroke patients were assessed with Brunnström's hemiplegic limb synergies, the modified Ashworth scale for spasticity, the Rivermead mobility index, and the Barthel ADL index. Three months after stroke, 8 of the 64 patients were moving completely or partly within the synergies. All patients whose movements were restricted to the synergies also exhibited spasticity. Hemiparetic patients whose movements were restricted to the synergies had significantly worse functioning scores than hemiparetic patients whose movements were not restricted to the synergies although severe disabilities were seen in both groups. Three months after stroke, the voluntary movements of only 13% of hemiparetic stroke patients were restricted to the synergies. The synergies were associated with spasticity and activity limitations. The use of the synergies might only be suitable for a small fraction of hemiparetic patients-namely, those displaying spasticity.
Saadi, Altaf; Okeng'o, Kigocha; Biseko, Maijo R; Shayo, Agness F; Mmbando, Theoflo N; Grundy, Sara J; Xu, Ai; Parker, Robert A; Wibecan, Leah; Iyer, Geetha; Onesmo, Peter M; Kapina, Boniphace N; Regenhardt, Robert W; Mateen, Farrah J
Background Evidence suggests that social networks improve functional recovery after stroke, but this work has not been extended to low- and middle-income countries (LMICs). Post-stroke depression interferes with functional outcome but is understudied in LMICs. Aims To determine the relationships between social networks, disability, and depressive symptoms in patients surviving 90-days post-stroke in Dar es Salaam, Tanzania. Methods Participants ≥ 18 years, admitted ≤ 14 days of stroke onset, were enrolled. Disability was measured using the modified Rankin Scale, social networks by the Berkman-Syme social network index, and depressive symptoms by the Patient Health Questionnaire-9 (PHQ-9) by telephone interview at 90 days. A Kruskal-Wallis test or Spearman's correlation coefficient was used to assess the associations between social networks, depressive symptoms, and disability. Results Of 176 participants, 43% (n = 75) died, with an additional 11% (n = 20) lost to follow-up by 90 days. Among 81 survivors, 94% (n = 76, 57% male, average age 54 years) had complete information on all scales (mean and median follow-up time of 101 and 88 days). Thirty percent (n = 23, 41.9%, 95% confidence interval 20.2) had at least mild depressive symptoms (PHQ-9 ≥ 5 points). Nearly two-thirds (n = 46, 61%) reported ≥ 3 close friends. A higher social network index score was associated with fewer depressive symptoms (p social isolation is associated with more depressive symptoms in Tanzania. Understanding social networks and the associated mechanisms of recovery in stroke is especially relevant in the context of limited resources.
Full Text Available Stroke is a huge public health problem because of its high morbidity and disability. The epidemiology of stroke is of relevance to construct practical paradigms to tackle this major health issue in the community. Recent data have shown that about 72-86% of strokes are ischemic, 9-18% are due to hemorrhage (intracerebral of subarachnoid and the rest are undefined. The risk factors for stroke are multiple and combined. At present, stroke is no more considered as unavoidable and untreatable. It is an emergency and specialized units and teams improve outcome and lower costs. Death related to stroke is declining in many countries and in both sexes. This decrease in multifactorial. The detection and more effective treatment of hypertension may play an important factor, as well as the improved medical care and improvement in diagnostic procedures. While stroke incidence appears stable and stroke mortality is slowly declining, the absolute magnitude of stroke is likely to grow over the next 30 years. as the population ages, the absolute number of stroke victims and demands on healthcare and other support systems is likely to increase substantially in the future. Keeping this in perspective, this chapter shall focus on the epidemiology of stroke in the world and in Indian, in particular.
Wildenschild, Cathrine; Mehnert, Frank; Thomsen, Reimar Wernich
BACKGROUND: The validity of the registration of patients in stroke-specific registries has seldom been investigated, nor compared with administrative hospital discharge registries. The objective of this study was to examine the validity of the registration of patients in a stroke-specific registry...... (The Danish Stroke Registry [DSR]) and a hospital discharge registry (The Danish National Patient Registry [DNRP]). METHODS: Assuming that all patients with stroke were registered in either the DSR, DNRP or both, we first identified a sample of 75 patients registered with stroke in 2009; 25 patients...... in the DSR, 25 patients in the DNRP, and 25 patients registered in both data sources. Using the medical record as a gold standard, we then estimated the sensitivity and positive predictive value of a stroke diagnosis in the DSR and the DNRP. Secondly, we reviewed 160 medical records for all potential stroke...
M V Padma Srivastav
Full Text Available Circadian variations in conjunction with sleep-related heart rhythm changes and sleepdisordered breathing (SDB are contributing risk factors for stroke. Strong scientificevidence now exists indicating that SDB contributes to systemic hypertension, aprominent risk factor for stroke, and compelling circumstantial evidence is presentsuggesting that SDB raises the risk for development of stroke through other circulatorymechanisms as well. Preliminary evidence indicates that post-stroke patients have ahigher prevalence of SDB, which is likely to compromise their rehabilitation outcomes.Since SDB is modifiable with the application of CPAP and other treatment modalities,there is practical value in investigating patients at risk of stroke or post stroke forpresence of SDB. Successful application of CPAP or BiPAP therapy may improve theoutcome in both instances.Key words : Sleep, Stroke, SDB, CPAP
Full Text Available Barriers to risk factor control may differ by race/ethnicity. The goal of this study was to identify barriers to stroke awareness and risk factor management unique to Hispanics as compared to non-Hispanic whites (NHWs. We performed a prospective study of stroke patients from an academic Stroke Center in Arizona and surveyed members of the general community. Questionnaires included: the Duke Social Support Index (DSSI, the Multidimensional Health Locus of Control (MHLC Scale, a stroke barriers questionnaire, and a Stroke Awareness Test. Of 145 stroke patients surveyed (72 Hispanic; 73 NHW, Hispanics scored lower on the Stroke Awareness Test compared to NHWs (72.5% vs. 79.1%, p = 0.029. Hispanic stroke patients also reported greater barriers related to medical knowledge, medication adherence, and healthcare access (p < 0.05 for all. Hispanics scored higher on the “powerful others” sub-scale (11.3 vs. 10, p < 0.05 of the MHLC. Of 177 members of the general public surveyed, Hispanics had lower stroke awareness compared to NHWs and tended to have lower awareness than Hispanic stroke patients. These results suggest that Hispanic stroke patients perceive less control over their health, experience more healthcare barriers, and demonstrate lower rates of stroke literacy. Interventions for stroke prevention and education in Hispanics should address these racial/ethnic differences in stroke awareness and barriers to risk factor control.
Goldstein, L.B.; Amarenco, P.; Zivin, J.
Scale, Barthel Index, and modified Rankin Scale score at enrollment (1 to 6 months after the index event) and 90 days poststroke in subjects having a stroke during the trial. RESULTS: Over 4.9 years, strokes occurred in 576 subjects. There were reductions in fatal, severe (modified Rankin Scale score 5...... or no event), there was only a trend toward lesser severity with treatment based on the modified Rankin Scale score (P=0.0647) with no difference based on the National Institutes of Health Stroke Scale or Barthel Index. CONCLUSIONS: The present exploratory analysis suggests that the outcome of recurrent...... or 4), moderate (modified Rankin Scale score 3 or 2), and mild (modified Rankin Scale score 1 or 0) outcome ischemic strokes and transient ischemic attacks and an increase in the proportion of event-free subjects randomized to atorvastatin (P
Menon, Bindu; Salini, P; Habeeba, K; Conjeevaram, Jyoti; Munisusmitha, K
Stroke is among the major causes of short- and long-term disability. This study aimed to understand the caregivers (CGs) stress in stroke survivors. A 22-item questionnaire was administered to 201 CGs of stroke survivors. The variables tested were physical and mental health, social support, financial, and personal problems. CGs were divided into Group A (Barthel index [BI] 75) according to patient's BI, according to gender (male and female CG) and relation; spouses (wife, husband), daughters, sons, daughter-in-law, grandchildren, and rest (father, mother, brother, sister, and in-laws). Data were analyzed using SPSS software version-21. Data were analyzed to determine which variables of the patient effects the CG stress. Majority of the CGs (74.62%) were females. 65% of CGs graded their burden as moderate to severe. 81% of CGs had left their work for caregiving. More than half of the CGs felt sleep disturbance and physical strain. Psychological instability and financial burdens were reported in 3/4 th of CGs. Group A CGs faced more sleep, financial, health, and social life disturbance. Patient's bladder and bowel problems, shoulder pain, patients noncooperative attitude for medication administration, and physiotherapy were more upsetting for Group A CGs. Female CGs were subjected to more sleep disturbance, physical and psychological stress, faced more difficulty regarding the patient's bladder, bowel, personal hygiene needs, and physiotherapy. Female CGs felt less motivated in caregiving than male CGs. Wives and daughters-in-law experienced more burden. Time spent and burden perceived was more by female CGs (χ 2 = 15.199, P = 0.002) than males (χ 2 = 11.931, P = 0.018); wives and daughters than other relations (χ 2 = 32.184, P = 0.000), (χ 2 = 35.162, P = 0.019). Our study showed that caregiving burden was predominantly shouldered by females CGs. CGs faced physical, psychological, and socioeconomic burden. The burden was more evident in female CGs and in
Full Text Available Background: Stroke is among the major causes of short- and long-term disability. This study aimed to understand the caregivers (CGs stress in stroke survivors. Materials and Methods: A 22-item questionnaire was administered to 201 CGs of stroke survivors. The variables tested were physical and mental health, social support, financial, and personal problems. CGs were divided into Group A (Barthel index [BI] 75 according to patient's BI, according to gender (male and female CG and relation; spouses (wife, husband, daughters, sons, daughter-in-law, grandchildren, and rest (father, mother, brother, sister, and in-laws. Data were analyzed using SPSS software version–21. Data were analyzed to determine which variables of the patient effects the CG stress. Results: Majority of the CGs (74.62% were females. 65% of CGs graded their burden as moderate to severe. 81% of CGs had left their work for caregiving. More than half of the CGs felt sleep disturbance and physical strain. Psychological instability and financial burdens were reported in 3/4th of CGs. Group A CGs faced more sleep, financial, health, and social life disturbance. Patient's bladder and bowel problems, shoulder pain, patients noncooperative attitude for medication administration, and physiotherapy were more upsetting for Group A CGs. Female CGs were subjected to more sleep disturbance, physical and psychological stress, faced more difficulty regarding the patient's bladder, bowel, personal hygiene needs, and physiotherapy. Female CGs felt less motivated in caregiving than male CGs. Wives and daughters-in-law experienced more burden. Time spent and burden perceived was more by female CGs (χ2 = 15.199, P = 0.002 than males (χ2 = 11.931, P = 0.018; wives and daughters than other relations (χ2 = 32.184, P = 0.000, (χ2 = 35.162, P = 0.019. Conclusion: Our study showed that caregiving burden was predominantly shouldered by females CGs. CGs faced physical, psychological, and socioeconomic
Jane Murray Cramm
Full Text Available Introduction: The quality of integrated stroke care depends on smooth team functioning but professionals may not always work well together. Professionals' perspectives on the factors that influence stroke team functioning remain largely unexamined. Understanding their experiences is critical to indentifying measures to improve team functioning. The aim of this study was to identify the factors that contributed to the success of interprofessional stroke teams as perceived by team members. Methods: We distributed questionnaires to professionals within 34 integrated stroke care teams at various health care facilities in 9 Dutch regions. 558 respondents (response rate: 39% completed the questionnaire. To account for the hierarchical structure of the study design we fitted a hierarchical random-effects model. The hierarchical structure comprised 558 stroke team members (level 1 nested in 34 teams (level 2. Results: Analyses showed that personal development, social well-being, interprofessional education, communication, and role understanding significantly contributed to stroke team functioning. Team-level constructs affecting interprofessional stroke team functioning were communication and role understanding. No significant relationships were found with individual-level personal autonomy and team-level cohesion. Discussion and conclusion: Our findings suggest that interventions to improve team members' social well-being, communication, and role understanding will improve teams' performance. To further advance interprofessional team functioning, healthcare organizations should pay attention to developing professionals' interpersonal skills and interprofessional education.
Jane Murray Cramm
Full Text Available Introduction: The quality of integrated stroke care depends on smooth team functioning but professionals may not always work well together. Professionals' perspectives on the factors that influence stroke team functioning remain largely unexamined. Understanding their experiences is critical to indentifying measures to improve team functioning. The aim of this study was to identify the factors that contributed to the success of interprofessional stroke teams as perceived by team members. Methods: We distributed questionnaires to professionals within 34 integrated stroke care teams at various health care facilities in 9 Dutch regions. 558 respondents (response rate: 39% completed the questionnaire. To account for the hierarchical structure of the study design we fitted a hierarchical random-effects model. The hierarchical structure comprised 558 stroke team members (level 1 nested in 34 teams (level 2. Results: Analyses showed that personal development, social well-being, interprofessional education, communication, and role understanding significantly contributed to stroke team functioning. Team-level constructs affecting interprofessional stroke team functioning were communication and role understanding. No significant relationships were found with individual-level personal autonomy and team-level cohesion. Discussion and conclusion: Our findings suggest that interventions to improve team members' social well-being, communication, and role understanding will improve teams' performance. To further advance interprofessional team functioning, healthcare organizations should pay attention to developing professionals' interpersonal skills and interprofessional education.
Anna Flávia Ferraz Barros Baroni
Full Text Available CONTEXT: Stroke is a frequent cause of dysphagia. OBJECTIVE: To evaluate in a tertiary care hospital the prevalence of swallowing dysfunction in stroke patients, to analyze factors associated with the dysfunction and to relate swallowing dysfunction to mortality 3 months after the stroke. METHODS: Clinical evaluation of deglutition was performed in 212 consecutive patients with a medical and radiologic diagnosis of stroke. The occurrence of death was determined 3 months after the stroke. RESULTS: It was observed that 63% of the patients had swallowing dysfunction. The variables gender and specific location of the lesion were not associated with the presence or absence of swallowing dysfunction. The patients with swallowing dysfunction had more frequently a previous stroke, had a stroke in the left hemisphere, motor and/or sensitivity alterations, difficulty in oral comprehension, alteration of oral expression, alteration of the level of consciousness, complications such as fever and pneumonia, high indexes on the Rankin scale, and low indexes on the Barthel scale. These patients had a higher mortality rate. CONCLUSIONS: Swallowing evaluation should be done in all patients with stroke, since swallowing dysfunction is associated with complications and an increased risk of death.
Ali, Myzoon; Ashburn, Ann; Bowen, Audrey; Brodie, Eric; Corr, Susan; Drummond, Avril; Edmans, Judi; Gladman, John; Kalra, Lalit; Langhorne, Peter; Lees, Kennedy R; Lincoln, Nadina; Logan, Pip; Mead, Gillian; Patchick, Emma; Pollock, Alex; Pomeroy, Val; Sackley, Catherine; Sunnerhagen, Katherina S; van Vliet, Paulette; Walker, Marion; Brady, Marian
Stroke rehabilitation is a complex intervention. Many factors influence the interaction between the patient and the elements of the intervention. Rehabilitation interventions are aimed at altering different domains of patient outcome including body functions, activity and participation. As a consequence, randomised clinical trials in this area are difficult to design. We developed an archive of stroke rehabilitation trials (VISTA-Rehab) to act as a resource to help trialists model and design future rehabilitation studies. We developed specific eligibility criteria for the entry of stroke rehabilitation trials into the archive. We established a Steering Committee to oversee projects and publications and commenced the recruitment of rehabilitation trials into this resource. As of August 2009, VISTA-Rehab contains data from 23 stroke rehabilitation trials (>3400 patients). Demographic data, including age [median=73, interquartile range (63,79)], gender (male=53%) and initial dependency [median baseline Barthel index score=6, interquartile range (9,19)], are available for all patients. Outcome measures include the modified Rankin Scale, Barthel Index, Rivermead Motor Assessment, Fugl-Meyer Assessment, General Health Questionnaire and Nottingham Extended Activities of Daily Living Scale. VISTA-Rehab expands the Virtual International Stroke Trials Archive to include rehabilitation trials. Anonymised data can be used to examine questions specific to stroke rehabilitation and to generate novel hypotheses. © 2010 The Authors. International Journal of Stroke © 2010 World Stroke Organization.
Kalowska, E.; Rostrup, E.; Rosenbaum, S.
the modified Rankin Scale, Barthel Index and SSS score. Patients with and without SIP were compared using both clinical and MRI data obtained on admission, on day 7 and after 3 months. RESULTS: Fifteen patients (37%) developed SIP. Increased DWI lesion volume on day 7 in all strokes was associated with SIP...... as a permanent decrease of >or=3 Scandinavian Stroke Scale (SSS) points for speech or >or=2 SSS points for consciousness or >or=2 SSS points for limb strength, when assessed at baseline compared to the day after admission and daily during the following week. Patients were followed up on day 90 and assessed using...
One of the most difficult challenges in engine technology today is the urgent need to increase engine thermal efficiency. Higher efficiencies mean less fuel consumption and lower atmospheric emissions per unit of work produced by the engine. In 1862 a Frenchman Alphouse Beau de Rochas gives his theory regarding the ideal cycle of the internal combustion engine. This theory is applied by a German engineer named Nikolaus A. Otto, who firstly built a successful four-stroke SI engine in 1876. The...
Xu, Mangmang; Li, Dan; Zhang, Shihong
Sensory stimulation via acupuncture has been reported to alter activities of numerous neural systems by activating multiple efferent pathways. Acupuncture, one of the main physical therapies in Traditional Chinese Medicine, has been widely used to treat patients with stroke for over hundreds of years. This is the first update of the Cochrane Review originally published in 2005. To assess whether acupuncture could reduce the proportion of people with death or dependency, while improving quality of life, after acute ischemic or hemorrhagic stroke. We searched the Cochrane Stroke Group trials register (last searched on February 2, 2017), the Cochrane Central Register of Controlled Trials Ovid (CENTRAL Ovid; 2017, Issue 2) in the Cochrane Library, MEDLINE Ovid (1946 to February 2017), Embase Ovid (1974 to February 2017), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) EBSCO (1982 to February 2017), the Allied and Complementary Medicine Database (AMED; 1985 to February 2017), China Academic Journal Network Publishing Database (1998 to February 2017), and the VIP database (VIP Chinese Science Journal Evaluation Reports; 1989 to February 2017). We also identified relevant trials in the Chinese Clinical Trial Registry (last searched on Feburuary 20, 2017), the World Health Organization (WHO) International Clinical Trials Registry Platform (last searched on April 30, 2017), and Clinicaltrials.gov (last searched on April 30, 2017). In addition, we handsearched the reference lists of systematic reviews and relevant clinical trials. We sought randomized clinical trials (RCTs) of acupuncture started within 30 days from stroke onset compared with placebo or sham acupuncture or open control (no placebo) in people with acute ischemic or hemorrhagic stroke, or both. Needling into the skin was required for acupuncture. Comparisons were made versus (1) all controls (open control or sham acupuncture), and (2) sham acupuncture controls. Two review authors applied
Álvarez-Velasco, Rodrigo; Masjuan, Jaime; DeFelipe, Alicia; Corral, Iñigo; Estévez-Fraga, Carlos; Crespo, Leticia; Alonso-Cánovas, Araceli
Stroke on board aircraft has been reported in retrospective case series, mainly focusing on economy class stroke syndrome. Data on the actual incidence, pathogenesis, and prognosis of stroke in commercial flights are lacking. A prospective registry was designed to include all consecutive patients referred from an international airport (40 million passengers a year) to our hospital with a diagnosis of ischemic stroke or transient ischemic attack and onset of symptoms during a flight or immediately after landing. Forty-four patients (32 ischemic strokes and 12 transient ischemic attacks) were included over a 76-month period (January 2008 to April 2014). The estimated incidence of stroke was 1 stroke in 35 000 flights. Pathogeneses of stroke or transient ischemic attack were atherothrombotic in 16 (36%), economy class stroke syndrome in 8 (18%), cardioembolic in 7 (16%), arterial dissection in 4 (9%), lacunar stroke in 4 (9%), and undetermined in 5 (12%) patients. Carotid stenosis >70% was found in 12 (27%) of the patients. Overall prognosis was good, and thrombolysis was applied in 44% of the cases. The most common reason for not treating patients who had experienced stroke onset midflight was the delay in reaching the hospital. Only 1 patient with symptom onset during the flight prompted a flight diversion. We found a low incidence of stroke in the setting of air travel. Economy class stroke syndrome and arterial dissection were well represented in our sample. However, the main pathogenesis was atherothrombosis with a high proportion of patients with high carotid stenosis. © 2016 American Heart Association, Inc.
Full Text Available Introduction: stroke in recreational substance users can be an indirect complication, like endocarditis and cardio embolism in parenteral drug users. With some drug like cocaine, stroke appear to be the result of a direct effect. In young subjects without other risk factors provide persuasive evidence for causality . OPIATES: Heroine is the most abused opiate drug, which is administered by injection, by snorting or by smoking. Stroke affects heroin users by diverse mechanisms,. Injectors are at risk of infections endocarditis, which carries risk for both ischemic and hemorrhagic stroke. Cerebral or subarachnoid hemorrhage usually occurs after rupture of a septic (mycotic aneurysm. Heroine users can are also at risk for hemorrhagic stroke secondary to liver failure with deranged clotting and to heroin nephropathy with uremia or malignant hypertension. In some heroin users the drug it self is directly causal due to vasculitis, hypersensitivity and immunologic changes. Embolization of foreign material to brain due to mixed of heroine with quinine can cause cerebral embolism. AMPHETAMINE AND other psychostimulants: In abuser of amphetamine hemorrhagic stroke can occur, oral, intravenous, nasal, and inhalational routes of administration have been reported. Most were chronic user, but in several patients, stroke followed a first exposure. Some of amphetamine induced intracranial hemorrhages are secondary to acute hypertension, some to cerebral vacuities, and some to a combination of two. Decongestants and diet pills: Phenylpropanolamine (PPA, an amphetamine – like drug, in decongestants and diet pills, induce acute hypertension, sever headache, psychiatric symptoms, seizures and hemorrhagic stroke. Ephedrine and pseudo ephedrine are present in decongestants and bronchodilators and induce headache, tachyarrhythmia, hypertensive emergency, and hemorrhagic and occlusive stroke. Ecstasy, 3,4 Methylenedioxymethamphetamin (MDMA with amphetamine like can
Ganesalingam, Jeban; Buddha, Sandeep; Carlton-Jones, Anoma L; Nicholas, Richard
Vasculitis is a rare, but treatable condition that can present to hyperacute stroke units. Thrombolysis does not treat the underlying pathology, and a rapidly evolving clinical picture drives clinical decision often before all the investigation results are available.
Full Text Available Hypertension is the most important modifiable risk factor for primary and secondary stroke prevention.All antihypertensive drugs are effective in primary prevention: the risk reduction for stroke is 30—42%. However, not all classes of drugs have the same effects: there is some indication that angiotensin receptor blockers may be superior to other classes of antihypertensive drugs in stroke prevention.Seventy-five percent of patients who present to hospital with acute stroke have elevated blood pressure within the first 24—48 hours. Extremes of systolic blood pressure (SBP increase the risk of death or dependency. The aim of treatment should be to achieve and maintain the SBP in the range 140—160 mmHg. However, fast and drastic blood pressure lowering can have adverse consequences.The PROGRESS trial of secondary prevention with perindopril + indapamide versus placebo + placebo showed a decrease in numbers of stroke recurrences in patients given both active antihypertensive agents, more impressive for cerebral haemorrhage.There were also indications that active treatment might decrease the development of post-stroke dementia.
Sibon, Igor; Rouanet, François; Meissner, Wassilios; Orgogozo, Jean Marc
Acute stroke is associated with serum elevations of numerous markers. We evaluated the additive accuracy of the Triage Stroke Panel (D-dimer, B-natriuretic peptide, matrix metalloproteinase 9, and S-100beta) to the triaging nurse for acute stroke diagnosis. Consecutive patients with suspected stroke were included in this prospective, controlled, single-center study. A well-trained stroke center triage nurse assigned a probability that the patient had experienced a stroke (certain, very probable, probable, not likely, doubtful, or other); then, the Triage Stroke Panel testing was performed. Patients' diagnosis was based on clinical and imaging data by a neurologist blinded to the test results. Two hundred four patients were evaluated. Confirmed strokes and transient ischemic attacks (TIAs) were observed in 131 patients. When considering an experienced stroke nurse's assessment of "other," "doubtful," or "not likely" to be negative for stroke and categorizing TIA with stroke, the stroke panel's Multimarker Index (MMX) value had identical accuracy (approximately 70%) and equivalent sensitivity (approximately 94%) and specificity (approximately 24%) for stroke diagnosis to that of the nurse. Combining nurse assessment with the MMX result significantly improved the specificity of diagnosing "mimic" vs stroke + TIA from 25.4% (nurse assessment only) to 46.0% (nurse assessment + MMX; P Stroke Panel provides objective information that complements a triage nurse in the assessment of a suspected stroke patient. Its performance compares favorably with that of a well-trained stroke center triage nurse, suggesting potential use in nonexpert centers for improving the accuracy of stroke diagnosis.
Grace Vincent-Onabajo; Taritei Moses
Background. Knowledge of stroke risk factors is expected to reduce the incidence of stroke?whether first-ever or recurrent. This study examined knowledge of stroke risk factors and its determinants among stroke survivors. Methods. A cross-sectional survey of consenting stroke survivors at two physiotherapy facilities in Nigeria was carried out. Sociodemographic and clinical data were obtained and knowledge of stroke risk factors (defined as the ability to mention at least one correct risk fac...
Relevance of genetics and genomics for prevention and treatment of cardiovascular disease: a scientific statement from the American Heart Association Council on Epidemiology and Prevention, the Stroke Council, and the Functional Genomics and Translational Biology Interdisciplinary Working Group.
Arnett, Donna K; Baird, Alison E; Barkley, Ruth A; Basson, Craig T; Boerwinkle, Eric; Ganesh, Santhi K; Herrington, David M; Hong, Yuling; Jaquish, Cashell; McDermott, Deborah A; O'Donnell, Christopher J
Atherosclerotic cardiovascular disease (CVD) is a major health problem in the United States and around the world. Evidence accumulated over decades convincingly demonstrates that family history in a parent or a sibling is associated with atherosclerotic CVD, manifested as coronary heart disease, stroke, and/or peripheral arterial disease. Although there are several mendelian disorders that contribute to CVD, most common forms of CVD are believed to be multifactorial and to result from many genes, each with a relatively small effect working alone or in combination with modifier genes and/or environmental factors. The identification and the characterization of these genes and their modifiers would enhance prediction of CVD risk and improve prevention, treatment, and quality of care. This scientific statement describes the approaches researchers are using to advance understanding of the genetic basis of CVD and details the current state of knowledge regarding the genetics of myocardial infarction, atherosclerotic CVD, hypercholesterolemia, and hypertension. Current areas of interest and investigation--including gene-environment interaction, pharmacogenetics, and genetic counseling--are also discussed. The statement concludes with a list of specific recommendations intended to help incorporate usable knowledge into current clinical and public health practice, foster and guide future research, and prepare both researchers and practitioners for the changes likely to occur as molecular genetics moves from the laboratory to clinic.
Mattle, Heinrich P.; Brainin, Michael; Chamorro, Angel; Diener, Hans Christoph; Hacke, Werner; Leys, Didier; Norrving, Bo; Ward, Nick
The European Stroke Organisation (ESO) held its first European Stroke Science Workshop in Garmisch-Partenkirchen, Germany (15-17 December 2011). Stroke experts based in Europe were invited to present and discuss their current research. The scope of the workshop was to review the most recent findings of selected topics in stroke, to exchange ideas, to stimulate new research and to enhance collaboration between European stroke research groups. Seven scientific sessions were held, each starting with a keynote lecture to review the state of the art of the given topic, followed by 4 or 5 short presentations by experts. They were asked to limit their presentations to 10 slides containing only recent information. The meeting was organized by the executive committee of the ESO (Heinrich Mattle, chairman, Michael Brainin, Angel Chamorro, Werner Hacke, Didier Leys) and supported by the European Stroke Conference (Michael Hennerici). In this article we summarize the main contents of this successful workshop. PMID:22836350
Clarke, David J; Forster, Anne
Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway.
Stenumgård, Pål Sigurd; Rakotondranaivo, Miadana Joshua; Sletvold, Olav; Follestad, Turid; Ellekjær, Hanne
Stroke is reported as the most frequent cause of in-hospital death in Madagascar. However, no descriptive data on hospitalized stroke patients in the country have been published. In the present study, we sought to investigate the feasibility of collecting data on stroke patients in a resource-constrained hospital in Madagascar. We also aimed to characterize patients hospitalized with stroke. We registered socio-demographics, clinical characteristics, and early outcomes of patients admitted for stroke between 23 September 2014 and 3 December 2014. We used several validated scales for the evaluation. Stroke severity was measured by the National Institutes of Health Stroke Scale (NIHSS), disability by the modified Rankin Scale (mRS), and function by the Barthel Index (BI). We studied 30 patients. Sixteen were males. The median age was 62.5 years (IQR 58-67). The NIHSS and mRS were completed for all of the patients, and BI was used for the survivors. Three patients received a computed tomography (CT) brain scan. The access to laboratory investigations was limited. Electrocardiographs (ECGs) were not performed. The median NIHSS score was 16.5 (IQR 10-35). The in-hospital stroke mortality was 30%. At discharge, the median mRS score was 5 (IQR 4-6), and the median BI score was 45 (IQR 0-72.5). Although the access to brain imaging and supporting investigations was deficient, this small-scale study suggests that it is feasible to collect essential data on stroke patients in a resource-constrained hospital in Madagascar. Such data should be useful for improving stroke services and planning further research. The hospitalized stroke patients had severe symptoms. The in-hospital stroke mortality was high. At discharge, the disability category was high, and functional status low.
Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.; Hacke, Werner; Kidwell, Chelsea S.; Kloska, Stephan P.; Koehrmann, Martin; Koroshetz, Walter; Lee, Ting-Yim; Lees, Kennedy R.; Lev, Michael H.; Liebeskind, David S.; Ostergaard, Leif; Powers, William J.; Provenzale, James; Schellinger, Peter; Silbergleit, Robert; Sorensen, Alma Gregory; Wardlaw, Joanna; Warach, Steven
The recent "Advanced Neuroimaging for Acute Stroke Treatment" meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke
Stahl, Stephanie M; Yaggi, H Klar; Taylor, Stanley; Qin, Li; Ivan, Cristina S; Austin, Charles; Ferguson, Jared; Radulescu, Radu; Tobias, Lauren; Sico, Jason; Vaz Fragoso, Carlos A; Williams, Linda S; Lampert, Rachel; Miech, Edward J; Matthias, Marianne S; Kapoor, John; Bravata, Dawn M
The literature about the relationship between obstructive sleep apnea (OSA) and stroke location is conflicting with some studies finding an association and others demonstrating no relationship. Among acute ischemic stroke patients, we sought to examine the relationship between stroke location and the prevalence of OSA; OSA severity based on apnea-hypopnea index (AHI), arousal frequency, and measure of hypoxia; and number of central and obstructive respiratory events. Data were obtained from patients who participated in a randomized controlled trial (NCT01446913) that evaluated the effectiveness of a strategy of diagnosing and treating OSA among patients with acute ischemic stroke and transient ischemic attack. Stroke location was classified by brain imaging reports into subdivisions of lobes, subcortical areas, brainstem, cerebellum, and vascular territory. The association between acute stroke location and polysomnographic findings was evaluated using logistic regression for OSA presence and negative binomial regression for AHI. Among 73 patients with complete polysomnography and stroke location data, 58 (79%) had OSA. In unadjusted models, no stroke location variable was associated with the prevalence or severity of OSA. Similarly, in multivariable modeling, groupings of stroke location were also not associated with OSA presence. These results indicate that OSA is present in the majority of stroke patients and imply that stroke location cannot be used to identify a group with higher risk of OSA. The results also suggest that OSA likely predated the stroke. Given this high overall prevalence, strong consideration should be given to obtaining polysomnography for all ischemic stroke patients. Published by Elsevier B.V.
Gredal, Hanne Birgit; Skerritt, G. C.; Gideon, P.
Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms.......Translation of experimental stroke research into the clinical setting is often unsuccessful. Novel approaches are therefore desirable. As humans, pet dogs suffer from spontaneous ischaemic stroke and may hence offer new ways of studying genuine stroke injury mechanisms....
Eum, Yeongcheol; Yim, Jongeun
Stroke is one of the leading causes of morbidity and long-term disability worldwide, and post-stroke depression (PSD) is a common and serious psychiatric complication of stroke. PSD makes patients have more severe deficits in activities of daily living, a worse functional outcome, more severe cognitive deficits and increased mortality as compared to stroke patients without depression. Therefore, to reduce or prevent mental problems of stroke patients, psychological treatment should be recommended. Literature and art therapy are highly effective psychological treatment for stroke patients. Literature therapy divided into poetry and story therapy is an assistive tool that treats neurosis as well as emotional or behavioral disorders. Poetry can add impression to the lethargic life of a patient with PSD, thereby acting as a natural treatment. Story therapy can change the gloomy psychological state of patients into a bright and healthy story, and therefore can help stroke patients to overcome their emotional disabilities. Art therapy is one form of psychological therapy that can treat depression and anxiety in stroke patients. Stroke patients can express their internal conflicts, emotions, and psychological status through art works or processes and it would be a healing process of mental problems. Music therapy can relieve the suppressed emotions of patients and add vitality to the body, while giving them the energy to share their feelings with others. In conclusion, literature and art therapy can identify the emotional status of patients and serve as a useful auxiliary tool to help stroke patients in their rehabilitation process.
Mazaux, Jean-Michel; Lagadec, Tiphaine; de Sèze, Mathieu Panchoa; Zongo, Drissa; Asselineau, Julien; Douce, Emmanuelle; Trias, Joel; Delair, Marie-France; Darrigrand, Bénédicte
To study communication disability in stroke patients with aphasia. Prospective, multicentric cohort study of patients with aphasia, consecutively included after a first stroke, and examined 1 year later at home. Assessment included a stroke severity scale, the Barthel Index, the boston diagnostic aphasia examination, a communication questionnaire, and the aphasia depression rating scale. A total of 164 patients were included. Among the 100 survivors assessed at follow-up, 24% had severe aphasia, 12% moderate aphasia and 64% mild aphasia according to the Boston diagnostic aphasia examination severity score. Patients mainly reported difficulties in conversation with strangers and/or on abstract topics, using a phone, reading and writing administrative documents, dealing with money and outdoor communication activities. Communication was strongly related to aphasia severity. Age, gender, education level, residence status and type of stroke had no influence on communication activity. On multivariate analysis, severity of stroke and severity of aphasia on inclusion were found to account for 58% of variance and were independent predictors of the communication questionnaire score at follow-up. Documenting the most impaired communication skills may help to set priority goals for speech and language therapy in aphasia.
Zhang, Yan; Wang, Wanhua; Cai, Sijie; Sheng, Qi; Pan, Shenggui; Shen, Fang; Tang, Qing; Liu, Yang
Obstructive sleep apnea (OSA) is very common in stroke survivors. It potentially worsens the cognitive dysfunction and inhibits their functional recovery. However, whether OSA independently damages the cognitive function in stroke patients is unclear. A simple method for evaluating OSA-induced cognitive impairment is also missing. Forty-four stroke patients six weeks after onset and 24 non-stroke patients with snoring were recruited for the polysomnographic study of OSA and sleep architecture. Their cognitive status was evaluated with a validated Chinese version of Cambridge Prospective Memory Test. The relationship between memory deficits and respiratory, sleeping, and dementia-related clinical variables were analyzed with correlation and multiple linear regression tests. OSA significantly and independently damaged time- and event-based prospective memory in stroke patients, although it had less power than the stroke itself. The impairment of prospective memory was correlated with increased apnea-hypopnea index, decreased minimal and mean levels of peripheral oxygen saturation, and disrupted sleeping continuity (reduced sleep efficiency and increased microarousal index). The further regression analysis identified minimal levels of peripheral oxygen saturation and sleep efficiency to be the two most important predictors for the decreased time-based prospective memory in stroke patients. OSA independently contributes to the cognitive dysfunction in stroke patients, potentially through OSA-caused hypoxemia and sleeping discontinuity. The prospective memory test is a simple but sensitive method to detect OSA-induced cognitive impairment in stroke patients. Proper therapies of OSA might improve the cognitive function and increase the life quality of stroke patients. Copyright © 2017 Elsevier B.V. All rights reserved.
Full Text Available Jennifer K Harrison,1 Katherine S McArthur,2 Terence J Quinn21Department of Cardiovascular Sciences, University of Leicester, Leicester, UK; 2Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UKAbstract: As stroke care has developed, there has been a need to robustly assess the efficacy of interventions both at the level of the individual stroke survivor and in the context of clinical trials. To describe stroke-survivor recovery meaningfully, more sophisticated measures are required than simple dichotomous end points, such as mortality or stroke recurrence. As stroke is an exemplar disabling long-term condition, measures of function are well suited as outcome assessment. In this review, we will describe functional assessment scales in stroke, concentrating on three of the more commonly used tools: the National Institutes of Health Stroke Scale, the modified Rankin Scale, and the Barthel Index. We will discuss the strengths, limitations, and application of these scales and use the scales to highlight important properties that are relevant to all assessment tools. We will frame much of this discussion in the context of "clinimetric" analysis. As they are increasingly used to inform stroke-survivor assessments, we will also discuss some of the commonly used quality-of-life measures. A recurring theme when considering functional assessment is that no tool suits all situations. Clinicians and researchers should chose their assessment tool based on the question of interest and the evidence base around clinimetric properties.Keywords: Barthel Index, clinimetrics, clinical trial, disability, methodology, modified Rankin Scale, National Institutes Health Stroke Scale, scales, stroke, outcomes
Lee, Meng; Wu, Yi-Ling; Saver, Jeffrey L; Lee, Hsuei-Chen; Lee, Jiann-Der; Chang, Ku-Chou; Wu, Chih-Ying; Lee, Tsong-Hai; Wang, Hui-Hsuan; Rao, Neal M; Ovbiagele, Bruce
There is insufficient evidence on which to base a recommendation for optimal antiplatelet therapy following a stroke while on aspirin. The objective was to compare clopidogrel initiation vs aspirin reinitiation for vascular risk reduction among patients with ischaemic stroke on aspirin at the time of their index stroke. Retrospective. We conducted a nationwide cohort study by retrieving all hospitalised patients (≥18 years) with a primary diagnosis of ischaemic stroke between 2003 and 2009 from Taiwan National Health Insurance Research Database. Among 3862 patients receiving aspirin before the index ischaemic stroke and receiving either aspirin or clopidogrel after index stroke during follow-up period, 1623 were excluded due to a medication possession ratio new-onset major adverse cardiovascular event (MACE: composite of any stroke or myocardial infarction). The leading secondary end point was any recurrent stroke. Compared to aspirin, clopidogrel was associated with a lower occurrence of future MACE (HR=0.54, 95% CI 0.43 to 0.68, p<0.001, number needed to treat: 8) and recurrent stroke (HR=0.54, 95% CI 0.42 to 0.69, p<0.001, number needed to treat: 9) after adjustment of relevant covariates. Among patients with an ischaemic stroke while taking aspirin, clopidogrel initiation was associated with fewer recurrent vascular events than aspirin reinitiation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Opara, Jozef A.; Langhorne, Peter; Larsen, Torben; Mehlich, Krzysztof; Szczygiel, Jaroslaw
The aim of this work was to survey the contemporary facilities for early post-stroke rehabilitation in Poland. The main research questions were as follows: what is the availability of inpatient rehabilitation for post-stroke patients in neurological departments and in rehabilitation departments? The growing costs of healthcare are encouraging…
Christopher L. Jones
Full Text Available Finger–thumb coordination is crucial to manual dexterity but remains incompletely understood, particularly following neurological injury such as stroke. While being controlled independently, the index finger and thumb especially must work in concert to perform a variety of tasks requiring lateral or palmar pinch. The impact of stroke on this functionally critical sensorimotor control during dynamic tasks has been largely unexplored. In this study, we explored finger–thumb coupling during close–open pinching motions in stroke survivors with chronic hemiparesis. Two types of perturbations were applied randomly to the index with a novel Cable-Actuated Finger Exoskeleton: a sudden joint acceleration stretching muscle groups of the index finger and a sudden increase in impedance in selected index finger joint(s. Electromyographic signals for specific thumb and index finger muscles, thumb tip trajectory, and index finger joint angles were recorded during each trial. Joint angle perturbations invoked reflex responses in the flexor digitorum superficialis (FDS, first dorsal interossei (FDI, and extensor digitorum communis muscles of the index finger and heteronymous reflex responses in flexor pollicis brevis of the thumb (p < 0.017. Phase of movement played a role as a faster peak reflex response was observed in FDI during opening than during closing (p < 0.002 and direction of perturbations resulted in shorter reflex times for FDS and FDI (p < 0.012 for extension perturbations. Surprisingly, when index finger joint impedance was suddenly increased, thumb tip movement was substantially increased, from 2 to 10 cm (p < 0.001. A greater effect was seen during the opening phase (p < 0.044. Thus, involuntary finger–thumb coupling was present during dynamic movement, with perturbation of the index finger impacting thumb activity. The degree of coupling modulated with the phase of motion. These findings reveal a potential
Zheng, Guo-Qing; Huang, Pei-Xin
Research works were done on origin and development of the denomination, the acute stage of etiopathogenisis and pathogenesis, therapeutical priniciple and therapeutical methods in hemorrhagic stroke. Stroke was divided into is chemic and hemorrhagic until the end of the Qing dynasty. In 1997, Terminology of Traditional Chinese Medicine Treatment-Disease Part of National Standard formally included the term hemorrhagic stroke. Before 1950s-1960s, the pathogenesis emphasizes the up-stirring of liver, the adverse-rising of both blood and qi. A proper remedy should to subdue the liver yang, calm down the endopathic wind and clear heat. Since 1970s, it has been considered that the disorder is closely related with the spleen and stomach. The focal pathogenesis was blocked passage of the middle jiao, disorder of qi in ascending and descending and the abnormal flow of qi and blood. Since 1980s, it was claimed that hemorrhagic stroke belongs to blood syndrome of TCM. The vital pathogenesis was accumulation of blood stasis in acute stage of hemorrhagic stroke. The key point of therapeutical method was to promote blood circulation to remove blood stasis. In recent years, the theories of endogenous toxic factor, consumption, yin and yang syndrome, and the therapeutical method of antidote, assisting the vital qi, especially the development of common therapeutical methods were developed, with an abundance of differential diagnosis and treatment in hemorrhagic stroke.
Full Text Available Cerebrovascular diseases are the second cause of mortality in the world, and hypertension is considered a main risk factor for occurrence of stroke. The mechanisms responsible for the increased stroke risk remain unclear. However, dietary interventions have been applied in the management and treatment of their risk factors, which include increased blood pressure levels, obesity, diabetes, and dyslipidemia. Further studies should be conducted to assess the effects of carotenoids, flavonoids, n-3 polyunsaturated fats, and lower salt and high glycemic index intake in risk of stroke.
Fu, Ying; Liu, Qiang; Anrather, Josef
Inflammatory and immune responses in the brain can shape the clinical presentation and outcome of stroke. Approaches for effective management of acute stroke are sparse and many measures for brain protection fail, but our ability to modulate the immune system and modify the disease progression of multiple sclerosis is increasing. As a result, immune interventions are currently being explored as therapeutic interventions in acute stroke. In this Review, we compare the immunological features of acute stroke with those of multiple sclerosis, identify unique immunological features of stroke, and consider the evidence for immune interventions. In acute stroke, microglia activation and cell death products trigger an inflammatory cascade that damages vessels and the parenchyma within minutes to hours of the ischaemia or haemorrhage. Immune interventions that restrict brain inflammation, vascular permeability and tissue oedema must be administered rapidly to reduce acute immune-mediated destruction and to avoid subsequent immunosuppression. Preliminary results suggest that the use of drugs that modify disease in multiple sclerosis might accomplish these goals in ischaemic and haemorrhagic stroke. Further elucidation of the immune mechanisms involved in stroke is likely to lead to successful immune interventions. PMID:26303850
Andrews, Glenda; Halford, Graeme S.; Shum, David; Maujean, Annick; Chappell, Mark; Birney, Damian
The research examined relational processing following stroke. Stroke patients (14 with frontal, 30 with non-frontal lesions) and 41 matched controls completed four relational processing tasks: sentence comprehension, Latin square matrix completion, modified Dimensional Change Card Sorting, and n-back. Each task included items at two or three…
... Event Join a Stroke Challenge Team Comeback Trail Tell Your Story Community Presentations Faces of Stroke Volunteer With Us ... in a video presentation. Watch Video ... to feel the right side of her body. Kathryn’s friends performed the FAST exam and soon ...
Jarenwattananon, A.; Khandji, A.; Brust, J.C.M.
Since the development of cerebral angiography 60 years ago, there has been a proliferation of increasingly sophisticated, expensive, and, fortunately, safe imaging techniques for patients with cerebrovascular disease. In addition, occlusive and hemorrhagic stroke are now recognized as having a wide variety of possible causes. This chapter addresses the different imaging options available for particular kinds of stroke
Buchinger, Mikael; Durigen, Susan; Dahl, Johan Rambech
The paper presents a preliminary investigation into aspects of the game of golf. A series of models is proposed for the golf stroke, the momentum transfer between club and ball and the flight of the ball.Numerical and asymptotic solutions are presented reproducing many of the features observed...... in the golf stroke of a professional golfer....
Norup, Anne; Guldberg, Anne-Mette; Friis, Claus Radmer
OBJECTIVE: To describe the work of an interdisciplinary visual team in a stroke unit providing early identification and assessment of patients with visual symptoms, and secondly to investigate frequency, type of visual deficits after stroke and self-evaluated impact on everyday life after stroke...
Johnsen, Søren Paaske; Ingeman, Annette; Hundborg, Heidi Holmager
AIM OF DATABASE: The aim of the Danish Stroke Registry is to monitor and improve the quality of care among all patients with acute stroke and transient ischemic attack (TIA) treated at Danish hospitals. STUDY POPULATION: All patients with acute stroke (from 2003) or TIA (from 2013) treated...... at Danish hospitals. Reporting is mandatory by law for all hospital departments treating these patients. The registry included >130,000 events by the end of 2014, including 10,822 strokes and 4,227 TIAs registered in 2014. MAIN VARIABLES: The registry holds prospectively collected data on key processes...... of care, mainly covering the early phase after stroke, including data on time of delivery of the processes and the eligibility of the individual patients for each process. The data are used for assessing 18 process indicators reflecting recommendations in the national clinical guidelines for patients...
Hayes, Sara; Donnellan, Claire; Stokes, Emma
To gain an understanding of physiotherapy practice in relation to executive dysfunction (ED) post-stroke. Three focus groups were conducted using semi-structured interview schedules to highlight how ED post-stroke was understood by 12 physiotherapists with greater than 1 year of experience working in the area of stroke care. The focus group data were analysed using qualitative data analysis. The themes extracted from the data on physiotherapists' self-reported knowledge of ED post-stroke were: physiotherapists' lack of knowledge of ED post-stroke; current physiotherapy practice regarding ED post-stroke; the negative impact of ED on physiotherapy rehabilitation post-stroke and the future learning needs of physiotherapists regarding ED post-stroke. Current results demonstrate that ED has negative implications for physiotherapy rehabilitation post-stroke. Although further interdisciplinary research is warranted, the present results suggest that physiotherapists should be aware of the presence of ED in people post-stroke and develop strategies to minimise the impact of ED on physiotherapy rehabilitation. Implications for Rehabilitation Physiotherapists report a lack of knowledge of ED post-stroke and a requirement for future learning and training regarding the optimal management of people with ED undergoing physiotherapy rehabilitation post-stroke. ED has negative implications for physiotherapy rehabilitation post-stroke and physiotherapists should be aware of the presence of ED in people post-stroke and develop strategies to minimise the impact of ED on physiotherapy rehabilitation.
Clark, Cari Jo; Guo, Hongfei; Lunos, Scott; Aggarwal, Neelum T; Beck, Todd; Evans, Denis A; Mendes de Leon, Carlos; Everson-Rose, Susan A
Greater social cohesion is related to lower rates of coronary heart disease, but its relation to stroke risk is unstudied. This study examined whether neighborhood social cohesion was protective against stroke mortality and incidence. Data come from 5789 participants (60% female; 62% black; mean age, 74.7 years) in a longitudinal study of chronic diseases in the elderly. Stroke mortality, ascertained through December 31, 2007, was verified through the National Death Index; 186 stroke deaths were identified in 11 years of follow-up. Stroke incidence was determined in a subset (N=3816) with linkage to Medicare claims files; 701 first-ever strokes were identified. Cohesion was measured by 6 items assessing frequency of contact and social interactions with neighbors; items were z-scored and averaged. Individual scores were averaged across 82 census block groups, forming a neighborhood-level measure of social cohesion. Marginal Cox proportional hazard models tested the association of neighborhood-level cohesion with stroke mortality and incidence. Each 1-point increase in cohesion related to a 53% reduced risk of stroke mortality (hazard ratio, 0.47; 95% CI, 0.24 to 0.90), adjusting for relevant covariates, including sociodemographics, known stroke risk factors, and neighborhood-level socioeconomic status. A race×cohesion interaction (P=0.04) revealed cohesion was protective in whites (hazard ratio, 0.34; 95% CI, 0.17 to 0.67) but not blacks (hazard ratio, 1.17; 95% CI, 0.35 to 3.86). Cohesion was unrelated to stroke incidence (P>0.5). Neighborhood-level social cohesion was independently protective against stroke mortality. Research is needed to further examine observed race differences and pathways by which cohesion is health-protective.
Dawson, Ang; Cloud, Geoffrey C; Pereira, Anthony C; Moynihan, Barry J
Stroke services have been centralised in several countries in recent years. Diagnosing acute stroke is challenging and a high proportion of patients admitted to stroke units are diagnosed as a non-stroke condition (stroke mimics). This study aims to describe the stroke mimic patient group, including their impact on stroke services. We analysed routine clinical data from 2,305 consecutive admissions to a stroke unit at St George's Hospital, London. Mimic groupings were derived from 335 individual codes into 17 groupings. From 2,305 admissions, 555 stroke mimic diagnoses were identified (24.2%) and 72% of stroke mimics had at least one stroke risk factor. Common mimic diagnoses were headache, seizure and syncope. Medically unexplained symptoms and decompensation of underlying conditions were also common. Median length of stay was 1 day; a diagnosis of dementia (p=0.028) or needing MRI (p=0.006) was associated with a longer stay. Despite emergency department assessment by specialist clinicians and computed tomography brain, one in four suspected stroke patients admitted to hospital had a non-stroke diagnosis. Stroke mimics represent a heterogeneous patient group with significant impacts on stroke services. Co-location of stroke and acute neurology services may offer advantages where service reorganisation is being considered. © Royal College of Physicians 2016. All rights reserved.
Background: The burden of stroke worldwide is increasing rapidly. There is paucity of data on post-stroke depression (PSD) among stroke survivors in Uganda, despite the high prevalence of PSD reported elsewhere. Methods: In a cross-sectional study, we assessed adult participants with confirmed first stroke with a ...
The perception of patients to stroke is variable. The aim of this study was to determine the perception of stroke among stroke patients. The study was carried out between January 2004 - December 2004 on all the patients presenting with features of stroke at the Federal Medical Center Ido, Nigeria. Data were collected by ...
Akarolo-Anthony, Sally N.; Jiménez, Monik C.; Chiuve, Stephanie E.; Spiegelman, Donna; Willett, Walter C.; Rexrode, Kathryn M.
Background and Purpose Lower plasma magnesium levels may be associated with higher blood pressure and endothelial dysfunction, but sparse prospective data are available for stroke. Methods Among 32,826 participants in the Nurses’ Health Study who provided blood samples in 1989–1990, incident ischemic strokes were identified and confirmed by medical records through 2006. We conducted a nested case-control analysis of 459 cases, matched 1:1 to controls on age, race/ethnicity, smoking status, date of blood draw, fasting status, menopausal status and hormone use. We used conditional logistic regression models to estimate the multivariable adjusted association of plasma magnesium and the risk of ischemic stroke and ischemic stroke subtypes. Results Median magnesium levels did not differ between ischemic stroke cases and controls (median=0.86 mmol/l for both; p-value=0.14). Conditional on matching factors, women in the lowest magnesium quintile had a relative risk (RR) of 1.34 (95% confidence interval [CI]: 0.86–2.10, p trend=0.13) for total ischemic stroke, compared to women in the highest quintile. Additional adjustment for risk factors and confounders did not substantially alter the risk estimates for total ischemic stroke. Women with magnesium levels magnesium levels ≥0.82 mmol/l. No significant effect modification was observed by age, body mass index, hypertension or diabetes. Conclusions Lower plasma magnesium levels may contribute to higher risk of ischemic stroke among women. PMID:25116874
Beyond the original meaning of chronic kidney disease (CKD) as high-risk state for future dialysis, CKD is now known as an established risk factor for cardiovascular diseases. Stroke is a major player of cardiovascular disease and has deep two-way relationships with CKD. CKD is an evident risk factor for stroke. Meta-analyses of cohort studies and trials indicate that proteinuria/albuminuria increases the risk of stroke by 71-92%, and reduced glomerular filtration rate increases the risk by 43%. In addition, CKD has a strong relationship with subclinical brain damage including white matter changes, microbleeds, cognitive impairment, and carotid atherosclerosis. CKD is prevalent in acute stroke patients; patients with estimated glomerular filtration rate stroke patients and 39% of total intracerebral hemorrhage patients in our institute. Acute and chronic management of stroke are influenced by CKD. Therapeutic effects of several antithrombotic and thrombolytic agents, including recently-developed novel oral anticoagulants, are affected by renal function. Moreover, reduced glomerular filtration rate is independently associated with increased 1- and 10-year mortalities in the end. Stroke also has deep relationships with end-stage kidney disease. Stroke occurs much more commonly in dialysis patients than general population or CKD patients without need for dialysis. The triggers of ischemic and hemorrhagic stroke in patients with end-stage kidney disease include special characteristics unique to dialysis, such as drastic hemodynamic change, dialysate and anticoagulants, and vascular calcification. As cohorts of dialysis patients become older, more hypertensive, and more diabetic than before, stroke become more prevalent and more serious events in dialysis clinics. Now, clinicians should have much interest in the association between CKD and cerebrovascular diseases, so-called the cerebro-renal interaction. Copyright © 2013 S. Karger AG, Basel.
Aidar, Felipe J; de Oliveira, Ricardo J; Silva, Ant?nio J; de Matos, Dihogo G; Carneiro, Andr? L; Garrido, Nuno; Hickner, Robert C; Reis, Victor M
Abstract Background The association between physical activity and quality of life in stroke survivors has not been analyzed within a framework related to the human development index. This study aimed to identify differences in physical activity level and in the quality of life of stroke survivors in two cities differing in economic aspects of the human development index. Methods Two groups of subjects who had suffered a stroke at least a year prior to testing and showed hemiplegia or hemipare...
Chen, Chun-Chih; Chen, Chin-Shyan; Liu, Tsai-Ching; Lin, Ying-Tzu
This paper investigates the impact of stock market movement on incidences of stroke utilizing population-based aggregate data in Taiwan. Using the daily data from the Taiwan Stock Exchange Capitalization Weighted Stock Index and from the National Health Insurance Research Database during 2001/1/1-2007/12/31, which consist of 2556 observations, we examine the effects of stock market on stroke incidence - the level effect and the daily change effects. In general, we find that both a low stock index level and a daily fall in the stock index are associated with greater incidences of stroke. We further partition the data on sex and age. The level effect is found to be significant for either gender, in the 45-64 and 65 ≥ age groups. In addition, two daily change effects are found to be significant for males and the elderly. Although stockholdings can increase wealth, they can also increase stroke incidence, thereby representing a cost to health. Copyright © 2012 Elsevier Ltd. All rights reserved.
Sandset, Else Charlotte; Murray, Gordon; Boysen, Gudrun
-European countries: Norway, Sweden, Denmark, Belgium, Germany, Poland, Lithuania, Estonia and Finland. STUDY OUTCOMES: There are two co-primary effect variables: • Functional status at 6-months, measured by the modified Rankin Scale, and • vascular death, myocardial infarction or stroke during the first 6-months....... Secondary outcome variables: Secondary effect variables include • the Barthel index (functional status) • EuroQol (quality of life) and • Mini-mental state examination (cognition) at 6-months • Health economic costs during the first 6-months FUNDING: The Scandinavian Candesartan Acute Stroke Trial receives...
U.S. Department of Health & Human Services — The National Death Index (NDI) is a centralized database of death record information on file in state vital statistics offices. Working with these state offices, the...
Amaricai, Elena; Poenaru, Dan V
Stroke is a leading cause of disability and a major public health problem. To determine frequency and degree of post-stroke depression (PSD) and its impact on functioning in young and adult stroke patients in a rehabilitation unit. The study included 72 stroke patients (aged 29-59 years) who were attending rehabilitation. The patients were assessed for depressive symptoms by Beck Depression Inventory (BDI), and their functioning by using the Stroke Impact Scale (SIS) and the Barthel Index of Activities of Daily Living (ADL). Forty-eight patients had different degrees of depression: borderline clinical depression (13.8%), moderate depression (34.7%), severe depression (15.2%) or extreme depression (2.9%). There were no significant differences of BDI scores in 30-39, 40-49 and 50-59 years groups. Statistically significant correlations were between BDI score and SIS score, between BDI score and ADL index, and between SIS score and ADL index in men, women and total study patients. More than half of the PSD patients had a moderate degree of depression. Significant correlations were noticed between depressive symptoms and functional status evaluated both by an instrument of assessing stroke impact upon general health and an instrument for assessing the everyday activities.
Lo, Suzanne Hoi Shan; Chang, Anne Marie; Chau, Janita Pak Chun
Self-efficacy is a significant factor influencing stroke survivors' participation in self-care and outcomes. The Stroke Self-Efficacy Questionnaire (SSEQ) is a stroke-specific measure of stroke survivors' self-efficacy in performing daily functional activities and self-management. However, there has been no Chinese version of the questionnaire. The current study aims to examine the reliability and validity of a translated Chinese version of SSEQ (SSEQ-C). The English version of SSEQ has been translated into Chinese. A descriptive study was conducted. A convenience sample of 135 Chinese stroke survivors (mean age 58.9, SD 9.75) was recruited from three community centers and a stroke support group. Eligible participants completed the SSEQ-C, and the Chinese versions of General Self-Efficacy Scale (GSES), Frenchay Activities Index (FAI), and Stroke-Specific Quality of Life Scale (SSQOL). Thirty of the participants completed the questionnaires at baseline and 4 weeks afterwards. SSEQ-C had a high internal consistency (Cronbach's α 0.92). Test-retest reliability was satisfactory with the intraclass correlation coefficient of the total scale 0.52. Positive correlations were found between the total scores of SSEQ-C, GSES, FAI, and SSQOL (Spearman's ρ: 0.48-0.68, p self-efficacy in managing post-stroke condition. More studies are warranted to confirm the two-factor model of the questionnaire.
Dichgans, Martin; Planas, Anna M.; Biessels, Geert Jan|info:eu-repo/dai/nl/165576367; van der Worp, Bart|info:eu-repo/dai/nl/189855010; Sudlow, Cathie; Norrving, B.; Lees, Kennedy; Mattle, Heinrich P.
Lake Eibsee, Garmisch-Partenkirchen, November 19 to 21, 2015: The European Stroke Organization convened >120 stroke experts from 27 countries to discuss latest results and hot topics in clinical, translational, and basic stroke research. Since its inception in 2011, the European Stroke Science
Lapadatu, Irina; Morris, Reg
To examine change in identity after stroke and to elucidate its relationship with mood and quality of life. To test Higgins' theory of the impact of identity (self-discrepancy) on anxiety and depression. To examine the role of self-esteem in mediating the relationship between identity and outcomes. Sixty-five community-living first-time stroke survivors, mean age 61.58 and time since stroke 5.60 years, were recruited from stroke charities. A cross-sectional study used the Head Injury Semantic Differential Scale, the Hospital Anxiety and Depression Scale, the Rosenberg Self-Esteem Scale, the Stroke-Specific Quality of Life Questionnaire (adapted) and the Barthel Index. Identity was rated more negatively after stroke than before (t(64) = 6.46, p self-esteem (r = -.48, p self-esteem (β = .30, p self-esteem are associated with important outcomes for stroke survivors.
Bisgaard, J; Gilsaa, T; Rønholm, E
, intraoperatively and post-operatively. Patients were followed up for 30 days. RESULTS: Stroke volume index and oxygen delivery index were both higher in the post-operative period in the intervention group. In this group, 27 of 32 achieved the post-operative oxygen delivery index target vs. 18 of 32 in the control...... group, stroke volume was optimised by 250 ml colloid boluses intraoperatively and for the first 6 h post-operatively. The optimisation aimed at an oxygen delivery of 600 ml/min/m(2) in the post-operative period. Haemodynamic data were collected at pre-defined time points, including baseline...... group (P = 0.01). However, the number of complications per patient or length of stay in the intensive care unit or hospital did not differ between the groups. CONCLUSION: Perioperative individualised goal-directed therapy targeting stroke volume and oxygen delivery did not affect post...
Threapleton, D E; Burley, V J; Greenwood, D C; Cade, J E
Stroke risk is modifiable through many risk factors, one being healthy dietary habits. Fibre intake was associated with a reduced stroke risk in recent meta-analyses; however, data were contributed by relatively few studies, and few examined different stroke types. A total of 27,373 disease-free women were followed up for 14.4 years. Diet was assessed with a 217-item food frequency questionnaire and stroke cases were identified using English Hospital Episode Statistics and mortality records. Survival analysis was applied to assess the risk of total, ischaemic or haemorrhagic stroke in relation to fibre intake. A total of 135 haemorrhagic and 184 ischaemic stroke cases were identified in addition to 138 cases where the stroke type was unknown or not recorded. Greater intake of total fibre, higher fibre density and greater soluble fibre, insoluble fibre and fibre from cereals were associated with a significantly lower risk for total stroke. For total stroke, the hazard ratio per 6 g/day total fibre intake was 0.89 (95% confidence intervals: 0.81-0.99). Different findings were observed for haemorrhagic and ischaemic stroke in healthy-weight or overweight women. Total fibre, insoluble fibre and cereal fibre were inversely associated with haemorrhagic stroke risk in overweight/obese participants, and in healthy-weight women greater cereal fibre was associated with a lower ischaemic stroke risk. In non-hypertensive women, higher fibre density was associated with lower ischaemic stroke risk. Greater total fibre and fibre from cereals are associated with a lower stroke risk, and associations were more consistent with ischaemic stroke. The different observations by stroke type, body mass index group or hypertensive status indicates potentially different mechanisms.
Mi Kyoung Son
Full Text Available Atrial fibrillation (AF is a major risk factor for ischemic stroke and associated with a 5-fold higher risk of stroke. In this retrospective cohort study, the incidence of and risk factors for ischemic stroke in patients with AF were identified. All patients (≥30 years old without previous stroke who were diagnosed with AF in 2007-2013 were selected from the National Health Insurance Service-National Sample Cohort. To identify factors that influenced ischemic stroke risk, Cox proportional hazard regression analysis was conducted. During a mean follow-up duration of 3.2 years, 1022 (9.6% patients were diagnosed with ischemic stroke. The overall incidence rate of ischemic stroke was 30.8/1000 person-years. Of all the ischemic stroke that occurred during the follow-up period, 61.0% occurred within 1-year after AF diagnosis. Of the patients with CHA2DS2-VASc score of ≥2, only 13.6% were receiving warfarin therapy within 30 days after AF diagnosis. Relative to no antithrombotic therapy, warfarin treatment for >90 days before the index event (ischemic stroke in stroke patients and death/study end in non-stroke patients associated with decreased ischemic stroke risk (Hazard Ratio = 0.41, 95%confidence intervals = 0.32-0.53. Heart failure, hypertension, and diabetes mellitus associated with greater ischemic stroke risk. AF patients in Korea had a higher ischemic stroke incidence rate than patients in other countries and ischemic stroke commonly occurred at early phase after AF diagnosis. Long-term (>90 days continuous warfarin treatment may be beneficial for AF patients. However, warfarin treatment rates were very low. To prevent stroke, programs that actively detect AF and provide anticoagulation therapy are needed.
M. V. Zamergrad
Full Text Available Differential diagnosis of new-onset acute vestibular vertigo is chiefly made between vestibular neuronitis and stroke. Dizziness in stroke is usually accompanied by other focal neurological symptoms of brainstem and cerebellar involvement. However, stroke may appear as isolated vestibular vertigo in some cases. An analysis of history data and the results of neurovestibular examination and brain magnetic resonance imaging allows stroke to be diagnosed in patients with acute isolated dizziness. The treatment of patients with stroke-induced dizziness involves a wide range of medications for the reduction of the degree of dizziness and unsteadiness and for the secondary prevention of stroke. Vestibular rehabilitation is an important component of treatment. The paper describes an observation of a patient with poorly controlled hypertension, who developed new-onset acute systemic dizziness. Vestibular neuronitis might be presumed to be a peripheral cause of vestibular disorders, by taking into account the absence of additional obvious neurological symptoms (such as pareses, defective sensation, diplopia, etc. and the nature of nystagmus. However, intention tremor in fingernose and heel-knee tests on the left side, a negative Halmagyi test, and results of Romberg’s test could suggest that stroke was a cause ofdizziness.
Rost, Natalia S
Understanding the genetic architecture of cerebrovascular disease holds promise of novel stroke prevention strategies and therapeutics that are both safe and effective. Apart from a few single-gene disorders associated with cerebral ischemia or intracerebral hemorrhage, stroke is a complex genetic phenotype that requires careful ascertainment and robust association testing for discovery and validation analyses. The recently uncovered shared genetic contribution between clinically manifest stroke syndromes and closely related intermediate cerebrovascular phenotypes offers effective and efficient approaches to complex trait analysis. Copyright © 2013 Elsevier Inc. All rights reserved.
Jennum, Poul; Iversen, Helle K; Ibsen, Rikke
. The attributable cost of direct net health care costs after the stroke (general practitioner services, hospital services, and medication) and indirect costs (loss of labor market income) were €10,720, €8,205 and €7,377 for patients, and €989, €1,544 and €1.645 for their partners, over and above that of controls......BACKGROUND: To estimate the direct and indirect costs of stroke in patients and their partners. DESCRIPTION: Direct and indirect costs were calculated using records from the Danish National Patient Registry from 93,047 ischemic, 26,012 hemorrhagic and 128,824 unspecified stroke patients...
Full Text Available Penyakit stroke merupakan penyebab kematian dan kecacatan kronik yang paling tinggi pada kelompok umur diatas usia 45 tahun terbanyak di Indonesia. Tujuan penelitian ini untuk mengidentifikasi determinan utama yang berhubungan dengan penyakit stroke pada masyarakat di kelurahan Kebon Kalapa Bogor. Analisis lanjut terhadap 1.912 responden subset baseline data penelitian “Studi Kohort Faktor Risiko Penyakit Tidak Menular” Data dikumpulkan dengan metode wawancara pada penduduk tetap di kelurahan Kebon Kalapa, Kecamatan Bogor Tengah, Bogor tahun 2012. Diagnosis stroke berdasarkan anamnesis dan pemeriksaan dokter spesialis syaraf. Variabel independen meliputi karakteristik sosiodemografi, status kesehatan dan perilaku berisiko. Data dianalisis dengan uji regresi logistik ganda. Penyakit stroke ditemukan pada 49 (2,6% orang. Determinan utama stroke meliputi hipertensi (OR = 4,20; IK 95% = 2,20 – 8,03, penyakit jantung koroner (OR = 2,74; IK 95% = 1,51 – 4,99, diabetes melitus (OR = 2,89; IK 95% = 1,47 – 5,64, dan status ekonomi miskin (OR = 1,83 ; IK 95% = 1,03 – 3,33. Pencegahan penyakit stroke dilakukan dengan peningkatan edukasi (kampanye/penyuluhan melalui pengendalian faktor risiko utama yaitu hipertensi dan pencegahan terjadinya penyakit degeneratif lain yaitu penyakit jantung koroner dan diabetes melitus. Stroke disease is the leading cause of death and chronic disabi lity in most over the age of 45 years in Indonesia. The aim of study was to identify the major determinants of stroke disease in Kebon Kalapa community in Bogor. A deep analyze was conducted in 1.912 respondents based on the subset of baseline data “Risk Factors Cohort Study of Non Communicable Diseases.” Data was collected by interviews on Kebon Kalapa community, Bogor in 2012. Stroke diagnosis was determined by anamnesis and neu-rological examination with specialist. Independent variables were sociodemographic characteristics, health status and risk behavior
Lee, Mi Ji; Lee, Chungbin; Chung, Chin-Sang
Migraine and stroke are common neurovascular disorders which share underlying physiological processes. Increased risks of ischemic stroke, hemorrhagic stroke, and subclinical ischemic lesions have been consistently found in migraineurs. Three possible associations are suggested. One is that underlying pathophysiology of migraine can lead to ischemic stroke. Second, common comorbidities between migraine and stroke can be present. Lastly, some syndromes can manifest with both migraine-like head...
Full Text Available Abstract Background Robotic devices are expected to be widely used in various applications including support for the independent mobility of the elderly with muscle weakness and people with impaired motor function as well as support for nursing care that involves heavy laborious work. We evaluated the effects of a hybrid assistive limb robot suit on the gait of stroke patients undergoing rehabilitation. Methods The study group comprised 16 stroke patients with severe hemiplegia. All patients underwent gait training. Four patients required assistance, and 12 needed supervision while walking. The stride length, walking speed and physiological cost index on wearing the hybrid assistive limb suit and a knee-ankle-foot orthosis were compared. Results The hybrid assistive limb suit increased the stride length and walking speed in 4 of 16 patients. The patients whose walking speed decreased on wearing the hybrid assistive limb suit either had not received sufficient gait training or had an established gait pattern with a knee-ankle-foot orthosis using a quad cane. The physiological cost index increased after wearing the hybrid assistive limb suit in 12 patients, but removal of the suit led to a decrease in the physiological cost index values to equivalent levels prior to the use of the suit. Conclusions Although the hybrid assistive limb suit is not useful for all hemiplegic patients, it may increase the walking speed and affect the walking ability. Further investigation would clarify its indication for the possibility of gait training.
Ozcan, Hakan; Yamin, Jehad A.A.
A computer simulation of a variable stroke length, LPG fuelled, four stroke, single cylinder, water cooled spark ignition engine was done. The engine capacity was varied by varying the stroke length of the engine, which also changed its compression ratio. The simulation model developed was verified with experimental results from the literature for both constant and variable stroke engines. The performance of the engine was simulated at each stroke length/compression ratio combination. The simulation results clearly indicate the advantages and utility of variable stroke engines in fuel economy and power issues. Using the variable stroke technique has significantly improved the engine's performance and emission characteristics within the range studied. The brake torque and power have registered an increase of about 7-54% at low speed and 7-57% at high speed relative to the original engine design and for all stroke lengths and engine speeds studied. The brake specific fuel consumption has registered variations from a reduction of about 6% to an increase of about 3% at low speed and from a reduction of about 6% to an increase of about 8% at high speed relative to the original engine design and for all stroke lengths and engine speeds studied. On the other hand, an increase of pollutants of about 0.65-2% occurred at low speed. Larger stroke lengths resulted in a reduction of the pollutants level of about 1.5% at higher speeds. At lower stroke lengths, on the other hand, an increase of about 2% occurred. Larger stroke lengths resulted in increased exhaust temperature and, hence, make the exhaust valve work under high temperature
Chen, Chun-Kai; Weng, Ming-Cheng; Chen, Tien-Wen; Huang, Mao-Hsiung
This study evaluated the impact of severity of hemiparesis on oxygen uptake (VO2) response in post-acute stroke patients. Sixty-four patients with a mean poststroke interval of 8.6 ± 3.8 days underwent a ramp cardiopulmonary exercise test on a cycling ergometer to volitional termination. Mean peak VO2 (VO2peak) and work efficiency (ΔVO2/ΔWR) were measured by open-circuit spirometry during standard upright ergometer cycling. Severity of the hemiparetic lower limb was assessed by Brunnstrom's motor recovery stages lower extremity (BMRSL). VO2peak was 10% lower in hemiparetic leg with BMRSL V than in that with BMRSL VI, 20% lower in BMRSL IV, and 50% lower in BMRSL III. ΔVO2/ΔWR was higher for the group with increased BMRSL. The relations were consistent after adjustment for age, sex, body mass index, stroke type, hemiparetic side, modified Ashworth Scale, time poststroke, comorbidities, and medications. Our findings revealed that O2peak is dependent on the severity of hemiparesis in leg, and along with ΔO2/ΔWR closely related to the severity of hemiparesis in post-acute stroke patients, regardless of the types and locations of lesion after stroke, as well as the differences in comorbidities and medications. Copyright © 2013. Published by Elsevier B.V.
Elias, Gavin J B; Namasivayam, Andrew A; Lozano, Andres M
Survivors of stroke often experience significant disability and impaired quality of life related to ongoing maladaptive responses and persistent neurologic deficits. Novel therapeutic options are urgently needed to augment current approaches. One way to promote recovery and ameliorate symptoms may be to electrically stimulate the surviving brain. Various forms of brain stimulation have been investigated for use in stroke, including deep brain stimulation (DBS). We conducted a comprehensive literature review in order to 1) review the use of DBS to treat post-stroke maladaptive responses including pain, dystonia, dyskinesias, and tremor and 2) assess the use and potential utility of DBS for enhancing plasticity and recovery from post-stroke neurologic deficits. A large variety of brain structures have been targeted in post-stroke patients, including motor thalamus, sensory thalamus, basal ganglia nuclei, internal capsule, and periventricular/periaqueductal grey. Overall, the reviewed clinical literature suggests a role for DBS in the management of several post-stroke maladaptive responses. More limited evidence was identified regarding DBS for post-stroke motor deficits, although existing work tentatively suggests DBS-particularly DBS targeting the posterior limb of the internal capsule-may improve paresis in certain circumstances. Substantial future work is required both to establish optimal targets and parameters for treatment of maladapative responses and to further investigate the effectiveness of DBS for post-stroke paresis. Copyright © 2017 Elsevier Inc. All rights reserved.
Linnet, Poul Martin
The Afghanistan index is a compilation of quantitative and qualitative data on the reconstruction and security effort in Afghanistan. The index aims at providing data for benchmarking of the international performance and thus provides the reader with a quick possibility to retrieve valid...... information on progress or lack of progress in the reconstruction of the post Taliban Afghanistan. The index is mainly based on information collected on the internet in order to provide quick access to the original source. The index is under development and thus new information will be added on a continuous...
García-Rodríguez, Luis A; Gaist, David; Morton, Jonathan
-based sampling was used to select 10,000 controls free from hemorrhagic stroke. Risk of hemorrhagic stroke was evaluated in current users and nonusers of antiplatelets and warfarin. Unconditional logistic regression models were used to adjust for age, sex, calendar year, alcohol, body mass index, hypertension...
... Brain cells can die, causing lasting damage. Risk factors are things that increase your chance of getting ... disease or condition. This article discusses the risk factors for stroke and things you can do to ...
... negotiate the provision of reasonable accommodations in the workplace. When can a stroke patient begin rehabilitation? Rehabilitation ... at home gives people the advantage of practicing skills and developing compensatory strategies in the context of ...
The author reflects on foreign-language learning by his EFL students as well as his own foreign-language learning. He concludes by musing on the possible and fantastical devastation on language-ability wrought by strokes.
Olsen, T S; Høgenhaven, H; Thage, O
Development of epilepsy was studied prospectively in a group of 77 consecutive stroke patients. Included were stroke patients less than 75 years old admitted within the first 3 days after the stroke. Excluded were patients with subarachnoid hemorrhage, vertebrobasilar stroke, and patients...... with other severe diseases. Cerebral angiography, CT, and EEG were performed in all patients. The patients were followed clinically for 2 to 4 years. Seven patients (9%) developed epilepsy. Of 23 patients with lesions involving the cortex, 6 (26%) developed epilepsy. Of 54 patients in whom the cortex...... was not involved, only 1 (2%) developed epilepsy. Patients with persisting paresis and cortical involvement seem to be at particularly high risk of developing epilepsy, as 50% of such patients (6 of 12) developed the disease....
Full Text Available Cheng-Sheng Yu,1,* Chih-Ming Lin,2,3,* Chi-Kuang Liu,4 Henry Horng-Shing Lu1 1Institute of Statistics and Big Data Research Center, National Chiao Tung University, Hsinchu, 2Stroke Centre and Department of Neurology, Chunghua Christian Hospital, Chunghua, 3Graduate Institute of Biological Science and Technology, National Chiao Tung University, Hsinchu, 4Department of Medical Imaging, Chunghua Christian Hospital, Chunghua, Taiwan, Republic of China *These authors contributed equally to this work Abstract: Carotid artery stenting is an effective treatment for ischemic stroke patients with moderate-to-severe carotid artery stenosis. However, the midterm outcome for patients undergoing this procedure varies considerably with baseline characteristics. To determine the impact of baseline characteristics on outcomes following carotid artery stenting, data from 107 eligible patients with a first episode of ischemic stroke were collected by retrospective chart review. A modified Rankin Scale (mRS was used to divide patients into two baseline groups, mRS ≤2 and mRS >2. A three-step decision-tree statistical analysis was conducted. After weighting the decision-tree parameters, the following impact hierarchy was obtained: admission low-density lipoprotein, gouty arthritis, chronic kidney disease, ipsilateral common carotid artery resistance index, contralateral ophthalmic artery resistance index, sex, and dyslipidemia. The finite-state machine model demonstrated that, in patients with baseline mRS ≤2, 46% had an improved mRS score at follow-up, whereas 54% had a stable mRS score. In patients with baseline mRS >2, a stable mRS score was observed in 75%, improved score in 23%, and a poorer score in 2%. Admission low-density lipoprotein was the strongest predictive factor influencing poststenting outcome. In addition, our study provides further evidence that carotid artery stenting can be of benefit in first-time ischemic stroke patients with baseline m
Simmons, Cailey; Noble, James M; Leighton-Herrmann, Ellyn; Hecht, Mindy F; Williams, Olajide
Community-level determinants of stroke knowledge among children are unknown but could meaningfully impact public stroke education campaigns. We explored for associations between community- and school-level quality measures relative to baseline stroke knowledge among children participating in the Hip Hop Stroke program. Baseline stroke knowledge assessments were performed in 2839 fourth-, fifth-, and sixth-grade students (ages 9-11 years) from November 2005 to April 2014. Knowledge was assessed relative to school performance grade (SPG, graded A-F; a school-level measure determined by the New York City [NYC] Department of Education) and economic need index (ENI, range: 0-2; a community-level, within-school measure of subsidized housing and meals with higher scores indicating more socioeconomic distress). Schools studied included those with SPG = B (n = 196), SPG = C (n = 1590), and SPG = D (n = 1053) and mean ENI = .85 (standard deviation: .23). A composite assessment of knowledge, including 4 stroke symptoms (blurred vision, facial droop, sudden headache, and slurred speech), was conducted consistently since 2006. Overall, students correctly identified a mean of 1.74 stroke symptoms (95% confidence interval: 1.70-1.79; possible range: 0-4, expected value of chance response alone or no knowledge = 2). For quartiles of ENI, mean knowledge scores are as follows: ENI Q1 = 2.00, ENI Q2 = 2.09, ENI Q3 = 1.46, and ENI Q4 = 1.56 (ENI Q3 and ENI Q4 versus ENI Q1 , P < .001). For SPG, SPG = B schools: 2.09, SPG = C: 1.83, and SPG = D: 1.56 (SPG = C and SPG = D versus SPG = B schools, P ≤ .05). Children's stroke knowledge was lowest in NYC communities with greater economic need and lower school performance. These findings could guide stroke education campaign implementation strategies. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.
van Mierlo, Maria L; van Heugten, Caroline M; Post, Marcel W M; Hajós, Tibor R S; Kappelle, L Jaap; Visser-Meily, Johanna M A
Little information is available about the course of quality of life (QoL) post stroke and how dependency on activities of daily living (ADL) influences this course. The aim of this study was therefore to describe the course of QoL from 2 months up to 2 years post stroke and to study the influence of ADL dependency in the first week post stroke. This is a multicenter prospective longitudinal cohort study in which 368 stroke patients were included and data were collected at 1 week, 2 months, 6 months, 12 months and 24 months post stroke. QoL assessment included measures of health-related quality of life (HRQoL) (short stroke-specific Quality of Life Scale), emotional functioning (Hospital Anxiety and Depression Scale), participation (Utrecht Scale for Evaluation of Rehabilitation-Participation), and life satisfaction (2LS). Dependency on ADL was defined as having a Barthel Index score ≤ 17 four days post stroke. Generalized Estimating Equations analyses were performed to examine the course of the 4 domains of QoL. Furthermore, the possible confounding effect of age, gender, marital status, level of education and discharge destination was examined. Results showed that HRQoL, participation and life satisfaction improved during the first year post stroke, with most changes occurring in the first 6 months. Furthermore, patients dependent in ADL scored consistently lower on all 4 QoL domains and test occasions compared to ADL-independent patients. In both patient groups separately, no changes over time were found in emotional functioning. ADL-independent patients improved in HRQoL (p = 0.002), participation (p post stroke and showed different patterns for specific domains of QoL and for patients with and without dependency in ADL in the first week post stroke. It is therefore important to differentiate between these different domains of QoL when the long-term perspective is considered. Furthermore, patients dependent in ADL consistently scored lower on all QoL domains
Joubert, Jacques; Joubert, Lynette B; de Bustos, Elizabeth Medeiros; Ware, Dallas; Jackson, David; Harrison, Terrence; Cadilhac, Dominique
Stroke is a high-frequency disorder placing a significant burden on the health care systems, being the foremost cause of complex chronic disability in adults. Devising systems that can enhance the prevention of stroke recurrence is an important priority and challenge in both the developed and the developing world. The potential for recurrent stroke can be substantially reduced by effective management of vascular risk factors. Telestroke is a tool with potential application to improve risk management of stroke survivors. Lack of acknowledgment of existing practices as well as lack of awareness of potential financial barriers to diffusion of telestroke can lead to limited implementation. Telestroke offers service providers the opportunity to access large numbers of stroke survivors targeting secondary prevention. The ideal 'telestroke model' provides service support, education for the patient and caregiver, as well as integration of specialist and primary care services. Effective use of technological advances, with adequate recognition of the importance of human interaction in the long-term management of a largely elderly population of stroke survivors is challenging but possible. Telestroke should be systems- and not technology-driven. Barriers in the implementation of telestroke have been identified as insufficient planning of IT infrastructure, lack of long-term vision for sustainability, a lack of contextual perspective as well as poor communication across domains. Future telestroke models should provide effective action in an integrated model of care recognizing and involving all existing players and practices. (c) 2009 S. Karger AG, Basel.
Stroke is a major cause of morbidity and mortality but the brain and other relevant tissues are often examined only cursorily when stroke patients come to autopsy. The pathological findings and clinical implications vary according to the type of stroke and its location and cause. Large ischaemic strokes are usually associated with atherosclerosis of extracranial or major intracranial arteries but can be caused by dissection. Most small cerebral infarcts are caused by arteriosclerosis or, in the elderly, cerebral amyloid angiopathy (CAA). However, vasculitides and coagulopathies can cause a range of different patterns of ischaemic (and, occasionally, haemorrhagic) stroke. Global brain ischaemia, caused by severe hypotension or raised intracranial pressure, produces damage that is accentuated in certain regions and neuronal populations and may be confused with hypoglycaemic injury. The main cause of subarachnoid haemorrhage is a ruptured berry aneurysm but CAA, arteriovenous malformations and infective aneurysms are occasionally responsible. These can also cause parenchymal brain haemorrhage, although this most often complicates hypertensive small vessel disease. Sometimes the haemorrhage arises from a neoplasm. Performing an adequate autopsy in stroke requires proper preparation, awareness of the likely pathological processes, familiarity with intracranial vascular anatomy, careful gross examination and dissection, and appropriate use of histology. © 2010 Blackwell Publishing Limited.
Full Text Available Mohammad Obadah Nakawah, Eugene C Lai Stanely H. Appel Department of Neurology, Houston Methodist Neurological Institute, Houston, TX, USA Abstract: Strokes, whether ischemic or hemorrhagic, are among the most common causes of secondary movement disorders in elderly patients. Stroke-related (vascular movement disorders, however, are uncommon complications of this relatively common disease. The spectrum of post-stroke movement disorders is broad and includes both hypo- and hyperkinetic syndromes. Post-stroke dyskinesias are involuntary hyperkinetic movements arising from cerebrovascular insults and often present with mixed phenotypes of hyperkinesia which can sometimes be difficult to classify. Nevertheless, identification of the most relevant motor phenotype, whenever possible, allows for a more specific phenomenological categorization of the dyskinesia and thus helps guide its treatment. Fortunately, post-stroke dyskinesias are usually self-limiting and resolve within 6 to 12 months of onset, but a short-term pharmacotherapy might sometimes be required for symptom control. Functional neurosurgical interventions targeting the motor thalamus or globus pallidus interna might be considered for patients with severe, disabling, and persistent dyskinesias (arbitrarily defined as duration longer than 12 months. Keywords: vascular dyskinesia, stroke, movement disorders
Lim, Tae Sung; Lee, Jin Soo; Yoon, Jung Han; Moon, So Young; Joo, In Soo; Huh, Kyoon; Hong, Ji Man
Post-stroke delirium is a common problem in the care of stroke patients, and is associated with longer hospitalization, high short-term mortality, and an increased need for long-term care. Although post-stroke delirium occurs in approximately 10 ~ 30% of patients, little is known about the risk factors for post-stroke delirium in patients who experience acute stroke. A total of 576 consecutive patients who experienced ischemic stroke (mean age, 65.2 years; range, 23-93 years) were screened for delirium over a 2-year period in an acute stroke care unit of a tertiary referral hospital. We screened for delirium using the Confusion Assessment Method. Once delirium was suspected, we evaluated the symptoms using the Korean Version of the Delirium Rating Scale-Revised-98. Neurological deficits were assessed using the National Institutes of Health Stroke Scale at admission and discharge, and functional ability was assessed using the Barthel Index and modified Rankin Scale at discharge and 3 months after discharge. Thirty-eight (6.7%) patients with stroke developed delirium during admission to the acute stroke care unit. Patients with delirium were significantly older (70.6 vs. 64.9 years of age, P = .001) and smoked cigarettes more frequently (40% vs. 24%, P = .033) than patients without delirium. In terms of clinical features, the delirium group experienced a significantly higher rate of major hemispheric stroke (55% vs. 26%, P delirium were older age, history of cigarette smoking, and major hemispheric stroke. Abrupt cessation of cigarette smoking may be a risk factor for post-stroke delirium in ischemic stroke patients. The development of delirium after stroke is associated with worse outcome and longer hospitalization.
Tulek, Zeliha; Poulsen, Ingrid; Gillis, Katrin
AIMS AND OBJECTIVES: To conduct a survey of the clinical nursing practice in European countries in accordance with the European Stroke Strategies (ESS) 2006, and to examine to what extent the ESS have been implemented in stroke care nursing in Europe. BACKGROUND: Stroke is a leading cause of death...... comprising 61 questions based on the ESS and scientific evidence in nursing practice was distributed to representatives of the European Association of Neuroscience Nurses, who sent the questionnaire to nurses active in stroke care. The questionnaire covered the following areas of stroke care: Organization...... of stroke services, Management of acute stroke and prevention including basic care and nursing, and Secondary prevention. RESULTS: Ninety-two nurses in stroke care in 11 European countries participated in the survey. Within the first 48 hours after stroke onset, 95% monitor patients regularly, 94% start...
Alberts, Mark J
Stroke is a common and serious disease. Most studies have shown that basic public knowledge about what a stroke is, symptoms of a stroke, and the proper reaction to a stroke is quite deficient. The fact that a stroke affects cognitive, communicative, and motor functions may partially explain the poor reaction to acute stroke symptoms. Several educational studies, using diverse formats and messaging paradigms, have been shown to positively affect public knowledge of stroke symptoms. Such efforts have often used mass media public education campaigns with an emphasis on recognizing symptoms of an acute stroke. Some have been able to demonstrate an increase in the chance of patients (or by-standers) calling 911 and seeking emergency care. However, many programs were of brief duration, and their long-term benefits are uncertain. Continual educational efforts will be needed to improve stroke knowledge and increase the percentage of patients who seek emergency care. © 2012 New York Academy of Sciences.
Wong, Adrian; Lau, Alexander Y L; Lo, Eugene; Tang, Michael; Wang, Zhaolu; Liu, Wenyan; Tanner, Nicole; Chau, Natalie; Law, Lorraine; Shi, Lin; Chu, Winnie C W; Yang, Jie; Xiong, Yun-Yun; Lam, Bonnie Y K; Au, Lisa; Chan, Anne Y Y; Soo, Yannie; Leung, Thomas W H; Wong, Lawrence K S; Lam, Linda C W; Mok, Vincent C T
Leisure activity participation has been shown to lower risks of cognitive decline in non-stroke populations. However, effects of leisure activities participation upon cognitive functions and risk of dementia after stroke are unclear. The purpose of this study is to examine the effects of recent past leisure activities participation upon cognitive functions and risk of incident dementia after stroke. Hospital-based, retrospective cohort study. 88 of 1,013 patients with stroke or TIA having no prestroke dementia were diagnosed to have incident poststroke dementia (PSD) 3-6 months after stroke. Regular participation (≥3 times per week) in intellectual, recreational, social and physical activities over the year before the index stroke was retrospectively recorded at 3-6 months after stroke. Logistic regression analyses showed that regular participation in intellectual (RR 0.36, 95%CI 0.20-0.63) and stretching & toning physical exercise (0.37, 0.21-0.64) was significantly associated with a reduced risk of PSD after controlling for age, education, prestroke cognitive decline, stroke subtype, prior strokes and chronic brain changes including white matter changes, old infarcts and global atrophy. Results were similar in patients with past strokes in unadjusted models. Participation in increased number of activities in general (r = 0.41, pleisure activities was associated with better poststroke cognitive performance. Findings of this retrospective cohort study call for studies of activity intervention for prevention of cognitive decline in individuals at elevated risk of stroke.
National Oceanic and Atmospheric Administration, Department of Commerce — Planetary Amplitude index - Bartels 1951. The a-index ranges from 0 to 400 and represents a K-value converted to a linear scale in gammas (nanoTeslas)--a scale that...
Ponsaing, Laura B; Iversen, Helle K; Jennum, Poul
PURPOSE: The purpose of the study was to assess polysomnographic indicators of increased mortality risk in patients with stroke or a transient ischemic attack (TIA). METHODS: We performed polysomnographies in 63 acute stroke/TIA patients. Mortality data were collected from a national database after...... a 19-37-month follow-up period. RESULTS: Of the 57 stroke and 6 TIA patients, 9 stroke patients died during follow-up. All nine had moderate or severe sleep-related breathing disorders (SRBDs). Binarily divided, the group with the highest apnea hypopnea index (AHI) had an almost 10-fold higher...... mortality risk (hazard ratio (HR) 9.71; 95 % confidence interval (CI) 1.20-78.29; p = 0.033) compared to the patients with the lowest AHI. The patients with the longest versus shortest nocturnal wake time had a higher mortality (HR 8.78; 95 % CI 1.1-71.8; p = 0.0428). Lung disease increased mortality (HR 9...
Hu, Heng; Doll, Danielle N.; Sun, Jiahong; Lewis, Sara E.; Wimsatt, Jeffrey H.; Kessler, Matthew J.; Simpkins, James W.; Ren, Xuefang
Stroke is the second leading cause of death worldwide. The prognostic influence of body temperature on acute stroke in patients has been recently reported; however, hypothermia has confounded experimental results in animal stroke models. This work aimed to investigate how body temperature could prognose stroke severity as well as reveal a possible mitochondrial mechanism in the association of body temperature and stroke severity. Lipopolysaccharide (LPS) compromises mitochondrial oxidative phosphorylation in cerebrovascular endothelial cells (CVECs) and worsens murine experimental stroke. In this study, we report that LPS (0.1 mg/kg) exacerbates stroke infarction and neurological deficits, in the mean time LPS causes temporary hypothermia in the hyperacute stage during 6 hours post-stroke. Lower body temperature is associated with worse infarction and higher neurological deficit score in the LPS-stroke study. However, warming of the LPS-stroke mice compromises animal survival. Furthermore, a high dose of LPS (2 mg/kg) worsens neurological deficits, but causes persistent severe hypothermia that conceals the LPS exacerbation of stroke infarction. Mitochondrial respiratory chain complex I inhibitor, rotenone, replicates the data profile of the LPS-stroke study. Moreover, we have confirmed that rotenone compromises mitochondrial oxidative phosphorylation in CVECs. Lastly, the pooled data analyses of a large sample size (n=353) demonstrate that stroke mice have lower body temperature compared to sham mice within 6 hours post-surgery; the body temperature is significantly correlated with stroke outcomes; linear regression shows that lower body temperature is significantly associated with higher neurological scores and larger infarct volume. We conclude that post-stroke body temperature predicts stroke severity and mitochondrial impairment in CVECs plays a pivotal role in this hypothermic response. These novel findings suggest that body temperature is prognostic for
Quinn, Terence J; Singh, Sarjit; Lees, Kennedy R; Bath, Philip M; Myint, Phyo K
To compare the prognostic accuracy of various acute stroke prognostic scales using a large, independent, clinical trials dataset. We directly compared 8 stroke prognostic scales, chosen based on focused literature review (Acute Stroke Registry and Analysis of Lausanne [ASTRAL]; iSCORE; iSCORE-revised; preadmission comorbidities, level of consciousness, age, and neurologic deficit [PLAN]; stroke subtype, Oxfordshire Community Stroke Project, age, and prestroke modified Rankin Scale [mRS] [SOAR]; modified SOAR; Stroke Prognosis Instrument 2 [SPI2]; and Totaled Health Risks in Vascular Events [THRIVE]) using individual patient-level data from a clinical trials archive (Virtual International Stroke Trials Archive [VISTA]). We calculated area under receiver operating characteristic curves (AUROC) for each scale against 90-day outcomes of mRS (dichotomized at mRS >2), Barthel Index (>85), and mortality. We performed 2 complementary analyses: the first limited to patients with complete data for all components of all scales (simultaneous) and the second using as many patients as possible for each individual scale (separate). We compared AUROCs and performed sensitivity analyses substituting extreme outcome values for missing data. In total, 10,777 patients contributed to the analyses. Our simultaneous analyses suggested that ASTRAL had greatest prognostic accuracy for mRS, AUROC 0.78 (95% confidence interval [CI] 0.75-0.82), and SPI2 had poorest AUROC, 0.61 (95% CI 0.57-0.66). Our separate analyses confirmed these results: ASTRAL AUROC 0.79 (95% CI 0.78-0.80 and SPI2 AUROC 0.60 (95% CI 0.59-0.61). On formal comparative testing, there was a significant difference in modified Rankin Scale AUROC between ASTRAL and all other scales. Sensitivity analysis identified no evidence of systematic bias from missing data. Our comparative analyses confirm differences in the prognostic accuracy of stroke scales. However, even the best performing scale had prognostic accuracy that may not
Vukasovic, Ines; Tesija-Kuna, Andrea; Topic, Elizabeta; Supanc, Visnja; Demarin, Vida; Petrovcic, Marija
The aim of the study was to determine serum levels of selected matrix metalloproteinases (MMPs) and their natural inhibitors (TIMPs) in the acute phase of different stroke types subdivided according to the Oxfordshire Community Stroke Project (OCSP) classification and the possibility of discriminating stroke types according to their levels. The study included 126 patients with acute stroke within the first 24 h of symptom onset, and 124 healthy volunteers. The stroke group had lower MMP-2 concentrations and MMP-2/TIMP-2 ratios (pnegative correlation of MMP-2 levels with MMP-9 and MMP-9/TIMP-1 ratio was recorded in all stroke subtypes except for TACI. Receiver operating characteristic analysis showed similar discriminating power for MMP-9 levels and Barthel index in the differential diagnosis of TACI. High MMP-9/TIMP-1 ratio (odds ratio 3.263) was associated with TACI. Our results demonstrate that the MMP-9/TIMP-1 ratio may provide information to help in assessing stroke patients in the future as a baseline biomarker of infarct extent.
Markidan, Janina; Cole, John W; Cronin, Carolyn A; Merino, Jose G; Phipps, Michael S; Wozniak, Marcella A; Kittner, Steven J
There is a strong dose-response relationship between smoking and risk of ischemic stroke in young women, but there are few data examining this association in young men. We examined the dose-response relationship between the quantity of cigarettes smoked and the odds of developing an ischemic stroke in men under age 50 years. The Stroke Prevention in Young Men Study is a population-based case-control study of risk factors for ischemic stroke in men ages 15 to 49 years. The χ 2 test was used to test categorical comparisons. Logistic regression models were used to calculate the odds ratio for ischemic stroke occurrence comparing current and former smokers to never smokers. In the first model, we adjusted solely for age. In the second model, we adjusted for potential confounding factors, including age, race, education, hypertension, myocardial infarction, angina, diabetes mellitus, and body mass index. The study population consisted of 615 cases and 530 controls. The odds ratio for the current smoking group compared with never smokers was 1.88. Furthermore, when the current smoking group was stratified by number of cigarettes smoked, there was a dose-response relationship for the odds ratio, ranging from 1.46 for those smoking ischemic stroke among young men. Although complete smoking cessation is the goal, even smoking fewer cigarettes may reduce the risk of ischemic stroke in young men. © 2018 American Heart Association, Inc.
Roquer, J; Segura, T; Serena, J; Castillo, J
Endothelial dysfunction is a fundamental step in the atherosclerotic disease process. Its presence is a risk factor for the development of clinical events, and may represent a marker of atherothrombotic burden. Also, endothelial dysfunction contributes to enhanced plaque vulnerability, may trigger plaque rupture, and favors thrombus formation. The assessment of endothelial vasomotion is a useful marker of atherosclerotic vascular disease. There are different methods to assess endothelial function: endothelium-dependent vasodilatation brachial flow-mediated dilation, cerebrovascular reactivity to L-arginine, and the determination of some biomarkers such as microalbuminuria, platelet function, and C-reactive protein. Endothelial dysfunction has been observed in stroke patients and has been related to stroke physiopathology, stroke subtypes, clinical severity and outcome. Resting ankle-brachial index (ABI) is also considered an indicator of generalized atherosclerosis, and a low ABI is associated with an increase in stroke incidence in the elderly. Despite all these data, there are no studies analyzing the predictive value of ABI for new cardiovascular events in patients after suffering an acute ischemic stroke. ARTICO is an ongoing prospective, observational, multicenter study being performed in 50 Spanish hospitals. The aim of the ARTICO study is to evaluate the prognostic value of a pathological ABI (ARTICO study will increase the knowledge of patient outcome after ischemic stroke and may help to improve our ability to detect patients at high risk of stroke recurrence or major cardiovascular events. (c) 2009 S. Karger AG, Basel.
Sallés, Laia; Martín-Casas, Patricia; Gironès, Xavier; Durà, María José; Lafuente, José Vicente; Perfetti, Carlo
[Purpose] This study aims to describe a protocol based on neurocognitive therapeutic exercises and determine its feasibility and usefulness for upper extremity functionality when compared with a conventional protocol. [Subjects and Methods] Eight subacute stroke patients were randomly assigned to a conventional (control group) or neurocognitive (experimental group) treatment protocol. Both lasted 30 minutes, 3 times a week for 10 weeks and assessments were blinded. Outcome measures included: Motor Evaluation Scale for Upper Extremity in Stroke Patients, Motricity Index, Revised Nottingham Sensory Assessment and Kinesthetic and Visual Imagery Questionnaire. Descriptive measures and nonparametric statistical tests were used for analysis. [Results] The results indicate a more favorable clinical progression in the neurocognitive group regarding upper extremity functional capacity with achievement of the minimal detectable change. The functionality results are related with improvements on muscle strength and sensory discrimination (tactile and kinesthetic). [Conclusion] Despite not showing significant group differences between pre and post-treatment, the neurocognitive approach could be a safe and useful strategy for recovering upper extremity movement following stroke, especially regarding affected hands, with better and longer lasting results. Although this work shows this protocol's feasibility with the panel of scales proposed, larger studies are required to demonstrate its effectiveness.
Full Text Available Background. Conductive Education for stroke survivors has shown promise but randomised evidence is unavailable. This study assessed the feasibility of a definitive randomised controlled trial to evaluate efficacy. Methods. Adult stroke survivors were recruited through local community notices. Those completing the baseline assessment were randomised using an online program and group allocation was independent. Intervention group participants received 10 weekly 1.5-hour sessions of Conductive Education at the National Institute of Conductive Education in Birmingham, UK. The control group participants attended two group meetings. The study evaluated the feasibility of recruitment procedures, delivery of the intervention, retention of participants, and appropriateness of outcome measures and data collection methods. Independent assessments included the Barthel Index, the Stroke Impact Scale, the Timed Up and Go test, and the Hospital Anxiety and Depression Scale. Results. Eighty-two patients were enrolled; 77 completed the baseline assessment (46 men, mean age 62.1 yrs. and were randomised. 70 commenced the intervention (n=37 or an equivalent waiting period (n=33. 32/37 completed the 10-week training and 32/33 the waiting period. There were no missing items from completed questionnaires and no adverse events. Discussion. Recruitment, intervention, and assessment methods worked well. Transport issues for intervention and assessment appointments require review. Conclusion. A definitive trial is feasible. This trial is registered with ISRCTN84064492.
Ditlevsen, Ove Dalager
The derivation of the life quality index (LQI) is revisited for a revision. This revision takes into account the unpaid but necessary work time needed to stay alive in clean and healthy conditions to be fit for effective wealth producing work and to enjoyable free time. Dimension analysis consist...
Brynningsen, P K; Damsgaard, Else Marie; Husted, Steen
INTRODUCTION: Nutritional status among stroke patients has received limited attention despite the fact, that it may have an influence on clinical outcome. Previous studies have estimated that 15-20 % of patients suffer from malnutrition in the acute phase of stroke, but so far no studies have...... focused on the late rehabilitation phase after stroke in the patients own home, where the attention on nutrition may be reduced. AIMS: To determine the prevalence of malnutrition during 6 months of stroke rehabilitation, and to investigate the association between nutritional status, functional recovery...... and 6 months. Nutritional status was evaluated by body weight, body mass index (BMI), mid upper arm circumference (MAC), triceps skinfold thickness (TSF) and serum concentrations of albumin and transferrin. Malnutrition was defined if the patients had 2 or more abnormal nutritional variables. RESULTS...
Christensen, L M; Krieger, D W; Højberg, S
lasting predominantly between 1 and 4 h. Four recurrent strokes were observed, three in patients with PAF; all three patients were on oral anticoagulation (OAC). CONCLUSIONS: One in five patients with CS had PAF, which occurred at low burden and long after stroke. Future studies should determine the role......BACKGROUND AND PURPOSE: Atrial fibrillation (AF) increases the risk of stroke fourfold and is associated with a poor clinical outcome. Despite work-up in compliance with guidelines, up to one-third of patients have cryptogenic stroke (CS). The prevalence of asymptomatic paroxysmal atrial...... patients (16.1%). In three patients PAF was detected by other methods before or after monitoring and was undiscovered due to device sensitivity in one case. The first event of PAF was documented at a mean of 109 days (SD ±48) after stroke onset. PAF was asymptomatic in all cases and occurred in episodes...
Full Text Available Cerebro-vascular disease in an important and a frequent cause of dementia. However, the prevalence and magnitude of global cognitive dysfunction in acute stroke has not been studied. Folstein′s mini mental state examination (MMSE is 2 sensitive and reliable test and may serve as a simple tool for screening dementia. Fifty consecutive patients with first ever completed stroke in life and no past history of cognitive disturbances were administered MMSE at least 10 days after the onset of stroke. Cranial CT scans were done in all after 48 hours of stroke. CT scans were blindly analysed and graded for number, location and volume of infarctions, white matter leukoaraiosis (WMLA and cortical and sub cortical atrophy. The radiological parameters of those with MMSE score of 23 or less on MMSE. Of all the conventional risk factors, only age of the patients was significantly higher in the "demented" group. Of the radiological parameters namely-number and volume of infarcts, WMLA, bi-frontal ratio (BFR, 3rd ventricular ratio (3 VR, cella media index (CMI and cortical index (CI, only cortical index was significantly more among patients with lower MMSE scores. Prevalence of global cerebral dysfunction first ever ischaemic stroke was 46% in this study. Advanced age and cortical atrophy appear to contribute to the low scores on MMSE. Though, volume and number of infarctions were higher among patients with low score, the differences were not statistically significant.
... How is a ministroke different from a regular stroke? Answers from Jerry W. Swanson, M.D. When ... brain, spinal cord or retina, which may cause stroke-like symptoms but does not damage brain cells ...
This article provides a critique and theoretical extension of a work that sought to describe the contribution of nurses to stroke rehabilitation. At the time, the role of nursing was considered important but therapeutically nonspecific. Stroke nursing research has increased significantly and so has research focusing on the patient experiences of the adjustment and rehabilitation processes following a stroke. These developments provide significant new insights that may refine and extend the original understanding of the role of nursing in stroke rehabilitation. This article proposes an extended theoretical framework of the role of nursing in stroke recovery and rehabilitation.
Dong, Yi; Cao, Wenjie; Cheng, Xin; Fang, Kun; Zhang, Xiaolong; Gu, Yuxiang; Leng, Bing; Dong, Qiang
Intravenous thrombolysis and intra-arterial thrombectomy are now the standard therapies for patients with acute ischemic stroke. In-house strokes have often been overlooked even at stroke centers and there is no consensus on how they should be managed. Perioperative stroke happens rather frequently but treatment protocol is lacking, In China, the issue of in-house strokes has not been explored. The aim of this study is to explore the current management of in-house stroke and identify the common risk factors associated with perioperative strokes. Altogether, 51,841 patients were admitted to a tertiary hospital in Shanghai and the records of those who had a neurological consult for stroke were reviewed. Their demographics, clinical characteristics, in-hospital complications and operations, and management plans were prospectively studied. Routine laboratory test results and risk factors of these patients were analyzed by multiple logistic regression model. From January 1, 2015, to December 31, 2015, over 1800 patients had neurological consultations. Among these patients, 37 had an in-house stroke and 20 had more severe stroke during the postoperative period. Compared to in-house stroke patients without a procedure or operation, leukocytosis and elevated fasting glucose levels were more common in perioperative strokes. In multiple logistic regression model, perioperative strokes were more likely related to large vessel occlusion. Patients with perioperative strokes had different risk factors and severity from other in-house strokes. For these patients, obtaining a neurological consultation prior to surgery may be appropriate in order to evaluate the risk of perioperative stroke. Copyright © 2017. Published by Elsevier Inc.
Kraywinkel, Klaus; Heidrich, Jan; Heuschmann, Peter U; Wagner, Markus; Berger, Klaus
Abstract Background Subjective risk factor perception is an important component of the motivation to change unhealthy life styles. While prior studies assessed cardiovascular risk factor knowledge, little is known about determinants of the individual perception of stroke risk. Methods Survey by mailed questionnaire among 1483 participants of a prior public stroke campaign in Germany. Participants had been informed about their individual stroke risk based on the Framingham stroke risk score. S...
Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William
Low thrombolysis rates for acute ischemic stroke are linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether "Child-Mediated Stroke Communication" could improve stroke literacy of parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke. Parents of children aged 9 to 12 years from 2 public schools in Harlem, New York City, were recruited to participate in stroke literacy questionnaires before and after their child's participation in Hip Hop Stroke, a novel Child-Mediated Stroke Communication intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week after the intervention. Fifth and sixth grade students (n=182) were enrolled into Hip Hop Stroke. One hundred two parents were approached in person to participate; 75 opted to participate and 71 completed both the pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program; before the program, 3 parents of 75 (3.9%) were able to identify the 5 cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911) compared with 21 of 71 parents (29.6%) postintervention (P<0.001). The FAST mnemonic was known by 2 (2.7%) of participants before the program versus 29 (41%) after program completion (P<0.001). Knowledge of stroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that school children aged 9 to 12 years may be effective conduits of critical stroke knowledge to their parents.
Lindsay, Patrice; Furie, Karen L.; Davis, Stephen M.; Donnan, Geoffrey A.; Norrving, Bo
Every two seconds, someone across the globe suffers a symptomatic stroke. 'Silent' cerebrovascular disease insidiously contributes to worldwide disability by causing cognitive impairment in the elderly. The risk of cerebrovascular disease is disproportionately higher in low to middle income countries where there may be barriers to stroke care. The last two decades have seen a major transformation in the stroke field with the emergence of evidence-based approaches to stroke prevention,...
National Oceanic and Atmospheric Administration, Department of Commerce — The geomagnetic aa index provides a long climatology of global geomagnetic activity using 2 antipodal observatories at Greenwich and Melbourne- IAGA Bulletin 37,...
Town of Chapel Hill, North Carolina — This map service summarizes racial and ethnic diversity in the United States in 2012.The Diversity Index shows the likelihood that two persons chosen at random from...
U.S. Environmental Protection Agency — The Walkability Index dataset characterizes every Census 2010 block group in the U.S. based on its relative walkability. Walkability depends upon characteristics of...
Williams, Olajide; DeSorbo, Alexandra; Noble, James; Gerin, William
Background and Purpose Low thrombolysis rates for acute ischemic stroke is linked to delays in seeking immediate treatment due to low public stroke awareness. We aimed to assess whether “Child-Mediated Stroke Communication” (CMSC) could improve stroke literacy parents of children enrolled in a school-based stroke literacy program called Hip Hop Stroke (HHS). Methods Parents of children aged 9 to 12 years from two public schools in Harlem, NYC, were recruited to participate in stroke literacy questionnaires before and after their child’s participation in HHS, a novel CMSC intervention delivered in school auditoriums. Parental recall of stroke information communicated through their child was assessed 1-week following the intervention. Results Fifth and Sixth grade students (n =182) were enrolled into HHS. 102 parents were approached in person to participate; 75 opted to participate and 71 completed both pretest and post-test (74% response rate and 95% retention rate). Parental stroke literacy improved after the program: before the program, 3 parents of 75 (3.9%) were able to identify the five cardinal stroke symptoms, distracting symptom (chest pains), and had an urgent action plan (calling 911), compared to 21 of 71 parents (29.6%) post-intervention (pstroke signs and symptoms remains low among residents of this high-risk population. The use of Child-Mediated Stroke Communication suggests that schoolchildren aged 9-12 may be effective conduits of critical stroke knowledge to their Parents. PMID:22033995
De Keyser, J; Sulter, G.
In some stroke units continuous monitoring of blood pressure, electrocardiogram, body temperature, and oxygen saturation has become an integral part of the management of acute stroke. In addition, regular measurements of blood glucose are performed. Stroke units equipped with such monitoring
In this paper we discuss the relevance of artificial intelligence to the automatic indexing of natural language text. We describe the use of domain-specific semantically-based thesauruses and address the problem of creating adequate knowledge bases for intelligent indexing systems. We also discuss the relevance of the Hilbert space ι 2 to the compact representation of documents and to the definition of the similarity of natural language texts. (author). 17 refs., 2 figs
Clarke, David J; Holt, Janet
Nurses represent the largest professional group working with stroke-survivors, but there is limited evidence regarding nurses' involvement in post-stroke rehabilitation. The purpose of this study was to identify and explore the perspectives of nurses and other multidisciplinary stroke team members on nurses' practice in stroke rehabilitation. Q-methodological study with 63 multidisciplinary stroke unit team members and semi-structured interviews with 27 stroke unit team members. Irrespective of their professional backgrounds, participants shared the view that nurses can make an active contribution to stroke rehabilitation and integrate rehabilitation principles in routine practice. Training in stroke rehabilitation skills was viewed as fundamental to effective stroke care, but nurses do not routinely receive such training. The view that integrating rehabilitation techniques can only occur when nursing staffing levels were high was rejected. There was also little support for the view that nurses are uniquely placed to co-ordinate care, or that nurses have an independent rehabilitation role. The contribution that nurses with stroke rehabilitation skills can make to effective stroke care was understood. However, realising the potential of nurses as full partners in stroke rehabilitation is unlikely to occur without introduction of structured competency-based multidisciplinary training in rehabilitation skills. Implications for Rehabilitation Multidisciplinary rehabilitation in stroke units is a cornerstone of effective stroke care. Views of stroke unit team members on nurses' involvement in rehabilitation have not been reported previously. Nurses can routinely incorporate rehabilitation principles in their care. Specialist competency-based stroke rehabilitation training needs to be provided for nurses as well as for allied health professionals.
... Disease, & Other Dental Problems Diabetes & Sexual & Urologic Problems Diabetes, Heart Disease, and Stroke Having diabetes means that ... help to stop. What is the link between diabetes, heart disease, and stroke? Over time, high blood ...
Craig A. Press
Full Text Available Investigators from the Vascular Effects of Infection in Pediatric Stroke (VIPS group studied the risk of arterial ischemic stroke (AIS associated with minor infection and routine childhood vaccinations.
Full Text Available Stroke disease in Ghana has been of increasing concern since the mid to late 20th century, in association with the increasing westernisation of diet and lifestyle . Two thirds of world-wide mortality cases from stroke occur in sub-Saharan Africa , and in the Ghanaian capital city region of Accra, stroke is now attributed as the second largest cause of death . The burden of stroke in sub-Saharan Africa is significant . Experts recommend a three-prong approach to dealing with the burden of non-communicable disease (NCD: epidemiological surveillance; primary prevention (preventing disease in healthy populations; and secondary prevention (preventing complications and improving quality of life in affected communities . This paper outlines the development of a specialist stroke service in Accra, Ghana. This work therefore broadly relates to the secondary prevention aspect, achieved through the development of a dedicated and specialised stroke service. Whilst this project took place in Ghana, the learning could be applied to the development of a stroke service in any resource poor setting, such as South Sudan. Indeed, because the focus is on establishing the fundamentals of organised stroke care, the principles are also entirely relevant to more developed health care systems.
West, C; Bowen, A; Hesketh, A; Vail, A
Apraxia is a cognitive disorder that can occur after stroke. It prevents a person from carrying out a learned movement. Various interventions are used to treat apraxia but evidence of their benefit has been lacking. To determine which therapeutic interventions targeted at motor apraxia reduce disability. We searched the Cochrane Stroke Group Trials Register (last searched November 2006). In addition, we searched the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2006), MEDLINE (1966 to November 2007), EMBASE (1980 to November 2006), CINAHL (1982 to November 2006), PsycINFO (1974 to November 2006), the Research Index of the Occupational Therapy Journal (searched November 2006), REHABDATA (1956 to November 2006), the National Research Register (searched November 2006) and Current Controlled Trials Register (searched November 2006). We reviewed the reference lists of all articles that we identified as relevant. We made efforts to find both published and unpublished trials by writing to key authors and journals. Randomised controlled trials of therapeutic intervention for motor apraxia in stroke. One review author searched the titles, abstracts and keywords. Four review authors extracted data and analysed trial quality. We contacted investigators for further details of trials if necessary. Three trials including a total of 132 participants were included in the review. There was evidence of a small and short-lived therapeutic effect in the two studies that reported change in activities of daily living (102 participants) but this was not considered clinically significant and did not persist at the longer-term follow up. There is insufficient evidence to support or refute the effectiveness of specific therapeutic interventions for motor apraxia after stroke. Further research of higher quality is required. As we did not review whether patients with apraxia benefit from rehabilitation input in general, they
Corraini, P; Ording, A G; Henderson, V W
was matched to the stroke patients by date of diagnosis, year of birth, sex, and specific comorbidities using the Charlson Comorbidity Index and other VTE risk factors. We computed VTE cumulative risks, rates and rate ratios, as well as the interaction with comorbidity (as the excess VTE rates not explained......INTRODUCTION: The impact of comorbidity and in particular cancer on the risk of venous thromboembolism (VTE) after stroke is poorly understood. AIM: We aimed to determine the impact of comorbidity, in particular cancer, on the risk of venous thromboembolism in stroke patients as the excess VTE...... by stroke and comorbidity alone) during five years of follow-up. RESULTS: Five-year VTE risks were 2.16% and 1.85% in the stroke and general population comparison cohorts, respectively. Three-month VTE rate ratios peaked at a 6-fold increase (95% confidence interval: 4.9;6.2) in stroke patients and remained...
Full Text Available With the development of molecular biology and gene-engineering technology, gene diagnosis has been an emerging approach for modern life sciences. Biological marker, recognized as the hot topic in the molecular and gene fields, has important values in early diagnosis, malignant tumor stage, treatment and therapeutic efficacy evaluation. So far, the researcher has not found any effective way to predict and distinguish different type of stroke. In this paper, we aim to optimize stroke biomarker and figure out effective stroke detection index based on SVM (support vector machine and information theory. Through mutual information analysis and principal component analysis to complete the selection of biomarkers and then we use SVM to verify our model. According to the testing data of patients provided by Xuanwu Hospital, we explore the significant markers of the stroke through data analysis. Our model can predict stroke well. Then discuss the effects of each biomarker on the incidence of stroke.
Krutulyte, Grazina; Kimtys, Algimantas; Krisciūnas, Aleksandras
The purpose of this study was to examine whether two different physiotherapy regimes caused any differences in outcome in the rehabilitation after stroke. We examined 240 patients with stroke. Examination was carried out at the Rehabilitation Center of Kaunas Second Clinical Hospital. Patients were divided into 2 groups: Bobath method was applied to the first (I) group (n=147), motor relearning program (MRP) method was applied to the second (II) group (n=93). In every group of patients we established samples according to sex, age, hospitalization to rehab unit as occurrence of CVA degree of disorder (hemiplegia, hemiparesis). The mobility of patients was evaluated according to European Federation for Research in Rehabilitation (EFRR) scale. Activities of daily living were evaluated by Barthel index. Analyzed groups were evaluated before physical therapy. When preliminary analysis was carried out it proved no statically reliable differences between analyzed groups (reliability 95%). The same statistical analysis was carried out after physical therapy. The results of differences between patient groups were compared using chi(2) method. Bobath method was applied working with the first group of patients. The aim of the method is to improve quality of the affected body side's movements in order to keep both sides working as harmoniously as possible. While applying this method at work, physical therapist guides patient's body on key-points, stimulating normal postural reactions, and training normal movement pattern. MRP method was used while working with the second group patients. This method is based on movement science, biomechanics and training of functional movement. Program is based on idea that movement pattern shouldn't be trained; it must be relearned. CONCLUSION. This study indicates that physiotherapy with task-oriented strategies represented by MRP, is preferable to physiotherapy with facilitation/inhibition strategies, such the Bobath programme, in the
Full Text Available Evidence suggests that excitatory transcranial direct current stimulation (tDCS may improve performance on a wide variety of cognitive tasks. Due to the non-invasive and inexpensive nature of the method, harnessing its potential could be particularly useful for the treatment of neuropsychiatric illnesses involving cognitive dysfunction. However, questions remain regarding the efficacious stimulation parameters. Here, using a double-blind between-subjects design, we explored whether 1 mA excitatory (anodal left dorsolateral prefrontal cortex stimulation with a contralateral extracephalic reference electrode, leads to enhanced working memory performance across two days, relative to sham stimulation. Participants performed the 3-back, a test of working memory, at baseline, and during and immediately following stimulation on two days, separated by 24-48 hours. Active stimulation did not significantly enhance performance versus sham over the course of the experiment. However, exploratory comparisons did reveal a significant effect of stimulation group on performance during the first stimulation phase only, with active stimulation recipients performing better than sham. While these results do not support the hypothesis that dorsolateral prefrontal cortex tDCS boosts working memory, they raise the possibility that its effects may be greatest during early learning stages.
Xie, Yue; Wang, Liping; He, Jinghua; Wu, Taixiang
Dysphagia after acute stroke is associated with poor prognosis, particularly if prolonged. Acupuncture has been widely used for this complication in China. However, its therapeutic effect is unclear. To determine the therapeutic effect of acupuncture for dysphagia after acute stroke compared with placebo, sham or no acupuncture intervention. We searched the Cochrane Stroke Group Trials Register (last searched September 2007), the Chinese Stroke Trials Register and the Trials Register of the Cochrane Complementary Medicine Field (last searched January 2007) and the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2007). In January 2007 we searched the following databases from the first available date; MEDLINE, EMBASE, CINAHL, AMED, CISCOM, BIOSIS Previews, ProQuest Digital Dissertations, Science Citation Index, ISI Proceedings, ACUBRIEFS, ACP Journal Club, Books@Ovid and Journals@Ovid, Chinese Biological Medicine Database, Chinese scientific periodical database of VIP INFORMATION, China periodical in China National Knowledge Infrastructure, Chinese Evidence-Based Medicine Database, Science China, Chinese Social Science Citation Index, and the Chinese Science and Technology Document Databases. We also searched databases of ongoing trials, conference proceedings, and grey literature, handsearched three Chinese journals and contacted authors and researchers. We included all truly randomised controlled trials that evaluated the effect of acupuncture, irrespective of type, in patients with dysphagia within 30 day after the onset of ischaemic or haemorrhagic stroke. All types of acupuncture interventions were eligible. The control intervention could be placebo acupuncture, sham acupuncture, or no acupuncture. The primary outcome was recovery of normal feeding. The secondary outcomes were case fatality, deterioration, late disability, length of hospital stay, quality of life, feeding tube removal, aspiration pneumonia and nutritional
Are simple strokes unique to the artist or designer who renders them? If so, can this idea be used to identify authorship or to classify artistic drawings? Also, could training methods be devised to develop particular styles? To answer these questions, we propose the Stroke Authorship Recognition (SAR) approach, a novel method that distinguishes the authorship of 2D digitized drawings. SAR converts a drawing into a histogram of stroke attributes that is discriminative of authorship. We provide extensive classification experiments on a large variety of data sets, which validate SAR\\'s ability to distinguish unique authorship of artists and designers. We also demonstrate the usefulness of SAR in several applications including the detection of fraudulent sketches, the training and monitoring of artists in learning a particular new style and the first quantitative way to measure the quality of automatic sketch synthesis tools. © 2015 The Eurographics Association and John Wiley & Sons Ltd.
Kegel, Jessica; Dux, Moira; Macko, Richard
Stroke is a leading cause of disability and sequelae may include physical, emotional, and cognitive impairments. The methods employed to cope with distress, both emotional and cognitive, have not been evaluated in individuals post-stroke. However, research in traumatic brain injury (TBI) suggests that executive function is positively correlated with adaptive coping and negatively correlated with maladaptive coping strategies (Krpan et al., 2007). Examination of these constructs post-stroke may assist with enriching our understanding of cognitive and emotional symptomatology and optimize rehabilitation strategies. The present study aimed to assess the association between executive function and coping strategies in a sample of chronic stroke survivors. The researchers hypothesized that executive function would be positively correlated with adaptive coping strategies and negatively correlated with maladaptive coping strategies. Fifteen stroke survivors were administered a battery of cognitive tests assessing executive function and also completed the Ways of Coping Questionnaire (WAYS), a self-report coping measure. Analyses indicated that executive function deficits were related to increased avoidant coping. Contrary to expectations, executive function was not significantly related to active coping. In addition, post hoc analyses revealed that executive function was a significant predictor of avoidant coping after controlling for demographics. Our data, in accordance with prior work in TBI, suggests that executive function and aspects of coping are associated. Rehabilitation strategies that improve executive function may also lead to utilization of adaptive coping strategies. Research has shown that aerobic exercise increases activation in the frontal lobe and improves executive function (Colcombe & Kramer, 2003; Colcombe et al., 2004). Future studies should examine whether aerobic exercise positively affects executive function and coping in stroke survivors.
As there appeared to be a need for personal accounts of stroke experiences, a book called "Speaking about Stroke" was written for stroke patients and their caregivers. For the past two years, a questionnaire was sent to the people who had ordered the book, to gain an insight into the characteristics
... stroke. High blood pressure increases your risk of stroke four to six times. Heart disease, especially a condition ... leading cause of serious, long-term adult disability. Four million Americans are living with the effects of stroke. The length of time to recover from a ...
Stroke is a personal, familial, and social disaster. It is the third cause of death worldwide, the first cause of acquired disability, the second cause of dementia, and its cost is astronomic. The burden of stroke is likely to increase given the aging of the population and the growing incidence of many vascular risk factors. Prevention of stroke includes--as for all other diseases--a "mass approach" aiming at decreasing the risk at the society level and an individual approach, aiming at reducing the risk in a given subject. The mass approach is primarily based on the identification and treatment of vascular risk factors and, if possible, in the implementation of protective factors. These measures are the basis of primary prevention but most of them have now been shown to be also effective in secondary prevention. The individual approach combines a vascular risk factor modification and various treatments addressing the specific subtypes of stroke, such as antiplatelet drugs for the prevention of cerebral infarction in large and small artery diseases of the brain, carotid endarterectomy or stenting for tight carotid artery stenosis, and oral anticoagulants for the prevention of cardiac emboli. There is a growing awareness of the huge evidence-to-practice gap that exists in stroke prevention largely due to socio-economic factors. Recent approaches include low cost intervention packages to reduce blood pressure and cheap "polypills" combining in a single tablet aspirin and several drugs to lower blood pressure and cholesterol. Polypill intake should however not lead to abandon the healthy life-style measures which remain the mainstay of stroke prevention.
Full Text Available Several studies have found that fatigue is one of the most commonly reported symptoms after stroke and the most difficult to cope with. The present study aimed to investigate the presence and severity of self-reported fatigue six years after stroke onset and associated factors. The cohort "Life After Stroke Phase I" (n = 349 persons was invited at six years to report fatigue (Fatigue Severity Scale 7-item version, perceived impact of stroke and global recovery after stroke (Stroke Impact Scale, anxiety and depression (Hospital Anxiety and Depression Scale, life satisfaction (Life Satisfaction Checklist and participation in everyday social activities (Frenchay Activities Index. At six years 37% of the 102 participants in this cross-sectional study reported fatigue. The results showed that in nearly all SIS domains the odds for post-stroke fatigue were higher in persons with a higher perceived impact. Furthermore, the odds for post-stroke fatigue were higher in those who had experienced a moderate/severe stroke and had signs of depression and anxiety. Fatigue is still present in one-third of persons as long as six years after stroke onset and is perceived to hinder many aspects of functioning in everyday life. There is an urgent need to develop and evaluate interventions to reduce fatigue.
Abzhandadze, Tamar; Forsberg-Wärleby, Gunilla; Holmegaard, Lukas; Redfors, Petra; Jern, Christina; Blomstrand, Christian; Jood, Katarina
To investigate life satisfaction in spouses of middle-aged stroke survivors from the long-term perspective and to identify factors that explain their life satisfaction. Cross-sectional, case-control study. Cohabitant spouses of survivors of ischaemic stroke aged life satisfaction was assessed with the Fugl-Meyer's Life Satisfaction Check-List (LiSAT 11). Stroke-related factors were examined with the National Institutes of Health stroke scale, Mini-Mental State Examination, Barthel Index and modified Rankin Scale. Spouses of stroke survivors had significantly lower satisfaction with general life, leisure, sexual life, partner relationship, family life, and poorer somatic and psychological health than spouses of controls. Caregiving spouses had significantly lower scores on all life domains except vocation and own activities of daily living than non-caregiving spouses. Spouses' satisfaction on different life domains was explained mainly by their age, sex, support given to the partner, and the survivor's level of global disability, to which both physical and cognitive impairments contributed. Seven years after stroke, spouses of stroke survivors reported lower life satisfaction compared with spouses of controls. Life satisfaction in stroke survivors' spouses was associated with spouses' age, sex, giving support, and the stroke survivors' level of global disability.
Bang, Oh Young; Seok, Jin Myoung; Kim, Seon Gyeong; Hong, Ji Man; Kim, Hahn Young; Lee, Jun; Chung, Pil-Wook; Park, Kwang-Yeol; Kim, Gyeong-Moon; Chung, Chin-Sang; Lee, Kwang Ho
Background Cancer and ischemic stroke are two of the most common causes of death among the elderly, and associations between them have been reported. However, the main pathomechanisms of stroke in cancer patients are not well known, and can only be established based on accurate knowledge of the characteristics of cancer-related strokes. We review herein recent studies concerning the clinical, laboratory, and radiological features of patients with cancer-related stroke. Main Contents This revi...
Full Text Available Background: Stroke is a devastating disease with increasing incidence and prevalence due to population aging. Even with the best care, a proportion of patients dies or is left with significant neurological and cognitive disability. Organization of stroke centers markedly improved outcomes worldwide. We initiated a ‘lysis alarm' program in September 2013 at our medical center. Methods: This is a retrospective review of electronic data from patients with acute ischemic stroke before (October 2012-June 2013 and after (October 2013-June 2014 the ‘lysis alarm' program was introduced at our medical center. Results: Prior to the introduction of the stroke program, there were only 19 thrombolysis procedures in 777 acute stroke patients in 9 months, while this figure rose to 32 thrombolysis procedures in 737 acute stroke patients after the initiation of the program. The ‘door-to-needle' time decreased from 88 to 71 min when the two study periods were compared. These changes were associated with decreased stroke mortality in patients receiving thrombolytic treatment (16% prior to the program and 9% during the program. In 2013, there were 1,439 thrombolysis procedures, representing 3.2% of all stroke cases throughout Hungary. After the introduction of the ‘lysis alarm' program, we have reached a 4% thrombolysis rate at our medical center. Conclusions: Our thrombolysis rate is higher than the national average, but still low compared to the rates of Western European countries. We are continuously working to enhance our stroke program. Here, we discuss those components that need to be further refined in order to improve stroke intervention and outcome.
Eriksen, Dorte; Rosthøj, Susanne; Burr, Hermann
OBJECTIVE: The aim of this study is to investigate the association between five-year changes in occupational sitting and body mass index (BMI) in working adults. METHODS: We analyzed data from The Danish Work Environment Cohort Study (2005 and 2010, n=3.482). Data on occupational sitting, weight...
Effects of aspirin plus extended-release dipyridamole versus clopidogrel and telmisartan on disability and cognitive function after recurrent stroke in patients with ischaemic stroke in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial
Diener, Hans-Christoph; Sacco, Ralph L; Yusuf, Salim
telmisartan were investigated in the Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial. METHODS: Patients who had had an ischaemic stroke were randomly assigned in a two by two factorial design to receive either 25 mg aspirin (ASA) and 200 mg extended-release dipyridamole (ER......-DP) twice a day or 75 mg clopidogrel once a day, and either 80 mg telmisartan or placebo once per day. The predefined endpoints for this substudy were disability after a recurrent stroke, assessed with the modified Rankin scale (mRS) and Barthel index at 3 months, and cognitive function, assessed...... of 2.4 years. Recurrent strokes occurred in 916 (9%) patients randomly assigned to ASA with ER-DP and 898 (9%) patients randomly assigned to clopidogrel; 880 (9%) patients randomly assigned to telmisartan and 934 (9%) patients given placebo had recurrent strokes. mRS scores were not statistically...
Full Text Available Chung-Liang Lai,1,* Ming-Miau Tsai,1,* Jia-Yuan Luo,1 Wan-Chun Liao,1 Pi-Shan Hsu,2,3 Han-Yu Chen4 1Department of Physical Medicine and Rehabilitation, 2Department of Family Medicine, Taichung Hospital, Ministry of Health and Welfare, 3Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung-Hsing University, 4Department of Physical Therapy, Hungkuang University, Taichung, Taiwan *These authors contributed equally to this work Background: Stroke often causes functional decline in patients. Therefore, after the acute phase, many patients require post-acute care (PAC to maximize their functional progress, reduce disability, and make it possible for them to return to their home and community. PAC can be provided in different settings. Taiwan’s National Health Insurance (NHI proposed a PAC pilot program, effective since 2014, for stroke patients that allowed patients with the potential for functional improvement to receive PAC rehabilitation in regional or community hospitals. The purpose of this study was to explore the initial achievements and clinical impact of this program in Taiwan. Methods: This was a retrospective cohort study that mainly analyzed basic hospitalization data and scores for function and quality of life, as recorded immediately after admission and before discharge, for stroke patients in the PAC program in a hospital in Taiwan. Results: This study collected complete data from a total of 168 patients. After an average of 43.57 days in the program, patients showed significant improvement in the Modified Rankin Scale (MRS, the Barthel Activity Daily Living Index (B-ADL, the Lawton–Brody Instrumental Activity Daily Living Scale (LB-IADL, the Functional Oral Intake Scale (FOIS, and the Mini Nutrition Assessment (MNA, in mobility, self-care, and usual activity, as well as on anxiety/depression in the EuroQol Five Dimensions Questionnaire (EQ-5D and in the Mini Mental State Examination
Thijs, Vincent; Grittner, Ulrike; Dichgans, Martin; Enzinger, Christian; Fazekas, Franz; Giese, Anne-Katrin; Kessler, Christof; Kolodny, Edwin; Kropp, Peter; Martus, Peter; Norrving, Bo; Ringelstein, Erich Bernd; Rothwell, Peter M; Schmidt, Reinhold; Tanislav, Christian; Tatlisumak, Turgut; von Sarnowski, Bettina; Rolfs, Arndt
Family history of stroke is an established risk factor for stroke. We evaluated whether family history of stroke predisposed to certain stroke subtypes and whether it differed by sex in young patients with stroke. We used data from the Stroke in Fabry Patients study, a large prospective, hospital-based, screening study for Fabry disease in young patients (aged stroke in whom cardiovascular risk factors and family history of stroke were obtained and detailed stroke subtyping was performed. A family history of stroke was present in 1578 of 4232 transient ischemic attack and ischemic stroke patients (37.3%). Female patients more often had a history of stroke in the maternal lineage (P=0.027) than in the paternal lineage. There was no association with stroke subtype according to Trial of Org 10172 in Acute Stroke Treatment nor with the presence of white matter disease on brain imaging. Patients with dissection less frequently reported a family history of stroke (30.4% versus 36.3%; P=0.018). Patients with a parental history of stroke more commonly had siblings with stroke (3.6% versus 2.6%; P=0.047). Although present in about a third of patients, a family history of stroke is not specifically related to stroke pathogenic subtypes in patients with young stroke. Young women with stroke more often report stroke in the maternal lineage. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00414583. © 2015 American Heart Association, Inc.
Wood, A.G.; Parker, G.E.; Berry, R.
It is stated that the indexing mechanism described can be used in a nuclear reactor fuel element inspection rig. It comprises a tubular body adapted to house a canister containing a number of fuel elements located longtitudinally, and has two chucks spaced apart for displacing the fuel elements longitudinally in a stepwise manner, together with a plunger mechanism for displacing them successively into the chucks. A measuring unit is located between the chucks for measuring the diameter of the fuel elements at intervals about their circumferences, and a secondary indexing mechanism is provided for rotating the measuring unit in a stepwise manner. (U.K.)
Borich, M R; Mackay, A L; Vavasour, I M; Rauscher, A; Boyd, L A
Multi-component T2 relaxation imaging (MCRI) provides specific in vivo measurement of myelin water content and tissue water environments through myelin water fraction (MWF), intra/extra-cellular water fraction (I/EWF) and intra/extracellular and global geometric mean T2 (GMT2) times. Quantitative MCRI assessment of tissue water environments has provided new insights into the progression and underlying white matter pathology in neural disorders such as multiple sclerosis. It has not previously been applied to investigate changes in white matter in the stroke-affected brain. Thus, the purposes of this study were to 1) use MCRI to index myelin water content and tissue water environments in the brain after stroke 2) evaluate relationships between MWF and diffusion behavior indexed by diffusion tensor imaging-based metrics and 3) examine the relationship between white matter status (MWF and fractional anisotropy) and motor behavior in the chronic phase of stroke recovery. Twenty individuals with ischemic stroke and 12 matched healthy controls participated. Excellent to good test/re-test and inter-rater reliability was observed for region of interest-based voxelwise MWF data. Reduced MWF was observed in whole-cerebrum white matter (p applications for the understanding of the neuropathology of stroke.
Isono, Naofumi; Imamura, Yuki; Ohmura, Keiko; Ueda, Norihide; Kawabata, Shinji; Furuse, Motomasa; Kuroiwa, Toshihiko
For stroke patients, intensive nutritional management is an important and effective component of inpatient rehabilitation. Accordingly, acute care hospitals must detect and prevent malnutrition at an early stage. Blood transthyretin levels are widely used as a nutritional monitoring index in critically ill patients. Here, we had analyzed the relationship between the transthyretin levels during the acute phase and Functional Independence Measure in stroke patients undergoing convalescent rehabilitation. We investigated 117 patients who were admitted to our hospital with acute ischemic or hemorrhagic stroke from February 2013 to October 2015 and subsequently transferred to convalescent hospitals after receiving acute treatment. Transthyretin concentrations were evaluated at 3 time points as follows: at admission, and 5 and 10 days after admission. After categorizing patients into 3 groups according to the minimum transthyretin level, we analyzed the association between transthyretin and Functional Independence Measure. In our patients, transthyretin levels decreased during the first 5 days after admission and recovered slightly during the subsequent 5 days. Notably, Functional Independence Measure efficiency was significantly associated with the decrease in transthyretin levels during the 5 days after admission. Patients with lower transthyretin levels had poorer Functional Independence Measure outcomes and tended not to be discharged to their own homes. A minimal transthyretin concentration (stroke patients undergoing convalescent rehabilitation. In particular, an early decrease in transthyretin levels suggests restricted rehabilitation efficiency. Accordingly, transthyretin levels should be monitored in acute stroke patients to indicate mid-term rehabilitation prospects. Copyright © 2017 National Stroke Association. Published by Elsevier Inc. All rights reserved.
Lauche, Romy; Peng, Wenbo; Ferguson, Caleb; Cramer, Holger; Frawley, Jane; Adams, Jon; Sibbritt, David
Abstract Background: This review aims to summarize the evidence of Tai Chi and qigong interventions for the primary prevention of stroke, including the effects on populations with major stroke risk factors. Methods: A systematic literature search was conducted on January 16, 2017 using the PubMed, Scopus, Cochrane Library, and CINAHL databases. Randomized controlled trials examining the efficacy of Tai Chi or qigong for stroke prevention and stroke risk factors were included. Risk of bias was assessed using the Cochrane Risk of Bias tool. Results: Twenty-one trials with n = 1604 patients with hypertension, hyperlipidaemia, diabetes, overweight or obesity, or metabolic syndrome were included. No trials were found that examined the effects of Tai Chi/qigong on stroke incidence. Meta-analyses revealed significant, but not robust, benefits of Tai Chi/qigong over no interventions for hypertension (systolic blood pressure: −15.55 mm Hg (95% CI: −21.16; −9.95); diastolic blood pressure: −10.66 mm Hg (95% CI: −14.90, −6.43); the homeostatic model assessment (HOMA) index (−2.86%; 95% CI: −5.35, −0.38) and fasting blood glucose (−9.6 mg/dL; 95% CI: −17.28, −1.91), and for the body mass index compared with exercise controls (−1.65 kg/m2; 95% CI: −3.11, −0.20). Risk of bias was unclear or high for the majority of trials and domains, and heterogeneity between trials was high. Only 6 trials adequately reported safety. No recommendation for the use of Tai Chi/qigong for the prevention of stroke can be given. Conclusion: Although Tai Chi and qigong show some potential more robust studies are required to provide conclusive evidence on the efficacy and safety of Tai Chi and qigong for reducing major stroke risk factors. PMID:29137055
Gaynor, Eva Joan; Geoghegan, Sheena Elizabeth; O'Neill, Desmond
stroke is predominantly a disease of older people. While age bias has been demonstrated in studies of pharmacological therapeutic interventions in stroke, the extent of discrimination by age in stroke rehabilitation studies is unknown. The aim of this study was to systematically review the literature to assess the extent of ageism in stroke rehabilitation studies. all randomised control trials (RCT) on stroke rehabilitation entered in the Cochrane database which reported mean age were included. Patient gender and exclusion criteria were also recorded. of 241 RCT's identified, 182 were eligible for inclusion. The mean age of all patients was 64.3, almost a decade younger than those seen by stroke physicians in daily practice in global terms, and 11-12 years younger than encountered in hospital practice in the British Isles. Almost half (46%) of trials excluded patients with cognitive impairment, almost one-quarter (23%) patients with dysphasia and one-eighth (13%) excluded patients with multiple strokes. we have identified a clear difference in the mean age of those included in stroke rehabilitation studies compared with the international mean age of stroke. In addition, a quarter of trials excluded dysphasic patients which may indicate omission of more severe strokes. This means that the evidence base for stroke rehabilitation is deficient in terms of matching the characteristics of patients encountered in clinical practice, and a more representative sample of older people and those with significant disability must be included in future trials.
Ingolfsdottir, Harpa Maria; Thomasen, Per Caye
We report the case of a patient admitted with aphasia, treated for a stroke. Subsequently, it was revealed that the symptoms were caused by complicated otitis media with localized meningitis. This case draws attention to the possible intracranial spread of infection when neurological symptoms occur...
Bousser, M.G.; Baron, J.C.; Chiras, J.
Lasting neurological deficits, though most infrequent, do occur in migrainous subjects and are well documented by clinical angiographic computed tomographic (CT scan) and even pathological studies. However the mechanism of cerebral ischemia in migraine remains widely unknown and the precise role of migraine in the pathogenesis of ischemic strokes is still debated. (orig./MG)
Kelly, W. F.; Roussak, J.
Jogging is a form of physical exercise that has stimulated the imagination of the public as shown by recent appearance of its own journal (Jogging Magazine, Editor J. Bryant). We wish to report the unusual complication of an acute stroke sustained during jogging.
Kelly, W. F.; Roussak, J.
Jogging is a form of physical exercise that has stimulated the imagination of the public as shown by recent appearance of its own journal (Jogging Magazine, Editor J. Bryant). We wish to report the unusual complication of an acute stroke sustained during jogging. Images p229-a Fig. 1 PMID:7448490
Haast, R.A.M.; Gustafson, D.R.; Kiliaan, A.J.
Sex differences in stroke are observed across epidemiologic studies, pathophysiology, treatments, and outcomes. These sex differences have profound implications for effective prevention and treatment and are the focus of this review. Epidemiologic studies reveal a clear age-by-sex interaction in
Waje-Andreassen, Ulrike; Næss, Halvor; Thomassen, Lars; Marøy, Tove Helene; Mazengia, Kibret Yimer; Eide, Geir Egil; Vedeler, Christian A.
Lifestyle risk factors, inflammation and genetics play a role in the development of atherosclerosis. We therefore studied Fc gamma receptor (FcγR) polymorphisms, interleukin (IL)-10 polymorphisms and other biomarkers related to carotid intima-media thickness (cIMT) in patients with ischemic stroke at a young age. Patients were evaluated 12 years after stroke occurrence. Patients (n = 232) 49 years of age or younger with an index stroke between 1988 and 1997 were retrospectively selected. Bloo...
Full Text Available Abstract Background It is known that repetitive, skilled, functional movement is beneficial in driving functional reorganisation of the brain early after stroke. This study will investigate a whether pedalling an upright, static exercise cycle, to provide such beneficial activity, will enhance recovery and b which stroke survivors might be able to participate in pedalling. Methods/Design Participants (n = 24 will be up to 30 days since stroke onset, with unilateral weakness and unable to walk without assistance. This study will use a modified exercise bicycle fitted with a UniCam crank. All participants will give informed consent, then undergo baseline measurements, and then attempt to pedal. Those able to pedal will be entered into a single-centre, observer-blinded randomised controlled trial (RCT. All participants will receive routine rehabilitation. The experimental group will, in addition, pedal daily for up to ten minutes, for up to ten working days. Prognostic indicators, measured at baseline, will be: site of stroke lesion, trunk control, ability to ambulate, and severity of lower limb paresis. The primary outcome for the RCT is ability to voluntarily contract paretic lower limb muscle, measured by the Motricity Index. Secondary outcomes include ability to ambulate and timing of onset and offset of activity in antagonist muscle groups during pedalling, measured by EMG. Discussion This protocol is for a trial of a novel therapy intervention. Findings will establish whether there is sufficient evidence of benefit to justify proceeding with further research into clinical efficacy of upright pedalling exercise early after stroke. Information on potential prognostic indicators will suggest which stroke survivors could benefit from the intervention. Trial Registration ISRCTN: ISRCTN45392701
Author Index. Alshaary, A. A. see Sharaf, M. A., 9. Banajh, M. A. see Sharaf, M. A., 9. Burbidge Geoffrey see Narlikar Jayant, V., 67. Chen, H. D. see Li, K. J., 147. Chen, Y. Q. see Huang, C., 139. Cui Wenyuan Evolution of the Distribution of Neutron Exposures in the Galaxy. Disc: An Analytical Model, 55. Dhurde Samir see ...
Author Index. Alecian, E. see Samadhi, R., 171; see Goupil, M.-J., 249. Antia, H. M. Helioseismology, 161. Ashoka, B. N. see Seetha, S., 301. Baudin, F. see Samadhi, R., 171. Boehm, T. see Goupil, M.-J., 249. Catala, C. see Goupil, M.-J., 249. Cunha Margarida S. Asteroseismic Theory of Rapidly Oscillating Ap Stars, 213.
SUBJECT INDEX. Absorption. Effect of NaCl on the spectral and kinetic properties of cresyl violet (CV)-sodium dodecyl sulphate (SDS) complex. 299. Acid catalysts. Temperature-programmed desorption of water and ammonia on sulphated zirconia catalysts for measuring their strong acidity and acidity distribution. 281.
J. Astrophys. Astr. (2008) 29, 405–409. Author Index. Aggarwal Malini see Jain Rajmal, 125; X-ray Emission Characteristics of Flares. Associated with CMEs, 195. Alyana Radharani see Rathod Jatin, 293; see Reddy Chandrasekhar, A., 313. Ambastha Ashok Helioseismic Effects of Energetic Transients, 93; see Maurya.
SUBJECT INDEX. Ab initio calculations. Basis set effects on energy and hardness profiles of the hydrogen fluoride dimer. 549. Activation by calcinations. Highly active and reusable catalyst from Fe-Mg- hydrotalcite anionic clay for Friedel–Crafts type benzyla- tion reactions. 635. Adsorption. Adsorption studies of iron(III) on ...
Author Index. Aggarwal Malini see Jain Rajmal, 155. Aghaee, A. Determination of the Mean Hi Absorption of the Intergalactic. Medium, 59. Agrawal, S. P. see Singh Ambika, 89. Biesiada Marek Could the Optical Transient SCP 06F6 be due to Micro- lensing?, 213. C¸ aliskan, S . see Küçük, ˙I., 135. Evans Lloyd, T. Carbon ...
Author Index. Ahmad Farooq see Iqbal Naseer, 373. Ali Syed Salman Study of a Large Helical Eruptive Prominence Associated with. Double CME on 21 April 2001, 347; see Uddin Wahab, 267. Ali, A. Chemistry of Carbon Rich Star IRAS 15194–5115, 399. Ambastha Ashok Photospheric, Chromospheric and Helioseismic ...
J. Astrophys. Astr. (2006) 27, 469–472. Subject Index. Astrophysical Processes. Spatial Damping of Linear Compressional Magnetoacoustic Waves in Quiescent. Prominences (K. A. P. Singh), 321. Report on the Dynamical Evolution of an Axially Symmetric Quasar Model. (N. J. Papadopoulos & N. D. Caranicolas), 389.
R. Narasimhan (Krishtel eMaging) 1461 1996 Oct 15 13:05:22
SUBJECT INDEX. 1D inversion. A direct inversion scheme for deep resistivity sound- ing data using artificial neural networks. 49. 40. Ar-. 39. Ar thermochronology. Tectono-thermal evolution of the India-Asia colli- sion zone based on. 40. Ar-. 39. Ar thermochronology in. Ladakh, India. 737. ANN. Artificial neural network ...
stricted geologic time range, easily preservable, of short species duration and found in multiple environment. Index fossils are used by geologists and palaeontologists as significant aids to determine the correlation and age of rock sequences . Geologists use both large fossils or 'macrofossils' and microscopic fossils or ...
Yan, X. L. see Deng, L. H., 221. Phase Relationship Between Sunspot Number, Flare Index and Solar Radio. Flux, 387. ZANINETTI, L. Revisiting the Cosmological Principle in a Cellular Framework, 399. ZHAO XIAN-FENG. Constraints on the Moment of Inertia of a Proto Neutron Star from the Hyperon Coupling Constants, ...
Home; Journals; Resonance – Journal of Science Education; Volume 11; Issue 10. Index Fossils - Evidences from Plant Sources. Dipanjan Ghosh. General Article ... Author Affiliations. Dipanjan Ghosh1. Biological Science Department Kirnahar Shib Chandra High School Kirnahar, Birbhum 731302, West Bengal, India.
Charles D A Wolfe
Full Text Available Although stroke is acknowledged as a long-term condition, population estimates of outcomes longer term are lacking. Such estimates would be useful for planning health services and developing research that might ultimately improve outcomes. This burden of disease study provides population-based estimates of outcomes with a focus on disability, cognition, and psychological outcomes up to 10 y after initial stroke event in a multi-ethnic European population.Data were collected from the population-based South London Stroke Register, a prospective population-based register documenting all first in a lifetime strokes since 1 January 1995 in a multi-ethnic inner city population. The outcomes assessed are reported as estimates of need and included disability (Barthel Index 10, and mental and physical domain scores of the Medical Outcomes Study 12-item short form (SF-12 health survey. Estimates were stratified by age, gender, and ethnicity, and age-adjusted using the standard European population. Plots of outcome estimates over time were constructed to examine temporal trends and sociodemographic differences. Between 1995 and 2006, 3,373 first-ever strokes were registered: 20%-30% of survivors had a poor outcome over 10 y of follow-up. The highest rate of disability was observed 7 d after stroke and remained at around 110 per 1,000 stroke survivors from 3 mo to 10 y. Rates of inactivity and cognitive impairment both declined up to 1 y (280/1,000 and 180/1,000 survivors, respectively; thereafter rates of inactivity remained stable till year eight, then increased, whereas rates of cognitive impairment fluctuated till year eight, then increased. Anxiety and depression showed some fluctuation over time, with a rate of 350 and 310 per 1,000 stroke survivors, respectively. SF-12 scores showed little variation from 3 mo to 10 y after stroke. Inactivity was higher in males at all time points, and in white compared to black stroke survivors, although black
Engels, Thomas; Baglione, Quentin; Audibert, Martine; Viallefont, Anne; Mourji, Fouzi; El Alaoui Faris, Mustapha
Background Stroke is a growing public health concern in low- and middle- income countries. Improved knowledge about the association between socioeconomic status and stroke in these countries would enable the development of effective stroke prevention and management strategies. This study presents the association between socioeconomic status and the prevalence of stroke in Morocco, a lower middle-income country. Methods Data on the prevalence of stroke and stroke-related risk factors were collected during a large population-based survey. The diagnosis of stroke in surviving patients was confirmed by neurologists while health, demographic, and socioeconomic characteristics of households were collected using structured questionnaires. We used Multiple Correspondence Analysis to develop a wealth index based on characteristics of the household dwelling as well as ownership of selected assets. We used logistic regressions controlling for multiple variables to assess the statistical association between socioeconomic status and stroke. Findings Our results showed a significant association between household socioeconomic status and the prevalence of stroke. This relationship was non-linear, with individuals from both the poorest (mainly rural) and richest (mainly urban) households having a lower prevalence of stroke as compared to individuals with medium wealth level. The latter belonged mainly to urban households with a lower socioeconomic status. When taking into account the urban population only, we observed that a third of poorest households experienced a significantly higher prevalence of stroke compared to the richest third (OR = 2.06; CI 95%: 1.09; 3.89). Conclusion We conclude that individuals from the most deprived urban households bear a higher risk of stroke than the rest of the population in Morocco. This result can be explained to a certain extent by the higher presence of behavioral risk factors in this specific category of the population, which leads in
Full Text Available BACKGROUND: Stroke is a growing public health concern in low- and middle- income countries. Improved knowledge about the association between socioeconomic status and stroke in these countries would enable the development of effective stroke prevention and management strategies. This study presents the association between socioeconomic status and the prevalence of stroke in Morocco, a lower middle-income country. METHODS: Data on the prevalence of stroke and stroke-related risk factors were collected during a large population-based survey. The diagnosis of stroke in surviving patients was confirmed by neurologists while health, demographic, and socioeconomic characteristics of households were collected using structured questionnaires. We used Multiple Correspondence Analysis to develop a wealth index based on characteristics of the household dwelling as well as ownership of selected assets. We used logistic regressions controlling for multiple variables to assess the statistical association between socioeconomic status and stroke. FINDINGS: Our results showed a significant association between household socioeconomic status and the prevalence of stroke. This relationship was non-linear, with individuals from both the poorest (mainly rural and richest (mainly urban households having a lower prevalence of stroke as compared to individuals with medium wealth level. The latter belonged mainly to urban households with a lower socioeconomic status. When taking into account the urban population only, we observed that a third of poorest households experienced a significantly higher prevalence of stroke compared to the richest third (OR = 2.06; CI 95%: 1.09; 3.89. CONCLUSION: We conclude that individuals from the most deprived urban households bear a higher risk of stroke than the rest of the population in Morocco. This result can be explained to a certain extent by the higher presence of behavioral risk factors in this specific category of the population
Voelkel, Nicolas; Hubert, Nikolai Dominik; Backhaus, Roland; Haberl, Roman Ludwig; Hubert, Gordian Jan
Intravenous thrombolysis (IVT) is beneficial in reducing disability in selected patients with acute ischemic stroke. There are numerous contraindications to IVT. One is recent surgery. The aim of this study was to analyze the safety of IVT in patients with postoperative stroke. Data of consecutive IVT patients from the Telemedical Project for Integrative Stroke Care thrombolysis registry (February 2003 to October 2014; n=4848) were retrospectively searched for keywords indicating preceding surgery. Patients were included if surgery was performed within the last 90 days before stroke. The primary outcome was defined as surgical site hemorrhage. Subgroups with major/minor surgery and recent/nonrecent surgery (within 10 days before IVT) were analyzed separately. One hundred thirty-four patients underwent surgical intervention before IVT. Surgery had been performed recently (days 1-10) in 49 (37%) and nonrecently (days 11-90) in 85 patients (63%). In 86 patients (64%), surgery was classified as major, and in 48 (36%) as minor. Nine patients (7%) developed surgical site hemorrhage after IVT, of whom 4 (3%) were serious, but none was fatal. One fatal bleeding occurred remotely from surgical area. Rate of surgical site hemorrhage was significantly higher in recent than in nonrecent surgery (14.3% versus 2.4%, respectively, odds ratio adjusted 10.73; 95% confidence interval, 1.88-61.27). Difference between patients with major and minor surgeries was less distinct (8.1% and 4.2%, respectively; odds ratio adjusted 4.03; 95% confidence interval, 0.65-25.04). Overall in-hospital mortality was 8.2%. Intracranial hemorrhage occurred in 9.7% and was asymptomatic in all cases. IVT may be administered safely in postoperative patients as off-label use after appropriate risk-benefit assessment. However, bleeding risk in surgical area should be taken into account particularly in patients who have undergone surgery shortly before stroke onset. © 2017 American Heart Association, Inc.
Hakimi, Ryan; Garg, Ankur
Hemorrhagic stroke comprises approximately 15% to 20% of all strokes. This article provides readers with an understanding of the indications and significance of various neuroimaging techniques available for patients presenting with hemorrhagic strokes of distinct causes. The most common initial neuroimaging study is a noncontrast head CT, which allows for the identification of hemorrhage. Once an intracranial hemorrhage has been identified, the pattern of blood and the patient's medical history, neurologic examination, and laboratory studies lead the practitioner to pursue further neuroimaging studies to guide the medical, surgical, and interventional management. Given that hemorrhagic stroke constitutes a heterogeneous collection of diagnoses, the subsequent neuroimaging pathway necessary to better evaluate and care for these patients is variable based on the etiology.With an increasing incidence and prevalence of atrial fibrillation associated with the aging population and the introduction of three new direct factor Xa inhibitors and one direct thrombin inhibitor to complement vitamin K antagonists, oral anticoagulant use continues to increase. Patients on oral anticoagulants have a sevenfold to tenfold increased risk for intracerebral hemorrhage (ICH). Furthermore, patients who have an ICH associated with oral anticoagulant use have a higher mortality rate than those with primary ICH. Despite the reduced incidence of hypertension-related ICH over the past decade, it is expected that the incidence of ICH will continue to increase. Neuroimaging studies are integral to the identification of hemorrhagic stroke, determination of the underlying etiology, prevention of hematoma expansion, treatment of acute complications, and treatment of the underlying etiology, if indicated. Neuroimaging is essential for prognostication and thus directly impacts patient care.
Full Text Available Objective The aim of this project was to complete an analysis of monograph and audiovisual items held in the Central Coast Health Service (CCHS Libraries and containing information relevant to the treatment of acute stroke. Acute stroke is treated by multidisciplinary teams of clinicians based at two hospitals within the CCHS. The adequacy of the library collection was measured by subject coverage and age. Methods The methodology used consisted of three main steps: a literature review; design, administration, and analysis of a questionnaire to members of the CCHS Acute Stroke Team; and an analysis of the libraries’ collections. The research project utilised project management methodology and an evidence based librarianship framework. Results The questionnaire revealed that electronic resources were by far the most frequently used by participants, followed in order by print journals, books, interlibrary loan articles, and audiovisual items. Collection analysis demonstrated that the monograph and audiovisual collections were adequate in both scope and currency to support the information needs of Acute Stroke Team members, with the exception of resources to support patient education. Conclusion The researchers developed recommendations for future collection development in the area of acute stroke resources. Conducting this project within the evidence based librarianship framework helped to develop library staff members’ confidence in their ability to make future collection development decisions, informed by the target group’s information needs and preferences. The collection analysis methodology was designed to be replicated, and new specialist groups within the client base of the library will be targeted to repeat the collection analysis process.
Agnoli, Claudia; Krogh, Vittorio; Grioni, Sara; Sieri, Sabina; Palli, Domenico; Masala, Giovanna; Sacerdote, Carlotta; Vineis, Paolo; Tumino, Rosario; Frasca, Graziella; Pala, Valeria; Berrino, Franco; Chiodini, Paolo; Mattiello, Amalia; Panico, Salvatore
Stroke is a major cause of death. Several foods and nutrients have been linked to stroke, but their effects may be best investigated considering the entire diet. In the present EPICOR study, we investigated the association between stroke and adherence to 4 a priori-defined dietary patterns: Healthy Eating Index 2005 (HEI-2005), Dietary Approaches to Stop Hypertension (DASH), Greek Mediterranean Index, and Italian Mediterranean Index. We followed 40,681 volunteers and estimated the HR and 95%CI for stroke according to dietary pattern by using multivariate Cox models with adjustment for risk factors. During a mean follow-up of 7.9 y, 178 stroke cases were diagnosed (100 ischemic, 47 hemorrhagic). Scores of 3 dietary patterns (not HEI) were inversely associated with risk of all types of stroke, with the strongest association for the Italian Index [HR = 0.47 (95%CI = 0.30-0.75); third vs. first tertile]. All patterns were significantly inversely associated with ischemic stroke except the Greek Index, with the strongest association for the Italian Index [HR = 0.37 (95%CI = 0.19-0.70); third vs. first tertile]. Only the Italian Index tended to be inversely associated with hemorrhagic stroke [HR = 0.51 (95%CI = 0.22-1.20); P = 0.07)]. These epidemiological findings suggest that adherence to any one dietary pattern investigated would protect against at least one type of stroke. For our Italian population, a diet with a high score on the Italian Index was associated with the greatest risk reduction, probably because it was conceived to capture healthy eating in the context of foods typically available in Italy.
Douiri, Abdel; Grace, Justin; Sarker, Shah-Jalal; Tilling, Kate; McKevitt, Christopher; Wolfe, Charles DA; Rudd, Anthony G
Background and aims Clinical predictive models for stroke recovery could offer the opportunity of targeted early intervention and more specific information for patients and carers. In this study, we developed and validated a patient-specific prognostic model for monitoring recovery after stroke and assessed its clinical utility. Methods Four hundred and ninety-five patients from the population-based South London Stroke Register were included in a substudy between 2002 and 2004. Activities of daily living were assessed using Barthel Index) at one, two, three, four, six, eight, 12, 26, and 52 weeks after stroke. Penalized linear mixed models were developed to predict patients' functional recovery trajectories. An external validation cohort included 1049 newly registered stroke patients between 2005 and 2011. Prediction errors on discrimination and calibration were assessed. The potential clinical utility was evaluated using prognostic accuracy measurements and decision curve analysis. Results Predictive recovery curves showed good accuracy, with root mean squared deviation of 3 Barthel Index points and a R 2 of 83% up to one year after stroke in the external cohort. The negative predictive values of the risk of poor recovery (Barthel Index <8) at three and 12 months were also excellent, 96% (95% CI [93.6-97.4]) and 93% [90.8-95.3], respectively, with a potential clinical utility measured by likelihood ratios (LR+:17 [10.8-26.8] at three months and LR+:11 [6.5-17.2] at 12 months). Decision curve analysis showed an increased clinical benefit, particularly at threshold probabilities of above 5% for predictive risk of poor outcomes. Conclusions A recovery curves tool seems to accurately predict progression of functional recovery in poststroke patients.
Ghali, Ahmed; Cunningham, Andrew S.; Pridmore, Tony P.
Stroke is a major cause of disability and health care expenditure around the world. Existing stroke rehabilitation methods can be effective but are costly and need to be improved. Even modest improvements in the effectiveness of rehabilitation techniques could produce large benefits in terms of quality of life. The work reported here is part of an ongoing effort to integrate virtual reality and machine vision technologies to produce innovative stroke rehabilitation methods. We describe a combined object recognition and event detection system that provides real time feedback to stroke patients performing everyday kitchen tasks necessary for independent living, e.g. making a cup of coffee. The image plane position of each object, including the patient"s hand, is monitored using histogram-based recognition methods. The relative positions of hand and objects are then reported to a task monitor that compares the patient"s actions against a model of the target task. A prototype system has been constructed and is currently undergoing technical and clinical evaluation.
Masjuan, J; Gállego Culleré, J; Ignacio García, E; Mira Solves, J J; Ollero Ortiz, A; Vidal de Francisco, D; López-Mesonero, L; Bestué, M; Albertí, O; Acebrón, F; Navarro Soler, I M
Organisational capacity in terms of resources and care circuits to shorten response times in new stroke cases is key to obtaining positive outcomes. This study compares therapeutic approaches and treatment outcomes between traditional care centres (with stroke teams and no stroke unit) and centres with stroke units. We conducted a prospective, quasi-experimental study (without randomisation of the units analysed) to draw comparisons between 2 centres with stroke units and 4 centres providing traditional care through the neurology department, analysing a selection of agreed indicators for monitoring quality of stroke care. A total of 225 patients participated in the study. In addition, self-administered questionnaires were used to collect patients' evaluations of the service and healthcare received. Centres with stroke units showed shorter response times after symptom onset, both in the time taken to arrive at the centre and in the time elapsed from patient's arrival at the hospital to diagnostic imaging. Hospitals with stroke units had greater capacity to respond through the application of intravenous thrombolysis than centres delivering traditional neurological care. Centres with stroke units showed a better fit to the reference standards for stroke response time, as calculated in the Quick study, than centres providing traditional care through the neurology department. Copyright © 2017 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.
Bogiatzi, Chrysi; Hackam, Daniel G; McLeod, A Ian; Spence, J David
Early diagnosis and treatment of a stroke improves patient outcomes, and knowledge of the cause of the initial event is crucial to identification of the appropriate therapy to maximally reduce risk of recurrence. Assumptions based on historical frequency of ischemic subtypes may need revision if stroke subtypes are changing as a result of recent changes in therapy, such as increased use of statins. We analyzed secular trends in stroke risk factors and ischemic stroke subtypes among patients with transient ischemic attack or minor or moderate stroke referred to an urgent transient ischemic attack clinic from 2002 to 2012. There was a significant decline in low-density lipoprotein cholesterol and blood pressure, associated with a significant decline in large artery stroke and small vessel stroke. The proportion of cardioembolic stroke increased from 26% in 2002 to 56% in 2012 (Prisk factors was observed, with a significant decline in stroke/transient ischemic attack caused by large artery atherosclerosis and small vessel disease. As a result, cardioembolic stroke/transient ischemic attack has increased significantly. Our findings suggest that more intensive investigation for cardiac sources of embolism and greater use of anticoagulation may be warranted. © 2014 American Heart Association, Inc.
Gustavo W. Kuster
Full Text Available Background. Stroke mortality in Brazil is one of the highest among Western countries. Nonetheless, stroke outcome determinants are still poorly known in this country. In this study we evaluate outcome determinants of stroke in a primary stroke center in São Paulo, Brazil. Methods. We evaluated demographic, clinical, and outcome data of patients with ischemic stroke (IS, transient ischemic attack (TIA, and intracerebral hemorrhage (ICH admitted at “Hospital Paulistano,” São Paulo, Brazil. In-hospital mortality and functional outcome determinants were assessed. Univariate and binary logistic regression analysis were performed. Results. Three hundred forty-one patients were included in the study, 52.2% being male with 66.8±15.7 years. The stroke type distribution was IS: 59.2%, TIA: 29.6%, and ICH: 11.1%. ICH was associated with greater severity and poorer functional outcome. The determinants of poorer functional outcome were higher NIHSS, lower Glasgow score, and lower oxygen saturation level. The most important mortality determinant was the presence of visual symptoms. Conclusions. The stroke mortality and stroke outcome determinants found in the present study do not remarkably differ from studies carried out in developed countries. Stroke prognosis studies are crucial to better understand the high burden of stroke in Brazil.
Alijan Ahmadi Ahangar
Full Text Available Background: Stroke is the leading cause of serious long-term disability. In recent studies hyponatremia as a risk factor for stroke. Methods: This cross-sectional descriptive study was to evaluate serum zinc level in serum sodium over the first 24 hours after the onset of stroke. Different intensities were determined on Stroke Scale NIH (National Institute of Health (mild 4-1 and (average moderate 15-5 and (moderate to severe 20-16 and (extreme severe 42- 21. Determination intensity of stroke after admission and discharge with Modified Rankin Scale and Barthel index. Blood serum concentrations of sodium 0.5 mL of venous blood were taken and sodium serum level was performed with Latex particle agglutination test in Ayatollah Rouhani Hospital. That normal range was defined 136-146 meq / L Findings: 125 patients were entered into this study; the prevalence of hyponatremia in female was 70% vs 60% in male. Of stroke patients included in this study 66% of them had hyponatremia and the frequency of hyponatremia in ischemic and hemorrhagic was 82% and 63%, respectively. Increase in hyponatremia with disability period of admission had statistically significant (10(12 mild vs 40(32 moderate, 32(25.6 severe, p=0.01 also with disability before discharge (24(19.2 mild, 26(20.8 moderate, 32(25.6 severe, p=0.03. Conclusions: Hyponatremia can effect on severity of the stroke and can be considered as a predictor of increased stroke severity and disability at admission and discharge.
Srivastava, Padma V; Sudhan, Paulin; Khurana, Dheeraj; Bhatia, Rohit; Kaul, Subash; Sylaja, P N; Moonis, Majaz; Pandian, Jeyaraj Durai
In India, stroke care services are not well developed. There is a need to explore alternative options to tackle the rising burden of stroke. Telemedicine has been used by the Indian Space Research Organization (ISRO) to meet the needs of remote hospitals in India. The telemedicine network implemented by ISRO in 2001 presently stretches to around 100 hospitals all over the country, with 78 remote/rural/district health centers connected to 22 specialty hospitals in major cities, thus providing treatment to more than 25 000 patients, which includes stroke patients. Telemedicine is currently used in India for diagnosing stroke patients, subtyping stroke as ischemic or hemorrhagic, and treating accordingly. However, a dedicated telestroke system for providing acute stroke care is needed. Keeping in mind India's flourishing technology sector and leading communication networks, the hub-and-spoke model could work out really well in the upcoming years. Until then, simpler alternatives like smartphones, online data transfer, and new mobile applications like WhatsApp could be used. Telestroke facilities could increase the pool of patients eligible for thrombolysis. But this primary aim of telestroke can be achieved in India only if thrombolysis and imaging techniques are made available at all levels of health care. © 2014 World Stroke Organization.
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Fleege, Virginia B.; And Others
This volume, the result of 2 years of work, is an index to 24 volumes on Montessori theory and practice. The books were read and analyzed a minimum of six times. Sixteen of the volumes are authored by Maria Montessori. (DR)
Fisse, Anna Lena; Kemmling, André; Teuber, Anja; Wersching, Heike; Young, Peter; Dittrich, Ralf; Ritter, Martin; Dziewas, Rainer; Minnerup, Jens
Sleep related breathing disorders (SRBD) are common in patients with ischemic stroke and are associated with poor outcome. SRBD after stroke were assumed to be a direct consequence of injury of specific central nervous system structures. However, whether specific locations of ischemic infarcts cause SRBD is yet unknown. We therefore investigated the association of ischemic lesion location with SRBD. Patients with acute ischemic stroke treated on our stroke unit were included in a prospective observational study. All patients underwent magnetic resonance imaging (MRI) and polygraphy in the acute phase after stroke. SRBD was defined by an apnea-hypopnea index (AHI) ≥10. MRI were evaluated using standardized maps to depict voxel-wise probability distribution of infarction for patients with and without SRBD. Groups were compared using logistic regression analysis. Of 142 patients included, 86 (59%) had a SRBD. Age, body mass index and prevalence of arterial hypertension were significantly higher in patients with SRBD. There was no statistically significant association between any lesion location and SRBD. We found no association of lesion location and SRBD in stroke patients, whereas established risk factors for SRBD, known from general population, were significantly associated with SRBD. Given the high prevalence of SRBD in stroke patients, these findings suggest that cerebral ischemia facilitates the occurrence of SRBD in patients with pre-existing risk factors rather than causing it by damaging specific central nervous system structures. Our findings can be used to identify stroke patients who might benefit from polygraphy screening.
Vincens, Natalia; Stafström, Martin
Stroke accounts for more than 10% of all deaths globally and most of it occurs in low- and middle-income countries (LMIC). Income inequality and gross domestic product (GDP) per capita has been associated to stroke mortality in developed countries. In LMIC, GDP per capita is considered to be a more relevant health determinant than income inequality. This study aims to investigate if income inequality is associated to stroke mortality in Brazil at large, but also on regional and state levels, and whether GDP per capita modulates the impact of this association. Stroke mortality rates, Gini index and GDP per capita data were pooled for the 2002 to 2009 period from public available databases. Random effects models were fitted, controlling for GDP per capita and other covariates. Income inequality was independently associated to stroke mortality rates, even after controlling for GDP per capita and other covariates. GDP per capita reduced only partially the impact of income inequality on stroke mortality. A decrease in 10 points in the Gini index was associated with 18% decrease in the stroke mortality rate in Brazil. Income inequality was independently associated to stroke mortality in Brazil.
Full Text Available Motor deficit, especially in the upper limb, is the primary contributor in post-stroke disability. Recovery of motor function relies on neural plasticity – cortical plastic reorganization – a spontaneous process, which could be enhanced from early phases by rehabilitative strategies. The subacute stage after stroke is the critical period during which the brain is most receptive to rehabilitation strategies. Based on the recent results of 2 trials in stroke rehabilitation using pharmacological intervention with Cerebrolysin in combination with standardized kinesitherapy, we conducted a pilot study of 4 consecutive patients with acute ischemic stroke, treated with Cerebrolysin for 28 days after stroke, and with intensive task-specific kinesitherapy from day 7 to day 28 after stroke. We assessed stroke severity with NIHSS score, upper limb function with ARAT (Action Research Arm Test score, disability with modified Rankin scale and patient’s autonomy with Barthel Index, at day 0 and day 30 after stroke. After 28 days of combined therapy all 4 patients improved, most significant improvement was seen in upper limb function, measured by ARAT score and in autonomy measured by Barthel Index.
Full Text Available David J Clarke, Anne Forster Academic Unit of Elderly Care and Rehabilitation, Bradford Institute for Health Research, Bradford, UK Abstract: Stroke is a leading cause of serious, long-term disability, the effects of which may be prolonged with physical, emotional, social, and financial consequences not only for those affected but also for their family and friends. Evidence for the effectiveness of stroke unit care and the benefits of thrombolysis have transformed treatment for people after stroke. Previously viewed nihilistically, stroke is now seen as a medical emergency with clear evidence-based care pathways from hospital admission to discharge. However, stroke remains a complex clinical condition that requires health professionals to work together to bring to bear their collective knowledge and specialist skills for the benefit of stroke survivors. Multidisciplinary team working is regarded as fundamental to delivering effective care across the stroke pathway. This paper discusses the contribution of team working in improving recovery at key points in the post-stroke pathway. Keywords: stroke care, rehabilitation, multidisciplinary, interdisciplinary, team working
Roth, Elliot J; Lovell, Linda
Stroke survivors experience functional loss in basic activities of daily living (ADLs) and in everyday community activities or instrumental activities of daily living (IADLs). Historically there has been a greater focus by rehabilitation professionals on basic ADLs than on IADLs. The purpose of this study was to describe the relationship between the ability to perform ADLs and community activities in a large group of stroke patients measured 1 year following rehabilitation discharge. A structured survey was administered by telephone. Outcome measures were the Frenchay Activities Index (FAI), a measure of IADL, and the FIM, a measure of disability. Visual inspection of the relationship between FAI scores and FIM scores revealed that the data largely followed a curvilinear pattern. Curve estimation regression models were used to determine the line of best fit. A cubic function was found to give a good fit with an R2 of 0.644. The three activities in which stroke patients most frequently engaged were social outings, walking outside for more than 15 minutes, and local shopping. The three activities in which stroke patients engaged the least were gainful work, gardening outside, and household/car maintenance. A score of approximately 80 or greater on the FIM was associated with a substantially increased level of participation in home and community activities.
Magnus Lie Hetland
Full Text Available This paper discusses a new family of bounds for use in similarity search, related to those used in metric indexing, but based on Ptolemy's inequality, rather than the metric axioms. Ptolemy's inequality holds for the well-known Euclidean distance, but is also shown here to hold for quadratic form metrics in general, with Mahalanobis distance as an important special case. The inequality is examined empirically on both synthetic and real-world data sets and is also found to hold approximately, with a very low degree of error, for important distances such as the angular pseudometric and several Lp norms. Indexing experiments are performed on several data sets, demonstrating a highly increased filtering power when using certain forms of Ptolemaic filtering, compared to existing, triangular methods. It is also shown that combining the Ptolemaic and triangular filtering can lead to better results than using either approach on its own.
Smeeton, Nigel C; Corbin, David O C; Hennis, Anselm J M; Hambleton, Ian R; Rose, Angela M C; Fraser, Henry S; Heuschmann, Peter U; Wolfe, Charles D A
Little is known about the poststroke outcome in Caribbean populations. We investigated differences in the activities of daily living, level of social activities, living circumstances and survival for stroke patients in Barbados and London. Data were collected from the South London Stroke Register and the Barbados Register of Strokes for patients with a first-ever stroke registered between January 2001 and December 2004. The ability to perform activities of daily living was measured by the Barthel Index and level of social activities by the Frenchay Activities Index. Living circumstances were categorised into private household vs. institutional care. Death and dependency, activities of daily living and social activities were assessed at three-months, one- and two-years using logistic regression, adjusted for differences in demographic, socioeconomic and stroke severity characteristics. At three-months, a high level of social activities was more likely for the Barbados Register of Strokes (odds ratio 1.84; 95% confidence interval 1.03-3.29); there were no differences in activities of daily living; and Barbados Register of Strokes patients were less likely to be in institutional care (relative risk ratio 0.38; 95% confidence interval 0.18-0.79). Following adjustment, Barbados Register of Strokes patients had a higher risk of mortality at three-months (relative risk ratio 1.85; 95% confidence interval 1.03-3.30), one-year (relative risk ratio 1.83; 95% confidence interval 1.08-3.09) and two-years (relative risk ratio 1.82; 95% confidence interval 1.08-3.07). This difference was due to early poststroke deaths; for patients alive at four-weeks poststroke, survival thereafter was similar in both settings. In Barbados, there was evidence for a healthy survivor effect, and short-term social activity was greater than that in the South London Stroke Register. © 2010 The Authors. International Journal of Stroke © 2010 World Stroke Organization.
Mehdi, Z; Birns, J; Bhalla, A
To provide a comprehensive review of the current evidence on post-stroke urinary incontinence. An electronic database search was performed to identify relevant studies and review articles related to Urinary Incontinence (UI) in the stroke population between the years 1966 and 2012. Urinary incontinence following stroke is a common problem affecting more than one-third of acute stroke patients and persisting in up to a quarter at 1 year. It is well established that this condition is a strong marker of stroke severity and is associated with poorer functional outcomes and increased institutionalisation and mortality rates compared with those who remain continent. Despite evidence linking better outcomes to those patients who regain continence, the results of national audits have demonstrated that the management of UI following stroke is suboptimal, with less than two-thirds of stroke units having a documented plan to promote continence. Current evidence supports a thorough assessment to categorise the type and severity of post-stroke urinary incontinence. An individually tailored, structured management strategy to promote continence should be employed. This has been associated with better stroke outcomes and should be the aim of all stroke health professionals. © 2013 John Wiley & Sons Ltd.
Chiu, En-Chi; Wu, Wen-Chi; Hung, Jen-Wen; Tseng, Yu-Hsuan
The Wisconsin Card Sorting Test (WCST) is the most widely used measure for assessing executive functions in patients with stroke. However, no study has examined the ecological, discriminative and convergent validities of the WCST in patients with stroke. This study aimed to examine the above validities of the WCST in patients with stroke. Ninety-eight patients were administered the WCST, two measures of activities of daily living and one cognitive measure. Seven indexes of the WCST were used in this study. Two WCST indexes ("total number correct" and "number of categories completed") had moderate correlations with two measures of activities of daily living (Pearson's r = 0.39-0.49). The other indexes showed low or moderate correlations with two measures of activities of daily living (r = 0.26-0.53). The results of independent t-test showed statistically significant difference between patients with and without disability for the seven WCST indexes (p = 0.001-0.013) and nonsignificant differences between patients with different affected regions of the brain (p > 0.05). Moderate correlations (r = 0.35-0.54) were found among the seven WCST indexes and one cognitive measure. The WCST has poor to adequate ecological validity, acceptable discriminative validity and acceptable convergent validity in patients with stroke. The two WCST indexes ("total number correct" and "number of categories completed") are recommended for use to reflect the degree of living independence in patients with stroke. Implications for rehabilitation The Wisconsin Card Sorting Test showed poor to adequate ecological validity, acceptable discriminative validity, and acceptable convergent validity in patients with stroke. Two indexes of the Wisconsin Card Sorting Test (i.e., ?total number correct? and ?number of categories completed?) can adequately reveal the degrees of living independence in patients with stroke.
Sheila Cristina Ouriques Martins
Full Text Available The second part of these Guidelines covers the topics of antiplatelet, anticoagulant, and statin therapy in acute ischemic stroke, reperfusion therapy, and classification of Stroke Centers. Information on the classes and levels of evidence used in this guideline is provided in Part I. A translated version of the Guidelines is available from the Brazilian Stroke Society website (www.sbdcv.com.br.
Full Text Available Heat stroke is the most complicated and dangerous amongst heat injuries that can lead to irreversible injury and even death with itself or with creating predisposibility to different diseases. The following case report depicts a patient who presented primarily with impairment of consciousness after walking 45 km in the summer heat to cross the Syria-Turkey border and later syncope. This case report aims to highlight the possibility of higher co-incidence with heat stroke and stroke.
Rodgers, Helen; Dennis, Martin; Cohen, David; Rudd, Anthony
the National Service Framework for Older People requires every general hospital which cares for stroke patients to introduce a specialist stroke service by 2004. to describe the organisation and staffing of specialist hospital-based stroke services in the UK. a national postal survey of consultant members of the British Association of Stroke Physicians (BASP) seeking details of the provision of neurovascular clinics, acute stroke units (ASUs), stroke rehabilitation units (SRUs), and the organisation and staffing of these services. the response rate was 91/126 (72%). Fifty-four neurovascular clinics, 40 ASUs and 68 SRUs were identified. Neurovascular clinics used a number of strategies to maintain rapid access and 30 (56%) were run by a single consultant. Only 50% ASUs usually admitted patients within 24 h of stroke. As the number of beds available on ASUs and SRUs did not reflect the total number of stroke in-patients, 21 (53%) ASUs and 45 (79%) SRUs had admission criteria. Training opportunities were limited: 37% ASUs and 82% SRUs had no specialist registrar. The therapy sessions (1 session=half a day) available per bed per week on a SRU were: physiotherapy 0.8; occupational therapy 0.6; speech and language therapy 0.25. significant development is needed to achieve the NSF target for hospital-based stroke services as few Trusts currently have all components in place and even when available not all stroke patients have access to specialist care. Stroke specialists will be required to run these services but training opportunities are currently limited. Stroke unit therapy staffing levels were lower than was available in randomised controlled trials.
Branco, João Paulo; Costa, Joana Santos; Sargento-Freitas, João; Oliveira, Sandra; Mendes, Bruno; Laíns, Jorge; Pinheiro, João
Stroke remains one of the leading causes of morbidity and mortality around the world and it is associated with an important long-term functional disability. Some neuroimaging resources and certain peripheral blood or cerebrospinal fluid proteins can give important information about etiology, therapeutic approach, follow-up and functional prognosis in acute ischemic stroke patients. However, among the scientific community, there is currently more interest in the stroke vital prognosis over the functional prognosis. Predicting the functional prognosis during acute phase would allow more objective rehabilitation programs and better management of the available resources. The aim of this work is to review the potential role of acute phase neuroimaging and blood biomarkers as functional recovery predictors after ischemic stroke. Review of the literature published between 2005 and 2015, in English, using the terms "ischemic stroke", "neuroimaging" e "blood biomarkers". We included nine studies, based on abstract reading. Computerized tomography, transcranial doppler ultrasound and diffuse magnetic resonance imaging show potential predictive value, based on the blood flow study and the evaluation of stroke's volume and localization, especially when combined with the National Institutes of Health Stroke Scale. Several biomarkers have been studied as diagnostic, risk stratification and prognostic tools, namely the S100 calcium binding protein B, C-reactive protein, matrix metalloproteinases and cerebral natriuretic peptide. Although some biomarkers and neuroimaging techniques have potential predictive value, none of the studies were able to support its use, alone or in association, as a clinically useful functionality predictor model. All the evaluated markers were considered insufficient to predict functional prognosis at three months, when applied in the first hours after stroke. Additional studies are necessary to identify reliable predictive markers for functional
Systematic review Executive dysfunction is commonly reported following stroke with most research in this area focused on frontal lobe lesions. A systematic review was carried out to evaluate the evidence of executive dysfunction following stroke as compared to control groups. It was found that executive functions are consistently impaired following stroke and is not limited to frontal lobe lesions. Processing speed, mental flexibility, attention and working memory impairment...
Aaronson, Justine A; van Bennekom, Coen A M; Hofman, Winni F; van Bezeij, Tijs; van den Aardweg, Joost G; Groet, Erny; Kylstra, Wytske A; Schmand, Ben
Obstructive sleep apnea (OSA) is a common sleep disorder in stroke patients and is associated with prolonged hospitalization, decreased functional outcome, and recurrent stroke. Research on the effect of OSA on cognitive functioning following stroke is scarce. The primary objective of this study was to compare stroke patients with and without OSA on cognitive and functional status upon admission to inpatient rehabilitation. Case-control study. 147 stroke patients admitted to a neurorehabilitation unit. N/A. All patients underwent sleep examination for diagnosis of OSA. We assessed cognitive status by neuropsychological examination and functional status by two neurological scales and a measure of functional independence. We included 80 stroke patients with OSA and 67 stroke patients without OSA. OSA patients were older and had a higher body mass index than patients without OSA. OSA patients performed worse on tests of attention, executive functioning, visuoperception, psychomotor ability, and intelligence than those without OSA. No differences were found for vigilance, memory, and language. OSA patients had a worse neurological status, lower functional independence scores, and a longer period of hospitalization in the neurorehabilitation unit than the patients without OSA. OSA status was not associated with stroke type or classification. Obstructive sleep apnea (OSA) is associated with a lower cognitive and functional status in patients admitted for stroke rehabilitation. This underlines the importance of OSA as a probable prognostic factor, and calls for well-designed randomized controlled trials to study its treatability. © 2015 Associated Professional Sleep Societies, LLC.
Rivera-Caravaca, José Miguel; Roldán, Vanessa; Esteve-Pastor, María Asunción; Valdés, Mariano; Vicente, Vicente; Lip, Gregory Y H; Marín, Francisco
The ABC-stroke score (age, biomarkers [N-terminal fragment B-type natriuretic peptide, high-sensitivity troponin], and clinical history [prior stroke/transient ischemic attack]) was proposed to predict stroke in atrial fibrillation (AF). This score was derived/validated in 2 clinical trial cohorts in which patients with AF were highly selected and carefully followed-up. However, the median follow-up was 1.9 years in the trial cohort; therefore, its long-term predictive performance remains uncertain. This study aimed to compare the long-term predictive performances of the ABC-stroke and CHA 2 DS 2 -VASc (cardiac failure or dysfunction, hypertension, age ≥75 [doubled], diabetes mellitus, stroke [doubled]-vascular disease, age 65 to 74 years and sex category [female]) scores in a cohort of anticoagulated patients with AF. We recruited 1125 consecutive patients with AF who were stable on vitamin K antagonists and followed-up for a median of 6.5 years. ABC-stroke and CHA 2 DS 2 -VASc (cardiac failure or dysfunction, hypertension, age ≥75 [doubled], diabetes mellitus, stroke [doubled]-vascular disease, age 65 to 74 years and sex category [female]) scores were calculated and compared. Median CHA 2 DS 2 -VASc and ABC-stroke scores were 4 (interquartile range 3-5) and 9.1 (interquartile range 7.3-11.3), respectively. There were 114 ischemic strokes (1.55% per year) at 6.5 years. The C-index of ABC-stroke at 3.5 years was significantly higher than CHA 2 DS 2 -VASc (0.663 versus 0.600, P =0.046), but both C-indexes were nonsignificantly different at 6.5 years. Integrated discrimination improvement showed a small improvement (ABC-stroke. For ABC-stroke, net reclassification improvement was nonsignificantly different at 3.5 years, and showed a negative reclassification at 6.5 years compared with CHA 2 DS 2 -VASc. Decision curve analyses did not show a marked improvement in clinical usefulness of the ABC-stroke score over the CHA 2 DS 2 -VASc score. In
Chun, Ho-Yan Yvonne; Whiteley, William N; Dennis, Martin S; Mead, Gillian E; Carson, Alan J
Anxiety after stroke is common and disabling. Stroke trialists have treated anxiety as a homogenous condition, and intervention studies have followed suit, neglecting the different treatment approaches for phobic and generalized anxiety. Using diagnostic psychiatric interviews, we aimed to report the frequency of phobic and generalized anxiety, phobic avoidance, predictors of anxiety, and patient outcomes at 3 months poststroke/transient ischemic attack. We followed prospectively a cohort of new diagnosis of stroke/transient ischemic attack at 3 months with a telephone semistructured psychiatric interview, Fear Questionnaire, modified Rankin Scale, EuroQol-5D5L, and Work and Social Adjustment Scale. Anxiety disorder was common (any anxiety disorder, 38 of 175 [22%]). Phobic disorder was the predominant anxiety subtype: phobic disorder only, 18 of 175 (10%); phobic and generalized anxiety disorder, 13 of 175 (7%); and generalized anxiety disorder only, 7 of 175 (4%). Participants with anxiety disorder reported higher level of phobic avoidance across all situations on the Fear Questionnaire. Younger age (per decade increase in odds ratio, 0.64; 95% confidence interval, 0.45-0.91) and having previous anxiety/depression (odds ratio, 4.38; 95% confidence interval, 1.94-9.89) were predictors for anxiety poststroke/transient ischemic attack. Participants with anxiety disorder were more dependent (modified Rankin Scale score 3-5, [anxiety] 55% versus [no anxiety] 29%; P anxiety] 19.5, 10-27 versus [no anxiety] 0, 0-5; P Anxiety after stroke/transient ischemic attack is predominantly phobic and is associated with poorer patient outcomes. Trials of anxiety intervention in stroke should consider the different treatment approaches needed for phobic and generalized anxiety. © 2018 The Authors.
Huttner, Hagen B; Köhrmann, Martin; Mauer, Christoph; Lücking, Hannes; Kloska, Stephan; Doerfler, Arnd; Schwab, Stefan; Schellinger, Peter D
There is little data on the association of peripheral arterial disease and stroke. We aimed to assess the prevalence of peripheral arterial disease in acute stroke and to identify the predisposing factors for peripheral arterial disease in a stroke cohort. We enrolled all consecutive patients who were admitted to our stroke- and neurocritical care units with the diagnosis of a transient ischaemic attack, ischaemic or haemorrhagic stroke over a period of 5 months. As controls, we analysed 50 nonvascular neurological patients who were matched to age. Upon admission, assessment of the ankle brachial index was performed in all patients. The only exclusion criteria was decompensated congestive heart failure. Altogether, we compared 374 stroke patients (95 transient ischaemic attack, 231 ischaemic, and 48 haemorrhagic strokes) and 50 nonstroke controls. The prevalence of peripheral arterial disease in the control group was 14%. There was a trend towards a higher prevalence of peripheral arterial disease in stroke patients (chi(2)-test: P=0.051; prevalence peripheral arterial disease in transient ischaemic attack: 16.8%, ischaemic stroke: 32%, and haemorrhagic stroke: 20.8%). A higher proportion of ischaemic stroke patients were peripheral arterial disease-positive, compared with transient ischaemic attack patients (P=0.005) and controls (P=0.011), respectively. Multivariate regression analyses identified the parameters age, arterial hypertension, current or former smokers and a history of cardiovascular events to be predisposing factors of peripheral arterial disease. This study represents the first systematic investigation of the prevalence of peripheral arterial disease in stroke. By now, it is clear that: * peripheral arterial disease is more commonly found in stroke than in nonstroke patients * ischaemic stroke patients show the highest prevalence of peripheral arterial disease, and * peripheral arterial disease in stroke is related to common vascular risk factors.
Meyer, Sarah; Verheyden, Geert; Brinkmann, Nadine; Dejaeger, Eddy; De Weerdt, Willy; Feys, Hilde; Gantenbein, Andreas R; Jenni, Walter; Laenen, Annouschka; Lincoln, Nadina; Putman, Koen; Schuback, Birgit; Schupp, Wilfried; Thijs, Vincent; De Wit, Liesbet
Recovery of patients within the first 6 months after stroke is well documented, but there has been little research on long-term recovery. The aim of this study was to analyze functional and motor recovery between admission to rehabilitation centres and 5 years after stroke. This follow-up of the Collaborative Evaluation of Rehabilitation in Stroke Across Europe study, included patients from 4 European rehabilitation centres. Patients were assessed on admission, at 2 and 6 months, and 5 years after stroke, using the Barthel Index, Rivermead Motor Assessment Gross Function, Leg and Trunk function, and Arm function. Linear mixed models were used, corrected for baseline characteristics. To account for the drop-out during follow-up, the analysis is likelihood-based (assumption of missingness at random). A total of 532 patients were included in this study, of which 238 were followed up at 5 years post stroke. Mean age at stroke onset was 69 (±10 SD) years, 53% were men, 84% had ischemic strokes, and 53% had left-sided motor impairment. Linear mixed model analysis revealed a significant deterioration for all 4 outcomes between 6 months and 5 years (Pstroke. Higher age (Pstroke severity on admission (Pstroke severity negatively affected recovery up to 5 years after stroke. © 2015 American Heart Association, Inc.
Full Text Available The deterioration of the balance between direct and indirect ways in the basal ganglia causes chorea. The lesions of contralateral basal ganglia, thalamus or the connection of them all together are responsible for this. Chorea can be observed during the course of metabolic and vascular diseases, neurodegenerative or hereditary diseases. Hyperkinetic movement disorders after acute ischemic stroke are reported as rare; however, hemichorea is the most frequent developing disorder of hyperkinetic movement as a result of cerebrovascular disease. In this case report, we presented two case who applied us with choreiform movements in his left half of the body after acute thalamic stroke. [Cukurova Med J 2016; 41(0.100: 29-32
Cigarette smoking is a risk factor for the brain infarction (lacunar and atherothrombotic brain infarction) and subarachnoid hemorrhage. Not only active smoking but also passive smoking and smokeless tobacco products pose a risk. The risk after smoking cessation for 5-10 years is equal to that faced by a non-smoker. Many patients continue smoking even after an attack of stroke; therefore, support measures to enforce nonsmoking are required in this high-risk population. We offer nonsmoking support using the 5A approach, and assess the nonsmoking stage (precontemplation, contemplation, preparation, action, and maintenance). We also administer medical therapy for smoking cessation when the patients find it difficult to quit smoking on their own accord. Nicotine dependency needs a follow-up like that required for other risk factors in the primary and secondary prevention of the stroke because smoking is a chronic disease that tends to recur.
In this study detrusor hyperreflexia was investigated by urodynamic study during the acute phase of stroke in patients who became incontinent after a cerebrovascular accident. Urodynamic studies reveal physiopathological findings of incontinence while the acute period of cerebrovascular accident do not cover neurogenic bladder features. In our study it was observed that most of the patients (60%) had normal bladder functions and detrusor hyperreflexia was a rare rindings. This res...
Introduction: The subacute and long-term assessment and management of patients who have suffered a stroke includes physical therapy and testing to determine the precise etiology of the event so as to prevent recurrence. The acute management differs. Immediate goals include minimizing brain injury, treating medical complications, and moving toward uncovering the pathophysiologic basis of the patient's symptoms. Methods: This is a review paper that report up to date finding with review some...
Іванна Михайлівна Мельнічек
Full Text Available The aim of the work. The aim of the work is an assessment of informativeness of several clinical and paraclinical predictors in prognostics of the results of effectiveness of thrombolytic therapy at the most acute period of ishemic stroke with the further definition of the most significant ones for achieving the least neurologic deficiency.Methods of research: There were retrospectively considered 61 patients 60,5±7,8 years old with ishemic stroket who sucsessfully underwent thrombolytic therapy as an intravenous administration of Actilyse. These patients demonstrated the next factors of gemostasis: prothrombin time, prothrombin index, fibrinogen. For the research there were also used the scales of neurological deficiency activisation (Rankin and NIHSS; ultrasound of the magistral arteries and extracranial CT of brain; methods of mathematical statistics (the definition of chances and confidence intervals ratio, Pirson and Student criteria, verification of hypothesis about the law of distribution and equality of the mean values in the both samplings.Results. There were defined the most informative factors in prognostication of the good result after thrombolytic therapy. There was formed the list of output factors that the results of actilyse thrombolytic therapy effectiveness in Lviv region are depending on. There was grounded the necessity of laboratory data monitoring in patients with stroke for receiving the best results of thrombolytic therapy.There was established that thrombolytic therapy of ishemic stroke must begin as early as possible (in computed tomography department if possible for receiving the maximal effectiveness. There was detected that ultrasound of magistral vessels that supply brain with blood is necessary for all patients who are candidates for thrombolytic therapy because the stenosis of the vessel lumen more than 60 % significantly worsens an effectiveness of treatment
Bernhardt, Julie; Godecke, Erin; Johnson, Liam; Langhorne, Peter
Early rehabilitation is recommended in many guidelines, with limited evidence to guide practice. Brain neurobiology suggests that early training, at the right dose, will aid recovery. In this review, we highlight recent trials of early mobilization, aphasia, dysphagia and upper limb treatment in which intervention is commenced within 7 days of stroke and discuss future research directions. Trials in this early time window are few. Although the seminal AVERT trial suggests that a cautious approach is necessary immediately (stroke, early mobility training and mobilization appear well tolerated, with few reasons to delay initiating some rehabilitation within the first week. The results of large clinical trials of early aphasia therapy are on the horizon, and examples of targeted upper limb treatments with better patient selection are emerging. Early rehabilitation trials are complex, particularly those that intervene across acute and rehabilitation care settings, but these trials are important if we are to optimize recovery potential in the critical window for repair. Concerted efforts to standardize 'early' recruitment, appropriately stratify participants and implement longer term follow-up is needed. Trial standards are improving. New recommendations from a recent Stroke Recovery and Rehabilitation Roundtable will help drive new research.
Bergh, Cecilia; Udumyan, Ruzan; Appelros, Peter; Fall, Katja; Montgomery, Scott
Physical and psychological characteristics in adolescence are associated with subsequent stroke risk. Our aim is to investigate their relevance to length of hospital stay and risk of second stroke. Swedish men born between 1952 and 1956 (n=237 879) were followed from 1987 to 2010 using information from population-based national registers. Stress resilience, body mass index, cognitive function, physical fitness, and blood pressure were measured at compulsory military conscription examinations in late adolescence. Joint Cox proportional hazards models estimated the associations of these characteristics with long compared with short duration of stroke-related hospital stay and with second stroke compared with first. Some 3000 men were diagnosed with nonfatal stroke between ages 31 and 58 years. Low stress resilience, underweight, and higher systolic blood pressure (per 1-mm Hg increase) during adolescence were associated with longer hospital stay (compared with shorter) in ischemic stroke, with adjusted relative hazard ratios (and 95% confidence intervals) of 1.46 (1.08-1.89), 1.41 (1.04-1.91), and 1.01 (1.00-1.02), respectively. Elevated systolic and diastolic blood pressures during adolescence were associated with longer hospital stay in men with intracerebral hemorrhage: 1.01 (1.00-1.03) and 1.02 (1.00-1.04), respectively. Among both stroke types, obesity in adolescence conferred an increased risk of second stroke: 2.06 (1.21-3.45). Some characteristics relevant to length of stroke-related hospital stay and risk of second stroke are already present in adolescence. Early lifestyle influences are of importance not only to stroke risk by middle age but also to recurrence and use of healthcare resources among stroke survivors. © 2016 American Heart Association, Inc.
Lombardi, David A; Wirtz, Anna; Willetts, Joanna L; Folkard, Simon
Fatigue has been linked to adverse safety outcomes, and poor quality or decreased sleep has been associated with obesity (higher body mass index, BMI). Additionally, higher BMI is related to an increased risk for injury; however, it is unclear whether BMI modifies the effect of short sleep or has an independent effect on work-related injury risk. To answer this question, the authors examined the risk of a work-related injury as a function of total daily sleep time and BMI using the US National Health Interview Survey (NHIS). The NHIS is an in-person household survey using a multistage, stratified, clustered sample design representing the US civilian population. Data were pooled for the 7-yr survey period from 2004 to 2010 for 101 891 "employed" adult subjects (51.7%; 41.1 ± yrs of age [mean ± SEM]) with data on both sleep and BMI. Weighted annualized work-related injury rates were estimated across a priori defined categories of BMI: healthy weight (BMI: risk of a work-related injury. The initial model examined the interaction among daily sleep duration and BMI, controlling for weekly working hours, age, sex, race/ethnicity, education, type of pay, industry, and occupation. No significant interaction was found between usual daily sleep duration and BMI (p = .72); thus, the interaction term of the final logistic model included these two variables as independent predictors of injury, along with the aforementioned covariates. Statistically significant covariates (p ≤ .05) included age, sex, weekly work hours, occupation, and if the worker was paid hourly. The lowest categories of usual sleep duration (risks than the referent category (7-8 h sleep), whereas sleeping >7-8 h did not significantly elevate risk. The adjusted injury risk odds ratio (OR) for a worker with a usual daily sleep of risk OR comparing workers who were obese (BMI: ≥30) to healthy weight workers (BMI: risk in comparing overweight workers (BMI: 25-29.99) to healthy weight risk was
Olsen, Tom Skyhøj
Blood glucose is often elevated in acute stroke, and higher admission glucose levels are associated with larger lesions, greater mortality and poorer functional outcome. In patients treated with thrombolysis, hyperglycemia is associated with an increased risk of hemorrhagic transformation...... to the risk of inducing potentially harmful hypoglycemia has been raised. Still, basic and observational research is overwhelmingly in support of a causal relationship between blood glucose and stroke outcome and further research on glucose-lowering therapy in acute stroke is highly warranted....
Wintermark, Max; Albers, Gregory W.; Alexandrov, Andrei V.; Alger, Jeffry R.; Bammer, Roland; Baron, Jean-Claude; Davis, Stephen; Demaerschalk, Bart M.; Derdeyn, Colin P.; Donnan, Geoffrey A.; Eastwood, James D.; Fiebach, Jochen B.; Fisher, Marc; Furie, Karen L.; Goldmakher, Gregory V.
The recent “Advanced Neuroimaging for Acute Stroke Treatment” meeting on September 7 and 8, 2007 in Washington DC, brought together stroke neurologists, neuroradiologists, emergency physicians, neuroimaging research scientists, members of the National Institute of Neurological Disorders and Stroke (NINDS), the National Institute of Biomedical Imaging and Bioengineering (NIBIB), industry representatives, and members of the US Food and Drug Administration (FDA) to discuss the role of advanced n...
Egan, Mary Y; Kessler, Dorothy; Ceci, Christine; Laliberté-Rudman, Debbie; McGrath, Colleen; Sikora, Lindsey; Gardner, Paula
Following stroke, re-engagement in personally valued activities requires some experience of risk. Risk, therefore, must be seen as having positive as well as negative aspects in rehabilitation. Our aim was to identify the dominant understanding of risk in stroke rehabilitation and the assumptions underpinning these understandings, determine how these understandings affect research and practise, and if necessary, propose alternate ways to conceptualise risk in research and practise. Alvesson and Sandberg's method of problematisation was used. We began with a historical overview of stroke rehabilitation, and proceeded through five steps undertaken in an iterative fashion: literature search and selection; data extraction; syntheses across texts; identification of assumptions informing the literature and; generation of alternatives. Discussion of risk in stroke rehabilitation is largely implicit. However, two prominent conceptualisations of risk underpin both knowledge development and clinical practise: the risk to the individual stroke survivor of remaining dependent in activities of daily living and the risk that the health care system will be overwhelmed by the costs of providing stroke rehabilitation. Conceptualisation of risk in stroke rehabilitation, while implicit, drives both research and practise in ways that reinforce a focus on impairment and a generic, decontextualised approach to rehabilitation. Implications for rehabilitation Much of stroke rehabilitation practise and research seems to centre implicitly on two risks: risk to the patient of remaining dependent in ADL and risk to the health care system of bankruptcy due to the provision of stroke rehabilitation. The implicit focus on ADL dependence limits the ability of clinicians and researchers to address other goals supportive of a good life following stroke. The implicit focus on financial risk to the health care system may limit access to rehabilitation for people who have experienced either milder or
Rane, M. V.; Uphade, D. B.
Novel Long Stroke Reciprocating Compressor is analysed for jaggery making while avoiding burning of bagasse for concentrating juice. Heat of evaporated water vapour along with small compressor work is recycled to enable boiling of juice. Condensate formed during heating of juice is pure water, as oil-less compressor is used. Superheat of compressor is suppressed by flow of superheated vapours through condensate. It limits heating surface temperature and avoids caramelization of sugar. Thereby improves quality of jaggery and eliminates need to use chemicals for colour improvement. Stroke to bore ratio is 0.6 to 1.2 in conventional reciprocating drives. Long stroke in reciprocating compressors enhances heat dissipation to surrounding by providing large surface area and increases isentropic efficiency by reducing compressor outlet temperature. Longer stroke increases inlet and exit valve operation timings, which reduces inertial effects substantially. Thereby allowing use of sturdier valves. This enables handling liquid along with vapour in compressors. Thereby supressing the superheat and reducing compressor power input. Longer stroke increases stroke to clearance ratios which increases volumetric efficiency and ability of compressor to compress through higher pressure ratios efficiently. Stress-strain simulation is performed in SolidWorks for gear drive. Long Stroke Reciprocating Compressor is developed at Heat Pump Laboratory, stroke/bore 292 mm/32 mm. It is operated and tested successfully at different speeds for operational stability of components. Theoretical volumetric efficiency is 93.9% at pressure ratio 2.0. Specific energy consumption is 108.3 kWhe/m3 separated water, considering free run power.
Kumar, Rohit; Suri, J C; Manocha, Rajesh
Sleep disordered breathing (SDB) is a prevalent yet underrecognized condition that may have major adverse consequences for those affected by it. We performed a prospective observational study to seek a correlation of severity of SDB with the severity of stroke and its functional outcome. Patients with history of recent-onset stroke were recruited and underwent overnight polysomnography (PSG) after the acute phase of the stroke was over; for defining hypopneas, 3% and 4% desaturation limits were used, and the apnea-hypopnea index was respectively calculated as AHI 3% and AHI 4% . Stroke severity was graded using the Scandinavian Stroke Scale. Functional disability and neurological impairment was evaluated six weeks after the PSG using the Barthel Index (2 = poor outcome; ≤2 = good outcome). A total of 50 patients were enrolled, 30 (60%) with ischemic stroke and 20 (40%) with hemorrhagic strokes. Of the patients, 39 (78%) had an AHI 4% of >5/h, 23 (46%) had an AHI 4% of >15/h, and 9 (18%) had an AHI 4% of >30/h. Multivariate analysis showed that body mass index (odds ratio [OR] = 1.26; 95% confidence interval [CI] = 1.04-1.54, p = 0.019) and Scandinavian Stroke Scale score (stroke severity) (OR = 0.86; 95% CI = 0.76-0.96, p = 0.009) were significant risk factors for predicting SDB (AHI 4% > 15) in patients of stroke. When we looked for factors predicting outcomes, only AHI 4% (OR = 1.20; 95% CI 1.01-1.43, p value 0.041) was predictive of the functional dependence (based on Barthel Index) of the patient and AHI 4% (OR = 1.14; 95% CI 1.03-1.25, p = 0.008) and body mass index (OR = 0.75; 95% CI 0.59-0.96, p = 0.024) were found to be predictive of poor outcome (based on modified Rankins Scale). We obtained similar results, regardless of the hypopnea definition used. In conclusion, given the high frequency of SDB in stroke patients and its correlation with poor outcome, screening for obstructive sleep apnea in all stroke and transient
Tibaek, S.; Dehlendorff, Christian
Objective – To determine the content and face validity of the Danish Prostate Symptom Score (DAN-PSS-1) questionnaire in stroke patients. Materials and methods – Content validity was judged among an expert panel in neuro-urology. The judgement was measured by the content validity index (CVI). Face...... validity was indicated in a clinical sample of 482 stroke patients in a hospital-based, cross-sectional survey. Results – I-CVI was rated >0.78 (range 0.94–1.00) for 75% of symptom and bother items corresponding to adequate content validity. The expert panel rated the entire DAN-PSS-1 questionnaire highly...... questionnaire appears to be content and face valid for measuring lower urinary tract symptoms after stroke....
Deng, Xiaotie; Zhang, Jie
The aim of this work is to explore the properties of the terminal Wiener index, which was recently proposed by Gutman et al. (2004) , and to show the fact that there exist pairs of trees and chemical trees which cannot be distinguished by using it. We give some general methods for constructing...... equiseparable pairs and compare the methods with the case for the Wiener index. More specifically, we show that the terminal Wiener index is degenerate to some extent....
National Stroke Association’s Guide to Choosing Stroke Rehabilitation Services Rehabilitation, often referred to as rehab, is an important part of stroke recovery. Through rehab, you: Re-learn basic skills such ...
... the brain. The other kind of stroke, called hemorrhagic stroke, is caused by a blood vessel that breaks ... are very common among African Americans. The best treatment for stroke is prevention. You can reduce your ...
Full Text Available Intracranial tumors may rarely cause stroke. We report an epidermoid cyst causing stroke in a pediatric patient. We have also reviewed the literature and pathogenesis of stroke caused by intracranial tumors.
... Cardiovascular Conditions What Are the Warning Signs of Stroke? Brain tissue affected by blockage Stroke is the fifth leading cause of death in ... over 55 years old have more chance of stroke, and the risk gets greater as you get ...
Demographic, health-related, and work-related factors associated with body mass index and body fat percentage among workers at six Connecticut manufacturing companies across different age groups: a cohort study.
Garza, Jennifer L; Dugan, Alicia G; Faghri, Pouran D; Gorin, Amy A; Huedo-Medina, Tania B; Kenny, Anne M; Cherniack, Martin G; Cavallari, Jennifer M
Effective workplace interventions that consider the multifactorial nature of obesity are needed to reduce and prevent obesity among adults. Furthermore, the factors associated with obesity may differ for workers across age groups. Therefore, the objective of this study was to identify demographic, health-related, and work-related factors associated with baseline and changes in body mass index (BMI) and body fat percentage (BFP) and among Connecticut manufacturing workers acrossage groups. BMI and BFPof 758 workers from six Connecticut manufacturing companies were objectively measuredat two time points approximately 36 months apart. Demographic, health-related, and work-related factors wereassessed via questionnaire. All variables were included in linear regression models to identify factors associated with baseline and changes in BMI and BFP for workers in 3 age groups: 55 years (28 %). There were differences in baseline and changes in BMI and BFP among manufacturing workers across age groups. Being interested in changing weight was significantly (p age categories. Other factors associated with higher baseline BMI and BFP differed by age group and included: male gender (BMI p = 0.04), female gender (BFP p age category, male gender (BMI p = 0.02), female gender (BFP p age category, and female gender (BFP p 55 year age category. Few factors were associated with change in BMI or BFP across any age category. Among manufacturing workers, we identified associations between individual, health-related, and work-related factors and baseline BMIand BFP that differed by age. Such results support the use of strategies tailored to the challenges faced by workers in specific age groups rather than adopting a one size fits all approach. Effective interventions should consider a full range of individual, health-related, and work-related factors. More work must be done to identify factors or strategies associated with changes in obesity over time.