Drivers of Chronic Pathology Following Ischemic Stroke: A Descriptive Review.

Stroke is the third leading cause of death and long-term disability in the world. Considered largely a disease of aging, its global economic and healthcare burden is expected to rise as more people survive into advanced age. With recent advances in acute stroke management, including the expansion of time windows for treatment with intravenous thrombolysis and mechanical thrombectomy, we are likely to see an increase in survival rates. It is therefore critically important to understand the complete pathophysiology of ischemic stroke, both in the acute and subacute stages and during the chronic phase in the months and years following an ischemic event. One of the most clinically relevant aspects of the chronic sequelae of stroke is its extended negative effect on cognition. Cognitive impairment may be related to the deterioration and dysfunctional reorganization of white matter seen at later timepoints after stroke, as well as ongoing progressive neurodegeneration. The vasculature of the brain also undergoes significant insult and remodeling following stroke, undergoing changes which may further contribute to chronic stroke pathology. While inflammation and the immune response are well established drivers of acute stroke pathology, the chronicity and functional role of innate and adaptive immune responses in the post-ischemic brain and in the peripheral environment remain largely uncharacterized. In this review, we summarize the current literature on post-stroke injury progression, its chronic pathological features, and the putative secondary injury mechanisms underlying the development of cognitive impairment and dementia. We present findings from clinical and experimental studies and discuss the long-term effects of ischemic stroke on both brain anatomy and functional outcome. Identifying mechanisms that occur months to years after injury could lead to treatment strategies in the chronic phase of stroke to help mitigate stroke-associated cognitive decline in patients.

Determinants of condom use at sexual debut among young Vietnamese.

BACKGROUND AND AIMS: Condom use at sexual debut is associated with subsequent condom use and with decreased risk of sexually transmitted infections. There is a dearth of data on determinants of condom use at first sexual intercourse. We aimed to determine factors associated with condom use at first sexual intercourse before marriage among Vietnamese adolescents and youths. METHODS: The study involved the analysis of data from the Survey Assessment of Vietnamese Youth, 2003, the first nationally representative survey of young people in Vietnam. The survey included 7584 adolescents and youths aged 14-25 years. In this study, data of 605 adolescents and youths who had engaged in premarital sex were analyzed for factors associated with condom use using descriptive analyses, and regression techniques, allowing for sampling weights, clustering and stratification. RESULTS: Of 605 adolescents and youths who had engaged in premarital sex, 28.6% reported condom use at first sexual intercourse. Condom use at sexual debut was less common in females than males [odds ratio (OR)=0.15; 95% confidence interval (95% CI)=0.07-0.30] and less common in those who experienced peer pressure to engage in social higher risk behaviors (OR=0.57; 95% CI=0.32-0.99). Condom use was more common if a friend/acquaintance or a stranger/sex worker was the first sexual partner (OR=2.20; 95% CI=1.16-4.17 and OR=17.90; 95% CI=6.88-46.54) respectively, each compared with fiancé/boyfriend/girlfriend as first sexual partner. CONCLUSIONS: These data suggest that approximately one in three unmarried Vietnamese youths used a condom at first sexual intercourse. Gender, peer pressure and the nature of the relationship to the first sexual partner were independently associated with condom use. These results can inform programs directed at preventing HIV and other sexually transmitted infections among young Vietnamese.