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‣ A stepwise approach to stroke surveillance in Brazil: the EMMA (Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral) study

GOULART, Alessandra C.; BUSTOS, Iara R.; ABE, Ivana M.; PEREIRA, Alexandre C.; FEDELI, Ligia M.; BENSENOR, Isabela M.; LOTUFO, Paulo A.
Fonte: WILEY-BLACKWELL; NEW YORK Publicador: WILEY-BLACKWELL; NEW YORK
Tipo: Artigo de Revista Científica
Português
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Background Stroke mortality rates in Brazil are the highest in the Americas. Deaths from cerebrovascular disease surpass coronary heart disease. Aim To verify stroke mortality rates and morbidity in an area of Sao Paulo, Brazil, using the World Health Organization Stepwise Approach to Stroke Surveillance. Methods We used the World Health Organization Stepwise Approach to Stroke Surveillance structure of stroke surveillance. The hospital-based data comprised fatal and nonfatal stroke (Step 1). We gathered stroke-related mortality data in the community using World Health Organization questionnaires (Step 2). The questionnaire determining stroke prevalence was activated door to door in a family-health-programme neighbourhood (Step 3). Results A total of 682 patients 18 years and above, including 472 incident cases, presented with cerebrovascular disease and were enrolled in Step 1 during April-May 2009. Cerebral infarction (84 center dot 3%) and first-ever stroke (85 center dot 2%) were the most frequent. In Step 2, 256 deaths from stroke were identified during 2006-2007. Forty-four per cent of deaths were classified as unspecified stroke, 1/3 as ischaemic stroke, and 1/4 due to haemorrhagic subtype. In Step 3, 577 subjects over 35 years old were evaluated at home...

‣ Associação entre o episódio depressivo maior após acidente vascular cerebral isquêmico e comprometimento de circuitos neuronais pela lesão: um estudo prospectivo de 4 meses; Association between post-stroke major depressive episode and neural circuits affected by lesion: a four-month prospective study

Terroni, Luisa de Marillac Niro
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 15/12/2009 Português
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INTRODUÇÃO: Alterações em circuito neural têm sido associadas com o transtorno depressivo maior. Entretanto, até o momento não se tem estudos investigando a associação entre a lesão do acidente vascular cerebral neste circuito e a incidência do episódio depressivo maior após o acidente vascular cerebral. Este estudo teve como objetivo principal investigar de modo prospectivo a associação entre o volume da lesão no circuito neural límbico-córtico-estriado-pálido-talâmico no hemisfério esquerdo e a incidência de episódio depressivo maior nos primeiros quatro meses posteriores ao acidente vascular cerebral isquêmico. Como objetivo secundário, visou investigar a associação entre o volume da lesão em regiões específicas do circuito e a incidência do episódio depressivo maior após o acidente vascular cerebral isquêmico. MÉTODOS: Neste estudo foram triados de modo consecutivo 326 pacientes admitidos na enfermaria de neurologia do Hospital das Clinicas de São Paulo. Destes, foram elegíveis 68 pacientes e foram acompanhados prospectivamente. A avaliação psiquiátrica consistiu na aplicação da entrevista clinica estruturada para diagnóstico pelo DSM-IV e no manual estruturado para entrevista da Escala de Hamilton para Depressão; o grau de comprometimento nas atividades de vida diária foi medido pelo Índice de Barthel; o grau de gravidade do acidente vascular cerebral foi mensurado pela escala para acidente vascular cerebral do National Institutes of Health e...

‣ Prevalência de acidente vascular cerebral em área de exclusão social na cidade de São Paulo, Brasil: utilizando questionário validado para sintomas; Stroke prevalence in a poor neighborhood of the city of São Paulo, Brazil: applying a stroke symptom questionnaire

Abe, Ivana Lie Makita
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 24/11/2010 Português
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A doença cerebrovascular é a maior causa de morte e uma grande causa de incapacidades no Brasil. A taxa de mortalidade no Brasil é uma das mais altas do mundo, principalmente entre os indivíduos com menor condição socioeconômica. A coleta de dados confiáveis e com qualidade sobre as características do acidente vascular cerebral (AVC) é essencial para sua prevenção. Entretanto, existem poucos estudos brasileiros sobre a prevalência da doença. A Organização Mundial de Saúde propõe uma estratégia de vigilância para o acidente vascular cerebral (The WHO STEPwise Approach to Stroke Surveillance) em 3 etapas. A etapa 1 analisa os eventos hospitalizados, a etapa 2, os eventos fatais na comunidade e a etapa 3, os casos de AVC na comunidade que não foram admitidos em hospitais. Por meio de padronização de instrumentos para coleta de dados nas três etapas, esta estratégia permite a comparação de dados sobre a epidemiologia do AVC ao longo do tempo e entre países. Este estudo transversal tem como objetivo avaliar a prevalência de acidente vascular cerebral na área de abrangência do Programa Saúde da Família no Jardim São Jorge, zona oeste do município de São Paulo, por meio da implantação do terceiro passo do WHO STEPS Stroke. Validou-se questionário sobre sintomas de AVC (fraqueza de membros em um dos lados do corpo...

‣ Associação entre qualidade de vida e sintomas depressivos em pacientes com acidente vascular cerebral; Association between quality of life and depressive symptoms in patients with stroke

Guajardo, Valeri Alexandra Delgado
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 31/07/2012 Português
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INTRODUÇÃO: O comprometimento da qualidade de vida após o acidente vascular cerebral tem sido associado com a sintomatologia depressiva. Entretanto, até o momento não se tem estudos investigando se a associação da sintomatologia depressiva com a qualidade de vida é independente da qualidade de vida no momento basal. Este estudo teve como objetivo principal investigar a associação entre sintomas depressivos detectados um mês após o acidente vascular cerebral e a qualidade de vida três meses posteriores ao acidente vascular cerebral e avaliar se essa associação independe da qualidade vida um mês após o acidente vascular cerebral. Como objetivo secundário visou investigar a associação entre sintomas depressivos detectados três meses após o acidente vascular cerebral e a qualidade de vida três meses após o acidente vascular cerebral e avaliar se essa associação independe da qualidade vida um mês após o acidente vascular cerebral. MÉTODOS: Neste estudo foram triados de modo consecutivo 343 pacientes admitidos na enfermaria de Neurologia do Hospital das Clínicas de São Paulo. Destes, foram elegíveis 106 pacientes, e 67 foram avaliados prospectivamente um e três meses após o acidente vascular cerebral. A avaliação psiquiátrica consistiu na aplicação da entrevista clínica estruturada para diagnóstico pelo DSM-IV e na versão de 31 itens da escala de Hamilton para depressão (HAM-D-31); a avaliação da qualidade de vida foi realizada com a versão de 36 itens do inventario de qualidade de vida do Medical Outcomes Study (SF-36). As avaliações foram realizadas em 2 momentos...

‣ Influência do hemisfério cerebral lesado e de déficits sensoriais sobre o equilíbrio corporal pós-acidente vascular encefálico; Influence of the injured brain hemisphere and of sensory deficits on body balance post-stroke

Fernandes, Corina Aparecida
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 12/12/2014 Português
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A influência do hemisfério cerebral lesado pós-AVE e da informação visual foram avaliados neste estudo no controle da postura quieta, em perturbação sensorial e mecânica. Também foram avaliados o efeito da informação tátil durante perturbação sensorial e respostas posturais após perturbação postural externa imprevisível. Participaram deste estudo 11 indivíduos pós- AVE no hemisfério cerebral direito, 11 indivíduos pós-AVE no hemisfério cerebral esquerdo e 24 indivíduos sem doenças neurológicas. O desempenho do equilíbrio corporal foi avaliado na postura quieta, na postura ereta com superfície maleável (almofada de espuma) e após perturbação mecânica provocada pela liberação de carga inesperada. A avaliação foi feita sob as condições de visão plena e de oclusão visual. Os resultados da postura quieta revelaram aumento e maior variabilidade de oscilação postural no plano mediolateral de indivíduos pós- AVE em comparação aos sem doenças neurológicas. Indivíduos pós-AVE no hemisfério cerebral direito apresentaram aumento da oscilação postural no plano anteroposterior em comparação aos indivíduos pós-AVE no hemisfério cerebral esquerdo e sem doenças neurológicas. A condição de oclusão visual levou ao aumento da oscilação postural nos indivíduos pós-AVE em comparação aos indivíduos sem doenças neurológicas...

‣ Efeitos do modelo inspiratório, da velocidade de nado e do nível de desempenho sobre a técnica do nado borboleta; Breathing pattern, pace and expertise effects on butterfly stroke technique

Silveira, Ricardo Peterson
Fonte: Universidade Federal do Rio Grande do Sul Publicador: Universidade Federal do Rio Grande do Sul
Tipo: Dissertação Formato: application/pdf
Português
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O objetivo deste estudo foi comparar variáveis cinemáticas e coordenativas do nado borboleta sob diferentes modelos inspiratórios, velocidades de nado e níveis de desempenho. Participaram 23 nadadores competitivos, divididos em grupo de nível iniciante (n = 9) e grupo de nível avançado (n = 14). Foram mensuradas as durações das fases da braçada (entrada e apoio, puxada, empurrada e recuperação) e da pernada (descendente1, ascendente 1, descendente 2, ascendente 2), bem como a duração relativa das duas fases propulsivas principais DP1 (do início ao final da fase descendente 1 da pernada) e DP2 (do início da puxada ao final da fase descendente da segunda pernada). Os ângulos de ataque do tronco foram avaliados nos pontos-chave de entrada das mãos, início da puxada, início da empurrada e saída das mãos da água. Com relação à coordenação de membros, foram avaliadas as diferenças temporais entre pontos-chave da braçada e da pernada, sendo: T1 (entrada das mãos – início da fase descendente da primeira pernada), T2 (final da fase descendente da primeira pernada – início da puxada), T3 (início da empurrada – início da fase descendente da segunda pernada), T4 (final da fase descendente da segunda pernada – saída das mãos da água) e TTG (diferença de tempo total). Foi realizado...

‣ Screening de deglutição na fase aguda do acidente vascular cerebral : uma análise dos preditores clínicos da disfagia; Swallowing screening in acute stroke : an analysis of the clinical predictor of dysphagia

Mariana Mendes Bahia
Fonte: Biblioteca Digital da Unicamp Publicador: Biblioteca Digital da Unicamp
Tipo: Dissertação de Mestrado Formato: application/pdf
Português
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O Acidente Vascular Cerebral (AVC) é a principal causa de morbi-mortalidade no Brasil, tendo a disfagia como uma importante sequela. A disfagia é responsável por complicações como pneumonia, desnutrição e desidratação. Atualmente, o screening é a forma de avaliação mais difundida para identificar de maneira rápida os pacientes com risco de disfagia na fase aguda do AVC. O objetivo da pesquisa é identificar a presença de disfagia orofaríngea na fase aguda do AVC, determinando sua frequência, relação com a gravidade do AVC e seus preditores, a partir da proposta de um screening. Trata-se de estudo de corte transversal e de abordagem quantitativa, aprovado pelo CEP, envolvendo a avaliação da deglutição nas primeiras 72 horas do AVC. Foram incluídos pacientes consecutivos admitidos na Unidade de Emergência Referenciada de um hospital terciário do Estado de São Paulo entre abril/2012 e agosto/2013, com presença de AVC único em qualquer topografia cerebral, sendo o diagnóstico de AVC determinado por avaliação neurológica e confirmado por TC e/ou RM de crânio. Foram excluídos pacientes cujo AVC havia ocorrido há mais de 72 horas, com evidência de AVC prévio, com história de doenças neurológicas ou psiquiátricas...

‣ Primary and Comprehensive Stroke Centers: History, Value and Certification Criteria

Gorelick, Philip B.
Fonte: Korean Stroke Society Publicador: Korean Stroke Society
Tipo: Artigo de Revista Científica
Português
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In the United States (US) stroke care has undergone a remarkable transformation in the past decades at several levels. At the clinical level, randomized trials have paved the way for many new stroke preventives, and recently, several new mechanical clot retrieval devices for acute stroke treatment have been cleared for use in practice by the US Federal Drug Administration. Furthermore, in the mid 1990s we witnessed regulatory approval of intravenous recombinant tissue plasminogen activator for administration in acute ischemic stroke. In the domain of organization of medical care and delivery of health services, stroke has transitioned from a disease dominated by neurologic consultation services only to one managed by vascular neurologists in geographical stroke units, stroke teams and care pathways, primary stroke center certification according to The Joint Commission, and most recently comprehensive stroke center designation under the aegis of The Joint Commission. Many organizations in the US have been involved to enhance stroke care. To name a few, the American Heart Association/American Stroke Association, Brain Attack Coalition, and National Stroke Association have been on the forefront of this movement. Additionally, governmental initiatives by the US Centers for Disease Control and Prevention and legislative initiatives such as the Paul Coverdell National Acute Stroke Registry program have paved the way to focus on stroke prevention...

‣ Stroke Statistics in Korea: Part I. Epidemiology and Risk Factors: A Report from the Korean Stroke Society and Clinical Research Center for Stroke

Hong, Keun-Sik; Bang, Oh Young; Kang, Dong-Wha; Yu, Kyung-Ho; Bae, Hee-Joon; Lee, Jin Soo; Heo, Ji Hoe; Kwon, Sun U.; Oh, Chang Wan; Lee, Byung-Chul; Kim, Jong S.; Yoon, Byung-Woo
Fonte: Korean Stroke Society Publicador: Korean Stroke Society
Tipo: Artigo de Revista Científica
Português
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The aim of the Part I of Stroke Statistics in Korea is to summarize nationally representative data of the epidemiology and risk factors of stroke in a single document. Every year, approximately 105,000 people experience a new or recurrent stroke and more than 26,000 die of stroke, which indicates that every 5 minutes stroke attacks someone and every 20 minutes stroke kills someone in Korea. Stroke accounts for roughly 1 of every 10 deaths. The estimated stroke prevalence is about 795,000 in people aged ≥30 years. The nationwide total cost for stroke care was 3,737 billion Korean won (US$3.3 billion) in 2005. Fortunately, the annual stroke mortality rate decreased substantially by 28.3% during the first decade of the 21th century (53.2/100,000 in 2010). Among OECD countries, Korea had the lowest in-hospital 30-day case-fatality rate for ischemic stroke and ranked third lowest for hemorrhagic stroke in 2009. The proportion of ischemic stroke has steadily increased and accounted for 76% of all strokes in 2009. According to hospital registry studies, the 90-day mortality rate was 3-7% for ischemic stroke and 17% for intracerebral hemorrhage. For risk factors, among Korean adults ≥30 years of age, one in 3-4 has hypertension, one in 10 diabetes...

‣ Stroke Epidemiology in Thailand

Suwanwela, Nijasri C.
Fonte: Korean Stroke Society Publicador: Korean Stroke Society
Tipo: Artigo de Revista Científica
Português
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Stroke is a major health burden in Thailand. It is the leading cause of death and long term disability in both men and women. Despite the improvement of healthcare system, the mortality rate of stroke is still increasing during the past 5 years. The incidence of stroke in Thailand is now being studied in a large population based cohort. The prevalence of stroke is estimated to be 1.88% among adults 45 years and older. Stroke is more prevalent in men than in women and the mean age of stroke onset is 65 years. Hypertension, diabetes, dyslipidemia, metabolic syndrome, and atrial fibrillation are major risk factors of stroke in the Thai population. Evolution from predominantly rural to urbanized industrial communities result in the increasing prevalence of these risk factors. Similar to other parts of the world, ischemic stroke is the most common stroke type but the proportion of hemorrhagic stroke is higher when compared to Caucasian populations. Among patients with ischemic stroke, lacunar stroke is most common, accounting for almost half followed by atherosclerotic disease. Intracranial atherosclerosis is also prevalent in Thai population. For acute treatment, intravenous thrombolysis has been used in Thailand for over 20 years. Its cost is reimbursed by the national health care system but its use is still limited. With the introduction of the stroke fast track system...

‣ Stroke: Morbidity, Risk Factors, and Care in Taiwan

Hsieh, Fang-I; Chiou, Hung-Yi
Fonte: Korean Stroke Society Publicador: Korean Stroke Society
Tipo: Artigo de Revista Científica
Português
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Stroke is the third leading cause of death and the most common cause of complex disability in Taiwan. The annual age-standardized mortality rate of stroke is steadily decreasing between 2001 and 2012. The average years of potential life lost before age 70 for stroke is 13.8 years, ranked the fifth in the cause of death. Its national impact is predicted to be greater accompany aging population. The most common type of stroke was ischemic stroke in Taiwan. Small vessel occlusion was the majority of ischemic strokes subtype. Age, gender, hypertension, diabetes hyperlipidemia, obesity, atrial fibrillation, and smoking were important contributory factors to stroke morbidity. The standard treatment for acute ischemic stroke in Taiwan is providing the intravenous thrombolysis with recombinant tissue plasminogen activator (IV tPA) therapy for ischemic stroke patients within 3 hours of symptom onset. However, the rate of IV tPA therapy for patients with acute ischemic stroke is still low in Taiwan. Therefore, improving the public awareness of stroke warning signs and act on stroke and improving in-hospital critical pathway for thrombolysis would be the most important and urgent issues in Taiwan. To improve acute stroke care quality, a program of Breakthrough Series-Stroke activity was conducted from 2010 to 2011 and stroke centers were established in the medical centers. For the prevention of stroke...

‣ Stroke Genetics: A Review and Update

Lindgren, Arne
Fonte: Korean Stroke Society Publicador: Korean Stroke Society
Tipo: Artigo de Revista Científica
Português
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Stroke genetics includes several topics of clinical interest, including (1) molecular genetic variations affecting risk of monogenic stroke syndromes; (2) molecular genetic variations affecting risk of common stroke syndromes, sometimes with specific effects on risk of specific main types of stroke or subtypes of ischemic and hemorrhagic stroke; (3) genetics of conditions associated with stroke risk e.g. white matter hyperintensities, atrial fibrillation and hypertension; (4) hereditary causes of familial aggregation of stroke; (5) epigenetic impact on protein expression during acute brain injury; (6) genetic influence on stroke recovery; and (7) pharmacogenetics. Genetic research methods include candidate gene studies; Genome Wide Association Studies; family studies; RNA and protein analyses; and advanced computer-aided analytical methods to detect statistically significant associations. Several methods that could improve our knowledge of stroke genetics are being developed e.g.: Exome content analysis; Next-generation sequencing; Whole genome sequencing; and Epigenetics. During 2012-2014, several Single Nucleotide Polymorphisms (SNPs) have been related to common ischemic stroke risk. Certain SNPs have been associated with risk of specific ischemic stroke subtypes such as large vessel disease and cardiac embolism...

‣ Association Between Genetic Variant on Chromosome 12p13 and Stroke Survival and Recurrence: A One Year Prospective Study in Taiwan

Hsieh, Yi-Chen; Seshadri, Sudha; Chung, Wen-Ting; Hsieh, Fang-I; Lin, Huey-Juan; Tseng, Hung-Pin; Lien, Li-Ming; Bai, Chyi-Huey; Hu, Chaur-Jong; Jeng, Jiann-Shing; Tang, Sung-Chun; Chen, Chin-I; Yu, Chia-Chen; Chiou, Hung-Yi; Hsu, Yi Hsiang
Fonte: BioMed Central Publicador: BioMed Central
Tipo: Artigo de Revista Científica
Português
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Background: The association between ischemic stroke and 2 single nucleotide polymorphisms (SNPs) on chromosome 12p13, rs12425791 and rs11833579 appears inconsistent across different samples. These SNPs are close to the ninjurin2 gene which may alter the risk of stroke by affecting brain response to ischemic injury. The purpose of this study was to investigate the association between these two SNPs and ischemic stroke risk, as well as prognostic outcomes in a Taiwanese sample. Methods We examined the relations of these two SNPs to the odds of new-onset ischemic stroke, ischemic stroke subtypes, and to the one year risk of stroke-related death or recurrent stroke following initial stroke in a case-control study. A total of 765 consecutive patients who had first-ever ischemic stroke were compared to 977 stroke-free, age-matched controls. SNPs were genotyped by Taqman fluorescent allelic discrimination assay. The association between ischemic stroke and SNPs were analyzed by multivariate logistic regression. Cox proportional hazard model was used to assess the effect of individual SNPs on stroke-related mortality or recurrent stroke. Results: There was no significant association between SNP rs12425791 and rs11833579 and ischemic stroke after multiple testing corrections. However...

‣ Short-Term Changes in Ambient Temperature and Risk of Ischemic Stroke

Mostofsky, Elizabeth; Wilker, Elissa H.; Schwartz, Joel; Zanobetti, Antonella; Gold, Diane R.; Wellenius, Gregory A.; Mittleman, Murray A.
Fonte: S. Karger AG Publicador: S. Karger AG
Tipo: Artigo de Revista Científica
Português
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Background: Despite consistent evidence of a higher short-term risk of cardiovascular mortality associated with ambient temperature, there have been discrepant findings on the association between temperature and ischemic stroke. Moreover, few studies have considered potential confounding by ambient fine particulate matter air pollution <2.5 μm in diameter (PM2.5) and none have examined the impact of temperature changes on stroke in the subsequent hours rather than days. The aim of this study was to evaluate whether changes in temperature trigger an ischemic stroke in the following hours and days and whether humid days are particularly harmful. Methods: We reviewed the medical records of 1,705 patients residing in the metropolitan region of Boston, Mass., USA, who were hospitalized with neurologist-confirmed ischemic stroke, and we abstracted data on the time of symptom onset and clinical characteristics. We obtained hourly meteorological data from the National Weather Service station and hourly PM2.5 data from the Harvard ambient monitoring station. We used the time-stratified case-crossover design to assess the association between ischemic stroke and apparent temperature averaged over 1-7 days prior to stroke onset adjusting for PM2.5. We assessed whether differences in apparent temperature trigger a stroke within shorter time periods by examining the association between stroke onset and apparent temperature levels averaged in 2-hour increments prior to stroke onset (0-2 h through 36-38 h). We tested whether the association varied by health characteristics or by PM2.5...

‣ Relationship between C - Reactive Protein and Stroke: A Large Prospective Community Based Study

Liu, Yanfang; Wang, Jing; Zhang, Liqun; Wang, Chunxue; Wu, Jianwei; Zhou, Yong; Gao, Xiang; Wang, Anxin; Wu, Shouling; Zhao, Xingquan
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
Português
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Objective: Previous studies have suggested that C-reactive protein (CRP) was associated with risk of stroke. There were few studies in Asian population, or on stroke subtypes other than ischemic stroke. We thus investigated the relationship between CRP and the risks of all stroke and its subtypes in a Chinese adult population. Methods: In the current study, we included 90,517 Chinese adults free of stroke and myocardial infarction at baseline (June 2006 to October 2007) in analyses. Strokes were classified as ischemic stroke (IS), intracranial heamorrhage (ICH) and subarachnoid heamorrhage (SAH). High-sensitivity CRP (hs-CRP) were categorized into three groups: <1 mg/L, 1 to 3 mg/L, and >3 mg/L. Cox proportional hazards regression was used to calculate the association between hs-CRP concentrations and all stroke, as well as its subtypes. Results: During a median follow-up time of 49 months, we documented 1,472 incident stroke cases. Of which 1,049 (71.3%) were IS, 383 (26.0%) were ICH, and 40 (2.7%) were SAH. After multivariate adjustment, hs-CRP concentrations ≥1 mg/L were associated with increased risks of all stroke (hs-CRP 1–3 mg/L: hazard ratio (HR) 1.17, 95% confidential interval (CI) 1.03–1.33; hs-CRP>3 mg/L: HR 1.25, 95% CI 1.07–1.46) and IS (hs-CRP 1–3 mg/L: HR 1.17...

‣ Do Healthcare Process and Outcomes Differ for Acute Ischemic Stroke Patients Admitted to Designated Stroke Centers?

Xian, Ying ; Friedman, Bruce
Fonte: Universidade de Rochester Publicador: Universidade de Rochester
Tipo: Tese de Doutorado
Português
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Thesis (Ph.D.)--University of Rochester. School of Medicine & Dentistry. Dept. of Community and Preventive Medicine, 2010.; Stroke is the third leading cause of mortality and the leading cause of serious long-term disability in the Unites States. Establishment of designated stroke centers has great potential to improve acute stroke care. Despite widespread support for the stroke center concept, few studies have demonstrated improved process of care at designated stroke centers, and none has examined mortality outcomes. This dissertation uses New York Statewide Planning and Research Cooperative System data (2005-2006) to examine two research questions controlling for the non-randomized study design: (1) Do New York State designated stroke centers increase the use of thrombolytic therapy among patients with acute ischemic stroke? (2) Do designated stroke centers reduce mortality? In addition, we evaluate racial/ethnic differences in the use of thrombolytic therapy and mortality. Our studies resulted in the following observations: • Compared to patients at non-designated hospitals, patients who were treated at designated stroke centers were significantly more likely to receive thrombolytic therapy. • Receiving care at designated stroke centers was associated with significantly lower mortality...

‣ Long-term disability after first-ever stroke and related prognostic factors in the Perth Community Stroke Study, 1989-1990

Hankey, Graeme J.; Jamrozik, Konrad; Broadhurst, Robyn J.; Forbes, Susanne; Anderson, Craig S.
Fonte: Lippincott Williams & Wilkins Publicador: Lippincott Williams & Wilkins
Tipo: Artigo de Revista Científica
Publicado em //2002 Português
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Background and Purpose— Few reliable estimates of the long-term functional outcome after stroke are available. This population-based study aimed to describe disability, dependency, and related independent prognostic factors at 5 years after a first-ever stroke in patients in Perth, Western Australia. Methods— All individuals with a suspected acute stroke who were resident in a geographically defined region (population, 138 708) of Perth, Western Australia, were registered prospectively and assessed according to standardized diagnostic criteria over a period of 18 months in 1989 to 1990. Patients were followed up prospectively at 4 and 12 months and 5 years after the index event. Results— There were 370 cases of first-ever stroke, and 277 patients survived to 30 days. Of these early survivors, 152 (55%) were alive at 5 years, and among those who were neither institutionalized (n=146) nor disabled (n=129) at the time of their stroke, 21 (14%) were institutionalized in a nursing home, and 47 (36%) were disabled. The most important predictors of death or disability at 5 years were increasing age, baseline disability defined by a Barthel Index score of <20/20 (odds ratio [OR], 6.3; 95% confidence interval [CI], 2.7 to 14), moderate hemiparesis (OR...

‣ Characterising the role of substance P in acute ischaemic stroke.

Turner, Renée Jade
Fonte: Universidade de Adelaide Publicador: Universidade de Adelaide
Tipo: Tese de Doutorado
Publicado em //2007 Português
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More than 15 million people worldwide will suffer a stroke each year two thirds will die or be left permanently disabled. Accordingly, stroke represents an enormous financial burden on the community, due to the cost of hospitalisation, treatment and rehabilitation of stroke patients. Despite the significance of this public health problem, a safe and widely applicable stroke therapeutic remains elusive. Cerebral oedema is widely recognised as a common and often fatal complication of stroke that is associated with worsened outcome. However, the exact mechanisms of oedema formation remain unclear, with current therapies largely ineffective in addressing the mechanisms of cerebral swelling, and also being associated with their own negative side-effect profile. This thesis characterises the role of neurogenic inflammation and the neuropeptide, substance P (SP), in mediating the development of blood brain barrier breakdown, cerebral oedema and resultant functional deficits following stroke, using a rodent model of reversible cerebral ischaemia. The findings of this thesis demonstrate that increased SP immunoreactivity, particularly of the penumbral tissue vasculature, is a feature of tissue perfusion following stroke, but not in non-reperfused infarcts. The central role for SP in the breakdown of the BBB following stroke and the associated deleterious effects of such breakdown was confirmed by studies using an NK₁ receptor antagonist. These antagonists conferred a profound attenuation of BBB breakdown...

‣ Association of the phosphodiesterase 4D (PDE4D) gene and cardioembolic stroke in an Australian cohort

Milton, A.; Aykanat, V.; Hamilton-Bruce, M.; Nezic, M.; Jannes, J.; Koblar, S.
Fonte: Wiley-Blackwell Publishing Asia Publicador: Wiley-Blackwell Publishing Asia
Tipo: Artigo de Revista Científica
Publicado em //2011 Português
Relevância na Pesquisa
36.740127%
Background: Large-scale epidemiological studies support an important role for susceptibility genes in the pathogenesis of ischemic stroke, with phosphodiesterase 4D identified as the first gene predisposing to ischemic stroke. Several single nucleotide polymorphisms within the phosphodiesterase 4D gene have been implicated in the pathogenesis of stroke. Aim: Undertake a multivariate analysis of six single nucleotide polymorphisms within the phosphodiesterase 4D gene in a previously defined Australian stroke cohort, to determine whether these single nucleotide polymorphisms have an association with ischemic stroke. Methods: This case–control study was performed using an existing genetic database of 180 ischemic stroke patients and 301 community controls, evaluated previously for cerebrovascular risk factors (hypertension, hypercholesterolemia, diabetes, paroxysmal atrial fibrillation, smoking and history of stroke in a first-degree relative). Based on previously reported associations with large vessel disease, ischemic stroke, cardioembolic stroke or a mixture of these, six single nucleotide polymorphisms in the phosphodiesterase 4D gene were selected for study, these being single nucleotide polymorphisms 13, 19, rs152312, 45, 83 and 87...

‣ Stroke Statistics in Korea: Part II Stroke Awareness and Acute Stroke Care, A Report from the Korean Stroke Society and Clinical Research Center For Stroke

Hong, Keun-Sik; Bang, Oh Young; Kim, Jong S.; Heo, Ji Hoe; Yu, Kyung-Ho; Bae, Hee-Joon; Kang, Dong-Wha; Lee, Jin Soo; Kwon, Sun U.; Oh, Chang Wan; Lee, Byung-Chul; Yoon, Byung-Woo
Fonte: Korean Stroke Society Publicador: Korean Stroke Society
Tipo: Artigo de Revista Científica
Português
Relevância na Pesquisa
36.76775%
The aim of the current Part II of Stroke Statistics in Korea is to summarize nationally representative data on public awareness, pre-hospital delay, thrombolysis, and quality of acute stroke care in a single document. The public's knowledge of stroke definition, risk factors, warning signs, and act on stroke generally remains low. According to studies using open-ended questions, the correct definition of stroke was recognized in less than 50%, hypertension as a stroke risk factor in less than 50%, and other well-defined risk factors in less than 20%. Among stroke warning signs, sudden paresis or numbness was best appreciated, with recognition rates ranging in 36.9-73.7%, but other warning signs including speech disturbance were underappreciated. In addition, less than one third of subjects in a representative population survey were aware of thrombolysis and had knowledge of the appropriate act on stroke, calling emergency medical services (EMS). Despite EMS being an essential element in the stroke chain of survival and outcome improvement, EMS protocols for field stroke diagnosis and prehospital notification for potential stroke patients are not well established. According to the Assessment for Quality of Acute Stroke Care, the median onset-to-door time for patients arriving at the emergency room was 4 hours (mean...