Incidence Of Stroke In Adults Research Articles

Desenvolvimento e avaliação do conteúdo do aplicativo móvel Cinesia para pacientes com déficits motores dimidiados após acidente vascular cerebral

Abstract Introduction The incidence of stroke in adults has increased in recent years, and individuals who survive often have one or more motor and cognitive deficits. In Brazil, the Unified Health System (SUS) faces difficulties in reabsorbing the entire population that needs physiotherapy after hospital discharge. In addition, the distance to rehabilitation units in Rio de Janeiro can be far, making it impossible for some patients to receive the treatment they need. Objective To create a complementary mobile application for adults with unilateral motor deficits and to evaluate its content through expert judges. Methods Applied research for the construction of a mobile app with the prototyping method by Pressman. Steps: 1) literature review; 2) development of the technological framework; 3) construction of the content; and 4) construction of a prototype. The app content was evaluated using the e-Delphi Method for peer review using a Likert-type questionnaire on the Google Forms platform. Results The application was developed and designed to run on the Android operating system. Three rounds were carried out to evaluate the app's content. The final average of the content validity index (CVI) of all content items was 0.85, reaching the minimum agreement of 0.80, suggested by authors. Conclusion The content of a mobile app for adults with unilateral post-stroke motor deficits was developed and approved, and its content was evaluated by expert judges. We believe that this app can contribute to the promotion of physical rehabilitation in people with unilateral motor deficits after hospital discharge.

Vitamin D intake and stroke incidence in adults

Stroke is one of the non-communicable diseases which becomes a global health problem. One of the micronutrient intakes associated with a risk factor for stroke is vitamin D, in which a deficiency of this vitamin is associated with the incidence of ischemic stroke. Therefore, the objective of this study is to determine the relationship between vitamin D intake and the incidence of stroke in adulthood. The method administered is analytic observational with a case-control design and encompasses 40 respondents aged 20-60 years who are members of the Happy Embung community of Yayasan Stroke Indonesia (YASTROKI) DI Yogyakarta. The sampling technique was purposive sampling in the YASTROKI community in Yogyakarta, the measuring instrument employed was the Semi-Quantitative Food Frequency Questionnaire (SQ-FFQ). Data were examined by employing Chi square test with the results that more than one third of the respondents in the case group and the control group possessed less vitamin D intake (40% and 85%). There was a significant association between the intake of vitamin D and the incidence of stroke in adults (p = 0.016). This study concludes that adequate nutritional intake, particularly vitamin D, is one way to reduce the risk of stroke and enhance the quality of life of stroke patients.

Relationship between waist-to-height ratio and overall and type specific incidence of stroke in adults in China: a prospective study

Objective: To analyze the association between waist-to-height ratio and the overall and type specific incidence of stroke in adults in China. Methods: A total of 36 632 people were selected from 60 surveillance sites (25 in urban area and 35 in rural area) in China Chronic Disease Surveillance Project in 2010. The China Chronic Disease Surveillance Project data in 2010 were used as baseline data. A total of 27 762 people were followed up from 2016 to 2017. Cox proportional risk regression model was used to analyze the risk ratio of waist-to-height ratio for the overall and type specific incidence of stroke. Subgroup analyses were performed based on baseline characteristics such as age and sex, and sensitivity analysis was performed by excluding those who died and those with diabetes at baseline survey. Results: A total of 27 112 subjects were included in the stroke analysis, and 1 333 stroke events were observed. A total of 26 907 subjects were included in the ischemic stroke analysis, and 1 128 ischemic stroke events were observed. A total of 25 984 subjects were included in the hemorrhagic stroke analysis, and 205 cases of hemorrhagic stroke were observed. After adjusting for relevant confounders and taking group with waist-to-height ratio of 0-0.45 as a reference, the stroke analysis indicated that in groups with waist-to-height ratio of 0.46-0.49, 0.50-0.54 and ≥0.55 the risk for stroke increased by 21% (HR=1.21, 95%CI:1.00-1.46), 26% (HR=1.26, 95%CI:1.04-1.53) and 60% (HR=1.60, 95%CI:1.29-1.99) respectively. Subgroup analysis revealed that age specific waist-to-height ratio had modification effect on the risk for stroke (interaction P=0.001). Ischemic stroke analysis indicated that in groups with waist-to-height ratio of 0.46-0.49, 0.50-0.54 and ≥0.55 the risk for ischemic stroke increased by 30% (HR=1.30, 95%CI: 1.05-1.60), 33% (HR=1.33, 95%CI: 1.07-1.64) and 61% (HR=1.61, 95%CI: 1.26-2.05) respectively. Subgroup analysis revealed that age specific waist-to-height ratio had modification effect on the risk for ischemic stroke (interaction P=0.024). Hemorrhagic stroke analysis indicated that in group with waist-to-height ratio of ≥0.55 the risk for hemorrhagic stroke increased by 73% (HR=1.73, 95%CI: 1.02-2.94), but the differences in the risk increase in groups with waist-to-height ratio of 0.46-0.49 and 0.50-0.54 were not significant. The sensitivity analysis showed no changes. Conclusions: In the prevention and control of stroke by body weight control, it is necessary to take waist to height ratio as one of the indicators of body weight control. Particular attention needed to be paid to the people aged <50 years with waist-to-height ratio of ≥0.55 as well as those with waist-to-height ratio of <0.5 (i.e., 0.46-0.49).

Abstract WMP49: Disparities in Rising Incidence of Stroke in Adults Younger Than 65

Introduction: Increased incidence of stroke in young adults has been attributed to rising prevalence of known stroke risk factors such as hypertension. Our aim is to identify young adult demographic groups most in need of clinical and public health intervention to prevent future increases in stroke incidence. Methods: We performed retrospective analyses on hospitalization data from the National Inpatient Sample (NIS) in adults aged 18- 64 years with diagnosis of ischemic stroke, hemorrhagic stroke, or subarachnoid hemorrhage from 2006 to 2015 and compared hospitalization rates over two-year periods. Results: We included data from 1,750,081 hospitalizations meeting inclusion criteria. Comparing 2006-07 to 2014-15, rates of hospitalization for stroke increased significantly across all analyzed gender and racial groups except Asian/Pacific Islanders aged 18-34 and 34-45. Non-Hispanic Blacks (NHB) had the highest stroke hospitalization rates in those aged 18-44, and Asian/Pacific Islander rates were highest in ages 45-64 (Figure 1d,f). In this period, there was a 26% overall increase in risk of hospitalization for stroke in young adults with 42% (CI 1.28 - 1.57) increased risk in women aged 18-34 and 41% (1.32 -1.51) in men aged 35-44. Regionally, the South had the highest incidence of stroke hospitalization in all age groups but the highest increase in risk over the decade was seen in the Northeast. Prevalence of hypertension among hospitalized patients remained unchanged or decreased while prevalence of all other risk factors increased, mostly in obesity and lipid disorders (Figure 1h). Conclusions: Despite public awareness, stroke incidence continues to increase in young patients remaining highest among minorities and in the Southern states, but rising more in the Northeast. Personalized approaches and geographic aspects, in addition to vascular risk factor control, will all likely be needed to reduce stroke risk in these different patient populations.

Incidence of stroke in adults according to age, sex and subtypes in urban Indian population

Introduction : In a developing country like India, it is imperative to study the effects of age and gender on the incidence of stroke as it has important implications in making health policy decisions. Methods: We evaluated the incidence of stroke in patients over 15 years of age at Navi Mumbai, India during the period 2013-19 in Navi Mumbai, India. Outcomes studied were incidence of stroke stratified by age, sex, and stroke subtype. Results: Out of a total of 1377 patients, 1246 were ischemic and 131 haemorrhagic. The mean age was 49.06 years and 53% were males. Nearly half of the strokes occurred in 46-65 years group, and one-thirds in over 65 years of age. 21% bleeds and 16% of infarcts occurred under 45years of age. Younger females had lesser risk stroke as compared to males but females above 65years had a significantly greater risk of infarct (P value 65 years of age) were more prone to ischemic stroke than elderly males. Intracerebral haemorrhage occurred significantly more often in men than women under the age of 45years. These findings have important implications for public health policy and sociocultural changes.

Proteinuria as an independent predictor of stroke: Systematic review and meta-analysis.

BackgroundProteinuria has emerged as an important vascular risk factor for adverse cardiovascular events including stroke. Hypertension has been proposed as the principal confounder of this relationship but its role has not been systematically examined.AimWe aimed to determine if proteinuria remains an independent predictor of stroke after more complete adjustment for blood pressure.Summary of reviewWe performed a systematic review, searching MEDLINE and EMBASE (to February 2018) for cohort studies or randomized controlled trials that reported stroke incidence in adults according to baseline proteinuria ± glomerular filtration rate. Study and participant characteristics and relative risks were extracted. Estimates were combined using a random effects model. Heterogeneity was assessed by χ2 statistics and I2, and by subgroup strata and meta-regression, with a particular focus on the impact of more complete adjustment for blood pressure on the association. The quality of cohort studies and post hoc analyses was assessed using the Newcastle–Ottawa Scale. We identified 38 studies comprising 1,735,390 participants with 26,405 stroke events. Overall, the presence of any level of proteinuria was associated with greater stroke risk (18 studies; pooled crude relative risk 2.00, 95%CI 1.63–2.46; p < 0.001) even after adjustment for established cardiovascular risk factors (33 studies; pooled adjusted relative risk 1.72, 1.51–1.95; p < 0.001), albeit with considerable heterogeneity between studies (p < 0.001; I2 = 77.3%). Moreover, the association did not substantially attenuate with more thorough adjustment for hypertension: single baseline blood pressure measure (10 studies; pooled adjusted relative risk = 1.92, 1.39–2.66; p < 0.001); history or treated hypertension (four studies; pooled adjusted relative risk = 1.76, 1.13–2.75, p = 0.013); multiple blood pressure measurements over months to years (four studies; relative risk = 1.68, 1.33–2.14; p < 0.001).ConclusionsEven after extensive adjustment for hypertension, proteinuria is strongly and independently associated with incident stroke risk, possibly indicating a shared renal and cerebral susceptibility to vascular injury that is not fully explained by traditional vascular risk factors.

Does Chronic Kidney Disease Predict Stroke Risk Independent of Blood Pressure?: A Systematic Review and Meta-Regression.

Background and Purpose- Chronic kidney disease is strongly associated with stroke with various purported mechanisms proposed. Low glomerular filtration rate appears to be a risk factor for stroke independent of cardiovascular risk factors in epidemiological studies, but there has been no systematic assessment of the impact of more complete adjustment for blood pressure on the association. Methods- We did a systematic review to February 2018 (MEDLINE/EMBASE) for cohort studies or randomized controlled trials that reported stroke incidence in adults according to baseline estimated glomerular filtration rate. Study and participant characteristics and relative risks (RR) were extracted. Estimates were combined using a random-effects model. Heterogeneity was assessed by x2 statistics and I2 and by subgroup strata and meta-regression. Results- We identified 168 studies reporting data on 5 611 939 participants with 115 770 stroke outcomes. Eighty-five studies (3 417 098 participants; 72 996 strokes) provided adequate data for meta-analysis of estimated glomerular filtration rate and stroke risk. Incident stroke risk was increased among participants with estimated glomerular filtration rate <60 mL/min per 1.73 m2 (RR=1.73; 95% CI, 1.57-1.90; P<0.001), but there was substantial heterogeneity between studies (P<0.0001; I2, 78.5%). Moreover, the association was reduced after adjustment for cardiovascular risk factors, with progressive attenuation on more thorough adjustment for hypertension: single baseline blood pressure measure (RR=1.63; CI, 1.34-1.99; P<0.001); history or treated hypertension (RR=1.35; CI, 1.24-1.46; P<0.001); multiple blood pressure measurements over months to years (RR=1.10; CI, 1.02-1.18; P=0.01). Conclusions- The association between chronic kidney disease and stroke appears to be highly dependent on the method of adjustment for hypertension. The apparently independent relationship between chronic kidney disease and stroke may be confounded by their shared association with long-term prior blood pressure.

Abstract WP408: Temporal Trends in Pediatric Stroke Hospitalization From 2000 - 2009: Analysis of the KID Inpatient Database

Background/Hypothesis: Stroke in children ≤18 years is an important public health problem. The incidence of stroke in adults has been falling over several decades, likely attributable to better management of vascular risk factors. Children have different risk factors for cerebrovascular disease, however we wanted to see if similar trends were observed in pediatric stroke. We examined pediatric hospital discharges for stroke over the last decade. Methods: We used the Kids’ Inpatient Database (KID) for 2000, 2003, 2006, and 2009 using the published weighting guidelines to estimate the number of overall discharges and number of discharges due to stroke. To identify stroke we queried primary position discharge ICD-9 stroke codes 430, 431, 432.9, 434.X1, 434.9, and 435.9; previously identified to have high PPV for detection of stroke in children in a physician-verified epidemiology stroke study. We calculated incidence for stroke among hospitalized children as number of stroke discharges / total number of discharges, and expressed the ratio per 100,000 discharges. We compared trends in stroke type, age, race and sex over the decade. Results: Stroke incidence in 2000 was 26.4 (95% CI 23.2-29.6). In the 2009 sample, incidence was 30.9 (27.7-34.1) showing a non-significant increasing trend over time. Ischemic stroke was increasingly diagnosed over the same interval with a statistically significantly higher incidence in 2006 and 2009 compared to 2000 (Figure 1). Groups with highest stroke incidence in hospitalized children were 10-14 year olds, males, and children identifying with the racial group “black.” Conclusion: In the KID database, we identified a rising incidence of ischemic stroke diagnosis over the past decade, however the overall rate of pediatric stroke has not increased significantly. The increasing rate of an ischemic stroke discharge diagnosis may be the result of increased awareness of childhood stroke.

Efficacy of direct factor Xa inhibitors compared to warfarin in preventing stroke in adults with non-valvular atrial fibrillation: a systematic review protocol.

The objective of this review is to determine the overall efficacy of direct factor Xa inhibitors in comparison with warfarin in preventing the incidence of stroke in adults with non-valvular atrial fibrillation with moderate-to-high risk for stroke.

Chronic kidney disease and the risk of stroke: a systematic review and meta-analysis.

People with chronic kidney disease (CKD) have an increased risk of stroke but the magnitude of increased risk and the independent effects of glomerular filtration rate (GFR) and albuminuria are unclear. We aimed to quantify the association between the independent and combined effects of GFR and albuminuria on stroke risk. We searched MEDLINE and EMBASE (February 2014) for cohort studies or randomized controlled trials (RCTs) which reported stroke incidence in adults with a baseline measurement of GFR and/or albuminuria. We extracted study and participant characteristics, risk of bias and relative risks (RR, with confidence interval; CI) of stroke associated with GFR and/or quantity of albuminuria, synthesized data using random effects meta-analysis and explored heterogeneity using meta-regression. We identified 83 studies; 63 cohort studies (2 085 225 participants) and 20 RCTs (168 516 participants) reporting 30 392 strokes. There was an inverse linear relationship between GFR and risk of stroke, with risk of stroke increasing 7% (RR: 1.07, CI: 1.04-1.09) for every 10 mL/min/1.73 m(2) decrease in GFR. A 25 mg/mmol increase in albumin-creatinine ratio was associated with a 10% increased risk of stroke (RR: 1.10, 95% CI: 1.01-1.20). The effect of albuminuria was independent of GFR. Results were not different across subtypes of stroke, sex and varying prevalence of cardiovascular risk factors. Stroke risk increases linearly and additively with declining GFR and increasing albuminuria. CKD staging may also be a useful clinical tool for identifying people who may benefit most from interventions to reduce cardiovascular risk.

The PlA1/A2 polymorphism of glycoprotein IIIa as a risk factor for stroke: a systematic review and meta-analysis.

BackgroundThe PlA1/A2 polymorphism of glycoprotein IIIa (GPIIIa) has been reported to be associated with risk of stroke in some studies, although other studies suggest no such association. This meta-analysis and systematic review was conducted to investigate the hypothesis that carriage of the PlA2 allele is a risk factor for stroke.MethodsElectronic databases (MEDLINE and EMBASE) were searched for all articles evaluating carriage of the PlA2 allele and the incidence of stroke. Pooled odds ratios (ORs) were calculated using fixed-effect and random-effect models.FindingsA total of 35 articles were eligible for inclusion, of which 25 studies were suitable for statistical analysis. For carriage of the PlA2 allele, OR 1.12 (n = 11,873; 95% CI = 1.03–1.22; p = 0.011) was observed for the incidence of stroke in adults, with subgroup analyses identifying the association driven by stroke of an ischaemic (n = 10,494; OR = 1.15, 95% CI = 1.05–1.27; p = 0.003) but not haemorrhagic aetiology (n = 2,470; OR = 0.90, 95% CI = 0.71–1.14; p = 0.398). This association with ischaemic stroke was strongest in individuals homozygous for the PlA2 allele compared to those homozygous for wild-type PlA1 (n = 5,906; OR = 1.74, 95% CI = 1.34–2.26; p<0.001). Subgroup analysis of ischaemic stroke subtypes revealed an increased association with stroke of cardioembolic (n = 1,271; OR 1.56, 95% CI 1.14–2.12; p = 0.005) and large vessel (n = 1,394; OR = 1.76, 95% CI 1.34–2.31; p<0.001) aetiology, but not those of small vessel origin (n = 1,356; OR = 0.99, 95% CI 0.74–1.33; p = 0.950). Egger's regression test suggested a low probability of publication bias for all analyses (p>0.05).ConclusionsThe totality of published data supports the hypothesis that carriage of the PlA2 polymorphism of GPIIIa is a risk factor for ischaemic strokes, and specifically those of cardioembolic and large vessel origin.

Stroke in the Young

Stroke in the Young

Posterior Reversible Encephalopathy Syndrome and Cerebral Vasculopathy Associated With Influenza A Infection

Influenza A infection can precipitate encephalopathy, encephalitis, or Reye syndrome with the development of cerebral edema in children and is associated with an increased incidence of stroke in adults. The mechanism of these events is poorly understood. Posterior reversible encephalopathy syndrome (PRES) is seen in association with infection/sepsis, and cerebral vasculopathy has been demonstrated in PRES. We describe a case of PRES that develops in association with influenza A. A normotensive 65-year-old woman presented with altered mentation and nausea in the setting of a viral prodromal illness ultimately confirmed as influenza A. Posterior reversible encephalopathy syndrome developed on the second day after admission. Catheter cerebral angiogram documented vasculopathy in PRES-involved regions with areas of focal vessel dilatation and string-of-bead appearance. The association between influenza A and PRES with documentation of cerebral vasculopathy suggests a common systemic vascular mechanism behind PRES and influenza-related encephalopathic edema and stroke.