Sex-Related Differences in Post-Stroke Anxiety, Depression and Quality of Life in a Cohort of Smokers.

BACKGROUND: We aimed to study anxiety, depression and quality of life in smokers after stroke by sex. METHODS: A longitudinal prospective study with a 24-month follow-up of acute stroke patients who were previously active smokers. Anxiety and depression were evaluated with the Hospital Anxiety and Depression scale, and quality of life was evaluated with the EQ-5D questionnaire. RESULTS: One hundred and eighty patients participated (79.4% men); their mean age was 57.6 years. Anxiety was most prevalent at 3 months (18.9% in men and 40.5% in women) and depression at 12 months (17.9% in men and 27% in women). The worst perceived health occurred at 24 months (EQ-VAS 67.5 in men and 65.1 in women), which was associated with depression (p < 0.001) and Rankin Scale was worse in men (p < 0.001) and depression in women (p < 0.001). Continued tobacco use was associated with worse perceived health at 3 months in men (p = 0.034) and at 12 months in both sexes. Predictor variables of worse perceived health at 24 months remaining at 3 and 12 months were tobacco use in men and neurological damage in women. CONCLUSION: Differences by sex are observed in the prevalence of anxiety and depression and associated factors and in the predictive factors of perceived health.

A Clinical Trial Comparing Smoking Cessation Interventions at Two Levels of Intensity in Stroke Patients, Stratified by the Presence of Insular Cortex Lesions.

INTRODUCTION: Smoking is a stroke risk factor but the most efficient way to promote cessation is unknown. The smoking behavior in patients during the first 2 years post-stroke is studied comparing brief advice and intensive behavioral counseling interventions, taking into consideration biological, psychological, and social factors. METHODS: Randomized clinical trial of 196 stroke patients, stratified by the presence or not of an insular cortex lesion, with two levels of smoking cessation intervention. RESULTS: The study retention rate was 85.2%. Abstinence point prevalence at three months after stroke was 50% in the brief advice group and 51.7% in the intensive behavioral counseling group (p = .82) and at 24 months, 48.3% in the brief group and 47.5% in the intensive group (p = .92). Most relapses occurred in the first weeks. After 3 months the curves separated with fewer events in the intensive group and at 24 months the Hazard Ratio was 0.91 (95% CI = 0.61 to 1.37; p = .67). Twenty-four months after stroke, patients with an insular lesion were more likely to be abstinent (OR 3.60, 95% CI = 1.27 to 10.14), as were those who lived with a partner (OR 2.31, 95% CI = 1.17 to 4.55) and those who were less dependent (OR 0.84, 95% CI = 0.73 to 0.97). CONCLUSIONS: A high percentage of patients gave up smoking in both intervention groups with no significant differences between the two. The effect of the insular lesion on smoking cessation, which is early and continued after two years, is particularly notable. IMPLICATIONS: This two-year clinical trial compares for the first time the efficacy of two different intensities of smoking cessation intervention in stroke patients, taking into consideration the effect of the insula. Good results are obtained both in the short and medium-term in people with stroke, especially when this is accompanied by an insular cortex lesion, but there is no evidence that better results are obtained with longer, more time-intensive, and possibly more costly follow-ups obtain better results than are obtained with briefer interventions.

Incidencia y factores desencadenantes de las caídas intrahospitalarias / Incidence and precipitating factors in in-hospital falls

Este estudio describe la incidencia de las caídas en el Hospital Universitario Dr. Josep Trueta de Girona durante el período de un año, y se identifican los factores intrínsecos y extrínsecos al paciente en relación con las caídas acontencidas. Entre los factores intrínsecos se destacan, de parte de los pacientes, la confusión, alteración de la comunicación, desorientación temporo-espacial, inestabilidad en la marcha, agitación, tratamiento con psicofármacos e hipotensores. Casi el 40 por ciento de los pacientes tenían medidas de protección en el momento de la caída. Se protegió de forma significativa a los pacientes más dependientes. En relación con los factores extrínsecos se identificaron suelos resbaladizos, calzado inseguro y ausencia de barandillas en la cama. Se concluye que es necesario un mayor reconocimiento de los factores desencadenantes y una mejor utilización de las medidas de protección en los hospitales