Correction: Validation of a Polish version of the National Institutes of Health Stroke Scale: Do moderate psychometric properties affect its clinical utility?

[This corrects the article DOI: 10.1371/journal.pone.0249211.].

Reliability and validity of the polish version of the vulnerability to Abuse Screening Scale (VASS).

Our aim was to assess the psychometric properties and reliability of a Polish version of the VASS. This cross-sectional validation study involved 228 patients above 65 years of age. Authors-Designed Questionnaire, the Geriatric Depression Scale, and the Activities of Daily Living Scale were used to assess construct validity. Psychometric properties, reliability and repeatability were assessed. Cronbach's alpha coefficient for the VASS scale was 0.89. Almost all items showed a high correlation value in relation to the others (R > 0.45). A high coefficient of repeatability and narrow limits of agreement were observed in the Bland-Altman analysis. All items analyzed had excellent intraclass correlation coefficient (ICC>0.9) and weighted kappa (κ > 0.9) scores. Very strong, significant correlations with other tools confirm the accuracy of the VASS scale. Our research shows promising validity and reliability Polish version of the VASS scale to assess the risk of elder abuse and neglect.

Analysis of job burnout, satisfaction and work-related depression among neurological and neurosurgical nurses in Poland: A cross-sectional and multicentre study.

AIM: This study investigated the status of job burnout, work-related depression and job satisfaction among neurological and neurosurgical nurses in Poland. DESIGN: A cross-sectional and multicentre study. METHODS: The sample consisted of 206 neurological and neurosurgical nurses, all of whom completed a self-report questionnaire designed by the authors. RESULTS: The results revealed a work-related burnout incidence of 32%, colleague-related burnout incidence of 44.2% and patient-related burnout incidence of 22.8%. Nurses working in neurological departments were statistically over three times more likely to struggle with colleague-related burnout than nurses working in neurosurgical departments were. Further, work-related burnout was higher in people aged above 54 years than those in the youngest age category. Nonetheless, 71.8% of the nurses expressed satisfaction with their work. In sum, our results indicated that job burnout is common among registered nurses and that personal (age) and workplace (type of ward, distance to work, experience and shift work) factors contributed to symptoms of burnout.

High Rate of Elder Abuse in the Time of COVID-19-A Cross Sectional Study of Geriatric and Neurology Clinic Patients.

The ongoing COVID-19 pandemic is believed to have caused a sharp increase in the incidence of elder abuse (EA), including as a result of isolation, social distance combined with increased interpersonal stressors. Thus, the aim of this study is to determine the impact of the COVID-19 pandemic on the elder abuse rates and the characteristics of risk factors. A total of 347 patients hospitalized in the Department of Neurology and Department of Geriatrics at University Hospital No. 1 in Bydgoszcz were selected as subjects for the analysis. The tools used in the study are: Authors-Designed Questionnaire, the Vulnerability to Abuse Screening Scale, the Geriatric Depression Scale and the Activities of Daily Living Scale. Descriptive statistics, chi-squared tests, Spearman's rank correlation test, and logistic regression analyses were used. In the studied population, nearly 45% of the elderly were victims of violence. This represents an increase of more than 6 percent compared to the pre-pandemic. The most common type of EA was psychological abuse (72.3%). In the final models, the risk factors include, among others, low income (OR = 3.60, 95% CI = 1.93-6.72), chronic diseases (OR = 2.06, 95% CI = 1.28-3.31), poor relationship with the family (OR = 3.26, 95% CI = 1.96-5.43), and moderate and severe depression (OR = 18.29, 95% CI = 10.24-32.69; OR = 18.49, 95% CI = 3.91-87.30, respectively). Moreover, moderate functional impairment 5.52 times more often and severe functional impairment 21.07 times more likely to predispose to EA. People who suffered from COVID-19 are 1.59 times more likely to be victims of EA (95% CI = 1.03-2.46). In this study, we saw significant increases in EA rates during the COVID-19 pandemic.

The Impact of Motor Disability and the Level of Fatigue on Adherence to Therapeutic Recommendations in Patients with Multiple Sclerosis Treated with Immunomodulation.

Aim: The aim of the study was to clarify whether the motor disability and the fatigue-related syndrome affect the level of compliance with therapeutic recommendations. Methods: Prospective studies were conducted among 165 patients treated under the drug program - Treatment of Multiple Sclerosis (MS) at the Department of Neurology and Clinical Neuroimmunology of the Regional Specialist Hospital in Grudziadz (Poland). The research was carried out by the method of diagnostic survey, questionnaire technique with the use of standardized research tools. The Adherence in Chronic Diseases Scale (ACDS) was used to assess the level of compliance with therapeutic recommendations. The Expanded Disability Status Scale (EDSS) was used to assess the degree of disability, and the Modified Fatigue Impact Scale (MFIS) was used to assess the degree of disability. The Chi-square test, Shapiro-Wilk test and Kruskal-Wallis were used. Results: The statistical analysis showed that there is a relationship (p=0.0055) between the patient's motor disability assessed in the EDSS scale and the level of compliance with therapeutic recommendations assessed in the ACDS scale. The higher the patient's disability level (EDSS 4.5-6.5), the lower the treatment adherence rate. The conducted research shows that the average score in the MFIS scale for individual levels of compliance with therapeutic recommendations expressed in the ACDS scale is, respectively: for the low level - 38.3 MFIS points, for the medium level - 34.4 MFIS points and for the high level- 33.2 MFIS points. The obtained results were not statistically significant (p=0.6098). Conclusion: It was found that the level of adherence to therapeutic recommendations in patients with relapsing-remitting multiple sclerosis treated with immunomodulation in the study group remained high. There is a relationship between the patient's disability and the level of adherence to therapeutic recommendations.

Introducing Adam's Scale of Posterior Stroke (ASPOS): A Novel Validated Tool to Assess and Predict Posterior Circulation Strokes.

BACKGROUND: Assessing the severity of posterior circulation strokes, due to the variety of symptoms, is a significant clinical problem. Current clinimetric scales show lower accuracy in the measurement of posterior stroke severity, compared with that of anterior strokes. The aim of the study was to design a validated tool, termed Adam's Scale of Posterior Stroke (ASPOS), for better assessment and prediction of posterior stroke. METHODS: This prospective, observational study involved 126 posterior circulation ischemic stroke subjects. Four researchers, previously trained in ASPOS, randomized the stroke severity using a novel tool and other appropriate stroke scales (The National Institute of Health Stroke Scale-NIHSS, modified Rankin Scale-mRS, Glasgow Coma Scale, Barthel Index, or Israeli Vertebrobasilar Stroke Scale-IVBSS) to assess the psychometric properties, reliability, and validity of ASPOS and investigate its predictive value. RESULTS: ASPOS reached a Cronbach's alpha coefficient of 0.7449, indicating good internal consistency. The Bland-Altman analysis showed a good coefficient of repeatability (CR) of 0.46, a 95% confidence interval (CI) of 0.41-0.53, and excellent intraclass correlation coefficients or weighted kappa values (>0.90), reflecting high reliability and reproducibility. Highly significant correlations with other scales confirmed the construct and predictive validity of ASPOS. A total ASPOS score of three points indicated a significantly increased probability of severe stroke based on the NIHSS, compared to a total ASPOS of 1-2 points (odds ratio (OR) 141; 95% CI: 6.72-2977.66; p = 0.0014). CONCLUSIONS: We developed a novel, valid, and reliable tool to assess posterior circulation strokes. This can contribute to a more comprehensive estimation of posterior stroke and, additionally, due to its predictive properties, it can be used to more accurately select candidates for specific treatments.

Validation of a Polish version of the National Institutes of Health Stroke Scale: Do moderate psychometric properties affect its clinical utility?

BACKGROUND: The National Institutes of Health Stroke Scale (NIHSS) is a validated tool for assessing the severity of stroke. It has been adapted into several languages; however, a Polish version with large-scale psychometric validation, including repeatability and separate assessments of anterior and posterior stroke, has not been developed. We aimed to adapt and validate a Polish version of the NIHSS (PL-NIHSS) while focusing on the psychometric properties and site of stroke. METHODS: The study included 225 patients with ischemic stroke (102 anterior and 123 posterior circulation stroke). Four NIHSS-certified researchers estimated stroke severity using the most appropriate scales to assess the psychometric properties (including internal consistency, homogeneity, scalability, and discriminatory power of individual items) and ultimately determine the reliability, repeatability, and validity of the PL-NIHSS. RESULTS: The PL-NIHSS achieved Cronbach's alpha coefficient of 0.6885, which indicates moderate internal consistency and homogeneity. Slightly more than half of the individual items provided sufficient discriminatory power (r > 0.3). A favorable coefficient of repeatability (0.6267; 95% confidence interval: 0.5737-0.6904), narrow limits of inter-rater agreement, and excellent intraclass correlation coefficients or weighted kappa values (> 0.90), demonstrated high reliability of PL-NIHSS. Highly significant correlations with other tools confirmed the validity and predictive value of the PL-NIHSS. In posterior stroke, the PL-NIHSS achieved the required Cronbach's alpha coefficient (0.71070). Additionally, stroke location did not affect other psychometric features or instrument reliability and validity. CONCLUSIONS: We developed a valid and reliable tool for assessing stroke severity in Polish-speaking participants. Moderate psychometric features were emphasized without limiting its clinical applications.

Hypercoagulability as Measured by Thrombelastography May Be Associated with the Size of Acute Ischemic Infarct-A Pilot Study.

BACKGROUND: Thromboelastography (TEG®) measures coagulation function in venous blood. Previous studies have reported that this device providing an integrated data on dynamics of clot formation may be useful for predicting clinical outcome in ischemic stroke. We investigated whether a hypercoagulability detected by thrombelastography may be associated with larger size of acute ischemic infarct. METHODS: We included 40 ischemic stroke subjects with large artery atherosclerosis or small-vessel disease to a cross-sectional pilot study. Thrombelastography parameters related to time of clot formation (R- reaction time, K-clot kinetics), clot growth and strengthening (angle-alpha and MA-maximum amplitude) and lysis (Ly30) were performed within first 24 h after the onset of stroke. A volume of ischemic infarct was assessed on the basis of diffusion-weighted imaging (DWI) sequence of magnetic resonance imaging. RESULTS: In the entire group, we reported that subjects with a large ischemic focus (>2 cm3) had a higher diameter of a clot (measured as MA) than subjects with a small ischemic focus (p = 0.0168). In the large artery atherosclerosis subgroup, we showed a significant correlation between MA and size of acute infarct (R = 0.64, p = 0.0138), between angle (alpha) and size of acute infarct (R = 0.55, p = 0.0428) and stroke subjects with hypercoagulability (MA > 69 mm) had significantly higher probability of a larger size of acute ischemic focus compared to normalcoagulable subjects (5.45 cm3 vs. 1.35 cm3; p = 0.0298). In multivariate logistic regression hypercoagulability was a predictor of a large size of ischemic infarct (Odds ratio OR = 59.5; 95% confidence interval (CI) 1.08-3558.8; p = 0.0488). CONCLUSIONS: We emphasized that thrombelastography, based on the parameters related to clot strength, may have clinical utility to identify the risk of the extensive ischemic infarct.

Unfavorable Dynamics of Platelet Reactivity during Clopidogrel Treatment Predict Severe Course and Poor Clinical Outcome of Ischemic Stroke.

BACKGROUND: Previous studies have revealed that high platelet reactivity while on clopidogrel may affect the severe course and worse prognosis of ischemic stroke. However, the above findings were based on a single measurement of platelet function. We aimed to investigate whether the dynamics of platelet reactivity over time would more accurately determine its actual impact on clinical outcome. METHODS: We enrolled 74 ischemic stroke subjects, taking a dose of 75 mg a day of clopidogrel to this prospective, single-center, and observational study. The determination of platelet function was based on the impedance aggregometry 6-12 h after the first dose of clopidogrel and 48 h later. We defined a favorable dynamics of platelet reactivity as a decrease in values at least equal to the median obtained in the entire study. The clinical condition was assessed by the National Institutes of Health Stroke Scale on the first, third, and ninetieth days and the functional status by modified Rankin Scale, respectively. RESULTS: A favorable dynamics of platelet reactivity was associated with the mild clinical condition and favorable functional status, both early and late. Early neurological deterioration was related to unfavorable dynamics of platelet reactivity over time. In multivariate regression models, we found that unfavorable dynamics of platelet reactivity, alone and combined with a high baseline value of platelet reactivity, is an independent predictor of a severe clinical condition, the risk of deterioration, and poor early and late prognosis. CONCLUSION: We highlighted that dynamics of platelet reactivity over time predict the clinical course and prognosis of stroke better than a single value.

Validation of a Polish version of the Israeli Vertebrobasilar Stroke Scale - An attempt to more accurately assess posterior Stroke.

OBJECTIVE: Posterior circulation stroke, in contrast to anterior circulation stroke, has a greater complexity and variability of clinical symptoms. This could be responsible for delayed diagnosis and treatment time and, as a consequence, worse prognosis. Certain blame in this respect can also be attributed to the clinimetric scales used to assess stroke severity, which are characterized by significantly lower accuracy than with anterior strokes. The Israeli Vertebrobasilar Stroke Scale (IVBSS) was the first attempt dedicated to posterior strokes and was devised for better measurement of clinical condition. We aimed to develop a Polish version of the IVBSS (PL-IVBSS) to assess the reliability, validity and psychometric properties of the tool to confirm its clinical utility. METHODS: We enrolled 126 posterior circulation ischemic stroke subjects. Four researchers estimated stroke severity using appropriate and widely accepted devices (the modified Rankin Scale - mRS, the National Institutes of Health Stroke Scale - NIHSS, the Barthel Index, and the Glasgow Coma Scale - GCS) and compared with the PL-IVBSS. We analyzed inter- and intrarater agreements, repeatability, concurrent and predictive validity, internal consistency, scalability and homogeneity, reflecting the psychometric features of a validated instrument. RESULTS: Cronbach's alpha coefficient was 0.67, and the median inter-item correlation coefficient was 0.22, indicating moderate internal consistency and insufficient homogeneity. A total of 63.6% of the individual items obtained required discriminatory power (r > 0.3), showing moderate scalability. The PL-IVBSS achieved a good coefficient of repeatability (CR = 1.21 95%CI 1.08-1.38) and narrow limits of agreement in Bland-Altman analysis, emphasizing the accuracy and high reproducibility. Excellent intraclass correlation coefficients and weighted kappa values (all >0.90) underlined the high reliability of the PL-IVBSS. Highly significant correlations with other relevant devices (all r > 0.5, p < 0.0001) highlighted the satisfactory concurrent and predictive validity of a validated clinimetric tool. CONCLUSION: We devised a validated version of the IVBSS, indicating the high reproducibility, repeatability and accuracy of the PL-IVBSS and confirming its clinical utility. Despite moderate psychometric properties, our findings support the need for its clinical application and widespread use in stroke units for a reliable assessment of posterior stroke severity.

The Phenomenon of Clopidogrel High On-Treatment Platelet Reactivity in Ischemic Stroke Subjects: A Comprehensive Review.

Clopidogrel is increasingly being used for the secondary prevention of ischemic stroke according to the updated guidelines on acute stroke management. Failure to achieve a drug response is referred to as clopidogrel resistance. Similarly, a higher activation of platelets during clopidogrel therapy-high on-treatment platelet reactivity-is equivalent to a reduced effectiveness of a therapy. Clopidogrel resistance is considered to be a common and multifactorial phenomenon that significantly limits the efficacy of antiplatelet agents. The aim of the current study is to review the latest literature data to identify the prevalance and predictors of clopidogrel high on-treatment platelet reactivity among stroke subjects and to establish the potential impact on clinical outcomes and prognosis. Clinical databases were searched by two independent researchers to select relevant papers on the topic, including all types of articles. Several important predictors contributing to clopidogrel resistance were identified, including genetic polymorphisms, the concomitant use of other drugs, or vascular risk factors, in particular nonsmoking and diabetes. Clopidogrel high on-treatment platelet reactivity has a negative impact on the clinical course of stroke, worsens the early- and long-term prognoses, and increases the risk of recurrent vascular events. Platelet function testing should be considered in selected stroke individuals, especially those predisposed to clopidogrel resistance, for whom an improvement in the efficacy of antiplatelet therapy is essential. This particular group may become the greatest beneficiaries of the modification of existing therapy based on platelet function monitoring.

Prevalence and associated factors of elder psychological abuse- a cross- sectional screening study, based on a hospitalized community from Poland.

OBJECTIVE: The aim of the present work was to exploring the prevalence, perpetrators and predictors of elder psychological abuse. METHOD: We conducted the cross- sectional study, based on a hospitalized community. The sample consisted of 200 respondents aged ≥60. The Chi-square test and logistic regression models were used. RESULTS: A total of 29 % respondents experienced at least one type of psychological abuse in the last 12 months. The percentage of women who statistically more often than men experienced arrogance, isolating, insulting and mocking was 71-77 %. It has been shown that the lower the monthly income, the higher the risk of psychological violence. Statistically, the highest percentage of violence in the form of arrogance, vulgarity and blackmail, threats was recorded in people aged 60-65 (48.9 % and 56.3 %, respectively). On the other hand, logistic regression analysis showed that the oldest respondents aged >70 more than three times more often than people from the youngest age category are victims of violence. The rate of arrogance, vulgarity (odd ratio (OR) 2.90;p < 0.01) and mocking (OR 3.56; p < 0.01) is statistically significantly higher, respectively, in people living in towns than in villages. People with chronic diseases are statistically more likely to experience violence in the form of isolation (OR 4.74; p = 0.04). Cohabitants, spouses or sons are the most frequent perpetrators of elder abuse and neglect. CONCLUSION: This study reveals that statistically more often, psychological abuse is experienced by women, older adults living in urban areas and people with a low socioeconomic status and chronic disease.

Endothelial Progenitor Cells as a Marker of Vascular Damage But not a Predictor in Acute Microangiopathy-Associated Stroke.

BACKGROUND: The aim of the study was to assess the number of endothelial progenitor cells (EPCs) in patients with acute stroke due to cerebral microangiopathy and evaluate whether there is a relationship between their number and clinical status, radiological findings, risk factors, selected biochemical parameters, and prognosis, both in ischemic and hemorrhagic stroke. METHODS: In total, 66 patients with lacunar ischemic stroke, 38 patients with typical location hemorrhagic stroke, and 22 subjects from the control group without acute cerebrovascular incidents were included in the prospective observational study. The number of EPCs was determined in serum on the first and eighth day after stroke onset using flow cytometry and identified with the immune-phenotype classification determinant (CD)45-, CD34+, CD133+. RESULTS: We demonstrated a significantly higher number of EPCs on the first day of stroke compared to the control group (med. 17.75 cells/µL (0-488 cells/µL) vs. 5.24 cells/µL (0-95 cells/µL); p = 0.0006). We did not find a relationship between the number of EPCs in the acute phase of stroke and the biochemical parameters, vascular risk factors, or clinical condition. In females, the higher number of EPCs on the first day of stroke is related to a favorable functional outcome on the eighth day after the stroke onset compared to males (p = 0.0355). We found that a higher volume of the hemorrhagic focus on the first day was correlated with a lower number of EPCs on the first day (correlation coefficient (R) = -0.3378, p = 0.0471), and a higher number of EPCs on the first day of the hemorrhagic stroke was correlated with a lower degree of regression of the hemorrhagic focus (R = -0.3896, p = 0.0367). CONCLUSION: The study showed that endothelial progenitor cells are an early marker in acute microangiopathy-associated stroke regardless of etiology and may affect the radiological findings in hemorrhagic stroke. Nevertheless, their prognostic value remains doubtful in stroke patients.

Are Depression and Dementia a Common Problem for Stroke Older Adults? A Review of Chosen Epidemiological Studies.

Stroke is the second leading cause of death in the world. It is often associated with various long-term physical and neuropsychological consequences. The aim of this article is to present the results of research on the occurrence of dementia and post-stroke depression. Using the keywords: post-stroke dementia, post-stroke depression, post-stroke cognitive impairment, stroke, Polish and foreign bibliographic databases were searched: PubMed, Science Direct, Wiley, Google Scholar. Documents that met the eligibility criteria were selected for inclusion in this review. After the conducted analyses, 7 Polish articles and 13 English-language articles were qualified for the review. In the group of people after stroke, there is an increased risk of depression and dementia. According to the data, up to every third person can deal with one of these neuropsychiatric disorders. The presented research analyses indicate that the results obtained by the respondents, at any time after the stroke, indicate the presence of mild cognitive impairment or slight degree dementia among the majority of respondents. It was also shown that people with a stroke in the dominant hemisphere are more likely to experience post-stroke depression. Depression and post-stroke dementia are a common and significant complication of stroke that negatively affects the functional outcome. The huge focus on neuropsychiatric disorders occurring after stroke in modern research is very important because of their negative impact on recovery, quality of life and survival after stroke.

The Prognostic Value of High Platelet Reactivity in Ischemic Stroke Depends on the Etiology: A Pilot Study.

BACKGROUND: Reduced aspirin response may result in a worse prognosis and a poor clinical outcome in ischemic stroke. The aim of this prospective pilot study was to assess the relationship between platelet reactivity and early and late prognosis, and the clinical and functional status in ischemic stroke, with the role of stroke etiology. METHODS: The study involved 69 subjects with ischemic stroke, divided into large and small vessel etiological subgroups. Platelet function testing was performed with two aggregometric methods-impedance and optical-while the clinical condition was assessed using the National Institute of Health Stroke Scale (NIHSS) and the functional status was assessed using the modified Rankin Scale (mRS) on the first and eighth day (early prognosis) and the 90th day of stroke (late prognosis). RESULTS: The initial platelet reactivity was found to be higher in patients with severe neurological deficits on the 90th day after stroke, than in the group with mild neurological deficits (median, respectively, 40 area under the curve (AUC) units vs. 25 AUC units, p = 0.033). In the large vessel disease group, a significant correlation between the platelet reactivity and the functional status on the first day of stroke was found (correlation coefficient (R) = 0.4526; p = 0.0451), the platelet reactivity was higher in the subgroup with a severe clinical condition compared to a mild clinical condition on the first day of stroke (p = 0.0372), and patients resistant to acetylsalicylic acid (aspirin) had a significantly greater possibility of a severe neurological deficit on the first day of stroke compared to those who were sensitive to aspirin (odds ratio (OR) = 14.00, 95% confidence interval (CI) 1.25-156.12, p = 0.0322). CONCLUSION: High on-treatment platelet reactivity in ischemic stroke was associated with a worse late prognosis regardless of the etiology. We demonstrated a significant relationship between high platelet reactivity and worse early prognosis and poor clinical and functional condition in the large vessel etiologic subgroup. However, due to the pilot nature of this study, its results should be interpreted with caution and further validation on a larger cohort is required.

Aspirin Resistance Affects Medium-Term Recurrent Vascular Events after Cerebrovascular Incidents: A Three-Year Follow-up Study.

Background: The aim of this prospective, a three-year follow-up study, was to establish the role of high on-treatment platelet reactivity (HTPR) in predicting the recurrence of vascular events in patients after cerebrovascular incidents, particularly in the aspect of stroke etiology. Methods: The study included 101 subjects with non-embolic cerebral ischemia (69 patients with ischemic stroke and 32 patients with transient ischemic attack) treated with 150 mg of acetylsalicylic acid (aspirin) a day. The platelet reactivity was tested in the first 24 h after the onset of cerebral ischemia by impedance aggregometry. Recurrent vascular events, including recurrent ischemic stroke, transient ischemic attack, myocardial infarction, systemic embolism, or sudden death of vascular reason, were assessed 36 months after the onset of cerebral ischemia. Results: Recurrent vascular events occurred between 3 and 9 months after onset in 8.5% of all subjects; in the HTPR subgroup, recurrent vascular events occurred in 17.9%; in the normal on-treatment platelet reactivity (NTPR) subgroup, they occurred in 4.6%. We did not notice early or long-term recurrent events. Aspirin resistant subjects had a significantly higher risk of recurrent vascular events than did aspirin sensitive subjects (Odds ratio (OR) = 4.57, 95% Confidence interval (CI) 1.00-20.64; p = 0.0486). Cox proportional hazard models showed that large-vessel disease (Hazard ratio (HR) 12.04, 95% CI 2.43-59.72; p = 0.0023) and high on-treatment platelet reactivity (HR 4.28, 95% CI 1.02-17.93; p = 0.0465) were independent predictors of recurrent vascular events. Conclusion: Aspirin resistance in the acute phase of cerebral ischemia was associated with a higher risk of recurrent medium-term vascular events, coexisting with large-vessel etiology of stroke. Platelet function-guided personalized antiplatelet treatment should be considered for patients with recurrent strokes, especially when due to large-vessel disease.

High On-Treatment Platelet Reactivity Affects the Extent of Ischemic Lesions in Stroke Patients Due to Large-Vessel Disease.

BACKGROUND: Excessive platelet activation and aggregation plays an important role in the pathogenesis of ischemic stroke. Correlation between platelet reactivity and ischemic lesions in the brain shows contradictory results and there are not enough data about the potential role of stroke etiology and its relationships with chronic lesions. The aim of this study is to assess the relationship between platelet reactivity and the extent of ischemic lesions with the particular role of etiopathogenesis. METHODS: The study involved 69 patients with ischemic stroke, including 20 patients with large-vessel disease and 49 patients with small-vessel disease. Evaluation of platelet reactivity was performed within 24 h after the onset of stroke using two aggregometric methods (impedance and optical), while ischemic volume measurement in the brain was performed using magnetic resonance imaging (in diffusion-weighted imaging (DWI) and fluid-attenuated inversion recovery (FLAIR) sequences) at day 2-5 after the onset of stroke. RESULTS: In the large-vessel disease subgroup, a correlation was found between platelet reactivity and acute ischemic focus volume (correlation coefficient (R) = 0.6858 and p = 0.0068 for DWI; R = 0.6064 and p = 0.0215 for FLAIR). Aspirin-resistant subjects were significantly more likely to have a large ischemic focus (Odds Ratio (OR) = 45.00, 95% Confidence Interval (CI) = 1.49-135.36, p = 0.0285 for DWI; OR = 28.00, 95% CI = 1.35-58.59, p = 0.0312 for FLAIR) than aspirin-sensitive subjects with large-vessel disease. CONCLUSION: In patients with ischemic stroke due to large-vessel disease, high on-treatment platelet reactivity affects the extent of acute and chronic ischemic lesions.

Assessment of the relationship between platelet reactivity, vascular risk factors and gender in cerebral ischaemia patients.

AIM: Excessive activation and platelet aggregation play important roles in the aetiopathogenesis of cerebral ischaemia. The aim of this study was to assess the relationship between platelet reactivity, gender and vascular risk factors in cerebral ischaemia patients. CLINICAL RATIONALE FOR THE STUDY: The research is useful because we found high risk groups of inefficient aspirin treatment in cerebral ischaemia patients. MATERIAL AND METHODS: The study involved 101 patients, including 69 patients with ischaemic stroke and 32 patients with transient ischaemic attack. The assessment of platelet reactivity was made within 24 hours of the disease onset using two aggregometric methods: impedance and optical. RESULTS: Resistance to acetylsalicylic acid among people with cerebral ischaemia was estimated at 30.69% using impedance aggregometry and 9.2% using optical aggregometry. There were no differences in platelet reactivity or ASA resistance between the groups of patients with stroke and TIA in either method. In the whole group of patients (p = 0.04), and in the group of patients with stroke (p = 0.0143), higher reactivity of platelets was observed by impedance aggregometry in men than in women. In the whole group of patients (p = 0.0229), and in the subgroup with stroke (p = 0.0123), it was shown that aspirin resistance is significantly more common in the subgroup of men than in women. In patients suffering from nicotine addiction, significantly higher platelet reactivity was found in the whole group of patients (p = 0.004), as well as in the subgroup of patients with stroke (p = 0.0135). CONCLUSIONS: There are no differences between platelet reactivity and the incidence of aspirin resistance in patients with stroke and TIA. Male gender and smoking are associated with greater reactivity of platelets and more frequent occurrence of acetylsalicylic acid resistance in patients with cerebral ischaemia. CLINICAL IMPLICATIONS: Dual antiplatelet therapy or clopidogrel treatment should be considered in smoking males with cerebral ischaemia due to the high risk of aspirin inefficiency.

Prevalence of elder abuse and neglect: screening in Poland families.

PURPOSE: Elder abuse and neglect is one of the most important problems of social and health policy among countries around the world. Making a real and reliable assessment of the occurrence of abuse is difficult to implement. The aim of this work is to show the frequency of physical, psychological, sexual abuse and financial exploitation among older adults. METHODS: Older adults, who were aged ≥ 60 years (N = 200) were qualified for the study. The studied population consisted of 112 women (56.0%) and 88 men (44.0%). The whole project procedure only included filling in the survey questionnaire. The verification of hypotheses was based on tests: Chi square test, Chi square test with continuity correction and logistic regression models. RESULTS: Within the obtained own results, out of 200 older adults, 77 respondents (38.5%) experienced abuse and neglect during the last 12 months. Most of the respondents (68.8%) experienced various forms of abuse simultaneously. Among those who experienced abuse, 75.3% experienced psychological abuse, 68.8% financial exploitation, 48.1% physical abuse, and 22.1% experienced sexual abuse. The rate of physical (OR 2.48; 95% CI 1.13, 5.44; p = 0.02), verbal (OR 1.94; 95% CI 1.02, 3.67; p = 0.04), sexual (OR 4.05; 95% CI 1.13, 14.5; p = 0.03) and economic (OR 1.98; 95% CI 1.02, 3.83; p = 0.04) abuse is statistically significantly higher, respectively, in women than in men. The level of education is a risk fact for physical abuse (p = 0.02). It has also been shown that singles, people with the income < 233 EUR and people living in urban areas are most often victims of elder abuse and neglect. CONCLUSIONS: The results suggest that elder abuse and neglect is a fairly common phenomenon. Our data also provide confirmation of other researches conducted in this area.