Stroke Research and Treatment最新文献

{"title":"Stroke in the 21^st Century: A Snapshot of the Burden, Epidemiology, and Quality of Life.","authors":"Eric S Donkor","doi":"10.1155/2018/3238165","DOIUrl":"https://doi.org/10.1155/2018/3238165","url":null,"abstract":"<p><p>Stroke is ranked as the second leading cause of death worldwide with an annual mortality rate of about 5.5 million. Not only does the burden of stroke lie in the high mortality but the high morbidity also results in up to 50% of survivors being chronically disabled. Thus stroke is a disease of immense public health importance with serious economic and social consequences. The public health burden of stroke is set to rise over future decades because of demographic transitions of populations, particularly in developing countries. This paper provides an overview of stroke in the 21^st century from a public health perspective.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2018 ","pages":"3238165"},"PeriodicalIF":1.5,"publicationDate":"2018-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/3238165","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36824872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TOAST Subtypes of Ischemic Stroke and Its Risk Factors: A Hospital-Based Study at Cipto Mangunkusumo Hospital, Indonesia.","authors":"Salim Harris,&nbsp;Saleha Sungkar,&nbsp;Al Rasyid,&nbsp;Mohammad Kurniawan,&nbsp;Taufik Mesiano,&nbsp;Rakhmad Hidayat","doi":"10.1155/2018/9589831","DOIUrl":"10.1155/2018/9589831","url":null,"abstract":"<p><strong>Background and purpose: </strong>Stroke is a leading cause of death and disability, with ischemic stroke as the highest prevalent cases in Indonesia. Ischemic stroke can be classified further into five subtypes according to TOAST classification. Numerous studies have revealed that stroke risk factor has variable correlation with different stroke subtype. Currently, there is no data regarding this phenomenon in Indonesia. The aim of study is to identify characteristic of ischemic stroke subtypes and the risk factors in TOAST classification.</p><p><strong>Methods: </strong>A retrospective, cross-sectional study of patients diagnosed with ischemic stroke at Cipto Mangunkusumo Hospital from January till December 2016. Demographic data, ischemic stroke subtypes, risk factors, and other relevant data were documented. Bivariate and multivariate analysis was done using SPSS 23.</p><p><strong>Results: </strong>235 recorded data patients were included. Large artery atherosclerosis (LAA) was the most prevalent stroke subtypes at 59,6%, followed with small vessel disease (SVD) at 26,7%, undetermined etiology at 9,8%, cardioembolism (CE) at 2,1%, and other determined etiology at 0,9%. Hypertension was the most common vascular risk factor. However, it was only significant in SVD (p=0,023) and undetermined etiology subtypes (p<0,001). Significant risk factor in LAA was diabetes (55%; p=0,016) while in CE subtypes was atrial fibrillation (60%;p<0,001). In multivariate analyses, hypertension (OR 3; 95% CI 1,12-8,05) was the only variable that was related to SVD while in CE it was atrial fibrillation (OR 113,5; 95% CI 13,6-946,5).</p><p><strong>Conclusion: </strong>LAA was the most common stroke ischemic subtypes. Associated risk factor in LAA was diabetes while in SVD and undetermined etiology subtypes it was hypertension. Atrial fibrillation was associated with cardioembolism.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2018 ","pages":"9589831"},"PeriodicalIF":1.5,"publicationDate":"2018-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/9589831","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36757700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical Thrombectomy by a Direct Aspiration First Pass Technique (ADAPT) in Ischemic Stroke: Results of Monocentric Study Based on Multimodal CT Patient Selection.","authors":"Giuseppe Guzzardi,&nbsp;Bruno Del Sette,&nbsp;Carmelo Stanca,&nbsp;Andrea Galbiati,&nbsp;Massimiliano Cernigliaro,&nbsp;Alessandro Carriero,&nbsp;Alessandro Stecco","doi":"10.1155/2018/6192483","DOIUrl":"https://doi.org/10.1155/2018/6192483","url":null,"abstract":"<p><strong>Introduction: </strong>Mechanical thrombectomy with ADAP-technique of ischemic stroke has been reported as fast and effective. Aim of this study is to evaluate imaging criteria as possible predictors of stroke severity, therapeutic success, and outcome.</p><p><strong>Materials and methods: </strong>Patients (30) presenting from October 2015 to April 2017 with Emergent Large Vessel Occlusion of the anterior circulation were treated with ADAP-technique. 22 received also IV tPA; 8 underwent endovascular treatment only. Every patient was evaluated with noncontrast CT, multiphase angiography-CT, and perfusion CT. Clinical and radiological characteristics were measured. Good clinical outcome was an improvement of 8 points on NIHSS at discharge or a modified Rankin Scale ≤2 at discharge and at 90 days.</p><p><strong>Results: </strong>Successful revascularization was obtained in 57% of patients, no procedural complications were witnessed, and only two hemorrhages were reported. Good outcome at discharge was obtained in 11 patients (37%) and predicted by NCCT ASPECT and TICI; outcome at 90 days was predicted by NCCT ASPECT, clot length, and premorbid mRS. Mortality was 23% at discharge and 30% at 90 days.</p><p><strong>Conclusion: </strong>ADAPT is an effective endovascular method of stroke treatment with fast procedural times. Multimodal CT evaluation is effective in assessing stroke severity, providing important prognostic information, which is able to select patients for the appropriate treatment.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2018 ","pages":"6192483"},"PeriodicalIF":1.5,"publicationDate":"2018-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/6192483","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36741039","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Rationale for Intervention and Dose Is Lacking in Stroke Recovery Trials: A Systematic Review.","authors":"Karen Borschmann, Kathryn S Hayward, Audrey Raffelt, Leonid Churilov, Sharon Kramer, Julie Bernhardt","doi":"10.1155/2018/8087372","DOIUrl":"10.1155/2018/8087372","url":null,"abstract":"<p><strong>Background: </strong>The ineffectiveness of most complex stroke recovery trials may be explained by inadequate intervention design. The primary aim of this review was to explore the rationales given for interventions and dose in stroke rehabilitation randomised controlled trials (RCTs).</p><p><strong>Methods: </strong>We searched the Cochrane Stroke Group library for RCTs that met the following criteria: (1) training based intervention; (2) >50% participants who were stroke survivors; (3) full peer-reviewed text; (4) English language. We extracted data on 16 quality items covering intervention dose (n= 3), trial design (n= 10), and risk of bias (n= 3) and 18 items related to trial method. Logistic regression analyses were performed to determine whether (1) reporting of trial quality items changed over time; (2) reporting of quality items was associated with the likelihood of a positive trial, adjusted for sample size and number of outcomes.</p><p><strong>Results: </strong>27 Cochrane reviews were included, containing 9,044 participants from 194 trials. Publication dates were 1979 to 2013, sample size was median 32 (IQR 20,58), and primary outcome was reported in 49 trials (25%). The median total quality score was 4 (IQR 3,6) and improved significantly each year (OR 1.12, 95% CI 1.07, 1.16, p<0.001). Total quality score was not associated with likelihood of a positive trial, but trials containing a biological rationale for the intervention were more likely to find a difference in patient outcome (OR 2.18, 95% CI 1.14, 4.19, p=0.02).</p><p><strong>Conclusion: </strong>To develop breakthrough treatments we need to build the rationale for research interventions and testing of intervention dosage. This will be achieved through a collective research agenda to understand the mechanistic principles that drive recovery and identification of clearer targets for clinical trials.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2018 ","pages":"8087372"},"PeriodicalIF":1.5,"publicationDate":"2018-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6234440/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36741040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Longitudinal Study on Low-Dose Aspirin versus Placebo Administration in Silent Brain Infarcts: The Silence Study.","authors":"Ilaria Maestrini,&nbsp;Marta Altieri,&nbsp;Laura Di Clemente,&nbsp;Edoardo Vicenzini,&nbsp;Patrizia Pantano,&nbsp;Eytan Raz,&nbsp;Mauro Silvestrini,&nbsp;Leandro Provinciali,&nbsp;Isabella Paolino,&nbsp;Carmine Marini,&nbsp;Matteo Di Giuseppe,&nbsp;Tommasina Russo,&nbsp;Francesco Federico,&nbsp;Cristiana Coppola,&nbsp;Maria Pia Prontera,&nbsp;Domenico Maria Mezzapesa,&nbsp;Vincenzo Lucivero,&nbsp;Lucilla Parnetti,&nbsp;Paola Sarchielli,&nbsp;Maria Peducci,&nbsp;Domenico Inzitari,&nbsp;Giovanna Carlucci,&nbsp;Carlo Serrati,&nbsp;Carla Zat,&nbsp;Anna Cavallini,&nbsp;Alessandra Persico,&nbsp;Giuseppe Micieli,&nbsp;Stefano Bastianello,&nbsp;Vittorio Di Piero","doi":"10.1155/2018/7532403","DOIUrl":"https://doi.org/10.1155/2018/7532403","url":null,"abstract":"<p><strong>Background: </strong>We investigated low-dose aspirin (ASA) efficacy and safety in subjects with silent brain infarcts (SBIs) in preventing new cerebrovascular (CVD) events as well as cognitive impairment.</p><p><strong>Methods: </strong>We included subjects aged ≥45 years, with at least one SBI and no previous CVD. Subjects were followed up to 4 years assessing CVD and SBI incidence as primary endpoint and as secondary endpoints: (a) cardiovascular and adverse events and (b) cognitive impairment.</p><p><strong>Results: </strong>Thirty-six subjects received ASA while 47 were untreated. Primary endpoint occurred in 9 controls (19.1%) versus 2 (5.6%) in the ASA group (p=0.10). Secondary endpoints did not differ in the two groups. Only baseline leukoaraiosis predicts primary [OR 5.4 (95%CI 1.3-22.9, p=0.022)] and secondary endpoint-a [3.2 (95%CI 1.1-9.6, p=0.040)] occurrence.</p><p><strong>Conclusions: </strong>These data show an increase of new CVD events in the untreated group. Despite the study limitations, SBI seems to be a negative prognostic factor and ASA preventive treatment might improve SBI prognosis. <b>EU Clinical trial</b> is registered with EudraCT Number: 2005-000996-16; Sponsor Protocol Number: 694/30.06.04.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2018 ","pages":"7532403"},"PeriodicalIF":1.5,"publicationDate":"2018-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/7532403","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36653143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Stroke Outcome and Determinants among Patients with and without Diabetes in a Tertiary Hospital in Ghana.","authors":"Josephine Akpalu, Alfred E Yawson, Foster Osei-Poku, Yacoba Atiase, Ernest Yorke, Patrick Adjei, Kodwo Nkromah, Albert Akpalu","doi":"10.1155/2018/7521351","DOIUrl":"10.1155/2018/7521351","url":null,"abstract":"<p><strong>Background: </strong>Diabetes mellitus, a well-established independent risk factor for stroke, has varied association with stroke outcome from previous studies. This study investigated stroke outcome and determinants among patients with and without diabetes in a tertiary hospital in Ghana.</p><p><strong>Methods: </strong>A prospective study conducted among stroke patients with and without diabetes admitted in a Ghanaian tertiary hospital. Baseline clinical and biochemical data were documented. Functional stroke outcome was evaluated at 1, 3, and 6 months after stroke using the modified Rankin Scale.</p><p><strong>Results: </strong>Number of participants enrolled were 326 and 105 (32.20%) had diabetes. Higher proportions of diabetes patients had poor functional stroke outcome at 1, 3, and 6 months (79%, 75.23%, 73.33%) compared with those without diabetes (70.13%, 65.16, 61.99) (p>0.05). Stroke patients with diabetes had lower survival compared with those without diabetes (p=0.0745). Mortality at 6 months was more likely among ischaemic stroke patients with diabetes compared with those without diabetes (Odds Ratio 2.037; CI: 1.058-3.923). Determinants of poor functional stroke outcome for diabetes patients were older age (Adjusted Odds Ratio (AOR)-1.07; CI-1.03-1.12), female gender (AOR-3.74; CI-1.26-12.65), and pneumonia (AOR-11.32; CI-1.93-220.05) whereas the determinants for those without diabetes were unemployment (AOR-4.19; CI-1.24-19.50), speech abnormalities (AOR-1.99; CI1.08-3.73), and pneumonia (AOR-4.05; CI-1.83-9.77). High fasting plasma glucose (HR-1.15; CI-1.07-1.23), elevated temperature (HR-1.41; CI-1.11-1.79), and pneumonia (HR-2.25; CI-1.44-3.50) were determinants of low survival among all stroke patients.</p><p><strong>Conclusion: </strong>Trends towards poorer functional outcome and reduced survival were found among Ghanaian stroke patients with diabetes compared with those without diabetes. Older age, female gender, pneumonia, elevated temperature, and fasting plasma glucose were determinants of adverse outcome in stroke patients with diabetes.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2018 ","pages":"7521351"},"PeriodicalIF":1.5,"publicationDate":"2018-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6157204/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36568108","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Treatment Outcomes and Associated Factors among Hospitalized Stroke Patients at Shashemene Referral Hospital, Ethiopia.","authors":"Tegegne Gobezie Temesgen,&nbsp;Berhanu Teshome,&nbsp;Peter Njogu","doi":"10.1155/2018/8079578","DOIUrl":"https://doi.org/10.1155/2018/8079578","url":null,"abstract":"<p><strong>Background: </strong>The 2013 Global Burden of Disease report indicated that 80% of stroke deaths occur in low- and middle-income regions. Although stroke has been consistently reported as one of the three leading causes of morbidity and mortality in the past years in Ethiopia, there is a paucity of data regarding treatment outcomes of stroke if sufficient. Hence, the present study aimed to assess patterns of treatment outcomes and associated factors among hospitalized stroke patients at Shashemene Referral Hospital.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted at the medical ward of Shashemene Referral Hospital. A total of 73 hospitalized stroke patients during the period 2012-2017 were included in the study. Demographic characteristics, risk factors, and stroke types and their hospital outcomes were reviewed from the medical records of the patients. The data were entered and analyzed using SPSS version 16.0. Descriptive statistics such as percent and frequency were used to summarize patients' characteristics. Binary logistic regression was used to investigate the potential predictors of treatment outcome. A p-value ≤0.05 was considered statistically significant.</p><p><strong>Result: </strong>Ischemic stroke was the most common type of stroke (65.8%) diagnosed in our setting. Hypertension (52.05%) was the common comorbid condition. More than half (54.79%) of the stroke patients improved on treatment. Dyslipidemics were prescribed to 68.49% of patients and the most popular antiplatelet was aspirin, which was prescribed to 61.64% of the study participants. Age, sex, type of stroke, and type of comorbidity were not significant factors of stroke treatment outcome.</p><p><strong>Conclusion: </strong>Ischemic stroke was the most common type of stroke diagnosed among the study participants while aspirin and statins were the most frequently used drugs in the management of stroke. Approximately 50% of hospitalized stroke patients had good treatment outcome and none of the investigated variables were significantly associated with the treatment outcomes.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2018 ","pages":"8079578"},"PeriodicalIF":1.5,"publicationDate":"2018-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/8079578","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36504091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determining the Joint Effect of Obesity and Diabetes on All-Cause Mortality and Cardiovascular-Related Mortality following an Ischemic Stroke.","authors":"Colleen Bauza,&nbsp;Renee' Martin,&nbsp;Sharon D Yeatts,&nbsp;Keith Borg,&nbsp;Gayenell Magwood,&nbsp;Anbesaw Selassie,&nbsp;Marvella E Ford","doi":"10.1155/2018/4812712","DOIUrl":"https://doi.org/10.1155/2018/4812712","url":null,"abstract":"<p><p>Although obesity and diabetes mellitus, or diabetes, are independently associated with mortality-related events (<i>e.g.,</i> all-cause mortality and cardiovascular-related mortality) following an ischemic stroke, little is known about the joint effect of obesity and diabetes on mortality-related events following an ischemic stroke. The aim of this study is to evaluate the joint effect of obesity and diabetes on mortality-related events in subjects with a recent ischemic stroke. Data from the multicenter Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial was analyzed for this study. The joint effect of obesity and diabetes on mortality-related events was estimated via Cox proportional hazards regression models. No difference in the hazard of all-cause mortality following an ischemic stroke was observed between obese subjects with diabetes and underweight/normal-weight subjects without diabetes. In contrast, obese subjects with diabetes had an increased hazard of cardiovascular-related mortality following an ischemic stroke compared with underweight/normal-weight subjects without diabetes. Additionally, there was evidence of an attributable proportion due to interaction as well as evidence of a highly statistically significant interaction on the multiplicative scale for cardiovascular-related mortality. In this clinical trial cohort of ischemic stroke survivors, obesity and diabetes synergistically interacted to increase the hazard of cardiovascular-related mortality.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2018 ","pages":"4812712"},"PeriodicalIF":1.5,"publicationDate":"2018-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/4812712","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36455708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Chronic Anticoagulation Control in Patients with Intracranial Haemorrhage due to Vitamin K Antagonists.","authors":"Carlos Estevez-Fraga,&nbsp;Maria Molina-Sanchez,&nbsp;Rodrigo Alvarez-Velasco,&nbsp;Pablo Agüero-Rabes,&nbsp;Leticia Crespo-Araico,&nbsp;Elena Viedma-Guiard,&nbsp;Antonio Cruz-Culebras,&nbsp;Consuelo Matute,&nbsp;Rocio Vera,&nbsp;Alicia De Felipe-Mimbrera,&nbsp;Jaime Masjuan Vallejo","doi":"10.1155/2018/5613103","DOIUrl":"https://doi.org/10.1155/2018/5613103","url":null,"abstract":"<p><strong>Introduction: </strong>Patients treated with vitamin K antagonists (VKA) are at increased risk of intracranial haemorrhage (ICH). The purpose of our study was to determine the quality of previous anticoagulation control in patients with VKA-associated ICH.</p><p><strong>Materials and methods: </strong>We prospectively assessed every consecutive patient admitted to our stroke unit with VKA-associated ICH between 2013 and 2016. Demographic, clinical, and radiological variables, as well as consecutive international normalized ratios (INR) during 7 previous months, were extracted. Time in therapeutic range (TTR), time over range (TOR), time below range (TBR), and percentage of INR within range (PINRR) were calculated.</p><p><strong>Results and discussion: </strong>The study population comprised 53 patients. Mean age was 79 years; 42% were women. Forty-eight patients had atrial fibrillation (AF) and 5 mechanical prosthetic valves. Therapeutic or infratherapeutic INR on arrival was detected in 64.4% of patients (95% CI 2.7 to 3.2). TTR was 67.8% (95% CI: 60.2 to 75.6 %) and PINRR was 75% (95% CI: 49.9-100). TOR was 17.2% (95% CI: 10.4 to 23.9% ) and TBR was 17% (95% CI: 10.6 to 23.9%).</p><p><strong>Conclusion: </strong>VKA-associated ICH happens usually in the context of good chronic anticoagulation control. Newer risk assessment methods are required.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2018 ","pages":"5613103"},"PeriodicalIF":1.5,"publicationDate":"2018-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/5613103","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36455709","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographic Variations of Stroke Hospitalization across France: A Diachronic Cluster Analysis.","authors":"Yacine Lachkhem,&nbsp;Étienne Minvielle,&nbsp;Stéphane Rican","doi":"10.1155/2018/1897569","DOIUrl":"https://doi.org/10.1155/2018/1897569","url":null,"abstract":"<p><strong>Background: </strong>This study evaluates the clustering of hospitalization rates for stroke and compares this clustering with two different time intervals 2009-2010 and 2012-2013, corresponding to the beginning of the French National Stroke Plan 2010-2014. In addition, these data will be compared with the deployment of stroke units as well as socioeconomic and healthcare characteristics at zip code level.</p><p><strong>Methods: </strong>We used the PMSI data from 2009 to 2013, which lists all hospitalizations for stroke between 2009 and 2013, identified on the most detailed geographic scale allowed by this database. We identify statistically significant clusters with high or low rates in the zip code level using the Getis-Ord statistics. Each of the significant clusters is monitored over time and evaluated according to the nearest stroke unit distance and the socioeconomic profile.</p><p><strong>Results: </strong>We identified clusters of low and high rate of stroke hospitalization (23.7% of all geographic codes). Most of these clusters are maintained over time (81%) but we also observed clusters in transition. Geographic codes with persistent high rates of stroke hospitalizations were mainly rural (78% versus 17%, <i>P</i> < .0001) and had a least favorable socioeconomic and healthcare profile.</p><p><strong>Conclusion: </strong>Our study reveals that high-stroke hospitalization rates cluster remains the same during our study period. While access to the stroke unit has increased overall, it remains low for these clusters. The socioeconomic and healthcare profile of these clusters are poor but variations were observed. These results are valuable tools to implement more targeted strategies to improve stroke care accessibility and reduce geographic disparities.</p>","PeriodicalId":22054,"journal":{"name":"Stroke Research and Treatment","volume":"2018 ","pages":"1897569"},"PeriodicalIF":1.5,"publicationDate":"2018-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1155/2018/1897569","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36401641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}