Abstract T MP69: Do Neighborhood Characteristics Elevate Post-Stroke Mortality?

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Theresa Osypuk ◽  
J. Robin Moon ◽  
Amy Ehntholt ◽  
M Maria Glymour
Keyword(s):  
General Population ◽  
Social Integration ◽  
Stroke Care ◽  
Racial Composition ◽  
Stroke Survivors ◽  
Stroke Mortality ◽  
Neighborhood Characteristics ◽  
Stroke Patients ◽  
Post Stroke ◽  
White Neighborhoods

Background: Neighborhood context predicts long-term mortality of both stroke patients and stroke-free general community populations. If the association of neighborhood characteristics and mortality is stronger among stroke survivors than in the general population, it would implicate stroke-care-specific mechanisms. We hypothesized that neighborhood risk factors predict post-stroke mortality, and that these associations are stronger than in stroke free populations. Methods: Health and Retirement Study participants age 50+ free of stroke at baseline (n=15,974) were followed up to 12 years for incident stroke (1,809 events) and mortality (5,578 Deaths). We compared mortality hazard ratios associated with both objective neighborhood measures (census tract poverty, racial composition, residential stability, and foreign born) and self-reported neighborhood social integration (social ties and informal socializing), among stroke-free and post-stroke individuals, using covariate adjusted Cox models. Results: Stroke predicted elevated mortality (HR= 1.98; 95% CI: 1.85, 2.13), as did residence in census tracts in the highest quartile of % non-white (HR= 1.12; 1.22, 1.04). Percent non-white was more strongly related to mortality among stroke patients (HR= 1.32; 1.52, 1.14) than among stroke-free individuals (HR= 1.08; 1.00, 1.18; p for interaction=.013). Low neighborhood social integration also significantly predicted mortality, but the relative effects were similar for stroke survivors and stroke-free individuals. Conclusions: In this large cohort, neighborhood racial composition and social integration predicted survival. Neighborhood racial composition had larger effects on post-stroke survival than on survival in the general population. Post-stroke care available to residents of non-white neighborhoods may be less effective than care available to residents of predominantly white neighborhoods.

Abstract P839: ‘Stroke Home Care’- A Mobile Application: Home Based Innovative Nursing Care Intervention Developed by Stroke Nurse: A Need of the Time in Covid-19 Pandemic Like Situation

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Ashok Kumar ◽  
Dheeraj Khurana ◽  
Smita Pattanaik ◽  
Mukesh Kumar ◽  
Manish Modi ◽  
...  
Keyword(s):  
Home Care ◽  
Nursing Care ◽  
Mobile Application ◽  
Frozen Shoulder ◽  
Tube Feeding ◽  
Stroke Care ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Post Stroke ◽  
Home Based

Introduction: Stroke nurse is functioning as a vital member of the stroke team. She/he provides care to the stroke patients in acute as well as post-acute periods. She/he coordinates among other team members to facilitate the stroke care continuum. Post-stroke care is always a challenge for health care professional as well as caregivers. During current pandemic conditions, it is essential to provide quality care at their home. Purpose: To develop a mobile application to provide home based care for prevention and management of post stroke complications among survivors. Methods: Survey was carried out among 170 bedridden stroke survivors and their caregivers to assess problems faced like aspiration pneumonia, bedsore, urinary tract infection, deep vein thrombosis, frozen shoulder, contractures, and caregiver burden. On the basis of findings ‘Stroke home care’ a bilingual (in Hindi and English) mobile application was developed which contains step by step nursing-care-procedural videos to prevent bedsore, bedsore dressing, positioning change, Ryle’s tube feeding, Foley’s catheter care, active and passive range of motion exercises, hand washing with soap-water as well with sanitizer, psychological support to patients. Results: Through this intervention, caregivers of bedridden stroke patients get trained for care procedures so that they can provide best possible nursing care to their patients at home and can prevent post stroke complications and ultimately enhances quality of life of survivors and reduce caregivers’ burden. Conclusion: ‘Stroke Home Care’ is a novel intervention developed by a stroke nurse which has been developed and tested not just for its feasibility and acceptability but also proven for its clinical applicability through PROBE designed study. This web based intervention can provide rehabilitation services to bedridden stroke survivors at their home in this pandemic.

scholarly journals Measuring Quality of Life in Stroke Survivors

2020 ◽  
Vol 25 (3) ◽  
pp. 11-16
Author(s):  
M. Tsalta-Mladenov ◽  
D. Georgieva ◽  
S. Andonova
Keyword(s):  
Quality Of Life ◽  
Treatment Options ◽  
Stroke Care ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Post Stroke ◽  
High Dependency ◽  
Evaluation Time ◽  
Number Of Patients

Introduction: The number of patients living with the consequences of stroke is increasing worldwide due to the improving stroke care and the modern differentiated treatment options for ischemic stroke – thrombolysis and thrombectomy. Hence, a significant interest has arisen in quality of life (QOL) measurement in post-stroke patients. Objectives. Measuring QOL in stroke survivors can be achieved by using various generic and stroke specific questionnaires. All tools should assess different domains of health such as physical acting, communication, daily activities and others. This article describes the most commonly used scales for measuring post-stroke QOL. Methods. We searched the PubMed electronic databases with the keywords — Quality of life, Stroke, Measuring for the period from January 2000 to May 2020. Results. Various generic and specific scales for quality of life measuring are available. The advantages of the specific scales include high accuracy and detailed information for the assessed domains. The limitations are due to numerous items, long evaluation time and high dependency on patient’s compliance. The generic scales give the ability to compare the QOL in patients with different diseases. The disadvantage is lack of detailed information for the health status in certain disease or condition. Conclusion. Measuring the different aspects of QOL in post-stroke patients is powerful tool in order to focus the further efforts to the most affected domains. A combination between generic and stroke-specific measure might be considered in order to overcome the limitations. The choice of measuring scales must be balanced in the terms of lengthy and repetitive surveys.

scholarly journals Incident Cancer in a Cohort of 3,247 Cancer Diagnosis Free Ischemic Stroke Patients

2015 ◽  
Vol 39 (5-6) ◽  
pp. 262-268 ◽  
Author(s):  
Adnan I. Qureshi ◽  
Ahmed A. Malik ◽  
Omar Saeed ◽  
Malik M. Adil ◽  
Gustavo J. Rodriguez ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ischemic Stroke ◽  
General Population ◽  
Annual Rate ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Incident Cancer ◽  
Race Ethnicity ◽  
Age Adjusted Rates

Background: Subclinical cancer can manifest as a thromboembolic event and may be detected at a later interval in ischemic stroke survivors. We determined the rate of incident cancer and effect on cardiovascular endpoints in a large cohort of ischemic stroke survivors. Methods: An analysis of 3,680 adults with nondisabling cerebral infarction who were followed for two years within the randomized, double-blinded VISP trial was performed. The primary intervention was best medical/surgical management plus a daily supplementation of vitamin B6, vitamin B12, and folic acid. We calculated age-adjusted rates of incidence of cancer among ischemic stroke survivors and standardized incidence ratios (SIR) with 95% confidence intervals (CI) based on comparison with age-adjusted rates in the general population. The significant variables from univariate analysis were entered in a Cox Proportional Hazards analysis to identify the association between various baseline factors and incident cancer after adjusting age, gender, and race/ethnicity. A logistic regression analysis evaluated the association between incident cancer and various endpoints including stroke, coronary heart disease, myocardial infarction, and death after adjusting age, gender, and race/ethnicity. Results: A total of 3,247 patients (mean age ± SD of 66 ± 11; 2,013 were men) were cancer free at the time of enrollment. The incidence of new cancer was 0.15, 0.80, 1.2, and 2.0 per 100 patients at 1 month, 6 months, 1 year, and 2 years, respectively. The age-adjusted annual rate of cancer in patients with ischemic stroke was higher than in persons in the general population at 1 year (581.8/100,000 persons vs. 486.5/100,000 persons, SIR 1.2, 95% CI 1.16-1.24) and 2 years (1,301.7/100,000 vs. 911.5/100,000, SIR 1.4, 95% CI 1.2-1.6) after recruitment. There was a higher risk for death (odds ratio (OR) 3.1, 95% CI 1.8-5.4), and composite endpoint of stroke, coronary heart disease, and/or death (OR 1.4, 95% CI 1.0-2.2) among participants who developed incident cancer compared with those who were cancer free after adjusting for potential confounders. Conclusions: The annual rate of age-adjusted cancer incidence was higher among ischemic stroke patients compared with those in the general population. The odds of mortality were three folds higher among stroke survivors who developed incident cancer.

scholarly journals LACK OF EMPHASIS ON PSYCHOLOGICAL REHABILITATION FOR STROKE PATIENTS

2012 ◽  
Vol 1 (1) ◽  
pp. 2
Author(s):  
Samina Masood Haider
Keyword(s):  
Emotional Difficulties ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Post Stroke ◽  
Post Stroke Depression ◽  
The Many ◽  
Over Time

It has been observed that most of the patients are not aware of the dilapidating affects of post stroke depression on their recovery, survival and a return to normal activities of life. The lack of emphasis on psychological rehabilitation for stroke patients is a source of concern for me and I would like to bring to your attention about the facts regarding the implications of proper psychological rehabilitation is not undertaken. Stroke survivors report a range of emotional difficulties, most common being fear, anxiety, frustration, anger, sadness and a sense of grief for their physical and mental losses. Usually these feelings may fade over time however, some patients may struggle with adjusting to the many changes following stroke. When this happens these feelings can develop into depression. It is estimated that approximately one-third of stroke1 survivors develop post-stroke depression (PSD)

scholarly journals Association among depression, cognitive impairment and executive dysfunction after stroke

2012 ◽  
Vol 6 (3) ◽  
pp. 152-157 ◽  
Author(s):  
Luisa Terroni ◽  
Matildes F.M. Sobreiro ◽  
Adriana B. Conforto ◽  
Carla C. Adda ◽  
Valeri D. Guajardo ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Neuropsychological Tests ◽  
Executive Dysfunction ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Adequate Treatment ◽  
Post Stroke ◽  
Quantitative Studies ◽  
Post Stroke Depression ◽  
The Relationship

ABSTRACT The relationship between depression and cognitive impairment, frequent after stroke, is complex and has not been sufficiently elucidated. Objective: To review the relationship between post-stroke depression and cognitive impairment. Methods: We performed a PubMed database search spanning the last ten years, using the terms post-stroke depression, cognitive dysfunction, cognitive impairment and neuropsychological tests. Our target studies were original quantitative studies that investigated the relationship between post-stroke depression (PSD) and cognitive impairment in stroke patients. Articles published in English, Spanish, Italian and Portuguese were considered. Selection criteria were the use of neuropsychological tests to assess cognitive function, and of either instruments to diagnose major depression, or scales to assess depressive symptoms, within the first three months after stroke. Results: Six original quantitative studies fulfilled the criteria. The prevalence of PSD within the first three months after stroke ranged from 22% to 31%. Incidence ranged from 25% to 27% and was evaluated in only two studies. PSD was associated with increased cognitive impairment. Cognitive impairment was reported in 35.2% to 87% of the patients. Post-stroke cognitive deficits were reported mostly in executive function, memory, language, and speed of processing. Conclusion: Executive dysfunction and depression occur in stroke survivors, are frequently coexistent, and also associated with worse stroke prognosis. Healthcare professionals need to address and provide adequate treatment for depression and executive dysfunctions in stroke patients early in the first three months after stroke. Future studies should evaluate the efficacy of programs evaluating the early detection and treatment of PSD and executive dysfunction in stroke survivors.

scholarly journals Gothenburg Very Early Supported Discharge study (GOTVED): a randomised controlled trial investigating anxiety and overall disability in the first year after stroke

BMC Neurology ◽  
2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Lena Rafsten ◽  
Anna Danielsson ◽  
Asa Nordin ◽  
Ann Björkdahl ◽  
Asa Lundgren-Nilsson ◽  
...  
Keyword(s):  
Multidisciplinary Team ◽  
Controlled Trial ◽  
Stroke Care ◽  
Secondary Outcome ◽  
Outpatient Rehabilitation ◽  
Control Group ◽  
Stroke Patients ◽  
Post Stroke ◽  
Early Supported Discharge ◽  
Significant Difference

Abstract Background and purpose Early supported discharge (ESD) has been shown to be efficient and safe as part of the stroke care pathway. The best results have been seen with a multidisciplinary team and after mild to moderate stroke. However, how very early supported discharge (VESD) works has not been studied. The aim of this study was to investigate whether VESD for stroke patients in need of ongoing individualized rehabilitation affects the level of anxiety and overall disability for the patient compared with ordinary discharge routine. Methods A randomized controlled trial was performed with intention to treat analyses comparing VESD and ordinary discharge from hospital. All patients admitted at the stroke care unit at Sahlgrenska University Hospital of Gothenburg between August 2011 and April 2016 were screened. Inclusion occurred on day 4 using a block randomization of 20 and with a blinded assessor. Assessments were made 5 days post-stroke and 3 and 12 months post-stroke. Patients in the VESD group underwent continued rehabilitation in their homes with a multidisciplinary team from the stroke care unit for a maximum of 1 month. The patients in the control group had support as usual after discharge when needed such as home care service and outpatient rehabilitation. The primary outcome was anxiety as assessed by the Hospital Anxiety and Depression Scale-Anxiety subscale (HADS-A). The secondary outcome was the patients’ degree of overall disability, measured by the modified Rankin Scale (mRS). Results No significant differences were found between the groups regarding anxiety at three or 12 months post-stroke (p = 0.811). The overall disability was significantly lower in the VESD group 3 months post-stroke (p = 0.004), compared to the control group. However, there was no significant difference between the groups 1 year post-stroke. Conclusions The VESD does not affects the level of anxiety compared to ordinary rehabilitation. The VESD leads to a faster improvement of overall disability compared to ordinary rehabilitation. We suggest considering coordinated VESD for patients with mild to moderate stroke in addition to ordinary rehabilitation as part of the service from a stroke unit. Trial registration Clinical Trials.gov: NCT01622205. Registered 19 June 2012 (retrospectively registered).

scholarly journals Changes in PHQ-9 depression scores in acute stroke patients shortly after returning home

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259806
Author(s):  
Brent Strong ◽  
Michele C. Fritz ◽  
Liming Dong ◽  
Lynda D. Lisabeth ◽  
Mathew J. Reeves
Keyword(s):  
Depressive Symptoms ◽  
Acute Stroke ◽  
Recovery Period ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Stroke Patients ◽  
Early Recovery ◽  
Post Stroke ◽  
Early Recovery Period ◽  
Over Time

Introduction Post-stroke depression is a disabling condition that occurs in approximately one-third of stroke survivors. There is limited information on changes in depressive symptoms shortly after stroke survivors return home. To identify factors associated with changes in post-stroke depressive symptoms during the early recovery period, we conducted a secondary analysis of patients enrolled in a clinical trial conducted during the transition period shortly after patients returned home (MISTT). Methods The Michigan Stroke Transitions Trial (MISTT) tested the efficacy of social worker case management and access to online information to improve patient-reported outcomes following an acute stroke. Patient Health Questionnaire-9 (PHQ-9) scores were collected via telephone interviews conducted at 7 and 90 days post-discharge; higher scores indicate more depressive symptoms. Generalized estimating equations were used to identify independent predictors of baseline PHQ-9 score at 7 days and of changes over time to 90 days. Results Of 265 patients, 193 and 185 completed the PHQ-9 survey at 7 and 90 days, respectively. The mean PHQ-9 score was 5.9 at 7 days and 5.1 at 90 days. Older age, being unmarried, and having moderate stroke severity (versus mild) were significantly associated with lower 7-day PHQ-9 scores (indicating fewer depressive symptoms). However, at 90 days, both unmarried patients and those with moderate or high stroke severity had significant increases in depressive symptoms over time. Conclusions In stroke patients who recently returned home, both marital status and stroke severity were associated with depressive symptom scores; however, the relationships were complex. Being unmarried and having higher stroke severity was associated with fewer depressive symptoms at baseline, but both factors were associated with worsening depressive symptoms over time. Identifying risk factors for changes in depressive symptoms may help guide effective management strategies during the early recovery period.

scholarly journals Hemispheric Coherence Analysis of Wide Band EEG Signals for Characterization of Post-Stroke Patients with Dementia

2021 ◽  
Vol 38 (4) ◽  
pp. 985-992
Author(s):  
Sugondo Hadiyoso ◽  
Hasballah Zakaria ◽  
Paulus Anam Ong ◽  
Tati Latifah E.R. Mengko
Keyword(s):  
Quantitative Analysis ◽  
Wide Band ◽  
P Value ◽  
Coherence Analysis ◽  
Stroke Survivors ◽  
Eeg Signals ◽  
Stroke Patients ◽  
Post Stroke ◽  
Significant Difference

Post-stroke dementia (PSD) is a type of vascular dementia (VaD) that might be occurred in post-stroke patients. Memory, language and behavior tests can be used for the analysis of cognitive impairment caused by PSD. Often a supporting clinical examination such as an electroencephalogram (EEG) is used to support the diagnosis or analyze the characteristic changes that occur in the brain. Conventional analysis or visual inspection of EEG signals can be very difficult, since the nature of the signal tends to be non-stationer. Therefore, this study proposes a quantitative analysis for the characterization of EEG signals in stroke survivors with dementia. It is thought that it has different characteristics with the normal subject so that this study can be used as a reference in supporting dementia detection in post-stroke survivors. The quantitative analysis used in this study is coherence analysis. Coherence analysis was performed on EEG signals recorded from six poststroke patients with dementia and then compared with ten normal healthy subjects. Analysis of coherence between brain areas includes inter and intra-hemispheric coherence. Validation was carried out by using the independent t-test where the confidence level was 95%, indicating that the p-value <0.05 had a significant difference. The test results show that in general the coherence of the electrode pairs in patients with dementia is lower than in the normal healthy group. It is notably, i) In interhemispheric, the C3-C4, T3-T4, and T5-T6 pairs generate significant differences, ii) the highest decrease in intrahemispheric coherence was found in C3-T5 with p = 0.0005. The coherence study presented in this paper is expected to be used for early detection of PSD in the future.

scholarly journals 1289Decline in duration, satisfaction and sleep quality among informal caregivers of stroke survivors, 18-months post-stroke

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Phd Filipa Teixeira ◽  
Ana Moura ◽  
Elisabete Alves
Keyword(s):  
Sleep Quality ◽  
Informal Caregivers ◽  
Stroke Care ◽  
Stroke Survivors ◽  
Care Provision ◽  
Post Stroke ◽  
Adverse Health Outcomes ◽  
Care Services ◽  
The North ◽  
Falling Asleep

Abstract Background Data on stroke caregivers’ sleep is scarce. We aimed to assess changes in duration, satisfaction and sleep quality among informal caregivers of stroke survivors. Methods Informal caregivers (n = 126) of stroke survivors hospitalized between September 2018 and August 2019 in the 12 Stroke Units of the North of Portugal were invited to participate in the study, 18 months’ post-stroke. Sociodemographic and sleep characteristics (duration, satisfaction and quality) were collected through structured questionnaires. Odds ratios and 95% confidence intervals (95%CI) were estimated through logistic regression, adjusted for age and sex. Answers to open-ended questions were synthetized using content analysis. Results Due to care provision, informal caregivers reported sleeping, on average (SD), significantly less hours (7.0 (1.7) vs. 6.4 (1.8); p &lt; 0.001). Since its beginning, caregivers’ satisfaction with their sleep decreased approximately 30%. Changes in sleep quality, namely difficulties in falling asleep and constant interruptions during sleep, were reported by almost 70% of caregivers. Only 6.4% described the prescription of medication to sleep after beginning care provision. Participants who returned to work (adjusted OR = 0.34; 95%CI:0.16-0.76) and with a monthly income above 1000€ (adjusted OR = 0.29; 95%CI:0.13-0.66) were less likely to report changes in sleep quality. Conclusions A decline in duration, satisfaction and sleep quality of informal caregivers of stroke survivors, 18 months’ post-stroke, was observed. Changes in sleep quality revealed socioeconomic inequalities, highlighting the need to prevent adverse health outcomes related to sleep disturbance. Key messages Sleep health dimensions of stroke caregivers should be considered an additional dimension of the post-stroke care services.

scholarly journals Temporal Trends in the Unmet Health Care Needs of Canadian Stroke Survivors

2019 ◽  
Vol 47 (2) ◽  
pp. 176-182
Author(s):  
Manav V. Vyas ◽  
Jiming Fang ◽  
Moira K. Kapral
Keyword(s):  
Health Care ◽  
General Population ◽  
Temporal Trends ◽  
Stroke Care ◽  
Integrated Systems ◽  
Stroke Survivors ◽  
Health Care Needs ◽  
Care Needs ◽  
Unmet Health Care Needs ◽  
Over Time

ABSTRACT:Background:Stroke survivors have higher unmet health care needs than the general population. However, it is unclear whether such needs have changed over time, and whether these have been affected by the introduction of integrated systems of stroke care.Methods:We used data from the Canadian Community Health Surveys between 2000 and 2014. We developed multivariable log-binomial generalized estimating equations to obtain adjusted risk ratios (aRRs) of unmet health care needs in stroke survivors compared to the general population, and over time. We conducted a difference in differences analysis to determine the association between the implementation of integrated systems of stroke care and unmet health care needs.Results:Data from 350,084 respondents were included in the study; 8072 (2.3%) were stroke survivors. Compared to the general population, stroke survivors were more likely to report unmet health care needs (aRR 1.27; 95% CI, 1.22–1.32). The unmet health care needs reported by stroke survivors were lower after compared to before 2006 (15.8% vs. 31.9%, P < 0.001). After accounting for temporal trends, there was no association between the implementation of integrated systems of stroke care and change in unmet health care needs of stroke survivors. However, this requires cautious interpretation due to limitations in the data available for this study.Conclusions:Unmet health care needs of stroke survivors have reduced over time but remain higher than the general population. Future research should focus on identifying stroke- and policy-related factors to mitigate disparities in health care access for stroke survivors.

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