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1.
J Stroke Cerebrovasc Dis ; 28(9): 2506-2516, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31255440

RESUMO

INTRODUCTION AND GOAL: Stroke is a serious health condition that disproportionally affects African-Americans relative to non-Hispanic whites. In the absence of clearly defined reasons for racial disparities in stroke recovery and subsequent stroke outcomes, a critical first step in mitigating poor stroke outcomes is to explore potential barriers and facilitators of poststroke recovery in African-American adults with stroke. The purpose of this study was to qualitatively explore poststroke recovery across the care continuum from the perspective of African-American adults with stroke, caregivers of African-American adults with stroke, and health care professionals with expertise in stroke care. MATERIALS AND METHODS: This qualitative descriptive study included in-depth key informant interviews with health care providers (n = 10) and focus groups with persons with stroke (n = 20 persons) and their family members or caregivers (n = 19 persons). Data were analyzed using thematic analysis according to the Social Ecological Model, using both inductive and deductive approaches. FINDINGS: Persons with stroke and their caregivers identified social support, resources, and knowledge as the most salient factors associated with stroke recovery. Perceived barriers to recovery included: (1) physical and cognitive deficits, mood; (2) medication issues; (3) lack of support and resources; (4) stigma, culture, and faith. Health care providers identified knowledge/information, care coordination, and resources in the community as key to facilitating stroke recovery outcomes. CONCLUSIONS: Key findings from this study can be incorporated into interventions designed to improve poststroke recovery outcomes and potentially reduce the current racial-ethnic disparity gap.


Assuntos
Afro-Americanos , Atitude do Pessoal de Saúde , Cuidadores/psicologia , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Reabilitação do Acidente Vascular Cerebral , Adulto , Afro-Americanos/psicologia , Feminino , Recursos em Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Recuperação de Função Fisiológica , Fatores de Risco , Apoio Social , South Carolina/epidemiologia , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/parasitologia , Acidente Vascular Cerebral/fisiopatologia , Resultado do Tratamento
2.
J Stroke Cerebrovasc Dis ; 28(8): 2232-2241, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31178360

RESUMO

BACKGROUND: TIAregistry.org is an international cohort of patients with transient ischemic attack (TIA) or minor stroke within 7 days before enrollment in the registry. Main analyses of 1-year follow-up data have been reported.5 We conducted subanalysis on the baseline and 1-year follow-up data of Japanese patients. METHODS: The patients were classified into 2 groups based on Japanese ethnicity, Japanese (345) and non-Japanese (3238), and their baseline data and 1-year event rates were compared. We also determined risk factors and predictors of 1-year stroke. RESULTS: Current smoking, regular alcohol drinking, intracranial arterial stenosis, and small vessel occlusion; and hypertension, dyslipidemia, coronary artery disease, and extracranial arterial stenosis were more and less common among Japanese patients, respectively. Stroke risk was higher and TIA risk was lower at 1-year follow-up among Japanese patients. The baseline risk factors for recurrent stroke were diabetes, alcohol drinking, and large artery atherosclerosis. Independent predictors of 1-year stroke risk were prior congestive heart failure and alcohol consumption. CONCLUSIONS: The two populations of patients featured differences in risk factors, stroke subtypes, and outcome events. Predictors of recurrent stroke among Japanese patients included congestive heart failure and regular alcohol drinking. Strategies to attenuate residual risk of stroke aside from adherence to current guidelines should take our Japanese-patient specific findings into account.


Assuntos
Grupo com Ancestrais do Continente Asiático , Disparidades nos Níveis de Saúde , Ataque Isquêmico Transitório/etnologia , Estilo de Vida/etnologia , Acidente Vascular Cerebral/etnologia , Idoso , Idoso de 80 Anos ou mais , Consumo de Bebidas Alcoólicas/efeitos adversos , Consumo de Bebidas Alcoólicas/etnologia , Comorbidade , Feminino , Humanos , Ataque Isquêmico Transitório/diagnóstico , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Recidiva , Sistema de Registros , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença , Fumar/efeitos adversos , Fumar/etnologia , Acidente Vascular Cerebral/diagnóstico , Fatores de Tempo
3.
J Stroke Cerebrovasc Dis ; 28(7): 1860-1865, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31064695

RESUMO

BACKGROUND AND PURPOSE: Previous studies have shown that common variants within CYP3A4 and CYP3A5 are associated with statin pharmacokinetics and the risk of cardiovascular disease. However, the association of variants in CYP3A4 and CYP3A5 with the prognosis of ischemic stroke remains undetermined. Therefore, we investigated this herein. METHODS: Four hundred thirty-three consecutive patients with acute ischemic stroke were recruited. The outcome at the 1-year follow-up was assessed using the modified Rankin Scale (mRS). Two variants, CYP3A4*1G and CYP3A5*3, were genotyped by the improved Multiple Ligase Detection Reaction platform. RESULTS: Binary logistic regression analysis showed that the CYP3A4*1G/*1G homozygote was associated with poor outcome at 1 year (mRS score ≥2) after adjustment for conventional factors in the additive model (odds ratio [OR] = 2.92; 95% confidence interval, 1.07-7.98; P = .037) and recessive model (OR = 3.37; 95% confidence interval, 1.26-9.04; P = .016). Subgroup analysis indicated that the CYP3A4*1G/*1G homozygote was associated with poor prognosis at 1 year among patients with stable high-intensity atorvastatin therapy (40-80 mg/d) after adjustment for conventional factors in the additive model (OR = 8.16; 95% confidence interval, 1.50-44.44; P = .015) and recessive model (OR = 9.06; 95% confidence interval, 1.72-47.64; P = .009). No significant association was identified between CYP3A5*3 and the 1-year outcome of patients with ischemic stroke. CONCLUSIONS: Our study findings suggest that the CYP3A4*1G/CYP3A4*1G genotype may be associated with poor prognosis at 1 year after acute ischemic stroke in the Han Chinese population.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Isquemia Encefálica/genética , Citocromo P-450 CYP3A/genética , Variantes Farmacogenômicos , Polimorfismo de Nucleotídeo Único , Acidente Vascular Cerebral/genética , Idoso , Atorvastatina/administração & dosagem , Atorvastatina/farmacocinética , Isquemia Encefálica/tratamento farmacológico , Isquemia Encefálica/enzimologia , Isquemia Encefálica/etnologia , China/epidemiologia , Citocromo P-450 CYP3A/metabolismo , Avaliação da Deficiência , Feminino , Frequência do Gene , Homozigoto , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacocinética , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Prevenção Secundária/métodos , Acidente Vascular Cerebral/tratamento farmacológico , Acidente Vascular Cerebral/enzimologia , Acidente Vascular Cerebral/etnologia , Fatores de Tempo , Resultado do Tratamento
4.
Medicine (Baltimore) ; 98(17): e15339, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31027107

RESUMO

Intracerebral hemorrhage (ICH) is a major cause of morbidity and mortality throughout the world. It is reported that the incidence of deep ICH and intracranial artery stenosis (ICAS) are higher in Asian countries. Thus, there are concerns regarding a potential relationship between ICAS and ICH. This study was aimed to investigate this potential relationship between intracranial artery (middle cerebral artery, MCA) stenosis and ICH in the lateral lenticulostriate artery (LLA) territory in Chinese. Totally, 973 in-hospital subjects were retrospectively enrolled including subjects with the diagnosis of ICH, acute ischemic stroke (IS), and prior IS and subjects without cerebral diseases. These subjects were divided into four groups: ICH, acute IS, prior IS, and normal group (without cerebral diseases). Multiple logistic regression analysis showed that severe MCA stenosis was associated with the increased risk of ICH (OR = 5.070) and acute IS (OR = 5.406) in the LLA territory. The moderate MCA stenosis was associated with the increased risk of ICH (OR = 9.899) and was not associated with acute IS in the LLA territory. The increased perfusion pressure to the LLA may be the cause. In conclusion, MCA stenosis, especially moderate MCA stenosis, is associated with ICH in the LLA territory in Chinese.


Assuntos
Hemorragia Cerebral/etnologia , Artéria Cerebral Média/patologia , Acidente Vascular Cerebral/etnologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , China/epidemiologia , Comorbidade , Constrição Patológica , Feminino , Humanos , Lipídeos/sangue , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores Sexuais
5.
J Stroke Cerebrovasc Dis ; 28(5): 1274-1280, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30853188

RESUMO

BACKGROUND: Recent studies in Caucasians with transient ischaemic attack or ischaemic stroke have demonstrated significant age-specific associations between cerebral small vessel disease (SVD) burden on magnetic resonance imaging and renal impairment. We aimed to validate these findings in a large cohort of Chinese with ischaemic stroke. METHODS: In 959 Chinese with ischaemic stroke who received a brain magnetic resonance imaging at the University of Hong Kong, we determined the age-specific associations of renal impairment (glomerular filtration rate < 60 mL/min/1.73 m2) with neuroimaging markers of SVD as well as with the SVD score. RESULTS: Although renal impairment was associated with the SVD score in univariate analysis in all patients (odds ratio 1.61, 95% confidence interval 1.24-2.09, P < .0001), these associations were attenuated after adjusting for age and sex (P = .38). Similar findings were noted in patients with ischaemic stroke due to SVD and non-SVD subtypes. However, in 222 of 959 patients aged <60, renal impairment was independently associated with an increasing microbleed (adjusted odds ratio 6.82, 2.26-20.59), subcortical (4.97, 1.62-15.24) periventricular white matter hyperintensity (3.96, 1.08-14.51) and global SVD burden (3.41, 1.16-10.04; all P < .05) even after adjusting for age, sex, and vascular risk factors. Nevertheless, there were no associations between renal impairment and individual neuroimaging markers of SVD nor with the SVD score in patients aged ≥60 after adjusting for age and sex (all P > .05). CONCLUSIONS: In Chinese with ischaemic stroke, renal impairment was independently associated with microbleed, white matter hyperintensity and global SVD burden in individuals aged <60, but not in those aged ≥60, suggesting that there may be shared susceptibilities to premature systemic disease.


Assuntos
Isquemia Encefálica/etnologia , Doenças de Pequenos Vasos Cerebrais/etnologia , Taxa de Filtração Glomerular , Nefropatias/etnologia , Rim/fisiopatologia , Acidente Vascular Cerebral/etnologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , Isquemia Encefálica/diagnóstico por imagem , Isquemia Encefálica/fisiopatologia , Doenças de Pequenos Vasos Cerebrais/diagnóstico por imagem , Estudos Transversais , Imagem de Difusão por Ressonância Magnética , Feminino , Hong Kong/epidemiologia , Humanos , Nefropatias/diagnóstico , Nefropatias/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Índice de Gravidade de Doença , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/fisiopatologia
6.
Medicine (Baltimore) ; 98(11): e14696, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882632

RESUMO

BACKGROUND: Numerous studies showed that vascular endothelial growth factor (VEGF) gene polymorphisms were linked with the regularity of stroke, but the results remained controversial. The aim of this meta-analysis was to determine the associations between VEGF gene polymorphisms and the risk of stroke. METHODS: A systematic literature search of PubMed, Embase, Wed of Science, The Cochrane Library, Elsevier, China National Knowledge Infrastructure, China Biology Medicine disc, WanFang Data, VIP Database for Chinese Technical Periodicals, and Science paper Online was conducted. Two authors independently assessed trial quality and extracted data. The pooled odds ratio (OR) with 95% confidence interval (CI) was used to assess the strength of associations. Begger funnel plot and Egger test were used to estimate the publication bias of included studies. Heterogeneity assumption was assessed by Cochran Chi-squared-based Q-statistic test and I test. RESULTS: Thirteen publications including 23 trails with a total of 3794 stroke patients and 3094 control subjects were enrolled. About 3747 cases and 2868 controls for +936C/T, 2134 cases and 1424 controls for -2578C/A, and 2187 cases and 1650 controls for -1154G/A were examined, respectively. The results indicated that VEGF +936C/T (T vs C, OR = 1.19, 95% CI = 1.01-1.40) or -2578C/A (A vs C, OR = 1.13, 95% CI = 1.02-1.27) was positively associated with the risk of stroke, whereas there was no association between -1154G/A (A vs G, OR = 0.99, 95% CI = 0.87-1.11) polymorphism and stroke risk in our study. Among the subgroup analyses on ethnicity, the results showed that VEGF +936C/T was an increased risk of stroke in Asian population (T vs C, OR = 1.21, 95% CI = 1.01-1.44), but not -1154G/A. CONCLUSION: Our findings suggest that VEGF +936C/T and -2578C/A might be related to the risk of stroke, especially in the Asian population, but not -1154G/A.


Assuntos
Acidente Vascular Cerebral/genética , Fator A de Crescimento do Endotélio Vascular/genética , Grupo com Ancestrais do Continente Asiático/genética , Estudos de Casos e Controles , Humanos , Polimorfismo de Nucleotídeo Único , Acidente Vascular Cerebral/etnologia
7.
Med Care ; 57(4): 262-269, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30870384

RESUMO

PURPOSE: The main purpose of this study was to determine whether there were temporal differences in the rates of first stroke hospitalizations and 30-day mortality after stroke between black and white Medicare enrollees. METHODS: We used a 20% sample of Medicare beneficiaries aged 65 years or older and described the annual rate of first hospitalization for ischemic and hemorrhagic strokes from years 1988 to 2013, as well as 30-day mortality after stroke hospitalization. We used linear tests of trend to determine whether stroke rates changed over time, and tested the interaction term between race and year to determine whether trends differed by race. RESULTS: We identified 1,009,057 incident hospitalizations for ischemic strokes and 147,817 for hemorrhagic strokes. Annual stroke hospitalizations decreased significantly over time for both blacks and whites, and in both stroke subtypes (P-values for all trend <0.001). Reductions in stroke rates were comparable between blacks and whites: among men, the odds ratio for the interaction term for race by year was 1.008 [95% confidence interval (CI), 1.004-1.012] for ischemic and 1.002 (95% CI, 0.999-1.004) for hemorrhagic; for women, it was 1.000 (95% CI, 0.997-1.004) for ischemic and 1.003 (95% CI, 1.001-1.006) for hemorrhagic. Both black men and women experienced greater improvements over time in terms of 30-day mortality after strokes. CONCLUSIONS: Rates of incident hospitalizations for ischemic and hemorrhagic strokes fell significantly over a 25-year period for both black and white Medicare enrollees. Black men and women experienced greater improvements in 30-day mortality after both ischemic and hemorrhagic stroke.


Assuntos
Grupos de Populações Continentais/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Medicare/estatística & dados numéricos , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/mortalidade , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hospitalização/tendências , Humanos , Masculino , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia
8.
J Stroke Cerebrovasc Dis ; 28(6): 1618-1622, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30898445

RESUMO

BACKGROUND: Recently, the NIHSS STroke Scale score, Age, pre-stroke mRS score, onset-to-treatment Time (START nomogram) predicts 3-month functional outcome after intravenous thrombolysis in ischemic stroke patients. However, this model has not yet been an external validation. We aim to validate the performance of START nomogram. METHODS: Data were derived from the stroke center of the Nanjing First Hospital (China). Patients who lacked the necessary data to calculate the nomogram and missed 3-month modified Ranking scale scores were excluded. Modified Rankin Scale score more than 2 at 3-month was assessed as an unfavorable outcome. We used areas under the receiver operator characteristic curves (AUC-ROC) to quantify the prognostic value. Calibration was assessed by calibration plots and Hosmer-Lemeshow (HL) goodness of fit test. RESULT: The final cohort included 306 eligible patients. For 3-month unfavorable outcome, the AUC-ROC of the START nomogram was .766 (95%CI: .7013-.8304, P < .0001), suggesting good discrimination in the START nomogram. It also showed good calibration (HL goodness of fit test P = .1261) in the external validation sample. CONCLUSION: The START nomogram with good predictive performance is a reliable and simple clinical instrument to predict unfavorable outcome after acute stroke.


Assuntos
Técnicas de Apoio para a Decisão , Nomogramas , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/métodos , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Asiático , China/epidemiologia , Bases de Dados Factuais , Avaliação da Deficiência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Sistema de Registros , Reprodutibilidade dos Testes , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etnologia , Acidente Vascular Cerebral/fisiopatologia , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
9.
Implement Sci ; 14(1): 24, 2019 03 07.
Artigo em Inglês | MEDLINE | ID: mdl-30845958

RESUMO

BACKGROUND: Post-stroke disability is common, costly, and projected to increase. Acute stroke treatments can substantially reduce post-stroke disability, but few patients take advantage of these cost-effective treatments. Practical, cost-efficient, and sustainable interventions to address underutilized acute stroke treatments are currently lacking. In this context, we present the Stroke Ready project, a stepped wedge design, multi-level intervention that combines implementation science and community-based participatory research approaches to increase acute stroke treatments in the predominately African American community of Flint, Michigan, USA. METHODS: Guided by the Tailored Implementation of Chronic Disease (TICD) framework, we begin with optimization of acute stroke care in emergency departments, with particular attention given to our safety-net hospital partners. Then, we move to a community-wide, multi-faceted, stroke preparedness intervention, with workshops led by peer educators, over 2 years. Measures of engagement of the safety-net hospital and the feasibility and sustainability of the implementation strategy as well as community intervention reach, dose delivered, and satisfaction will be collected. The primary outcome is acute stroke treatment rates, which includes both intravenous tissue plasminogen activator, and endovascular treatment. The co-secondary outcomes are intravenous tissue plasminogen activator treatment rates and the proportion of stroke patients who arrive by ambulance. DISCUSSION: If successful, Stroke Ready will increase acute stroke treatment rates through emergency department and community level interventions. The stepped wedge design and process evaluation will provide insight into how Stroke Ready works and where it might work best. By exploring the relative effectiveness of the emergency department optimization and the community intervention, we will inform hospitals and communities as they determine how best to use their resources to optimize acute stroke care. TRIAL REGISTRATION: ClinicalTrials.gov Trial Identifier NCT03645590 .


Assuntos
Acidente Vascular Cerebral/terapia , Doença Aguda , Afro-Americanos/etnologia , Ensaios Clínicos como Assunto/métodos , Análise Custo-Benefício , Humanos , Michigan , Anos de Vida Ajustados por Qualidade de Vida , Acidente Vascular Cerebral/economia , Acidente Vascular Cerebral/etnologia , Resultado do Tratamento
10.
Medicine (Baltimore) ; 98(7): e14593, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30762812

RESUMO

BACKGROUND: Telomere length is closely related to the onset and prognosis of ischemic stroke. This study was to investigate the relationship between telomere length and the incidence of ischemic stroke in Han population of northern China. METHODS: In the present study, 152 patients with ischemic stroke were selected as the case group, and 152 healthy persons were used as the control group. Detection of telomere length was done by real-time polymerase chain reaction after extraction of genomic DNA from peripheral venous blood. RESULTS: Our results showed that the telomere length of the patients in the case group was significantly lower than that of the control group (Z = -11.843, P < .0001). Further analysis found that the telomere length of the control group was inversely correlated with age (r = -0.234, P = .004), and the telomere length and homocysteine (HCY) were inversely correlated in the case group (r = -0.176, P = .03), especially in women (r = -0.357, P = .024). Multivariate regression analysis showed that telomere length was a protective factor for ischemic stroke (odds ratio [OR] 95% confidence interval [95% CI] = 0.748 [0.681-0.823], ß = -0.29, P < .0001). The receiver operating characteristic curve showed that telomere length was a good diagnostic biomarker of ischemic stroke (area under the curve: 0.894, sensitivity: 84.7%, specificity: 93.4%). CONCLUSION: Our results indicate that shorter telomere length has some connection with the risk of ischemic stroke in the northern Chinese Han population. Telomere length might serve as a potential candidate biomarker for ischemic stroke. This requires a large sample to be further verified.


Assuntos
Grupo com Ancestrais do Continente Asiático/genética , Acidente Vascular Cerebral/genética , Telômero , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Biomarcadores , China/epidemiologia , Feminino , Homocisteína/metabolismo , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Reação em Cadeia da Polimerase em Tempo Real , Fatores de Risco , Acidente Vascular Cerebral/etnologia
11.
Prev Chronic Dis ; 16: E21, 2019 02 14.
Artigo em Inglês | MEDLINE | ID: mdl-30767859

RESUMO

INTRODUCTION: On average, more than 1,700 people in Mississippi die from stroke annually, but data on trends by age, sex, and race in Mississippi are limited. We examined trends in the stroke death rate among adults in Mississippi aged 35 or older by age, sex, and race. METHODS: We used Mississippi Vital Statistics data to calculate age-specific death rates for stroke among people in Mississippi aged 35 or older from 2000 to 2016. We identified cases according to underlying cause-of-death codes from the International Classification of Diseases, Tenth Revision (ICD-10). We used Joinpoint software to calculate annual percentage change (APC) and the average annual percentage change (AAPC) in death rates for stroke by age, sex, and race (non-Hispanic black and non-Hispanic white). RESULTS: Among adults aged 35 or older, the age-adjusted stroke death rate declined 30.7% from 141.3 per 100,000 population in 2000 to 97.9 per 100,000 population in 2016, with an AAPC of -2.4% (95% confidence interval, -3.1% to -1.6%). Stroke death rates declined significantly among both men and women in the first trend segment (2000-2009 for men and 2000-2007 for women) but did not decline in the second trend segment (2009-2016 for men and 2007-2016 for women). Non-Hispanic black men had the smallest decline in stroke death rates during the full study period. Among people aged 55 to 64 and non-Hispanic white men, rates shifted from a significant annual decline during the first segment to a significant annual increase during the second segment. CONCLUSION: Age-adjusted stroke death rates among adults in Mississippi aged 35 or older declined significantly between 2000 and 2016, but trends differed by age, race, and sex. Clinical and community interventions aimed at reducing stroke risk factors, particularly for adults aged 55 to 64, are needed in Mississippi.


Assuntos
Acidente Vascular Cerebral/mortalidade , Adulto , Afro-Americanos/estatística & dados numéricos , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Causas de Morte/tendências , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Mississippi/epidemiologia , Distribuição por Sexo , Acidente Vascular Cerebral/etnologia
12.
J Stroke Cerebrovasc Dis ; 28(5): 1243-1251, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30745230

RESUMO

OBJECTIVE: To explore a 5-year comparison of disparities in intravenous t-PA (IV t-PA) use among acute ischemic stroke (AIS) patients based on race, gender, age, ethnic origin, hospital status, and geographic location. METHODS: We extracted patients' demographic information and hospital characteristics for 2010 and 2014 from the New York Statewide Planning and Research Cooperative System (SPARCS). We compared disparities in IV t-PA use among AIS patients in 2010 to that in 2014 to estimate temporal trends. Multiple logistic regression was performed to compare disparities based on demographic variables, hospital designation, and geographic location. RESULTS: Overall, there was approximately a 2% increase in IV t-PA from 2010 to 2014. Blacks were 15% less likely to receive IV t-PA compared to Whites in 2014, but in 2010, there was no difference. Patients aged 62-73 had lower odds of receiving IV t-PA than age group ≤61 in both 2010 and 2014. Designated stroke centers in the Lower New York State region were associated with reduced odds of IV t-PA use in 2010 while those located in the Upper New York State region were associated with increased odds of IV t-PA use in both 2010 and 2014, compared to their respective nondesignated counterparts. Gender, ethnic origin, and insurance status were not associated with IV t-PA utilization in both 2010 and 2014. CONCLUSION: Overall IV t-PA utilization among AIS patients increased between 2010 and 2014. However, there are evident disparities in IV t-PA use based on patient's race, age, hospital geography, and stroke designation status.


Assuntos
Isquemia Encefálica/tratamento farmacológico , Fibrinolíticos/administração & dosagem , Acesso aos Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/tendências , Avaliação de Processos (Cuidados de Saúde)/tendências , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica/tendências , Administração Intravenosa , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etnologia , Grupos de Populações Continentais , Bases de Dados Factuais , Feminino , Disparidades em Assistência à Saúde/etnologia , Humanos , Masculino , Pessoa de Meia-Idade , New York/epidemiologia , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etnologia , Fatores de Tempo , Resultado do Tratamento
13.
J Stroke Cerebrovasc Dis ; 28(5): 1311-1316, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30772157

RESUMO

BACKGROUND: There is evidence of a greater incidence of stroke in native populations and minorities. A total of 34% of the population in the Araucanía Region is indigenous. The association between Mapuche ethnicity and stroke is unknown. The aim of the study was to estimate the magnitude of the association between Mapuche ethnicity and stroke occurrence in patients admitted to the Dr. Hernán Henríquez Aravena Hospital (HHHA) in Temuco, Chile. METHODS: We performed an incident case-control-paired study with patients hospitalized with an acute stroke in the internal medicine service and controls from other medical services at the HHHA. One control was selected for each case, matched by gender and age (±5 years). RESULTS: A total of 104 nonconsecutive cases of stroke were included. The proportion of Mapuche individuals was similar between cases and controls (27.9% and 32.7%, respectively, P = .45). Hypertension and overweight-obesity were associated with stroke. Low socioeconomic status, rurality, diabetes, and smoking were associated with Mapuche ethnicity. In the conditional logistic regression model, Mapuche ethnicity was not associated with stroke. The odds ratio was .75 (P = .47, 95% confidence intervals: .35-1.62). CONCLUSIONS: There is no statistically significant evidence in the study to support the hypothesis of an association between Mapuche ethnicity and stroke. None of the control variables modified the effect of ethnicity on stroke.


Assuntos
Índios Sul-Americanos , Acidente Vascular Cerebral/etnologia , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Chile/epidemiologia , Comorbidade , Diabetes Mellitus/etnologia , Feminino , Humanos , Hipertensão/etnologia , Incidência , Masculino , Pessoa de Meia-Idade , Obesidade/etnologia , Medição de Risco , Fatores de Risco , Saúde da População Rural/etnologia , Fumar/efeitos adversos , Fumar/etnologia , Classe Social , Determinantes Sociais da Saúde/etnologia , Acidente Vascular Cerebral/diagnóstico , Saúde da População Urbana/etnologia
14.
J Stroke Cerebrovasc Dis ; 28(5): 1323-1328, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30795966

RESUMO

BACKGROUND: To explore the association of platelet activation markers, vitamin D, and antiplatelet drugs resistance in ischemic stroke patients. METHODS: A total of 230 patients with ischemic stroke were enrolled in this study. Platelet aggregation, platelet activation marker (CD62p), and vitamin D were measured after 7-14 days of dual antiplatelet treatment (aspirin + clopidogrel). All individuals were divided into a drug resistance group and a drug sensitive group according to the platelet maximum aggregation rate induced by antagonist adenosine diphosphate or arachidonic acid. RESULTS: In this study, the prevalence of aspirin resistance was low (1.2%), while the prevalence of clopidogrel resistance (CR) was 24.8%, so we focused on CR. The percentage of CD62p on activated platelet [(25.74 ± 4.61) versus (12.41 ± 3.93), P < .001] and the prevalence of hypertension [93.0% (53) versus 79.8% (138), P = .021] in CR group were significantly higher than those in clopidogrel sensitive (CS) group, while the vitamin D concentration [(8.96 ± 4.41) versus (13.9 ± 4.84) ng/mL, P = .003] in CR group was significantly lower compared with the CS group. No significant difference was found in soluble P-selectin between these 2 groups [(56.2 ± 16.13) versus (54.2 ± 14.87) ng/mL, P = .258], neither in calcium [(2.29 ± .12) versus (2.33 ± .13) mmol/L, P = .821]. Logistic regression analysis showed that hypertension (odds ratio [OR] = 5.348, 95% confidence intervals [CI] 1.184-23.350, P = .026), expression of platelet CD62p (OR = 1.095, 95% CI 1.052-1.201, P = .018) and vitamin D level (OR = .832, 95% CI .763-.934, P = .005) were associated with CR in ischemic stroke patients. CONCLUSIONS: CR in ischemic stroke patients is associated with several independent predictors, including increased platelet activation marker CD62p, decreased vitamin D level, and hypertension.


Assuntos
Plaquetas/efeitos dos fármacos , Isquemia Encefálica/tratamento farmacológico , Clopidogrel/uso terapêutico , Resistência a Medicamentos , Selectina-P/sangue , Inibidores da Agregação de Plaquetas/uso terapêutico , Acidente Vascular Cerebral/tratamento farmacológico , Deficiência de Vitamina D/sangue , Vitamina D/análogos & derivados , Idoso , Grupo com Ancestrais do Continente Asiático , Aspirina/uso terapêutico , Biomarcadores/sangue , Plaquetas/metabolismo , Isquemia Encefálica/sangue , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etnologia , China , Quimioterapia Combinada , Feminino , Humanos , Hipertensão/sangue , Hipertensão/etnologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etnologia , Resultado do Tratamento , Vitamina D/sangue , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/etnologia
15.
Zhonghua Nei Ke Za Zhi ; 58(1): 17-26, 2019 Jan 01.
Artigo em Chinês | MEDLINE | ID: mdl-30605946

RESUMO

Stroke-related sleep disorders (SSD) are common symptoms after stroke, which are common but easily ignored. Studies have shown that sleep disorders in stroke patients would have negative impact on prognosis. However, there is still a lack of consensus and guidance on SSD evaluation and management worldwide. This consensus proposes the concept of SSD based on systemic literature review and discussion with experts. It comprises recommendations of assessment and management for all types of SSD, including insomnia, excessive daytime sleepiness, sleep apnea, rapid eye movement (REM) sleep behavior disorder, restless leg syndrome/periodic limb movements of sleep, circadian rhythm sleep-wake disorders. The purpose of this consensus is to provide a standard reference of SSD management.


Assuntos
Isquemia Encefálica/etnologia , Síndromes da Apneia do Sono/etnologia , Transtornos do Sono do Ritmo Circadiano/etnologia , Transtornos do Sono-Vigília/etnologia , Acidente Vascular Cerebral/etnologia , Grupo com Ancestrais do Continente Asiático , Isquemia Encefálica/diagnóstico , China/epidemiologia , Consenso , Humanos , Síndrome das Pernas Inquietas , Sono , Síndromes da Apneia do Sono/diagnóstico , Síndromes da Apneia do Sono/terapia , Transtornos do Sono do Ritmo Circadiano/diagnóstico , Transtornos do Sono do Ritmo Circadiano/terapia , Distúrbios do Início e da Manutenção do Sono , Transtornos do Sono-Vigília/diagnóstico , Acidente Vascular Cerebral/diagnóstico
16.
Circulation ; 139(2): 295-298, 2019 01 08.
Artigo em Inglês | MEDLINE | ID: mdl-30615506
17.
J Stroke Cerebrovasc Dis ; 28(3): 550-556, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30552028

RESUMO

BACKGROUND AND PURPOSE: Mechanical thrombectomy (MT) is a time-dependent therapy that is only available at a limited number of hospitals. As such, patients that live at a considerable distance of those specialized centers often require rapid interhospital emergent evacuation with Helicopter Emergency Medical Services (HEMS) to be considered for MT. It is not known whether the use of HEMS is equitable across different groups of patients. METHODS: Acute ischemic stroke patients emergently transferred to another facility were identified in a retrospective review of a large Medicare claims database. Mode of transportation (HEMS, advanced, or basic ground ambulances) was determined by CPT codes. Distance from patient's residence to the closest center with MT capabilities was calculated. Generalized linear mixed logit models were used to determine the odds of HEMS relative to ground services for Hispanic and non-Hispanic black (NHB) patients relative to non-Hispanic white (NHW) patients while controlling for confounders. RESULTS: A total of 8027 patients that underwent emergent interhospital transportation were analyzed. HEMS utilization was 18.1% for NHB, 20.6% for Hispanics, and 21.6% for NHW (P = .054). In adjusted analyses for confounders, including distance to a MT-capable hospital, Hispanic patients were less likely than NHWs to be transported by HEMS. While that association had marginal significance for the whole United States (OR = .76; 95% CI, .57-1.01; P = .055), it was statistically significant for patients living in the southern region of the United States (OR = .6; 95% CI, .40-.92; P = .019). DISCUSSION: Our findings suggest there is a disparity in the use of HEMS in Hispanic stroke patients compared to NHW. Such a disparity may delay arrival to a MT-capable hospital, delay treatment times, or lead to ineligibility for MT altogether. Given the known benefit of MT and known existing disparities in stroke treatment and outcomes, it is important to further investigate and address disparities in mode of interhospital transportation.


Assuntos
Afro-Americanos , Resgate Aéreo , Isquemia Encefálica/cirurgia , Grupo com Ancestrais do Continente Europeu , Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos , Acidente Vascular Cerebral/cirurgia , Trombectomia/métodos , Demandas Administrativas em Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/etnologia , Área Programática (Saúde) , Bases de Dados Factuais , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Medicare , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/etnologia , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento , Estados Unidos/epidemiologia
18.
Gene ; 691: 18-23, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30580071

RESUMO

BACKGROUND AND AIMS: A recent genome-wide association study (GWAS) reported an association between a single nucleotide polymorphism (SNP) rs11196288 and risk of early-onset large artery atherosclerotic (LAA) stroke in European population. The interaction between genetic and environmental factors such as age has also received increasing attention. We performed this study to investigate the association between the rs11196288A > G polymorphism and LAA stroke risk in the Chinese Han population and test whether age interacts rs11196288 to influence LAA stroke risk. METHODS: Genotyping of rs11196288 was performed in 1066 LAA stroke patients and 1167 healthy controls. Multivariate logistic regression analyses were applied to assess the effect of the rs11196288A > G polymorphism on susceptibility and short-term outcome of LAA stroke. Nomograms were performed to estimate probability of risk for an individual patient. RESULTS: A significant decrement of LAA stroke risk was found in co-dominant (AG vs. AA, OR = 0.76, 95% CI = 0.64-0.91, P = 0.003; GG vs. AA, OR = 0.65, 95% CI = 0.50-0.85, P = 0.002), dominant (AG/GG vs. AA, OR = 0.74, 95% CI = 0.62-0.87, P < 0.001) and recessive models (GG vs. AA/AG, OR = 0.76, 95% CI = 0.59-0.97, P = 0.028) of rs11196288. However, the interaction between age and genotypes of rs11196288 was not statistically significant, and no significant association was observed between the rs11196288A > G polymorphism and short-term outcome of LAA stroke (P > 0.05). CONCLUSIONS: In the southeastern Chinese population, the rs11196288A > G polymorphism is associated with decreased risk of LAA stroke.


Assuntos
Aterosclerose/genética , Cromossomos Humanos Par 10/genética , Estudo de Associação Genômica Ampla/métodos , Polimorfismo de Nucleotídeo Único , Acidente Vascular Cerebral/genética , Adulto , Idoso , Aterosclerose/etnologia , Estudos de Casos e Controles , China/etnologia , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Nomogramas , Acidente Vascular Cerebral/etnologia
19.
JAMA Neurol ; 76(2): 179-186, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30535250

RESUMO

Importance: Race-specific and sex-specific stroke risk varies across the lifespan, yet few reports describe sex differences in stroke risk separately in black individuals and white individuals. Objective: To examine incidence and risk factors for ischemic stroke by sex for black and white individuals. Design, Setting, and Participants: This prospective cohort study included participants 45 years and older who were stroke-free from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort, enrolled from the continental United States 2003 through 2007 with follow-up through October 2016. Data were analyzed from March 2018 to September 2018. Exposures: Sex and race. Main Outcomes and Measures: Physician-adjudicated incident ischemic stroke, self-reported race/ethnicity, and measured and self-reported risk factors. Results: A total of 25 789 participants (14 170 women [54.9%]; 10 301 black individuals [39.9%]) were included. Over 222 120 person-years of follow-up, 939 ischemic strokes occurred: 159 (16.9%) in black men, 326 in white men (34.7%), 217 in black women (23.1%), and 237 in white women (25.2%). Between 45 and 64 years of age, white women had 32% lower stroke risk than white men (incidence rate ratio [IRR], 0.68 [95% CI, 0.49-0.94]), and black women had a 28% lower risk than black men (IRR, 0.72 [95% CI, 0.52-0.99]). Lower stroke risk in women than men persisted at age 65 through 74 years in white individuals (IRR, 0.71 [95% CI, 0.55-0.94]) but not in black individuals (IRR, 0.94 [95% CI, 0.68-1.30]); however, the race-sex interaction was not significant. At 75 years and older, there was no sex difference in stroke risk for either race. For white individuals, associations of systolic blood pressure (women: hazard ratio [HR], 1.13 [95% CI, 1.05-1.22]; men: 1.04 [95% CI, 0.97-1.11]; P = .099), diabetes (women: HR, 1.84 [95% CI, 1.35-2.52]; men: 1.13 [95% CI, 0.86-1.49]; P = .02), and heart disease (women: HR, 1.76 [95% CI, 1.30-2.39]; men, 1.26 [95% CI, 0.99-1.60]; P = .09) with stroke risk were larger for women than men, while antihypertensive medication use had a smaller association in women than men (women: HR, 1.17 [95% CI, 0.89-1.54]; men: 1.61 [95% CI, 1.29-2.03]; P = .08). In black individuals, there was no evidence of a sex difference for any risk factors. Conclusions and Relevance: For both races, at age 45 through 64 years, women were at lower stroke risk than men, and there was no sex difference at 75 years or older; however, the sex difference pattern may differ by race from age 65 through 74 years. The association of risk factors on stroke risk differed by race-sex groups. While the need for primordial prevention, optimal management, and control of risk factors is universal across all age, racial/ethnic, and sex groups, some demographic subgroups may require earlier and more aggressive strategies.


Assuntos
Afro-Americanos/etnologia , Isquemia Encefálica/epidemiologia , Grupo com Ancestrais do Continente Europeu/etnologia , Acidente Vascular Cerebral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Isquemia Encefálica/etnologia , Estudos de Coortes , Diabetes Mellitus/epidemiologia , Feminino , Cardiopatias/epidemiologia , Humanos , Hipertensão/epidemiologia , Incidência , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Acidente Vascular Cerebral/etnologia , Estados Unidos/epidemiologia
20.
Medicine (Baltimore) ; 97(51): e13645, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30572478

RESUMO

Previous studies have shown that methylenetetrahydrofolate reductase (MTHFR) gene to be a genetic risk factor for the susceptibility to ischemic stroke. The aim of this case-control study was to investigate whether the polymorphisms of MTHFR C677T were associated with the susceptibility to ischemic stroke in a southern Chinese Hakka population. In this study, a total of 1967 ischemic stroke patients and 2565 controls of Chinese Hakka ethnicity were recruited. The MTHFR C677T polymorphisms were genotyped by polymerase chain reaction (PCR) amplification and microarray method. The risk of ischemic stroke was estimated by logistic regression analysis. The frequencies of CC, CT, and TT genotypes were 52.67% versus 55.63%, 40.31% versus 38.52%, and 7.02% versus 5.85% in patients with ischemic stroke versus controls, respectively. The frequency of T allele was significantly higher in ischemic stroke patients (27.17%) than in controls (25.11%) (P = .026, odds ratio [OR] 1.113, 95% confidence interval [CI] 1.013-1.223). The homozygous TT genotype in the ischemic stroke patients was associated with increased risk (P = .049, OR 1.132, 95% CI 1.001-1.281) when compared with the controls after adjustment for age and sex. The positive association was only found in dominant model without adjustment for age and sex (P = .047, OR 1.127, 95% CI 1.002-1.268). Also, the carrier status of the MTHFR T allele was identified as an independent risk factor for the development ischemic stroke even after the adjustment for conventional risk factors (P = 0.047, OR 1.109, 95% CI 0.964-1.225). Our results provide evidence that variants of MTHFR C677T gene may influence the risk of developing ischemic stroke in a southern Chinese Hakka population. Further studies are needed to confirm this association, which will promote the development of strategies for prevention and treatment of ischemic stroke in our study population.


Assuntos
Isquemia Encefálica/genética , Metilenotetra-Hidrofolato Redutase (NADPH2)/genética , Polimorfismo Genético/genética , Acidente Vascular Cerebral/genética , Idoso , Alelos , Isquemia Encefálica/etnologia , Estudos de Casos e Controles , China/etnologia , Grupos Étnicos/genética , Feminino , Genótipo , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Reação em Cadeia da Polimerase , Fatores de Risco , Acidente Vascular Cerebral/etnologia
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