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Stroke Systems of Care:: A Systematic Approach to Saving Neurons. 中风护理系统:保存神经元的系统方法。
Pub Date : 2023-08-01 DOI: 10.32481/djph.2023.08.005
Kim Gannon

Stroke continues to be a major public health concern, accounting for more than 800,000 strokes per year and remains the leading cause of disability. Stroke systems of care are comprehensive frameworks designed to ensure efficient and effective management of stroke patients. This article provides a brief overview of the coordinated network of healthcare providers, emergency medical services, and hospitals working together to deliver timely and specialized care including pre-hospital care, acute hospital care, rehabilitation, and community reintegration.

中风仍然是一个主要的公共卫生问题,每年有80多万例中风,仍然是导致残疾的主要原因。脑卒中护理系统是旨在确保对脑卒中患者进行高效和有效管理的综合性框架。本文简要概述了医疗保健提供者、紧急医疗服务和医院协同工作的协调网络,以提供及时和专业的护理,包括院前护理、急性医院护理、康复和社区重返社会。
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引用次数: 0
In This Issue 本期
Pub Date : 2023-08-01 DOI: 10.32481/djph.2023.08.001
O. Khan, Tim Gibbs
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引用次数: 0
Evaluation & Treatment of Psychological Effects of Stroke. 脑卒中心理效应的评价与治疗。
Pub Date : 2023-08-01 DOI: 10.32481/djph.2023.08.011
Nancy Devereux, Ashley M Berns

Strokes are a common medical condition in the United States, including in Delaware. An under-recognized effect of stroke is the impact on mood that often occurs. Many individuals develop depression, anxiety, PTSD, and other psychological sequelae. These disorders can significantly affect their lives and their relationships. The emotional effects of stroke pose a public health problem for our residents, leading to devastating decreases in the quality of life for the patient and the family. These challenges negatively impact the community due to the associated healthcare and economic burdens. The population of the State of Delaware is growing, and the proportion of senior residents, who are also at greater risk for strokes, is also increasing. Strokes will remain an ongoing important clinical concern for our healthcare providers. Emotional changes after a stroke will occur in many Delaware residents who suffer a stroke. The emotional sequelae of stroke are under-treated. It is critical for healthcare professionals to be trained to recognize, assess, and treat the psychological disorders that can result from having a stroke. This article provides an overview of the major psychological effects of stroke, recommended assessment tools, promising treatment trends, and directions for further research. Improving our ability to detect and treat these difficult emotional challenges can facilitate effective treatment and prevention strategies and increase quality of life for stroke survivors, their loved ones, and their communities.

中风在美国是一种常见的疾病,包括在特拉华州。中风的一个未被认识到的影响是经常发生的对情绪的影响。许多人会出现抑郁、焦虑、创伤后应激障碍和其他心理后遗症。这些障碍会严重影响他们的生活和人际关系。中风的情绪影响对我们的居民构成了一个公共健康问题,导致病人和家属的生活质量严重下降。由于相关的医疗保健和经济负担,这些挑战对社区产生了负面影响。特拉华州的人口正在增长,老年居民的比例也在增加,他们患中风的风险也更大。中风仍将是我们医疗保健提供者持续关注的重要临床问题。许多特拉华州居民中风后都会出现情绪变化。中风的情绪后遗症没有得到充分治疗。对于医疗保健专业人员来说,接受培训以识别、评估和治疗中风可能导致的心理障碍是至关重要的。本文概述了中风的主要心理影响,推荐的评估工具,有希望的治疗趋势,以及进一步研究的方向。提高我们检测和治疗这些困难情绪挑战的能力,可以促进有效的治疗和预防策略,并提高中风幸存者、他们的亲人和他们的社区的生活质量。
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引用次数: 0
Lessons on Health Literacy and Communication in Post-Stroke Rehabilitation:: A Primer and Proposal. 卒中后康复中健康素养和沟通的教训::入门和建议。
Pub Date : 2023-08-01 DOI: 10.32481/djph.2023.08.010
Christine V Cook, Rebecca Hunting Pompon

Health literacy, or the ability to find, understand, and use information to make well-informed health decisions, has been linked to post-stroke rehabilitation outcomes. Importantly, barriers to health literacy stem from stroke survivor characteristics, clinician practices, institutional norms, as well as systemic variables. These barriers impact recovery and rehabilitation outcomes. To address these obstacles, clinicians can learn from the evidence-based practices used by speech-language pathologists in their work with stroke survivors with aphasia, a language impairment that can follow stroke. These methods to overcome communication barriers are appropriate and recommended for patients and family members regardless of stroke impairment, and include a transdisciplinary care model, multimodal approaches to patient education, along with consistent engagement with patients and their care partners. These strategies may be adopted for both personal and organizational health literacy efforts and help optimize the rehabilitation and recovery outcomes of stroke survivors with and without aphasia.

健康素养,或发现、理解和使用信息以做出明智健康决策的能力,与卒中后康复结果有关。重要的是,健康素养的障碍来自中风幸存者的特征、临床医生的做法、机构规范以及系统变量。这些障碍影响恢复和康复的结果。为了解决这些障碍,临床医生可以学习语言病理学家在治疗患有失语症的中风幸存者时使用的循证实践。失语症是中风后可能出现的一种语言障碍。这些克服沟通障碍的方法适合并推荐给患者和家属,无论其脑卒中是否受损,这些方法包括跨学科护理模式、多模式患者教育方法,以及与患者及其护理伙伴的持续接触。这些策略可用于个人和组织的健康素养工作,并有助于优化患有或不患有失语症的中风幸存者的康复和恢复结果。
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引用次数: 0
Atrial Fibrillation:: A Common Cause of Stroke. 心房颤动:中风的常见原因。
Pub Date : 2023-08-01 DOI: 10.32481/djph.2023.08.004
Waimei Tai

Atrial fibrillation is the culprit causal mechanism of twenty percent of acute ischemic strokes. As the population of Delaware ages, atrial fibrillation is a growing cause of stroke. Thus, the detection of atrial fibrillation and treatment of this cardioembolic risk factor of stroke is paramount.

心房颤动是20%的急性缺血性中风的罪魁祸首。随着特拉华州人口的老龄化,房颤是中风的一个日益增长的原因。因此,房颤的检测和治疗这种中风的心脏栓塞危险因素是至关重要的。
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引用次数: 0
The Nation Needs to Invest in Public Health Now. 国家现在需要投资公共卫生。
Pub Date : 2023-08-01 DOI: 10.32481/djph.2023.08.015
Timothy E Gibbs, Katherine Smith
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引用次数: 0
Update on Neurointerventional Therapy for the Treatment of Acute Cerebral Ischemia. 急性脑缺血的神经介入治疗进展。
Pub Date : 2023-08-01 DOI: 10.32481/djph.2023.08.007
Sudhakar Satti, Thinesh Sivapatham

Mechanical thrombectomy (MT) is a minimally invasive, fluoroscopically guided procedure to remove clots from the arteries in the head and neck. The procedure can be performed very quickly and effectively, with low complication rates, as techniques and technology have advanced in recent years. MT is among the most efficacious procedures performed today, with a very low number needed to treat (NNT) to impact outcomes. Expanded indications for MT include patients with large core infarcts, extended time windows from stroke onset, more distal occlusions, and milder symptoms. Trials have shown a significant benefit of MT in terms of reduced disability in nearly every patient population studied.

机械取栓术(MT)是一种微创的,在透视引导下从头颈部动脉中去除血栓的手术。随着近年来技术和技术的进步,该手术可以非常快速有效地进行,并发症发生率低。MT是当今最有效的治疗方法之一,只需非常少的治疗(NNT)就能影响结果。MT的扩展适应症包括大核心梗死、卒中发作时间窗延长、远端闭塞较多和症状较轻的患者。试验表明,在几乎所有研究的患者群体中,MT在减少残疾方面都有显著的益处。
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引用次数: 0
Interview with Two Delaware Stroke Survivors. 采访特拉华州的两名中风幸存者。
Pub Date : 2023-08-01 DOI: 10.32481/djph.2023.08.002
Lee P Dresser
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引用次数: 0
LGBTQ+ Youth Homelessness in Delaware:: Building a Case for Targeted Surveillance and Assessment of LGBTQ+ Youth Needs and Experiences. 特拉华州 LGBTQ+ 青年无家可归问题::对 LGBTQ+ 青年的需求和经历进行有针对性的监测和评估。
Pub Date : 2023-06-12 eCollection Date: 2023-06-01 DOI: 10.32481/djph.2023.06.014
Mary Louise Mitsdarffer, Rebecca McColl, Erin Nescott, Jim Bianchetta, Eric K Layland, Tibor Tóth

Objective: In this article, we examine the issue of LGBTQ+ youth homelessness in Delaware, summarize current services available and prior research work that has been done, examining the number, needs, and experiences of unaccompanied unhoused LGBTQ+ youth.

Methods: We provide a literature review detailing risks associated with LGBTQ+ youth homelessness, resources available, and prior studies and surveys examining this population.

Results: LGBTQ+ youth experiencing homelessness are particularly vulnerable to physical and mental health challenges, abuse, and violence. The unique needs of this population necessitate specialized resources, yet there are a limited number of such resources available in Delaware and a dearth of information on youth homelessness in general, including LGBTQ+ youth. For example, administrative barriers exist for unaccompanied queer youth seeking shelter services, such as need for legal identification or being grouped in shelter populations based on sex assigned at birth rather than gender identity. Exposure to unsafe environments is a general problem for queer youth. This can make public spaces feel unsafe and increase risk of physical or mental harm, mistreatment, or abuse when seeking shelter outside of agency services and resources. In order to accurately identify and appropriately serve this population, additional research is necessary.

Conclusions: Evidence building is a critical first step in creating an effective study to examine the issue of LGBTQ+ youth homelessness in Delaware. With the evidence acquired in our literature review our next step to establish an informed methodology is to hold service provider and LGBTQ+ lived experience focus groups. Through a qualitative approach we aim to learn how to appropriately utilize the quantitative tools identified in our analysis and to assess what questions are missing to advance the needs of this population.

目的:本文探讨了特拉华州 LGBTQ+ 青年无家可归的问题,总结了当前可用的服务以及之前所做的研究工作,研究了无人陪伴、无家可归的 LGBTQ+ 青年的数量、需求和经历:我们提供了一份文献综述,详细介绍了与 LGBTQ+ 青年无家可归相关的风险、可用资源以及之前对这一人群进行的研究和调查:无家可归的 LGBTQ+ 青年尤其容易受到身心健康挑战、虐待和暴力的影响。这一群体的特殊需求需要专门的资源,但特拉华州现有的此类资源数量有限,有关包括 LGBTQ+ 青年在内的一般无家可归青年的信息也十分匮乏。例如,无人陪伴的同性恋青年在寻求庇护服务时就会遇到行政障碍,如需要合法身份证明,或根据出生时的性别而不是性别认同被归入庇护人群。暴露在不安全的环境中是同性恋青年面临的一个普遍问题。在机构服务和资源之外寻求庇护时,这可能会使公共场所让人感觉不安全,增加身体或 精神伤害、虐待或凌辱的风险。为了准确识别并为这一人群提供适当的服务,有必要开展更多的研究:要对特拉华州 LGBTQ+ 青年无家可归问题进行有效研究,证据积累是关键的第一步。有了文献综述中获得的证据,我们下一步要做的就是建立一个有依据的方法论,即举行服务提供者和 LGBTQ+ 生活经验焦点小组会议。通过定性方法,我们旨在了解如何适当利用我们分析中确定的定量工具,并评估还缺少哪些问题来推进这一人群的需求。
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引用次数: 0
Postpartum Contraceptive Use, Pregnancy Intentions in Women With and Without a Delivery of a NAS-Affected Infant in Delaware, 2012-2018. 2012-2018 年特拉华州分娩过和未分娩过受 NAS 影响婴儿的妇女的产后避孕药具使用情况、怀孕意向。
Pub Date : 2023-06-12 eCollection Date: 2023-06-01 DOI: 10.32481/djph.2023.06.025
Khaleel Hussaini, George Yocher

Objective: Assess differences in postpartum contraceptive use and pregnancy intentions in women with a recent live birth who delivered a neonatal abstinence syndrome (NAS) affected infant.

Study design: Using linked Delaware Birth Certificate Data, Hospital Discharge Data and PRAMS data for 2012-2018 (n = 6,358 singleton births), we assessed differences among women with and without a delivery of an NAS-affected infant by effective postpartum contraceptive use and pregnancy intentions. We calculated prevalence estimates, crude (cPOR), and prevalence odds ratios adjusted (aPOR) for NAS by maternal characteristics. We used alpha ≤ 0.05 to determine statistical significance.

Results: Prevalence of NAS was 2.2% (95% CI: 1.8 - 2.6). Effective postpartum contraceptive use was 60.4% (95% CI: 51.9-69.0) among women with delivery of an NAS-affected infant compared with a non-NAS delivery 56.4% (95% CI: 55.1-57.8%) and cPOR was 1.2 (95% CI: 0.8-1.7). Prevalence of intended pregnancy was 26.5% (95% CI: 18.9-34.0) among women with delivery of an NAS-affected infant compared with a non-NAS delivery 53.0% (95% CI: 51.7-54.4) and cPOR was 0.3 (95% CI: 0.2-0.5). After adjustment, women who delivered an NAS-affected infant had lower odds (aPOR = 0.5; 95% CI: 0.3-0.8) of indicating that their pregnancy was intended as compared to those who did not deliver an NAS-affected infant.

Conclusions: Our study found no association between delivery of an NAS-affected infant and use of an effective postpartum contraceptive method. However, we found that pregnancy intendedness was lower among women delivering an NAS-affected infant compared with women without an NAS delivery even after accounting for maternal characteristics.

目标:评估最近分娩过新生儿禁欲综合症(NAS)婴儿的活产妇女产后避孕药具使用情况和怀孕意愿的差异:评估最近分娩过新生儿禁欲综合征(NAS)患儿的活产妇女在产后避孕药具使用和怀孕意愿方面的差异:利用 2012-2018 年特拉华州出生证明数据、医院出院数据和 PRAMS 数据(n = 6358 例单胎新生儿),我们评估了分娩过受 NAS 影响婴儿的女性与未分娩过受 NAS 影响婴儿的女性在有效产后避孕药具使用和怀孕意愿方面的差异。我们按产妇特征计算了NAS的流行率估计值、粗略值(cPOR)和调整后的流行率几率比(aPOR)。我们使用α≤0.05来确定统计显著性:NAS发生率为2.2%(95% CI:1.8 - 2.6)。分娩受 NAS 影响婴儿的妇女产后有效避孕率为 60.4%(95% CI:51.9-69.0),而未分娩受 NAS 影响婴儿的妇女产后有效避孕率为 56.4%(95% CI:55.1-57.8%),cPOR 为 1.2(95% CI:0.8-1.7)。分娩过受 NAS 影响婴儿的妇女中,计划怀孕率为 26.5%(95% CI:18.9-34.0),而未分娩过受 NAS 影响婴儿的妇女中,计划怀孕率为 53.0%(95% CI:51.7-54.4),cPOR 为 0.3(95% CI:0.2-0.5)。经调整后,与未分娩受 NAS 影响婴儿的妇女相比,分娩受 NAS 影响婴儿的妇女表示其怀孕是有意的几率较低(aPOR = 0.5;95% CI:0.3-0.8):我们的研究发现,分娩受 NAS 影响的婴儿与使用有效的产后避孕方法之间没有关联。然而,我们发现,与未分娩受 NAS 影响婴儿的妇女相比,分娩受 NAS 影响婴儿的妇女的妊娠意愿较低,即使考虑了母亲的特征也是如此。
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Delaware journal of public health
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