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Predictive validity of the Brazilian version of the Expected Treatment Outcome Scale in cocaine-dependent outpatients at a drug treatment referral center
Dinis, Marcelle Maria Lobo;Passos, Sonia Regina Lambert;Camacho, Luiz Antonio Bastos;
Revista Brasileira de Psiquiatria , 2005, DOI: 10.1590/S1516-44462005000300012
Abstract: background: high dropout rates among patients under treatment for cocaine dependence have stimulated research into predictors of treatment outcome. objective: to assess the predictive value of the brazilian version of the expected treatment outcome scale. methods: the original english version of the scale was translated and back-translated. a total of 210 subjects participating in a 10-week randomized double-blind clinical trial (nefazodone versus placebo) completed the questionnaire at their first appointment. mean expected treatment outcome scale scores were compared with treatment outcomes. results: there were ten subjects (5%) who failed to complete at least six items, and 37 (17.5%) failed to complete 1 to 3 items. the most frequently unanswered questions involved time estimates (treatment time and abstinence) and third-party judgments. the mean score was 34.4 (9.3) (median, 33.9). there were no differences in mean scores between subjects evaluated in the first to the fifth appointment 35.2 (9.3) or in the sixth to the eleventh appointment 35.2 (9.3) (p = 0.13); completing the treatment 33.8 (10.3) or not 34.6 (9.1) (p = 0.64); remaining abstinent for three weeks 34 (9.3) or not 34.8 (9.4) (p = 0.58), and medication compliance 33.9 (8.8) or noncompliance 35.3 (10.3) (p = 0.34). the roc curve of expected treatment outcome scale scores, when dropout was defined as not appearing for all 11 appointments, was linear, with an area under the curve of .54 (range, .44-.64), suggesting that the scale is ineffective in discriminating between cases and noncases. conclusion: in this study, the brazilian version of the expected treatment outcome scale was found to have no predictive value for treatment adherence and abstinence in cocaine-dependent subjects subjected to a standardized treatment protocol.
Infections and Ischemic Stroke Outcome  [PDF]
Katarzyna Grabska,Gra?yna Gromadzka,Anna Cz?onkowska
Neurology Research International , 2011, DOI: 10.1155/2011/691348
Abstract: Background. Infections increase the risk of ischemic stroke (IS) and may worsen IS prognosis. Adverse effects of in-hospital infections on stroke outcome were also reported. We aimed to study the prevalence of pre- and poststroke infections and their impact on IS outcome. Methods. We analysed clinical data of 2066 IS patients to assess the effect of pre-stroke and post-stroke infections on IS severity, as well as short-term (up to 30 days) and long-term (90 days) outcome. The independent impact of infections on poor outcome (death, death/dependency) was investigated by use of logistic regression analysis. The effect of antibiotic therapy during hospitalization on the outcome was also assessed. Results. Pre-stroke infections independently predicted worse short-term outcome. In-hospital infections were associated with worse short-term and long-term IS prognosis. Antibacterial treatment during hospitalization did not improve patients' outcome. Conclusions. Prevention of infections may improve IS prognosis. The role of antibiotic therapy after IS requires further investigations. 1. Introduction Infections preceding the ischemic stroke (IS), as well as infections occurring in the acute phase of IS, are a frequent phenomenon [1, 2]. Chronic infections of both viral and bacterial etiology and coexistent vascular inflammatory state promote atherosclerosis, contributing to an increased cerebrovascular risk [3, 4]. The association of prestroke acute infectious events, in particular, respiratory tract infections, with increased risk of stroke [5], especially of cardioembolic and atherothrombotic etiology, was reported [2, 6]. Some authors suggest that prestroke infections are related not only to the risk but also to IS severity [7, 8]. On the other hand, stroke severity and lesion location are associated with the risk of in-hospital (post-stroke) infections. For example, patients with brainstem or diffuse cerebral lesions characterize with an increased risk of respiratory tract infection, that frequently results from dysphagia [9, 10]. It seems possible that post-stroke infectious events are favoured by the stroke-induced immunodepression [2]. The impact of post-stroke infections on IS outcome is the next important issue [11]. Some authors describe an association of post-stroke infections with poor patients’ outcome [12–14]. According to the presented data, a proper treatment of stroke-related infections may improve patients’ outcome. Until now some reports suggest that therapy with antibiotics in the acute phase of stroke (even in patients without the obvious
Outcome Scales in Stroke Rehabilitation
Elif Aksakall?,Yasemin Turan,?mer Faruk ?endur
Türkiye Fiziksel Tip ve Rehabilitasyon Dergisi , 2009,
Abstract: Stroke is known as the most common neurological disorder requiring rehabilitation. It is essential to assess the efficiency of rehabilitation for good practice. Studies on stroke rehabilitation led to the development of outcome measures, which can provide better assessment of stroke. In this review, functional and quality of life scales, commonly used and familiar to clinicians, are presented with their advantages and limitations.Turk J Phys Med Rehab 2009;55:168-72.
Prognosis and outcome of acute stroke in the University College Hospital Ibadan, Nigeria
OR Obiako, SK Oparah, A Ogunniyi
Nigerian Journal of Clinical Practice , 2011,
Abstract: Background: Many factors influence the outcome of acute stroke, the third leading cause of morbidity and mortality globally. Objective: To identify the determinants of outcome of acute stroke. Materials and Methods: A prospectively study of 66 adult patients who presented to the medical emergency unit of University College Hospital (U.C.H), Ibadan, in coma from acute stroke, from August 2004 to March 2005, was undertaken after obtaining ethical clearance and written consent of the patients’ relations. Result: Acute stroke constituted 33% of medical coma, 3.2% of hospital emergencies, 1.0% of total hospital admissions, and 7.3% of medical deaths during the study period. The stroke subtypes were intracerebral hemorrhage (78.8%) and large cerebral infarction (21.2%) with respective case fatalities of 69.7% and 13.6% at 4 weeks. Males constituted 75.8% of the patient population with sex-specific mortality of 68.2%. The highest age specific mortality of 65.2% was in the 40-59 years group. The common risk factors were systemic hypertension, obesity, alcohol/substance abuse, and diabetes mellitus. Co-morbidities included aspiration pneumonia, recurrent seizures, hyperglycemia, and sepsis. Conclusion: Age above 39 years, male gender, systemic hypertension, early onset of coma after stroke, and presence of co-morbidities were associated with poor stroke outcome.
Lesions to Primary Sensory and Posterior Parietal Cortices Impair Recovery from Hand Paresis after Stroke  [PDF]
Eugenio Abela, John Missimer, Roland Wiest, Andrea Federspiel, Christian Hess, Matthias Sturzenegger, Bruno Weder
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0031275
Abstract: Background Neuroanatomical determinants of motor skill recovery after stroke are still poorly understood. Although lesion load onto the corticospinal tract is known to affect recovery, less is known about the effect of lesions to cortical sensorimotor areas. Here, we test the hypothesis that lesions of somatosensory cortices interfere with the capacity to recover motor skills after stroke. Methods Standardized tests of motor skill and somatosensory functions were acquired longitudinally over nine months in 29 patients with stroke to the pre- and postcentral gyrus, including adjacent areas of the frontal, parietal and insular cortices. We derived the recovery trajectories of each patient for five motor subtest using least-squares curve fitting and objective model selection procedures for linear and exponential models. Patients were classified into subgroups based on their motor recovery models. Lesions were mapped onto diffusion weighted imaging scans and normalized into stereotaxic space using cost-function masking. To identify critical neuranatomical regions, voxel-wise subtractions were calculated between subgroup lesion maps. A probabilistic cytoarchitectonic atlas was used to quantify of lesion extent and location. Results Twenty-three patients with moderate to severe initial deficits showed exponential recovery trajectories for motor subtests that relied on precise distal movements. Those that retained a chronic motor deficit had lesions that extended to the center of the somatosensory cortex (area 2) and the intraparietal sulcus (areas hIP1, hIP2). Impaired recovery outcome correlated with lesion extent on this areas and somatosensory performance. The rate of recovery, however, depended on the lesion load onto the primary motor cortex (areas 4a, 4p). Conclusions Our findings support a critical role of uni-and multimodal somatosensory cortices in motor skill recovery. Whereas lesions to these areas influence recovery outcome, lesions to the primary motor cortex affect recovery dynamics. This points to a possible dissociation of neural substrates for different aspects of post-stroke recovery.
Social Determinants of Stroke as Related to Stress at Work among Working Women: A Literature Review  [PDF]
Susanna Toivanen
Stroke Research and Treatment , 2012, DOI: 10.1155/2012/873678
Abstract: In adult life, many of the social determinants of health are connected to working life. Yet, our knowledge of the role of work-related factors for the risk of stroke is fairly limited. In contemporary occupational health research, the Demand-Control Model (DCM) is frequently used to measure work stress. Previous literature reviews of the association of work stress and cardiovascular disease (CVD) do not include stroke as a specific outcome. Results regarding work stress and the risk of CVD are less evident in working women. With the focus on working women, the purpose of the present paper was to review the current research into the DCM in relation to stroke and to scrutinize potential gender differences. A literature search was performed and eight studies from three countries were identified. Based on the reviewed studies, there is some evidence that high psychological demands, low job control, and job strain are associated with increased stroke risk in women as well as in men. Any major reduction in deaths and disability from stroke is likely to come from decreasing social inequalities in health, and reducing work stress has a potential to contribute to a reduced risk of stroke in working populations. 1. Introduction Social determinants of health, that is, those conditions under which people are born, live, work, and grow old, shape population health in a systematic way [1]. Unequal distribution of and access to resources such as power, education, income, goods, and services influence social inequalities in health between countries and between groups of people within countries. In adult life, many of the social determinants of health are connected to working life. Both employment conditions and adverse work environments contribute to social inequalities in health, and these conditions are unequally distributed across occupational classes and women and men in working populations [2]. Labor markets are clearly segregated by gender meaning that women and men usually work in different industrial sectors with different types of work environments. More women than men have a low occupational class and the share of work stress is usually higher in women’s jobs [3]. Yet, our knowledge of associations of work related factors and the risk of stroke is fairly limited [4–6]. There is a clear social gradient in stroke mortality and morbidity as lower socioeconomic groups worldwide have consistently higher rates of stroke than higher socioeconomic groups [7]. A fourth of all stroke events occur among people of working age (<65 years of age), and the consequences with
Costs of stroke and stroke services: Determinants of patient costs and a comparison of costs of regular care and care organised in stroke services
Job van Exel, Marc A Koopmanschap, Jeroen DH van Wijngaarden, Wilma JM Scholte op Reimer
Cost Effectiveness and Resource Allocation , 2003, DOI: 10.1186/1478-7547-1-2
Abstract: Costs were calculated within the framework of the evaluation of three experiments with stroke services in the Netherlands. Cost calculations are base on medical consumption data and actual costs.598 patients were consecutively admitted to hospital after stroke. The average total costs of care per patient for the 6 month follow-up are estimated at €16,000. Costs are dominated by institutional and accommodation costs. Patients who die after stroke incur less costs. For patients that survive the acute phase, the most important determinants of costs are disability status and having a partner – as they influence patients' stroke careers. These determinants also interact. The most efficient stroke service experiment was most successful in co-ordinating patient flow from hospital to (nursing) home, through capacity planning and efficient discharge procedures. In this region the costs of stroke service care are the same as for regular stroke care. The other experiments suffered from waiting lists for nursing homes and home care, leading to "blocked beds" in hospitals and nursing homes and higher costs of care. Costs of co-ordination are estimated at about 3% of total costs of care.This paper demonstrates that by organising care for stroke patients in a stroke service, better health effects can be achieved with the same budget. In addition, it provides insight in need, predisposing and enabling factors that determine costs of care after stroke.Stroke is a major cause of long-term disability in Western societies [1]. At present about 27,000 Dutch citizens (i.e., about 0.2% of the total population) suffer from a stroke each year and with the ageing of the population this number is expected to increase to 36,000 in 2015 [2]. One third of this group dies within 36 months and about 60% survives with moderate or severe disability [3]. In 1999 12,409 people died from a stroke, making stroke the third cause of death in the Netherlands [4]. Stroke was estimated to be responsible for
Rising statin use and effect on ischemic stroke outcome
Sung Yoon, James Dambrosia, Julio Chalela, Mustapha Ezzeddine, Steven Warach, Joseph Haymore, Lisa Davis, Alison E Baird
BMC Medicine , 2004, DOI: 10.1186/1741-7015-2-4
Abstract: This was an observational study of 436 patients admitted to the National Institutes of Health Suburban Hospital Stroke Program between July 2000 and December 2002. Self-reported risk factors for stroke were obtained on admission. Stroke severity was determined by the admission National Institutes of Health Stroke Scale score. Good outcome was defined as a Rankin score < 2 at discharge. Statistical analyses used univariate and multivariate logistic regression models.There were 436 patients with a final diagnosis of ischemic stroke; statin data were available for 433 of them. A total of 95/433 (22%) of patients were taking a statin when they were admitted, rising from 16% in 2000 to 26% in 2002. Fifty-one percent of patients taking statins had a good outcome compared to 38% of patients not taking statins (p = 0.03). After adjustment for confounding factors, statin pretreatment was associated with a 2.9 odds (95% CI: 1.2–6.7) of a good outcome at the time of hospital discharge.The proportion of patients taking statins when they are admitted with stroke is rising rapidly. Statin pretreatment was significantly associated with an improved functional outcome at discharge. This finding could support the early initiation of statin therapy after stroke.Statins inhibit 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase, which converts HMG-CoA to mevalonate, a precursor of cholesterol, and are widely used for the treatment of hypercholesterolemia. These agents have also been proven to significantly reduce the risk of heart attack and stroke in patients with proven coronary artery disease [1-4]. They have also been shown to reduce the risk of transient ischemic attack (TIA) but not stroke in elderly individuals at risk of vascular disease [5]. Some of these cardiovascular protective effects may be through mechanisms other than lipid lowering, including the modification of endothelial function, anti-inflammatory effects, increased plaque stability, and reduction in thrombu
Improving stroke outcome: the benefits of increasing availability of technology
Heller,Richard F.; Langhorne,Peter; James,Erica;
Bulletin of the World Health Organization , 2000, DOI: 10.1590/S0042-96862000001100009
Abstract: introduction: a decision analysis was performed to explore the potential benefits of interventions to improve the outcome of patients admitted to hospital with a stroke, in the context of the technology available in different parts of the world. methods: the outcome of death or dependency was used with a six-month end-point. results: four settings were identified that would depend on the resources available. the proportion of stroke patients who were dead or dependent at six months was 61.5% with no intervention at all. setting 4, with the only intervention being the delayed introduction of aspirin, produced a 0.5% absolute improvement in outcome (death or dependency), and the addition of an organized stroke unit (setting 3) produced the largest incremental improvement, of 2.7%. extra interventions associated with non-urgent computed tomography and thus the ability to avoid anticoagulation or aspirin for those with a haemorrhagic stroke (setting 2), and immediate computed tomography scanning to allow the use of thrombolytics in non-haemorrhagic stroke (setting 1), produced only small incremental benefits of 0.4% in each case. discussion: to reduce the burden of illness due to stroke, efforts at primary prevention are essential and likely to have a greater impact than even the best interventions after the event. in the absence of good primary prevention, whatever is possible must be done to reduce the sequelae of stroke. this analysis provides a rational basis for beginning the development of clinical guidelines applicable to the economic setting of the patient.
The determinants of stroke phenotypes were different from the predictors (CHADS2 and CHA2DS2-VASc) of stroke in patients with atrial fibrillation: a comprehensive approach
Semi Oh, Suk Kim, Soo-Kyoung Ryu, Gyeong-Moon Kim, Chin Chung, Kwang Lee, Oh Bang
BMC Neurology , 2011, DOI: 10.1186/1471-2377-11-107
Abstract: We analyzed data pertaining to consecutive AF patients admitted over a 6-year period with acute MCA territory infarcts. We divided the patients according to DWI (diffusion-weighted imaging) lesion volumes and patterns, and the relationship between stroke predictors (the CHADS2 and CHA2DS2-VASc score), systemic, and local factors and each stroke phenotype were then evaluated.The stroke phenotypes varied among 231 patients (admission INR median 1.06, interquartile range (IQR) 1.00-1.14). Specifically, (1) the DWI lesion volumes ranged from 0.04-338.62 ml (median 11.86 ml; IQR, 3.07-44.20 ml) and (2) 46 patients had a territorial infarct pattern, 118 had a lobar/deep pattern and 67 had a small scattered pattern. Multivariate testing revealed that the CHADS2 and CHA2DS2-VASc score were not related to either stroke phenotype. Additionally, the prior use of antiplatelet agents was not related to the stroke phenotypes. Congestive heart failure and diastolic dysfunction were not associated with stroke phenotypes.The results of this study indicated that the determinants of stroke phenotypes were different from the predictors (i.e., CHADS2 and CHA2DS2-VASc score) of stroke in patients with AF.Atrial fibrillation (AF) affects 3% to 5% of the population older than 65 years of age [1] and is a leading cause of fatal ischemic stroke [2,3]. Stroke in patients with AF is generally more severe and the outcome is markedly poorer than in patients with sinus rhythm [4]. Adjusted-dose warfarin is highly effective (~60% reduction), and aspirin is modestly effective (~20% reduction) for the prevention of stroke in AF [5,6]. Moreover, international normalized ratio (INR) levels at the time of stroke were recently reported to be associated with infarct volumes [7].However, the factors affecting stroke phenotypes are unknown among AF patients. Several studies have suggested that infarct patterns are better delineated by DWI than other imaging modalities, are correlated with the underlying st
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