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  • 1
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 31, No. 2 ( 2011), p. 130-137
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Lower socioeconomic status (SES) is associated with an increased risk of stroke but the mechanisms are unclear. We aimed to determine whether low-SES stroke/transient ischaemic attack (TIA) patients have a greater burden of vascular risk factors/co-morbidity and reduced health care access. 〈 i 〉 Methods: 〈 /i 〉 We prospectively studied 467 consecutive stroke and TIA patients from 3 Scottish hospitals (outpatients and inpatients) during 2007/2008. We recorded vascular risk factors, stroke severity, co-morbidity measures, investigations and health service utilisation. SES was derived from postcodes using Scottish Neighbourhood Statistics and analysed in quartiles. 〈 i 〉 Results: 〈 /i 〉 TIA/stroke patients in the lowest SES quartile were younger (64 years, SD 14.1) than those in the highest quartile (72 years, SD 12.9; p 〈 0.0001). They were more likely to be current smokers (42 vs. 22%; p = 0.001) but there was no association with other vascular risk factors/co-morbidity. There was a trend for those with lower SES to have a more severe stroke [modified National Institutes of Health Stroke Scale score and interquartile range: 4 (2–6) vs. 3 (1–5); multivariate p = 0.05]. Lower SES groups were less likely to have neuro-imaging (82 vs. 90%; p = 0.036) or an electrocardiogram (72 vs. 87%; p = 0.003), but differences were no longer significant on multivariate analysis. However, there was equal access to stroke unit care. 〈 i 〉 Conclusions: 〈 /i 〉 Low-SES TIA and stroke patients are younger and have a more severe deficit; an increased prevalence of smoking is likely to be a major contributor. We found equal access to stroke unit care for low-SES patients.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
    detail.hit.zdb_id: 1482069-9
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  • 2
    In: Neuroepidemiology, S. Karger AG, Vol. 56, No. 5 ( 2022), p. 355-364
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Measuring patient-reported information in stroke research is challenging. To overcome this, use of proxy respondents is often a necessary strategy. In this study, we report on use and effect of proxy respondents on patient case-mix in a large international epidemiologic stroke study (INTERSTROKE). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 This was a cross-sectional study of 13,458 cases of acute first stroke in 32 countries. A standardized study questionnaire recording behavioural cardiovascular risk factors was administered to the patient, and if unable to communicate adequately, a valid proxy, or both. We used logistic regression to evaluate the association of age, sex, education, occupation, stroke severity, and region with need for proxy respondent, and report odds ratio (OR) with 95% confidence interval (CI). 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Among 13,458 participants with acute stroke, questionnaires were completed by patients alone in 41.4% ( 〈 i 〉 n 〈 /i 〉 = 5,573), combination of patient and proxy together in 21.7% ( 〈 i 〉 n 〈 /i 〉 = 2,918), and proxy alone in 36.9% ( 〈 i 〉 n 〈 /i 〉 = 4,967). Use of proxy alone was greater in participants with severe stroke (4.7% with modified-Rankin score of 0 vs. 80.5% in those with score 5; OR 187.13; 95% CI: 119.61–308.22), older persons (43.8% of those aged 80 years and over vs. 33.2% of those aged less than 40 years; age per decade OR 1.09; 95% CI: 1.06–1.12), women (40.7% vs. 34.3% of men; OR 1.32 95% CI: 1.22–1.43), and those less educated (58.9% of those never educated vs. 25.7% of those who attended third level education; OR 7.84; 95% CI: 6.78–9.08). 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Use of proxy respondents enhances the generalizability of international research studies of stroke, by increasing representation of women, patients with severe stroke, older age, and lower education.
    Type of Medium: Online Resource
    ISSN: 0251-5350 , 1423-0208
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 1483032-2
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  • 3
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 17, No. Suppl. 2 ( 2004), p. 1-14
    Type of Medium: Online Resource
    ISSN: 1421-9786 , 1015-9770
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2004
    detail.hit.zdb_id: 1482069-9
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  • 4
    Online Resource
    Online Resource
    S. Karger AG ; 2007
    In:  Cerebrovascular Diseases Vol. 24, No. 1 ( 2007), p. 157-158
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 24, No. 1 ( 2007), p. 157-158
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2007
    detail.hit.zdb_id: 1482069-9
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  • 5
    Online Resource
    Online Resource
    S. Karger AG ; 2007
    In:  Cerebrovascular Diseases Vol. 23, No. 4 ( 2007), p. 320-321
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 23, No. 4 ( 2007), p. 320-321
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2007
    detail.hit.zdb_id: 1482069-9
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  • 6
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 35, No. 6 ( 2013), p. 544-553
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Cross-sectional studies have shown an association between the severity of age-related white matter change (ARWMC) and lower body motor function. However, the association between prevalent ARWMC and incident deterioration of balance and gait remains insufficiently investigated. This study investigates if the degree of prevalent ARWMC has a differential effect on lower body motor function as it changes over time, hypothesizing that individuals with more severe baseline white matter pathology experience greater clinical deterioration independent of potential confounders. This is of clinical relevance: given the increasing use of neuroimaging, incidental white matter pathology is common; being able to delineate natural trajectories of balance and gait function given ARWMC may improve patient advice and help optimize allocation of care. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 639 non-disabled elderly individuals with prevalent ARWMC (grading of severity of ARWMC using the Fazekas scale) were followed up yearly for 3 years, as part of the Leukoaraiosis and Disability Study. The primary outcome variable, reflecting the temporal course of gait and balance function, was the change of scores on the Short Physical Performance Battery (SPPB) over time versus the severity of ARWMC. We used linear mixed modelling to analyse change over time. Explorative analysis was carried out investigating the effect of age on potential deterioration of gait and balance function. We used propensity scores to adjust for multiple confounders that affect both the exposure (i.e. ARWMC) and outcome. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Subjects' lower body motor function deteriorated by 2.6% per year. However, after adjustment for baseline motor impairment and potential confounders, only subjects with moderate [-0.22 points per year on the SPPB (equals -2.3%); 95% CI -0.35 to -0.09, p 〈 0.001] or severe [-0.46 points per year (equals -4.7%); 95% CI -0.63 to -0.28, p 〈 0.0001] ARWMC show a loss of function. Age shows differential effects: relatively younger elderly subjects have similar temporal dynamics in SPPB change independent of their individual degree of ARWMC severity; however, subjects with severe ARWMC and who are older than 75.9 years deteriorate significantly more rapidly than their counterparts with only mild or moderate white matter pathology. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Only moderate and severe ARWMC is independently associated - on average - with a deterioration of gait and balance. Albeit the possibility of unmeasured confounding and other methodological constraints, there is nonetheless evidence of large interindividual variability: some subjects with moderate or severe ARWMC stay stable over time or even show improvement. Furthermore, there is explorative analysis showing that younger elderly subjects may be able to better compensate even severe ARWMC. These individuals' gait and balance function stays relatively stable over time, whereas their older counterparts deteriorate significantly. This may point towards a threshold effect given ARWMC.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2013
    detail.hit.zdb_id: 1482069-9
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  • 7
    Online Resource
    Online Resource
    S. Karger AG ; 2007
    In:  Cerebrovascular Diseases Vol. 23, No. 5-6 ( 2007), p. 464-464
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 23, No. 5-6 ( 2007), p. 464-464
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2007
    detail.hit.zdb_id: 1482069-9
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  • 8
    Online Resource
    Online Resource
    S. Karger AG ; 2004
    In:  Cerebrovascular Diseases Vol. 18, No. 3 ( 2004), p. 256-256
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 18, No. 3 ( 2004), p. 256-256
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2004
    detail.hit.zdb_id: 1482069-9
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  • 9
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 31, No. 1 ( 2011), p. 57-63
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Reduced socioeconomic status (SES) is associated with an increased risk of stroke, although the mechanism is not clear. It may be that those with lower SES have a greater burden of classic vascular risk factors. 〈 i 〉 Methods: 〈 /i 〉 Our aim was to quantify the extent to which classic vascular risk factors explain the association between SES and stroke incidence. We conducted a systematic review and meta-analysis of studies examining the association of SES and stroke incidence, where classic vascular risk factors were considered. Searching MEDLINE, EMBASE and the Cochrane Library from 1980 onwards we identified 17 studies, 12 of these studies provided sufficient information to allow a meta-analysis. From each study the increased risk of stroke incidence, where the lowest socioeconomic category was compared with the highest, was recorded and pooled. The stroke incidence risks, adjusted for grouped classic risk factors, were also pooled. Review Manager 5 software was used for all analyses and results were analysed using hazard ratios (HR, 95% confidence interval, 95% CI) with a random effects model. 〈 i 〉 Results: 〈 /i 〉 Those with a lower SES were more likely to have a stroke (HR 1.67; 95% CI 1.46–1.91). Additional risk was reduced, but not eliminated, when classic vascular risk factors were adjusted for (HR 1.31; 95% CI 1.16–1.48). 〈 i 〉 Conclusion: 〈 /i 〉 Low SES is associated with an increased risk of stroke that is partly explained by known classic vascular risk factors.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
    detail.hit.zdb_id: 1482069-9
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  • 10
    Online Resource
    Online Resource
    S. Karger AG ; 2010
    In:  Cerebrovascular Diseases Vol. 29, No. 4 ( 2010), p. 352-360
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 29, No. 4 ( 2010), p. 352-360
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Stroke patients are more likely to make a good recovery if they receive care in a well-organised stroke unit. However, there are uncertainties about how best to provide such care. We studied 2 key aspects of early stroke unit care: early active mobilisation (EM) and automated monitoring (AM) for physiological complications such as hypoxia. 〈 i 〉 Methods: 〈 /i 〉 This was an observer-blinded, factorial (2 × 2) pilot randomised controlled trial recruiting stroke patients within 36 h of symptom onset. The patients were randomised to 1 of 4 nurse-led treatment protocols: (a) standard stroke unit care, (b) EM, (c) AM or (d) combined EM and AM. The primary outcome was the Rankin score at 3 months. We also report the data on feasibility and safety. 〈 i 〉 Results: 〈 /i 〉 We randomised 32 patients (mean age = 65 years; mean baseline modified NIH score = 6). On unadjusted comparisons, the EM patients were significantly (p 〈 0.05) more likely to mobilise very early (within 1 h of randomisation) and to achieve walking by day 5 and were less likely to develop complications of immobility. The AM group was significantly (p 〈 0.05) more likely to have pre-defined physiological complication events detected. All these associations remained, but were less statistically significant, after correcting for age, baseline NIH score and co-interventions. There were no significant safety concerns. 〈 i 〉 Discussion: 〈 /i 〉 We have demonstrated the feasibility of implementing EM and AM for physiological complications in a randomised controlled trial. Larger trials are warranted to determine whether these interventions have clinical benefits.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2010
    detail.hit.zdb_id: 1482069-9
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