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A scoping review of patient and public involvement in empirical stroke research. 卒中实证研究中患者和公众参与 (PPI) 的范围审查。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-31 DOI: 10.1177/17474930241262638
Paula da Cruz Peniche, Christina Danielli Coelho de Morais Faria, Patricia Hall, Caitriona Fingleton, Louise McPhillips, Rebecca Gaetz, Aaron Roche, Laura McCann, Padraig O'Beaglaoich, Diarmuid Murphy, Julianne Hickey, Olive Lennon

Background: Impactful, evidence-based solutions in surveillance, prevention, acute care, and rehabilitation for stroke survivors are required to address the high global burden of stroke. Patient and public involvement (PPI), where patients, their families, and the public are actively involved as research partners, enhances the relevance, credibility, and impact of stroke-related research.

Aims: This scoping review, adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Scoping Review guidelines, aims to identify and summarize how PPI is currently implemented and reported in empirical stroke research using a participatory approach.

Summary of review: A comprehensive search strategy was developed and implemented across Medline, CINAHL, EMBASE, PsynchINFO, and Cochrane electronic databases, supplemented by gray literature searches. Empirical stroke research articles in the English language, published from 2014 up to 2023, and documenting PPI activity were included. Of the 18,143 original articles identified, 2824 full-text manuscripts matching from this time window were screened. Only 2% (n = 72) of these directly reported embedded PPI activity in empirical research. The majority were qualitative in design (60%) and conducted in high-income countries (96%). Only one included study originated from a developing country, where the burden of stroke is highest. Most studies (94%) provided some information about the activities carried out with their PPI partners, mainly centered on the study design (57%) and management (64%), with only 4% of studies integrating PPI across all research cycle phases from funding application to dissemination. When studies were examined for compliance with the Guidance for Reporting Involvement of Patients and the Public (GRIPP) short-form checklist, only 11% of included studies were 100% compliant. Twenty-one studies (29%) reported barriers and facilitators to including PPI in stroke research. Organization, authentic partnership, and experienced PPI representatives were common facilitators and identified barriers reflected concerns around adequate funding, time required, and diversity in perspectives. A positive reporting bias for PPI impact was observed, summarized as keeping the patient perspective central to the research process, improved care of study participants, validation of study findings, and improved communication/lay-summaries of complex research concepts.

Conclusions: PPI is underutilized and inconsistently reported in current empirical stroke research. PPI must become more widely adopted, notably in low- and middle-income countries. Consensus-driven standards for inclusion of PPI by funding organizations and publishers are required to support its widespread adoption.

背景:要解决中风给全球带来的沉重负担,需要在监测、预防、急性期治疗和康复方面为中 风幸存者提供有影响力的循证解决方案。患者和公众参与(Patient and Public Involvement,PPI),即患者、患者家属和公众作为研究伙伴积极参与,可提高中风相关研究的相关性、可信度和影响力。目的:本范围界定综述遵循 PRISMA 范围界定综述指南,旨在确定和总结目前在实证中风研究中如何使用参与式方法实施和报告 PPI:制定并实施了全面的检索策略,涵盖 Medline、CINAHL、EMBASE、PsynchINFO 和 Cochrane 电子数据库,并辅以灰色文献检索。纳入了从 2014 年到 2023 年发表的、记录 PPI 活动的英文脑卒中实证研究论文。在确定的 18,143 篇原始论文中,筛选了 2,824 篇与该时间窗口匹配的全文手稿。其中只有 2%(n=72)直接报告了实证研究中的嵌入式 PPI 活动。大多数研究采用定性设计(60%),在高收入国家进行(96%)。只有一项纳入的研究来自中风负担最重的发展中国家。大多数研究(94%)提供了一些有关与其 PPI 合作伙伴开展活动的信息,主要集中在研究设计(57%)和管理(64%)方面,只有 4% 的研究将 PPI 纳入了从资金申请到传播的所有研究周期阶段。在检查研究是否符合《患者和公众参与报告指南》(GRIPP2)简表清单时,只有 11% 的纳入研究 100%符合要求。21项研究(29%)报告了将患者和公众参与纳入卒中研究的障碍和促进因素。组织、真实的合作关系和经验丰富的 PPI 代表是常见的促进因素,已确定的障碍反映了对充足资金、所需时间和观点多样性的担忧。研究发现,PPI 的影响存在积极的报告偏差,概括为将患者视角置于研究过程的中心位置、改善对研究参与者的护理、验证研究结果以及改善复杂研究概念的沟通/非专业总结:结论:在目前的卒中实证研究中,PPI 未得到充分利用,报告也不一致。必须更广泛地采用 PPI,尤其是在中低收入国家。为支持 PPI 的广泛采用,资助机构和出版商需要制定以共识为导向的 PPI 纳入标准。
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引用次数: 0
Tea and coffee consumption and risk of acute stroke: The INTERSTROKE Study. 茶和咖啡的饮用量与急性中风风险:INTERSTROKE 研究。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-07-31 DOI: 10.1177/17474930241264685
Andrew Smyth, Graeme J Hankey, Peter Langhorne, Catriona Reddin, Danuta Ryglewicz, Annika Rosengren, Dennis Xavier, Michelle Canavan, Shahram Oveisgharan, Xingyu Wang, Patricio Lopez Jaramillo, Albertino Damasceno, Anna Czlonkowska, Helle Klingenberg Iversen, Fernando Lanas, Salim Yusuf, Martin O'Donnell

Background: Stroke is a leading global cause of death and disability. Daily tea/coffee intake is consumed by > 50% of populations and may represent an important population-level exposure. Therefore, it is first essential that we better understand the associations between the tea/coffee intake and stroke.

Aims: This research aims to generate hypotheses about the global associations between tea and coffee intake and stroke. These insights will identify interventions for stroke prevention that can be further explored using alternative study designs.

Methods: INTERSTROKE is a large international matched case-control study of first stroke from 32 countries. Participants were asked "how many cups do you drink each day?" of coffee, green tea, black tea, and other tea. Multivariable conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for associations between intake and stroke.

Results: We included 13,462 cases and 13,488 controls from INTERSTROKE; mean age was 61.7 (13.4) years and 59.6% (n = 16,010) were male. Overall, 19.4% (n = 5239) did not consume tea/coffee, 47.0% (n = 12,666) consumed tea only, 14.9% (n = 4024) consumed coffee alone, and 18.6% (n = 5021) consumed both, with significant regional variations. After multivariable adjustment, there was no association between low/moderate coffee intake and stroke, but high consumption (> 4/day) was associated with higher odds of all stroke (OR = 1.37 (95% CI = 1.06-1.77)) or ischemic stroke (OR = 1.32 (95% CI = 1.00-1.74)). Tea consumption was associated with lower odds of all (OR = 0.81 (95% CI = 0.69-0.94) for highest intake) or ischemic stroke (OR = 0.81 (95% CI = 0.68-0.98) for highest intake).

Conclusions: High coffee consumption was associated with higher odds of all or ischemic stroke; low-moderate coffee had no association with stroke. In contrast, tea consumption was associated with lower odds of stroke. These associations suggest that individuals consider avoiding high coffee consumption (⩾ five cups/day) to impact future stroke risk.

Data access statement: The design and rationale of INTERSTROKE was published previously. Individual participant data, or other documents are not available.

背景:中风是导致死亡和残疾的全球主要原因。每日摄入茶/咖啡的人群超过 50%,可能是重要的人群暴露。因此,我们首先必须更好地了解茶/咖啡摄入量与中风之间的关联。目的:本研究旨在就茶和咖啡摄入量与中风之间的全球关联提出假设。这些见解将确定预防中风的干预措施,可通过其他研究设计进一步探讨:INTERSTROKE是一项针对32个国家首次中风患者的大型国际匹配病例对照研究。参与者被问及 "您每天喝多少杯咖啡、绿茶、红茶和其他茶?研究采用多变量条件逻辑回归法估算摄入量与中风之间关系的几率比(OR)和 95% 置信区间(CI):我们纳入了来自 INTERSTROKE 的 13,462 例病例和 13,488 例对照;平均年龄为 61.7 (13.4) 岁,59.6%(n=16,010)为男性。总体而言,19.4%(n=5239)的人不喝茶/咖啡,47.0%(n=12666)的人只喝茶,14.9%(n=4024)的人只喝咖啡,18.6%(n=5021)的人既喝茶又喝咖啡,地区差异显著。经多变量调整后,低度/中度咖啡摄入量与中风之间没有关联,但高摄入量(>4/天)与较高的所有中风(OR 1.37 (95%CI 1.06-1.77))或缺血性中风(OR 1.32 (95%CI 1.00-1.74))几率有关。结论:大量饮用咖啡与所有中风(最高摄入量的 OR 为 0.81(95% CI 为 0.69-0.94))或缺血性中风(最高摄入量的 OR 为 0.81(95% CI 为 0.68-0.98))的几率较低有关:结论:大量饮用咖啡与较高的全部或缺血性中风几率有关;中低浓度咖啡与中风无关。相比之下,饮茶与中风的几率较低有关。这些关联表明,个人应考虑避免饮用大量咖啡(>=5 杯/天),以影响未来的中风风险:INTERSTROKE的设计和原理已于之前公布。未提供单个参与者数据或其他文件。
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引用次数: 0
Exercise to prevent stroke and dementia-World Stroke Day 2024. 运动预防中风和痴呆--2024 年世界中风日。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-10-01 Epub Date: 2024-10-09 DOI: 10.1177/17474930241291618
Hugh S Markus
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引用次数: 0
Clusters of parental socioeconomic status in early childhood and inherited risk for cerebrovascular disease until mid-life-Northern Finland Birth Cohort 1966. 幼儿期父母的社会经济地位与中年前脑血管疾病的遗传风险集群 - 1966 年芬兰北部出生队列。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-30 DOI: 10.1177/17474930241282521
Veronika Hyytiäinen, Leena Ala-Mursula, Petteri Oura, Markus Paananen, Ville Karhunen, Harri Rusanen, Mirjam I Geerlings, Jouko Miettunen, Ina Rissanen

Background and aims: The incidence of cerebrovascular disease (CVD) is rising among young adults (< 55 years). The risk for CVD starts to form in early childhood and is comprised of genetic and environmental risk factors. The aim of this study is to investigate the relationship between early family socioeconomic status (SES), inherited risk, and CVD until midlife.

Methods: In the Northern Finland Birth Cohort 1966 of 12,058 children, individuals were followed from gestational period up to 54 years. We used previously published early family SES clusters, based on latent class analysis of a wide set of prenatally collected variables. We investigated inherited risk with polygenic risk score (PRS) and parental CVDs during follow-up. The associations of the five distinct clusters, inherited risk, and consequent risk for various types of CVDs until middle age were analyzed with Cox regression. All analyses were conducted first in the whole sample and then stratified by sex as is recommended in cardiovascular studies.

Results: During the follow-up of 586,943 person-years, 512 CVDs occurred. No clear association between SES clusters and CVD were found. Higher PRS associated with any CVD (hazard ratio (HR) per 1 SD increase: 1.15; 95% confidence interval (CI): 1.02-1.31), and ischemic CVD (HR: 1.21; 1.05-1.40). We found no combined associations of early family SES and inherited risk for CVD.

Conclusions: Inherited risk was associated with the risk for CVD in mid-life in Finnish population. We found no clear connection with early family SES and CVD. Being born to a specific SES group did not increase the effect of inherited risk.

Data access statement: NFBC1966 data are available from the University of Oulu, Infrastructure for Population Studies for researchers who meet the criteria for accessing confidential data. In the use of data, we follow the EU general data protection regulation (679/2016) and Finnish Data Protection Act. Permission to use the data can be applied for research purposes from https://www.oulu.fi/nfbc.

背景和目的:脑血管疾病(CVD)的发病率在年轻成年人中呈上升趋势(方法:在 1966 年芬兰北部出生队列(Northern Finland Birth Cohort)的 12,058 名儿童中,我们对个体进行了从妊娠期到 54 岁的跟踪调查。我们使用了之前公布的早期家庭经济和社会地位群组,该群组基于对产前收集的大量变量进行的潜类分析。我们利用多基因风险评分(PRS)和随访期间的父母心血管疾病调查了遗传风险。我们利用 Cox 回归分析了五个不同群组、遗传风险和中年前各类心血管疾病的相应风险之间的关联。所有分析首先在整个样本中进行,然后按照心血管研究的建议按性别进行分层:结果:在 586 943 人年的随访期间,共发生了 512 起心血管疾病。在 SES 群组与心血管疾病之间没有发现明显的关联。较高的 PRS 与任何心血管疾病有关(HR 每增加 1 SD 为 1.15;95%CI 为 1.02-1.31),与缺血性心血管疾病有关(HR 为 1.21;1.05-1.40)。我们没有发现早期家庭社会经济地位与心血管疾病遗传风险的综合关联:结论:在芬兰人口中,遗传风险与中年心血管疾病风险有关。我们没有发现早期家庭经济状况与心血管疾病之间有明显的联系。出生在特定的社会经济地位群体并不会增加遗传风险的影响。
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引用次数: 0
The association between social networks and functional recovery after stroke. 中风后社交网络与功能恢复之间的关联。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-23 DOI: 10.1177/17474930241283167
Lauri Bishop, Scott C Brown, Hannah E Gardener, Antonio J Bustillo, D Akeim George, Gillian Gordon Perue, Karlon H Johnson, Neva Kirk-Sanchez, Negar Asdaghi, Carolina M Gutierrez, Tatjana Rundek, Jose G Romano

Background and purpose: Social determinants of health (SDOH), including social networks, impact disability and quality of life post-stroke, yet the direct influence of SDOH on functional change remains undetermined. We aimed to identify which SDOH predict change on the modified Rankin Scale (mRS) within 90 days after stroke hospitalization.

Methods: Stroke patients from the Transitions of Care Stroke Disparities Study (TCSDS) were enrolled from 12 hospitals in the Florida Stroke Registry. TCSDS aims to identify disparities in hospital-to-home transitions after stroke. SDOH were collected by trained interviewers at hospital discharge. The mRS was assessed at discharge, 30- and 90-day post-stroke. Multinomial logistic regression models examined contributions of each SDOH to mRS improvement or worsening (compared to no change) from discharge to 30- and 90-day, respectively.

Results: Of 1190 participants, median age was 64 years, 42% were women, 52% were non-Hispanic White, and 91% had an ischemic stroke. Those with a limited social support network had greater odds of functional decline at 30 days (aOR = 1.39, 1.17-1.66), adjusting for age and onset to arrival time and at 90 days (aOR = 1.50, 1.10-2.05) after adjusting for age. Results were consistent after further adjustment for additional SDOH and participant characteristics. Individuals living with a spouse/partner had reduced odds of functional decline at 90 days (aOR = 0.74, 0.57-0.98); however, results were inconsistent with more conservative modeling approaches.

Conclusion: The findings highlight the importance of SDOH, specifically having a greater number of individuals in your social network in functional recovery after stroke.

背景和目的:健康的社会决定因素(SDOH),包括社会网络会影响中风后的残疾和生活质量,但 SDOH 对功能变化的直接影响仍未确定。我们旨在确定哪些 SDOH 可预测中风住院后 90 天内修正的 Rankin 量表(mRS)的变化:方法:从佛罗里达州卒中登记处的 12 家医院中招募了来自 "卒中差异过渡护理研究"(TCSDS)的卒中患者。TCSDS 的目的是确定中风后从医院到家庭的转变过程中存在的差异。出院时由训练有素的访问员收集 SDOH。在出院、卒中后 30 天和 90 天时对 mRS 进行评估。多叉逻辑回归模型检验了从出院到 30 天和 90 天期间,每项 SDOH 对 mRS 改善或恶化(与无变化相比)的影响:在 1190 名参与者中,中位年龄为 64 岁,42% 为女性,52% 为非西班牙裔白人,91% 为缺血性中风患者。社会支持网络有限者在 30 天后功能下降的几率更大(aOR = 1.39,1.17-1.66),调整年龄和发病至到达时间后,在 90 天后功能下降的几率更大(aOR = 1.50,1.10-2.05)。在进一步调整其他 SDOH 和参与者特征后,结果一致。与配偶/伴侣同住的人在90天后功能衰退的几率降低(aOR = 0.74, 0.57-0.98);然而,更保守的建模方法得出的结果并不一致:研究结果强调了 SDOH 的重要性,特别是在中风后的功能恢复过程中拥有更多的社会网络。
{"title":"The association between social networks and functional recovery after stroke.","authors":"Lauri Bishop, Scott C Brown, Hannah E Gardener, Antonio J Bustillo, D Akeim George, Gillian Gordon Perue, Karlon H Johnson, Neva Kirk-Sanchez, Negar Asdaghi, Carolina M Gutierrez, Tatjana Rundek, Jose G Romano","doi":"10.1177/17474930241283167","DOIUrl":"10.1177/17474930241283167","url":null,"abstract":"<p><strong>Background and purpose: </strong>Social determinants of health (SDOH), including social networks, impact disability and quality of life post-stroke, yet the direct influence of SDOH on functional change remains undetermined. We aimed to identify which SDOH predict change on the modified Rankin Scale (mRS) within 90 days after stroke hospitalization.</p><p><strong>Methods: </strong>Stroke patients from the Transitions of Care Stroke Disparities Study (TCSDS) were enrolled from 12 hospitals in the Florida Stroke Registry. TCSDS aims to identify disparities in hospital-to-home transitions after stroke. SDOH were collected by trained interviewers at hospital discharge. The mRS was assessed at discharge, 30- and 90-day post-stroke. Multinomial logistic regression models examined contributions of each SDOH to mRS improvement or worsening (compared to no change) from discharge to 30- and 90-day, respectively.</p><p><strong>Results: </strong>Of 1190 participants, median age was 64 years, 42% were women, 52% were non-Hispanic White, and 91% had an ischemic stroke. Those with a limited social support network had greater odds of functional decline at 30 days (aOR = 1.39, 1.17-1.66), adjusting for age and onset to arrival time and at 90 days (aOR = 1.50, 1.10-2.05) after adjusting for age. Results were consistent after further adjustment for additional SDOH and participant characteristics. Individuals living with a spouse/partner had reduced odds of functional decline at 90 days (aOR = 0.74, 0.57-0.98); however, results were inconsistent with more conservative modeling approaches.</p><p><strong>Conclusion: </strong>The findings highlight the importance of SDOH, specifically having a greater number of individuals in your social network in functional recovery after stroke.</p>","PeriodicalId":14442,"journal":{"name":"International Journal of Stroke","volume":" ","pages":"17474930241283167"},"PeriodicalIF":6.3,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Recurrent ischemic stroke/transient ischemic attack after patent foramen ovale closure: A cohort study. 卵圆孔闭合术后复发性缺血性中风/短暂性脑缺血发作:一项队列研究。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-20 DOI: 10.1177/17474930241281120
Henrik Sørensen, Erik L Grove, Johanne Andersen Hojbjerg, Asger Andersen, Jens Erik Nielsen-Kudsk, Claus Z Simonsen

Background: Patent foramen ovale (PFO) has been associated with ischemic stroke and transient ischemic attack (TIA). Guidelines recommend PFO closure for stroke prevention in selected patients, but the risk of recurrent stroke remains high compared to the background population. We aimed to evaluate the causes of recurrent stroke/TIA and post-interventional complications in patients after PFO closure.

Methods: Patients from the Central Denmark Region who underwent PFO closure at Aarhus University Hospital between November 5, 2018, and May 12, 2023, following an ischemic stroke, TIA, amaurosis fugax, or retinal emboli were included. Data on patient demographics, risk factors, procedural details, post-interventional complications, and recurrent stroke/TIA were collected from electronic medical records.

Results: PFO closure was performed in 310 patients (median age: 49 years). During a median follow-up of 2.6 years (interquartile range: 1.5-3.6, 814 total patient-years), recurrent stroke/TIA was observed in 8 patients (2.6%), or 0.98 recurrent strokes per 100 patient-years. Recurrent stroke/TIA was more frequent in patients with hypertension (50.0% vs. 16.9%, p = 0.039). Recurrent stroke/TIA was related to thrombophilia or hematologic conditions entailing hypercoagulability in 62.5% of patients. New-onset atrial fibrillation was observed in 9.4% of patients within 45 days after the procedure. None of these patients subsequently developed an ischemic event. Other adverse outcomes were uncommon.

Conclusion: Rates of recurrent ischemic stroke/TIA after PFO closure were comparable to findings in previous trials. Pre-existing vascular risk factors (hypertension), and a hypercoagulable state were associated with recurrent ischemic stroke/TIA.

背景:卵圆孔未闭(PFO)与缺血性中风和短暂性脑缺血发作(TIA)有关。指南建议对特定患者进行 PFO 关闭以预防中风,但与背景人群相比,复发中风的风险仍然很高。我们的目的是评估 PFO 关闭术后患者复发中风/TIA 的原因和介入治疗后的并发症:纳入了丹麦中部地区在2018年11月5日至2023年5月12日期间在奥胡斯大学医院接受PFO闭合术的缺血性中风、TIA、昏厥或视网膜栓塞患者。从电子病历中收集了有关患者人口统计学、风险因素、手术细节、介入后并发症和复发中风/TIA的数据:310名患者(中位年龄:49岁)接受了PFO闭合术。中位随访 2.6 年(四分位间范围:1.5-3.6,患者总年数为 814 年),发现 8 例患者(2.6%)复发中风/TIA,即每 100 患者年复发中风 0.98 例。高血压患者中复发性卒中/TIA 的发生率更高(50.0% vs 16.9%,p = 0.039)。62.5%的患者的复发性中风/TIA 与血栓性疾病或导致高凝状态的血液病有关。术后 45 天内,9.4% 的患者出现新发心房颤动。这些患者随后均未发生缺血性事件。其他不良后果并不常见:结论:PFO闭合术后缺血性中风/TIA复发率与之前的试验结果相当。已有的血管风险因素(高血压)和高凝状态与缺血性中风/TIA复发有关。
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引用次数: 0
Sex, Gender, and Stroke Recovery: Functional Limitations and Inpatient Care Needs in Canadian and European Survivors. 性、性别与中风康复:加拿大和欧洲幸存者的功能限制和住院护理需求。
IF 6.7 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-18 DOI: 10.1177/17474930241288033
Yusheng Zhou,Teresa Gisinger,Simon D Lindner,Valeria Raparelli,Colleen M Norris,Alexandra Kautzky-Willer,Louise Pilote
BACKGROUNDStroke is a leading cause of long-term disability among survivors. Past literature already investigated the biological sex differences in stroke outcome, still limited work on gender differences is published. Therefore, the study aimed at investigating whether biological sex and sociocultural gender of survivors play a role as determinants of disability and quality of life among stroke survivors across Europe and Canada.METHODSData were gathered from the European Health Information Survey (EHIS, n=316,333) and Canadian Community Health Survey (CCHS, n=127,462) datasets. Main outcomes of interest were disability, assessed through evaluating the impairment of Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (iADL), and inpatient care needs, such as hospitalization or institutionalization. Multivariate logistic regression models were utilized to identify factors independently associated with outcomes. Federated analysis was conducted for cross-country comparisons. Data were adjusted for the country-specific Gender Inequality Index (GII), with higher score corresponding to more gender inequality towards femalesResults: Female survivors showed greater impairments in iADL (OR=1.73, 95% CI 1.53 - 1.96) and ADL (OR=1.25, 95% CI 1.09-1.44), without a corresponding increase in inpatient care needs. Socioeconomic factors such as marital status and income level were significant predictors of disability, with low income and being single/divorced associated with higher risks. The impact of sex was more pronounced in countries with higher GII, indicating the influence of gender inequality on stroke outcomes.INTERPRETATIONThe findings highlight the significant impact of biological sex and gender-related social determinants on post-stroke disability, with female sex and unfavorable socioeconomic conditions being associated with worse outcomes.
背景脑卒中是导致幸存者长期残疾的主要原因。过去的文献已经研究了中风结局中的生理性别差异,但有关性别差异的研究仍然有限。因此,本研究旨在调查欧洲和加拿大中风幸存者的生理性别和社会文化性别是否对残疾和生活质量起决定作用。方法数据收集自欧洲健康信息调查(EHIS,n=316,333)和加拿大社区健康调查(CCHS,n=127,462)数据集。主要研究结果为残疾(通过评估日常生活活动(ADL)和工具性日常生活活动(iADL)的损伤情况进行评估)和住院护理需求(如住院或入住养老院)。多变量逻辑回归模型用于识别与结果独立相关的因素。为了进行跨国比较,我们进行了联合分析。数据根据特定国家的性别不平等指数(GII)进行了调整,得分越高,说明女性遭受的性别不平等越严重:女性幸存者在 iADL(OR=1.73,95% CI 1.53 - 1.96)和 ADL(OR=1.25,95% CI 1.09-1.44)方面的损伤更大,但住院护理需求并未相应增加。婚姻状况和收入水平等社会经济因素是残疾的重要预测因素,其中低收入和单身/离婚与较高的风险相关。性别的影响在 GII 较高的国家更为明显,这表明性别不平等对中风后遗症的影响。
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引用次数: 0
Cerebral vasculitis as the clinical manifestation of neuroborreliosis: pattern of vascular pathology and prognostic factors of outcome. 作为神经源性疾病临床表现的脑血管炎:血管病理学模式和预后因素。
IF 6.7 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-18 DOI: 10.1177/17474930241287326
Yaroslav Winter,Ole Simon,Annette Spreer,Ahmed E Othman,Sebastian Altmann,Moritz Brandt,Kristian Barlinn,Tobias Back,Arda Civelek,Jan-Philipp Bach,Julia Schiffer,Christian Dresel,Sven Meuth,Stefan Bittner,Sergiu Groppa,Tobias Brummer
BACKGROUNDNeuroborreliosis is a tick-borne condition that affects the central and/or peripheral nervous system. Cerebral infarction associated with neuroborreliosis-related vasculitis has been reported in only a handful of cases. Therefore, specific patterns of vascular pathology and prognostic outcome factors in these patients are still incompletely understood.AIMSTo determine the pattern of vascular pathology and prognostic outcome factors in patients with neuroborreliosis-related vasculitis.METHODSWe performed a longitudinal multicenter study between 1997 and 2022 in five academic study sites in Germany with a cumulative reference area of 1,620,000 inhabitants. All patients diagnosed with neuroborreliosis-associated cerebral vasculitis were included. The evaluation of clinical parameters, including NIH Stroke Scale (NIHSS), disability ranking (modified Rankin Scale, mRS), and neuroimaging with the estimation of patterns of vascular involvement were performed at admission as well as after three and twelve months. Linear regression analysis was used to identify the independent predictors of recurrent strokes, involvement of posterior circulation or multiple vessels.RESULTSPatients with neuroborreliosis-related vasculitis (n=51) were relatively young (mean age: females: 60±11 years; male patients: 60±8 years) and displayed a predominance of vascular events within the posterior circulation (60.8%). A history of smoking was linked to recurrent strokes/TIA (64.7% vs. 23.5%; p=0.006), strokes in multiple territories (100% vs. 35.9%; p<0.0001), and posterior circulation events (64.5% vs. 30.0%, p=0.017), whereas other cardiovascular risk factors showed no significant differences. Linear regression analysis further confirmed smoking's significant association with recurrent strokes/ transient ischemic attacks (B: 0.412; p=0.002), multiple territory strokes/TIA (B: 0.467; p=0.033), and posterior circulation events (B: 0.317; p=0.033).CONCLUSIONA thorough CSF examination for neuroborreliosis is crucial, especially in younger stroke patients, particularly those experiencing posterior circulation ischemic events. Smoking-cessation should be prompted in patients with neuroborreliosis-associated cerebral vasculitis.
背景神经源性疾病是一种影响中枢和/或外周神经系统的蜱媒疾病。与神经包虫病相关的血管炎引起脑梗塞的报道屈指可数。目的:确定神经包虫病相关血管炎患者的血管病理学模式和预后结果因素。方法:我们在 1997 年至 2022 年期间在德国的五个学术研究机构进行了一项纵向多中心研究,研究机构的参考区域累计有 162 万居民。所有确诊为神经源性脑血管炎的患者均被纳入研究范围。在入院时以及三个月和十二个月后,对临床参数进行评估,包括美国国立卫生研究院卒中量表(NIHSS)、残疾等级(改良Rankin量表,mRS)和神经影像学,并对血管受累模式进行评估。结果神经包虫病相关血管炎患者(51 人)相对年轻(平均年龄:女性:60±11 岁;男性:60±8 岁),后循环血管事件占多数(60.8%)。吸烟史与复发性中风/TIA(64.7% vs. 23.5%;p=0.006)、多部位中风(100% vs. 35.9%;p<0.0001)和后循环事件(64.5% vs. 30.0%,p=0.017)有关,而其他心血管风险因素则无显著差异。线性回归分析进一步证实吸烟与复发性脑卒中/短暂性脑缺血发作(B:0.412;P=0.002)、多发区脑卒中/TIA(B:0.467;P=0.033)和后循环事件(B:0.317;P=0.033)显著相关。对于神经包虫病相关脑血管炎患者应戒烟。
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引用次数: 0
Vascular cognitive impairment and dementia: Mechanisms, treatment, and future directions 血管性认知障碍和痴呆症:机制、治疗和未来方向
IF 6.7 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-17 DOI: 10.1177/17474930241279888
Vincent Chung Tong Mok, Yuan Cai, Hugh S Markus
Worldwide, around 50 million people live with dementia, and this number is projected to triple by 2050. It has been estimated that 20% of all dementia cases have a predominant cerebrovascular pathology, while perhaps another 20% of vascular diseases contribute to a mixed dementia picture. Therefore, the vascular contribution to dementia affects 20 million people currently and will increase markedly in the next few decades, particularly in lower- and middle-income countries.In this review, we discuss the mechanisms of vascular cognitive impairment (VCI) and review management. VCI refers to the spectrum of cerebrovascular pathologies that contribute to any degree of cognitive impairment, ranging from subjective cognitive decline, to mild cognitive impairment, to dementia. While acute cognitive decline occurring soon after a stroke is the most recognized form of VCI, chronic cerebrovascular disease, in particular cerebral small-vessel disease, can cause insidious cognitive decline in the absence of stroke. Moreover, cerebrovascular disease not only commonly co-occurs with Alzheimer’s disease (AD) and increases the probability that AD pathology will result in clinical dementia, but may also contribute etiologically to the development of AD pathologies.Despite its enormous health and economic impact, VCI has been a neglected research area, with few adequately powered trials of therapies, resulting in few proven treatments. Current management of VCI emphasizes prevention and treatment of stroke and vascular risk factors, with most evidence for intensive hypertension control. Reperfusion therapies in acute stroke may attenuate the risk of VCI. Associated behavioral symptoms such as apathy and poststroke emotionalism are common. We also highlight novel treatment strategies that will hopefully lead to new disease course-modifying therapies. Finally, we highlight the importance of including cognitive endpoints in large cardiovascular prevention trials and the need for an increased research focus and funding for this important area.
全世界约有 5000 万人患有痴呆症,预计到 2050 年,这一数字将增加两倍。据估计,在所有痴呆症病例中,有 20% 主要是脑血管病变,而另外 20% 的血管疾病可能会导致混合型痴呆症。因此,目前受血管性痴呆影响的患者有 2,000 万人,而且在未来几十年中还将显著增加,尤其是在中低收入国家。在这篇综述中,我们将讨论血管性认知障碍(VCI)的发病机制,并对其管理进行回顾。血管性认知障碍是指导致任何程度认知功能障碍的脑血管病变,包括主观认知功能下降、轻度认知功能障碍和痴呆。虽然中风后不久出现的急性认知功能下降是最常见的 VCI 形式,但慢性脑血管疾病,尤其是脑小血管疾病,可在没有中风的情况下引起隐匿性认知功能下降。此外,脑血管疾病不仅常与阿尔茨海默病(AD)并发,增加了 AD 病变导致临床痴呆的几率,还可能从病因学上导致 AD 病变的发生。尽管 VCI 对健康和经济有巨大影响,但它一直是一个被忽视的研究领域,很少有充分有效的治疗试验,因此几乎没有行之有效的治疗方法。目前对 VCI 的治疗强调中风和血管风险因素的预防和治疗,大多数证据表明应加强高血压控制。急性中风的再灌注疗法可减轻 VCI 风险。相关的行为症状如冷漠和卒中后情绪化很常见。我们还强调了新的治疗策略,希望这些策略能带来新的改变病程的疗法。最后,我们强调了将认知终点纳入大型心血管预防试验的重要性,以及加强对这一重要领域的研究关注和资金投入的必要性。
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引用次数: 0
Stroke Measures Analysis of pRognostic Testing-Mortality nomogram predicts long-term mortality after ischemic stroke. 卒中措施分析认知测试-死亡率(SMART-M)提名图可预测缺血性卒中后的长期死亡率。
IF 6.3 2区 医学 Q1 CLINICAL NEUROLOGY Pub Date : 2024-09-15 DOI: 10.1177/17474930241278808
Tae Jung Kim, Ji Sung Lee, Mi Sun Oh, Ji-Woo Kim, Soo-Hyun Park, Kyung-Ho Yu, Byung-Chul Lee, Byung-Woo Yoon, Sang-Bae Ko

Background: Predicting long-term mortality is essential for understanding prognosis and guiding treatment decisions in patients with ischemic stroke. Therefore, this study aimed to develop and validate the method for predicting 1- and 5-year mortality after ischemic stroke.

Methods: We used data from the linked dataset comprising the administrative claims database of the Health Insurance Review and Assessment Service and the Clinical Research Center for Stroke registry data for patients with acute stroke within 7 days of onset. The outcome was all-cause mortality following ischemic stroke. Clinical variables linked to long-term mortality following ischemic stroke were determined. A nomogram was constructed based on the Cox's regression analysis. The performance of the risk prediction model was evaluated using the Harrell's C-index.

Results: This study included 42,207 ischemic stroke patients, with a mean age of 66.6 years and 59.2% being male. The patients were randomly divided into training (n = 29,916) and validation (n = 12,291) groups. Variables correlated with long-term mortality in patients with ischemic stroke, including age, sex, body mass index, stroke severity, stroke mechanisms, onset-to-door time, pre-stroke dependency, history of stroke, diabetes mellitus, hypertension, coronary artery disease, chronic kidney disease, cancer, smoking, fasting glucose level, previous statin therapy, thrombolytic therapy, such as intravenous thrombolysis and endovascular recanalization therapy, medications, and discharge modified Rankin Scale were identified as predictors. We developed a predictive system named Stroke Measures Analysis of pRognostic Testing-Mortality (SMART-M) by constructing a nomogram using the identified features. The C-statistics of the nomogram in the developing and validation groups were 0.806 (95% confidence interval (CI), 0.802-0.812) and 0.803 (95% CI, 0.795-0.811), respectively.

Conclusion: The SMART-M method demonstrated good performance in predicting long-term mortality in ischemic stroke patients. This method may help physicians and family members understand the long-term outcomes and guide the appropriate decision-making process.

背景:预测长期死亡率对于了解缺血性卒中患者的预后和指导治疗决策至关重要。因此,本研究旨在开发和验证缺血性脑卒中后 1 年和 5 年死亡率的预测方法:我们利用了由健康保险审查与评估服务行政索赔数据库和中风临床研究中心登记数据组成的链接数据集中的数据,这些数据是急性中风患者发病 7 天内的数据。结果是缺血性中风后的全因死亡率。确定了与缺血性中风后长期死亡率相关的临床变量。根据 Cox 回归分析构建了一个提名图。使用 Harrell's C 指数评估了风险预测模型的性能:本研究共纳入 42207 名缺血性脑卒中患者,平均年龄为 66.6 岁,59.2% 为男性。患者被随机分为训练组(29,916 人)和验证组(12,291 人)。与缺血性卒中患者长期死亡率相关的变量包括年龄、性别、体重指数、卒中严重程度、卒中机制、发病至出院时间、卒中前依赖性、卒中史、糖尿病、高血压、冠心病、慢性肾脏病、癌症、吸烟、空腹血糖水平、既往他汀类药物治疗、溶栓治疗(如静脉溶栓和血管内再通治疗)、药物和出院修正兰肯量表。我们利用所确定的特征构建了一个提名图,从而开发了一个名为 "卒中措施认知测试分析-死亡率(SMART-M)"的预测系统。在开发组和验证组中,提名图的 C 统计量分别为 0.806(95% 置信区间 [CI],0.802-0.812)和 0.803(95% CI,0.795-0.811):SMART-M方法在预测缺血性卒中患者的长期死亡率方面表现良好。结论:SMART-M 方法在预测缺血性脑卒中患者的长期死亡率方面表现良好,可帮助医生和家属了解患者的长期预后并指导适当的决策过程。
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引用次数: 0
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International Journal of Stroke
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