Middle-aged Stroke Patients Research Articles

Positive effects of lower extremity constraint-induced movement therapy on balance, leg strength and dual-task ability in stroke patients: a longitudinal cohort study.

To investigate whether high-intensity lower extremity constraint-induced movement therapy can improve balance, leg strength, and dual-task ability. A longitudinal cohort study in a real-world outpatient clinic. 147 community-dwelling participants in the subacute and chronic poststroke phases. Participants received lower extremity constraint-induced movement therapy for 6 hours/day during 2 consecutive weeks, including balance, strength, and functional training. The Berg Balance Scale (BBS), Single-Leg-Stance (SLS) bilaterally, one Repetition Maximum (1RM) in a leg press, symmetry of leg strength (Diff-1RM), Timed Up and Go (TUG), and the TUG Manual test were assessed before, after, and 3 months after lower extremity constraint-induced movement therapy. Compared with preintervention data, statistically significant improvements after lower extremity constraint-induced movement therapy (p < 0.001) were demonstrated for balance with an absolute value in BBS at 1.9 points (effect size 0.38) and SLS at 2.4 s (effect size 0.24), and for leg strength at 10.2 kg (effect size 0.54) for the affected leg. Diff 1RM decreased significantly at 5.8 kg (effect size 0.39) and improvements on dual-task ability at 2.7 s were significant (effect size 0.14). The effects persisted at the 3-month follow-up. High-intensity lower extremity constraint-induced movement therapy may be a feasible treatment option for middle-aged stroke patients to affect balance, leg strength, and dual-task ability positively in an out-patient clinical setting.

Assessing the Mental Health Literacy Among Young and Middle-Aged Stroke Patients: Implications for Health Education

Assessing the Mental Health Literacy Among Young and Middle-Aged Stroke Patients: Implications for Health Education

Exploring the status and associated factors of the readiness for return-to-work in young and middle-aged stroke patients.

Stroke increasingly affects individuals of working age. An accurate assessment of Readiness for Return-to-Work (RRTW) can help determine the optimal timing for RRTW and facilitate an early reintegration into society. This study investigates the current state of RRTW and the influencing factors among young and middle-aged stroke patients in China. A sample of young and middle-aged stroke patients hospitalized in a tertiary hospital in Henan Province between December 2021 and May 2022 were included in this study. A general information questionnaire and the Readiness for RRTW scale, the Social Support Rate Scale, the Stroke Self-Efficacy Scale, and the Fatigue Severity Scale were administered to the patients. Of the 203 patients successfully surveyed, 60 (29.6%) were in the pre-contemplation stage, 35 (17.2%) in the contemplation stage, 81 (39.9%) in the prepared for action-self-evaluative stage, and 27 (13.3%) in the prepared for action- behavior stage. Logistic regression analysis identified education level, monthly income, time to start rehabilitation therapy, social support, stroke self-efficacy, and fatigue severity as key factors affecting RRTW scale readiness in young and middle-aged stroke patients. The readiness of young and middle-aged stroke patients to Return-to-Work needs to be increased further. Healthcare professionals should consider the influencing factors of RRTW and design targeted intervention programs to facilitate a successful Return-to-Work and normal life.

Experience of financial toxicity and coping strategies in young and middle-aged patients with stroke: a qualitative study

BackgroundWhile financial toxicity (FT) is prevalent in patients with cancer, young and middle-aged patients with stroke are also affected by FT, which can exacerbate their physical and psychological challenges. Understanding the patient’s experience and response measures can further understand the impact of FT on patients with stroke, to help alleviate FT. However, little is known concerning the experience of patients with stroke with FT or their coping strategies. Therefore, this study aimed to describe the experiences of FT in young and middle-aged patients with stroke and their coping strategies.MethodsA phenomenological method was utilized. Semi-structured interviews were conducted with 21 young and middle-aged stroke patients (aged 18–59) between October 2022 and March 2023. The participants were recruited from a tertiary hospital in Shanghai, China. The research team used NVivo 12.0 software. Giorgi’s phenomenological analysis method was used to analyse the interview data.ResultsThe interview results were divided into two categories in terms of patients’ experiences of FT and their coping strategies. Nine subthemes were constructed. The experience category included four subthemes: (1) taking on multifaceted economic pressure, (2) dual choice of treatment, (3) decline in material living standards, and (4) suffering from negative emotions such as anxiety and depression. The coping strategy category included five subthemes: (1) reducing expenses, (2) improving living habits, (3) proactive participation in medical decision-making, (4) making a job position choice, and (5) seeking social support.ConclusionsFT in young and middle-aged patients with stroke, which affected their physical and mental health, led them to implement strategies for dealing with FT. The Chinese government needs to broaden the reach of health insurance coverage and advance the fairness of healthcare policies. Healthcare professionals must pay active attention to FT in such patients in terms of strengthening their health education and considering their needs and preferences. Patients need to improve their sense of self-efficacy, actively reintegrate into society, and adhere to rehabilitation and treatment. Individuals at a high risk of stroke are recommended to purchase health insurance. Multifaceted efforts are needed to reduce the impact of FT in young and middle-aged patients with stroke.

Depressive Symptoms in Young and Middle-Aged Stroke Patients: A Transition Analysis.

There is heterogeneity in depressive symptoms. However, latent classes of depressive symptoms and the transition and influences of these in young and middle-aged stroke patients are unclear. The aim of this study was to identify the latent classes of depressive symptoms and their transition patterns over time and the influencing factors in young and middle-aged stroke patients from stabilization to 6 months after discharge. This is a longitudinal study following the Strengthening the Reporting of Observational Studies in Epidemiology checklist. A total of 272 young and middle-aged stroke participants were recruited from a hospital neurology ward in Henan Province, China. Participants completed a questionnaire on sociodemographic and health information. Latent transition analysis was used to evaluate the transition pattern of latent classes from stabilization to 6 months after discharge and its influencing factors. One hundred seventy-nine participants were included in the analysis. Three latent classes of depressive symptoms were identified as "mild symptoms," "grief-sleep-fatigue symptoms," and "severe symptoms." Most participants remained in the original latent class from stabilization to 6 months after discharge (probability of 83.8%, 83.8%, and 88.8%). From 3 to 6 months after discharge, the participants with fewer complications were more likely to transition into the mild symptom class. The findings indicate that from stabilization to 6 months after discharge, depressive symptoms in young and middle-aged stroke patients in China transitioned gradually from the severe symptom class to the mild symptom. Patients with fewer numbers of poststroke complications were more likely to transition to the mild symptoms class. Future research should focus on depressive symptoms in early-stage stroke patients and provide sufficient psychological support to patients with a high number of complications.

Resourcefulness as a mediator in the relationship between self-perceived burden and depression among the young and middle-aged stroke patients: A cross-sectional study

ObjectiveTo explore the relationships among self-perceived burden, resourcefulness and depression, and to study further whether resourcefulness mediates the effects of self-perceived burden on depression in young and middle-aged stroke patients. MethodsA cross-sectional survey was conducted with 1050 young and middle-aged stroke patients. We used a general demographic questionnaire, Self-Perceived Burden Scale (SPBS), Resourcefulness Scale© (RS) and Hamilton Depression Scale (HAMD) to assess self-perceived burden, resourcefulness, and depression. Statistical methods included correlation analysis, multiple linear regression, and structural equation model. Results1018 valid questionnaires were collected with a response rate of 96.95%. Resourcefulness was inversely correlated with self-perceived burden (r = −0.367, p < 0.01) and depression (r = −0.625, p < 0.01); Self-perceived burden was positively associated with depression (r = 0.698, p < 0.01). Multiple linear regression analyses showed that resourcefulness mediated the effects of self-perceived burden on depression; The structural equation model demonstrated that the resourcefulness mediated the relationship between self-perceived burden and depression. ConclusionResourcefulness is a mediator between self-perceived burden and depression. Medical staff adjust the psychological state of stroke patients based on the theory of resourcefulness, thereby improving their problem-solving ability, actively encouraging patients to establish problem-solving strategies, providing disease rehabilitation knowledge and skills, and promoting the improvement of resourcefulness level.

An Age-Stratified Cross-Sectional Study of Physical Activity and Exercise Adherence of Stroke Survivors in Rural Regions.

To describe the Physical Activity and Exercise (PAE) adherence of stroke survivors in rural regions, additionally, to analyze the influential factors through age stratification. This is a cross-sectional study. Totally, 596 stroke patients (65.70±10.76 years) from three rural regions were selected, PAE scale was used for measuring compliance. The influential factors among different age groups were explored separately. This study adheres to the EQUATOR checklist, SROBE. Only 17.8% (106) of participants regularly participated in PAE. Altogether, 42.45% were classified as a young-middle age group, and the rest 57.55% were in the old age group. Positive attitudes and better PAE-relevant knowledge were protective factors for adherence in the young and middle-aged group (OR=0.683; 95% CI 0.173~0.588 and OR=0.939; 95% CI 0.013~0.114), as well as in the old group (OR=0.704; 95% CI 0.193~0.534 and OR=0.929; 95% CI 0.035~0.118); having no home rehabilitation equipment was a strong risk factor for younger patients (OR=16.078; 95% CI 1.235~4.320); however, without hemiplegia can positively affect their adherence (OR=0.891; 95% CI 0.045~0.229). In addition, the presence of a spouse can lead to a better compliance among old patients (OR=0.436; 95% CI -0.496~-0.165). It is necessary to improve the knowledge of physical activity in rural stroke patients of all ages. It is of great significance to install home rehabilitation equipment to promote exercise for young and middle-aged stroke patients. While for the old stroke patients, we strongly suggest focusing on the role of spouses, which would be more useful in low-income regions.

An investigation of the level of stigma and the factors influencing it in the rehabilitation of young and middle-aged stroke patients-a cross-sectional study

BackgroundThere are few reported studies on stigma in young and middle-aged stroke patients during the rehabilitation period, however, the rehabilitation period plays a key role in the patients’ disease regression. Exploring the level of stigma and the influencing factors in young and middle-aged stroke patients during the rehabilitation period is crucial for determining how to reduce the level of stigma and improve the patients’ motivation for rehabilitation treatment. Therefore, this study investigated the level of stigma in young and middle-aged stroke patients and analyzed the factors influencing stigma in order to provide a reference or basis for healthcare professionals to develop effective and targeted stigma intervention programs.MethodsUsing a convenience sampling method, 285 young and middle-aged stroke patients admitted to the rehabilitation medicine department of a tertiary care hospital in Shenzhen, China, from November 2021 to September 2022 were selected and surveyed using a general information questionnaire, the Stroke Stigma Scale(SSS), the Barthel Index(BI), and the Positive and Negative Emotions Scale(PANAS), and multiple linear regression and smoothed curve fitting were used to analyze the factors influencing the stigma of young and middle-aged stroke patients during the rehabilitation period.ResultsSSS score of 45.08 ± 11.06, univariate analysis of age, occupation, education level, pre-stroke monthly income, insurance type, comorbid chronic disease status, primary caregiver, BI, positive and negative emotion as factors influencing stigma. Multiple linear regression showed that age, pre-stroke monthly income, BI, positive and negative emotions were independent influences on stigma in young and middle-aged stroke patients, explaining 58.0% of the total variance in stigma. A smoothed curve fit revealed a curvilinear relationship between the above influences and stigma.ConclusionYoung and middle-aged stroke patients have a moderate level of stigma. Medical staff should focus on young patients aged 18–44 years, those with high monthly income before the stroke, those with poor self-care ability, and those with low positive and high negative emotion scores, and conduct early assessments and adopt targeted intervention programs according to the influencing factors to reduce the stigma of young and middle-aged stroke patients, improve their motivation for rehabilitation, and help them return to their families and society as soon as possible.Trial RegistrationRegistration number of China Clinical Trials Registration Center: 20,220,328,004-FS01.

Abstract WMP15: Health Belief And Exercise Adherence Of Young And Middle-aged Stroke Patients: A Moderated Mediation Model Of Planning And Exercise Self-efficacy

Background: Health belief and exercise self-efficacy are meaningful protective factors that help individuals maintain health. However, few studies have explored their impact on planning and exercise adherence. Purpose: To explore the mediating role of planning in the impact of health beliefs on exercise compliance in young and middle-aged stroke patients, and the regulatory role of exercise self-efficacy in this mediating model. Method: Convenience sampling method was used to select 369 young and middle-aged patients with hemorrhagic stroke from 3 Grade A hospitals in China from July 2021 to May 2022. General data questionnaire, stroke health belief Scale, exercise self-efficacy scale, exercise plan scale and functional exercise compliance scale were used to investigate. Results: Health belief was positively correlated with exercise self-efficacy, planning and exercise compliance ( r =0.136, 0.531, 0.529, all P &lt;0.01). The indirect effect of health belief on exercise compliance in young and middle-aged stroke patients was 0.206 (95% CI : 0.158-0.259), and the direct effect was 0.167 (95% CI : 0.106-0.229), indicating that planning played an intermediary role between health belief and exercise compliance, accounting for 55.23%. Using the PROCESS macro (model 8) test, it was found that sports self-efficacy had a regulating effect, and had a significant interaction between planning and sports compliance( β =0.009, 95% CI : 0.001-0.018; β =0.008, 95% CI : 0.001-0.014). Conclusion: Health beliefs and plans can improve the exercise compliance of young and middle-aged stroke patients, and this benefit is related to exercise self-efficacy. We should enhance the health beliefs of patients, improve their exercise self-efficacy, encourage them to make exercise plans, and then improve their exercise compliance.

Abstract WMP14: Status And Influencing Factors Of Rehabilitation Exercise Compliance In Young And Middle-aged Patients With Hemorrhagic Stroke Based On The Hapa Model: A Multi-center Cross-sectional Survey

Background and Purpose: Exercise rehabilitation is the preferred rehabilitation therapy for stroke patients, but exercise compliance of patients is generally low. The study aimed to investigate and analyze the status and influencing factors of rehabilitation exercise compliance in young and middle-aged patients with hemorrhagic stroke. Methods: Convenience sampling method was adopted to select 397 young and middle-aged hemorrhagic stroke patients from three hospitals in central, eastern and northern China from July 2021 to January 2022 in accordance with the geographical classification standards of the National Bureau of Statistics and multi-center research cooperation. According to the Health Action Process Approach(HAPA), the general data survey scale, stroke functional exercise compliance Scale, exercise self-efficacy scale, exercise plan scale, stroke health belief scale and self-care ability scale were used for cross-sectional investigation. Results: The total score of exercise compliance in young and middle-aged stroke patients was (43.46±9.58), and the average compliance rate was 77.60%, which was in the middle level. Multivariate regression analysis showed that total score of exercise self-efficacy, total score of exercise program, perceived susceptibility, perceived severity, perceived benefit, perceived obstacle, health motivation and self-efficacy were the influencing factors of exercise compliance in young and middle-aged stroke patients ( P &lt; 0.05). Conclusions: According to the HAPA model, clinical medical staff should accurately evaluate the rehabilitation exercise stage of patients, and formulate and implement stroke rehabilitation exercise strategies according to the actual situation of patients and various possible influencing factors, so as to improve the exercise compliance of patients, improve their functional status, and further improve their quality of life.

Retracted: Effects of Self-Management Intervention Programs Based on the Health Belief Model and Planned Behavior Theory on Self-Management Behavior and Quality of Life in Middle-Aged Stroke Patients.

[This retracts the article DOI: 10.1155/2021/8911143.].

Retracted: Risk factors of Recurrent Stroke in Young and Middle-Aged Stroke Patients After Interventional Therapy.

[This retracts the article DOI: 10.1155/2022/5728991.].

Risk Factors of Recurrent Stroke in Young and Middle-Aged Stroke Patients after Interventional Therapy.

Objective To explore the risk factors of recurrent stroke in young and middle-aged stroke patients after interventional therapy. Methods Retrospective analysis was conducted on the data of 300 young and middle-aged stroke patients treated in our hospital (February 2015–February 2017). All patients received interventional therapy. They were followed up continuously after the interventional therapy, with recurrent stroke as the only endpoint event, and those who did not have the endpoint events were followed up for 5 years. Then, the patients were divided into the occurrence group and the nonoccurrence group according to whether there was a stroke. The social demographic data and clinical examination data of all patients were collected to analyze the differences between the groups. Logistic regression analysis was performed on the factors with statistically significant differences to verify the factors affecting recurrent stroke in young and middle-aged stroke patients after interventional therapy. Results Among the 300 patients, 69 (23.0%) had recurrent stroke and 231 (77.0%) had no recurrent stroke. The occurrence group (n = 69) had 12 cases (17.4%) of massive cerebral infarction, 18 cases (26.1%) of cerebral watershed infarction, 5 cases (7.2%) of multiple cerebral infarction, 25 cases (36.2%) of lacunar infarction, and 9 cases (13.0%) of TIA. Notable differences were observed in age, drinking history, marital status, body weight, diastolic pressure, systolic pressure, fasting blood glucose, glycosylated hemoglobin, cholesterol, and fibrinogen between the occurrence group and the nonoccurrence group (P < 0.05). The binary logistic regression analysis showed that age, drinking history, diastolic pressure, fasting blood glucose, glycosylated hemoglobin, cholesterol, and fibrinogen were the influencing factors of recurrent stroke in young and middle-aged stroke patients after interventional therapy. Conclusion Blood glucose, blood lipid, blood pressure, age, and living habits have an impact on recurrent stroke in young and middle-aged patients after interventional therapy. Therefore, while strictly controlling blood glucose, blood lipid, and blood pressure, patients should improve their living habits and enhance the awareness of prevention after interventional therapy.

Effects of Self-Management Intervention Programs Based on the Health Belief Model and Planned Behavior Theory on Self-Management Behavior and Quality of Life in Middle-Aged Stroke Patients.

Objectives To study the effect of self-management intervention programs based on the health belief model and planned behavior theory on self-management behavior and quality of life in middle-aged stroke patients. Most of the intervention studies on the self-management of middle-aged stroke patients focus on traditional Chinese medicine nursing and continuous nursing, lacking theoretical support. In particular, there is a lack of interventions based on the integration of two or more theories. Method The middle-aged stroke patients were divided into the control group and the intervention group according to the disease area. A total of 70 patients were included, and 35 patients were included in the control group and the intervention group, respectively. The control group received routine neurological treatment and health education during hospitalization and continued to receive routine health education for 3 months after discharge. On this basis, the intervention group received an intervention program based on an integrated model of health beliefs and planned behavior theory, including 3 health education sessions during hospitalization and 3 months of postdischarge health education. A self-administered stroke general information questionnaire was used to collect basic information on patients' age, gender, and comorbidities. The Stroke Self-Management Behavior Rating Scale and Stroke-Specific Quality-of-Life Scale (SS-QOL) were used to evaluate the management behavior and quality of life of the patients in both groups before and after the intervention. Results Before the intervention, there was no statistically significant difference between the two groups in terms of self-management score, quality of life total score, and scores of each dimension (P > 0.05). At different periods after the intervention, the total score of self-management, total score of quality of life, and scores of each dimension were significantly higher in both groups than before the intervention (P < 0.05). In particular, the self-management and quality of life scores of the intervention group were higher than those of the control group at 1 and 3 months after the intervention (P < 0.05). Conclusion The self-management intervention scheme based on the integrated model of health belief and planned behavior theory is beneficial to improve the self-management ability and quality of life of stroke patients. It provides basis for clinical nurses to further improve the self-management ability and quality of life of stroke patients. Our findings may also serve as a reference for caregivers in other countries to improve the self-management and quality of life of stroke patients.

The impact of age and 24-h blood pressure on arterial health in acute ischemic stroke patients: The Norwegian stroke in the young study.

The impact of age and 24‐h ambulatory blood pressure (ABPM) on arterial stiffness and carotid intima‐media thickness (cIMT) in ischemic stroke patients younger than 60 years of age is poorly explored. A total of 385 acute ischemic stroke patients (aged 49.6±9.7 years, 68% men) were prospectively included and grouped in younger (15–44 years, n = 93) and middle‐aged (45–60 years, n = 292). Arterial stiffness was measured by carotid‐femoral pulse wave velocity (PWV), and cIMT by carotid ultrasound. 24‐h ABPM was recorded. The middle‐aged stroke patients had higher prevalence of smoking, hypertension, diabetes mellitus, metabolic syndrome and hypercholesterolemia, and had higher PWV and cIMT (all p < .05). In multivariable linear regression analyses adjusted for sex, BMI, smoking, diabetes mellitus, total cholesterol, high‐density lipoprotein cholesterol, triglycerides, eGFR, systolic BP and concomitant antihypertensive treatment, 1SD (4.4 years) higher age was associated with higher PWV (β = 0.44,R2 = 0.46, p < .001) in the younger group, and with higher mean cIMT (β = 0.16, R2 = 0.21, p = .01) in the middle‐aged group. In the middle‐aged group, 24‐h pulse pressure had a significant association with PWV (β = 0.18, R2 = 0.19, p = .009), while the association with cIMT was attenuated (β = 0.13, R2 = 0.16, p = .065). 24‐h diastolic BP was associated with higher cIMT in the middle‐aged group (β = 0.24, p < .001, R2 = 0.23), but not with PWV in either age groups. Among ischemic stroke patients < 60 years, higher age was associated with increased arterial stiffness for patients up to age 44 years, and with cIMT in middle‐aged patients. 24‐h pulse pressure was associated with arterial stiffness, and 24‐h diastolic BP was associated with cIMT only in middle‐aged patients.

Trajectories of posttraumatic growth in young and middle-aged stroke patients and their predictive effects on mental health.

The increasingly younger age of stroke onset has posed a serious threat to the physical and mental health of young and middle-aged adults. Young and middle-aged stroke patients often suffer from varying degrees of motor, cognitive, and language disabilities, which can trigger considerable psychological trauma. However, these patients may have certain posttraumatic growth (PTG). As a positive psychological experience, PTG provides a new entry point for clinical psychological interventions. Here, we explored the trajectories of PTG in young and middle-aged stroke patients and their predictive effects on mental health. A total of in 165 patients who were treated at our center from January to December 2019 were enrolled with randomized sampling. The survey was conducted at 5 times follow up through use of the Posttraumatic Growth Inventory (PTGI), Social Support Rating Scale (SSRS), and Symptom Checklist-90 (SCL-90). Data were analyzed by using the latent growth mixture modeling (LGMM). The PTG levels in young and middle-aged stroke patients showed a gradual increase (F=9.927; P<0.01). According to the relevant parameters of the trajectories, the subjects were divided into the high PTG group (n=43, 26.06%), low PTG group (n=25, 15.15%), rapidly increasing PTG group (n=47, 28.48%), and constantly decreasing PTG group (n=50 cases, 30.30%). Both the initial level and developmental rate of PTG had significantly negative predictive effects on SCL-90 score (B=-0.46, P<0.01; B=-0.31, P<0.01); in other words, they had positive predictive effects on mental health. There are different trajectories of PTG in young and middle-aged stroke patients, and the initial level and developmental speed of PTG have positive predictive effects on mental health in these patients.

Shorter visual aura characterizes young and middle-aged stroke patients with migraine with aura.

To identify the clinical profile and aura characteristics of patients with Migraine with Aura (MwA) having acute cerebral ischemia, we compared stroke phenotype and risk factors in stroke patients with (S+MwA+) or without (S+MwA-) MwA and aura features in MwA patients with (S+MwA+) or without (S-MwA+) stroke. In this retrospective multicenter case-control study, we reviewed stroke phenotypes and vascular risk factors in S+MwA+ and S+MwA- patients younger than 60years and risk factors and aura type, duration, onset age, and the frequency in the previous year in S+MwA+ patients and S-MwA+ subjects matched for age and disease history, investigated for patent foramen ovale (PFO). 539 stroke (7.7% S+MwA+) and 94 S-MwA + patients were enrolled. S+MwA+ patients were younger (p =.0.004) and more frequently presented PFO [OR 4.89 (95% CI 2.12-11.27)], septal interatrial aneurism [OR 2.69 (95% CI 1.15-6.27)] and cryptogenic ischemic stroke (CIS) [OR 6.80 (95% CI 3.26-14.18)] than S+MwA- subjects. Significant atherosclerosis was not detected in S+MwA+ patients. Compared to S-MwA+, S+MwA+ patients were characterized by visual [OR 3.82 (95% CI 1.36-10.66)] and shorter-lasting (20.0min IQr 13.1 vs 30.0min IQr 25.0; p < 0.001) aura, and PFO [OR 1.26 (95% CI 1.03-1.54)]. Regression analysis evidenced that only shorter aura duration associated with stroke (p = 0.001). High-risk PFO was equally represented in S+MwA-, S+MwA+, S-MwA+ groups. Shorter visual aura and CIS characterize MwA patients with stroke. Although more prevalent, PFO can not be considered the main responsible for the increased stroke risk in MwA patients but as a part of a complex multifactorial condition.

Intervention study of Snyder’s hope theory on the stigma of stroke in young and middle-aged patients: a randomised trial

Stigma refers to the sense of discrimination that society has towards a certain group of people, and this part of the group will also have a sense of shame due to their own negative circumstance. Young and middle-aged stroke patients need long-term effective support from their families and society, which can easily produce shame, and have a negative impact on disease treatment. A total of 94 young and middle-aged stroke patients admitted to our hospital from November 2018 to November 2020 were selected and randomly allocated to 2 groups, with 47 cases in each group. The control group received routine intervention, and the observation group received SHT intervention. The stigma, hope level, compliance with functional exercise, National Institute of Health Stroke Scale (NIHSS) score and changes in activities of daily living were compared between the 2 groups before and after intervention. The total scores of social interaction, treatment, ability, and stigma of the observation group were lower than those of the control group after 1 month of intervention (P<0.05). The observation group's positive attitude towards reality and the future, taking positive actions, maintaining close relationships with others, and hope levels after 1 month of intervention were all higher than the control group (P<0.05). The functional exercise compliance of the observation group was higher than that of the control group after 1 month of intervention (P<0.05). The Barthel index score of the observation group was higher than that of the control group after 1 month of intervention, and the NIHSS score was lower than that of the control group (P<0.05). The application of SHT to young and middle-aged stroke patients can reduce stigma, improve hope level and compliance with functional exercise, improve neurological function, and enhance the ability for daily living. Chinese Clinical Trial Registry ChiCTR2100045926.

2019 novel coronavirus disease with secondary ischemic stroke: two case reports

BackgroundThe COVID-19 pandemic, which broke out in Wuhan in 2019, has become the global health crisis of our time. Elderly patients with certain fundamental diseases are more likely to develop severe cases. The secondary lesion following viral infection have only rarely been reported.Case presentationWe here report two cases of coronavirus-infected pneumonia with acute ischemic stroke in middle-aged patients. In both COVID-19 cases, neurological physical examinations showed normal results before infection. Lymphocytopenia, accompanied by elevated cytokines and D-dimers, were found from serum clinical laboratory examination at admission. Dysarthria and limb muscle weakness are initial manifestations, occurring one week after infect-causative pathogen, SARS-CoV-2. The head CT and head/neck arterial CTA showed small-vessel occlusion. The patients were diagnosed with coronavirus diseases with secondary acute ischemic stroke. They were treated with tirofiban and followed up with daily aspirin and atorvastatin.ConclusionsThese cases suggested that secondary ischemic stroke, mainly manifested as small-vessel occlusion, should be considered for COVID-19 patients and diagnosed and treated promptly.

A model to predict risk of stroke in middle-aged adults with type 2 diabetes generated from a nationwide population-based cohort study in Korea

AimsThe incidence of stroke differs between Asians and Caucasians, and between people with or without diabetes mellitus (DM). This study aimed to develop a model to predict the risk of stroke in middle-aged patients with type 2 DM. MethodsUsing the National Health Insurance Database in Korea, data from patients aged 40–64 years with type 2 DM who received a health examination from 2009 to 2012 (n = 1,297,131) were analyzed as development (n = 907,992) and validation (n = 389,139) cohorts. Cox proportional-hazards regression model was used to derive a risk-scoring system, and 13 predictive variables were selected. A risk score nomogram based on the risk prediction model was created to estimate the 5-year risk of stroke. ResultsIn patients with type 2 DM, significant predictors for the development of stroke were older age, being male or a current smoker, lack of exercise, low body mass index, low estimated glomerular filtration rate, presence of coronary heart disease, longer duration of DM, insulin or multiple oral hypoglycemic agents use, low (<100 mg/dL) or high (≥140 mg/dL) fasting blood glucose, high systolic blood pressure, high total cholesterol, and presence of atrial fibrillation. The concordance indexes for stroke prediction were 0.703 (95% confidence interval [CI] 0.700–0.707) in the development cohort and 0.703 (95% CI 0.698–0.708) in the validation cohort. ConclusionsWe developed a risk model using various clinical parameters to predict stroke in patients with type 2 DM. This model may provide helpful information for identifying high-risk patients and guide prevention of stroke in this specific population.