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  • 1
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    Abstract WMP104: Race And Regional Disparities In Prevalence Of Poor Metabolic Health Among Community Dwelling Adults With Stroke: Nationwide Analysis Of 2019 BRFSS Data
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. Suppl_1 ( 2022-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
    Abstract: Introduction: High burden of Metabolic Syndrome (MS) results in incident stroke and poor outcomes. We report contemporary national estimates of stroke prevalence and quantify MS burden and its socio-demographic associates among stroke individuals. Methods: We analyzed 2019 Behavioral Risk Factor Surveillance System data; a nationally representative survey of health-related conditions and behaviors among community dwelling adults. We identified individuals with self-reported stroke and flagged 4 MS indicators (diabetes, hypertension, BMI ≥ 25 kg/m 2 , hypercholesterolemia). Individuals with ≥ 2 features were categorized as High MS (HMS). We compared socio-demographic characteristics (age, sex, race, education, income, marital and employment status, stroke belt residence) and healthcare utilization (insurance status and frequency of healthcare visits) among HMS and no-HMS groups. We fit survey design logistic regression models with appropriate sampling weights and report national estimates of stroke prevalence and HMS associates. Results: In 2019, there were 8,570,876 adults (≥ 18 years) with stroke in the US; translating into a nationwide prevalence of 3.4% (7.9% among ≥ 65 years). Overall, 94.4% had at least one MS feature; 77.4% had HMS. Advanced age, male sex, non-Hispanic Black (NHB) race and residence in stroke belt region were associated with HMS. Participants with high income (≥ $75,000) and health insurance coverage were less likely to have HMS. In the fully adjusted model, advanced age; Asian American / Pacific Islander race and Hispanic ethnicity (vs. Non-Hispanic White) and residence in the US stroke belt had higher likelihood of HMS (Figure). Healthcare utilization patterns and sex were not significantly associated with HMS. Updated 2020 BRFSS data will be presented. Conclusion: Racial and regional disparities exist in HMS burden among stroke individuals. Targeted MS prevention and management measures are needed for high-risk populations.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.WMP104
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1467823-8
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  • 2
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    Abstract TP187: Contemporary Estimates Of Poor Cardiovascular Health Among Individuals With Stroke: Nationwide Analysis Of The American Heart Association’s Simple 7
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. Suppl_1 ( 2022-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
    Abstract: Introduction: The American Heart Association’s (AHA) “Simple 7” are lifestyle behaviors for maintenance of ideal cardiovascular health (CVH). Methods: We analyzed 2019 Behavioral Risk Factor Surveillance System (BRFSS) data (nationally representative, annual, health-related survey of community dwelling US adults), and flagged individuals with a stroke diagnosis. Among stroke individuals (SI), we identified validated CVH features (diabetes, hypertension, BMI ≥ 25 kg/m 2 , hypercholesterolemia, smoking, poor eating habits, and lack of exercise) based on AHA’s simple 7. SI with ≥ 5 CVH features were categorized as ‘Poor CVH’ (PCVH). We evaluated socio-demographic, regional and healthcare utilization factors associated with PCVH. We fit survey design logistic regression models, and report nationally representative estimates as adjusted Odds Ratios (aOR) and 95% confidence intervals (CI). Results: The 2019 estimated national count of SI is 8,570,876 translating into a nationwide stroke prevalence of 3.4% among US adults (7.9% among ≥ 65 years). SI who were divorced/separated (vs. married), non-Hispanic Black or Native American (vs. Non-Hispanic White - NHW), had lower income, resided in the stroke belt had higher likelihood of PCVH. In our adjusted model (Figure), males had a significantly higher PCVH aOR (CI) 1.26 (1.00 - 1.59). Moreover, Asian American and Pacific Islanders vs. NHW demonstrated higher PCVH, aOR (CI) 4.74 (1.25 - 17.95). Compared to the New England region, residence in following divisions was associated with higher PCVH; aOR (CI) for West South-Central: 1.73 (1.05 -2.85), East North Central: 1.64 (1.11 - 2.43), East South Central: 2.29 (1.37 - 3.83), South Atlantic: 1.74 (1.18 - 2.57). Analyses for 2020 BRFSS data will be presented. Conclusion: National stroke prevalence rates are provided. Poor CVH among stroke individuals continues to be disparately high. These analyses are important to identify and target high-risk population sub-groups.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.TP187
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1467823-8
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  • 3
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    National Institutes of Health StrokeNet Training Core
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. 1 ( 2020-01), p. 347-352
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 1 ( 2020-01), p. 347-352
    Abstract: The National Institutes of Health (NIH) StrokeNet provides a nationwide infrastructure to advance stroke research. Capitalizing on this unique opportunity, the NIH StrokeNet Training Core (NSTC) was established with the overarching goal of enhancing the professional development of a diverse spectrum of professionals who are embedded in the stroke clinical trials network of the NIH StrokeNet. Methods— This special report provides a descriptive account of the rationale, organization, and activities of the NSTC since its inception in 2013. Current processes and their evolution over time for facilitating training of NIH StrokeNet trainees have been highlighted. Data collected for monitoring training are summarized. Outcomes data (publications and grants) collected by NSTC was supplemented by publicly available resources. Results— The NSTC comprises of cross-network faculty, trainees, and education coordinators. It helps in the development and monitoring of training programs and organizes educational and career development activities. Trainees are provided directed guidance towards their mandated research projects, including opportunities to present at the International Stroke Conference. The committee has focused on developing sustainable models of peer-to-peer interaction and cross-institutional mentorships. A total of 124 professionals (43.7% female, 10.5% underrepresented minorities) have completed training between 2013 and 2018, of whom 55% were clinical vascular neurologists. Of the total, 85% transitioned to a formal academic position and 95% were involved in stroke research post-training. Altogether, 1659 indexed publications have been authored or co-authored by NIH StrokeNet Trainees, of which 58% were published during or after their training years. Based on data from 109 trainees, 33% had submitted 72 grant proposals as principal or co-principal investigators of which 22.2% proposals have been funded. Conclusions— NSTC has provided a foundation to foster nationwide training in stroke research. Our data demonstrate strong contribution of trainees towards academic scholarship. Continued innovation in educational methodologies is required to adapt to unique training opportunities such as the NIH StrokeNet.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.119.027946
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
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  • 4
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    Online Resource
    Association Between Sociodemographic Determinants and Disparities in Stroke Symptom Awareness Among US Young Adults
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Stroke Vol. 51, No. 12 ( 2020-12), p. 3552-3561
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 51, No. 12 ( 2020-12), p. 3552-3561
    Abstract: Despite declining stroke rates in the general population, stroke incidence and hospitalizations are rising among younger individuals. Awareness of and prompt response to stroke symptoms are crucial components of a timely diagnosis and disease management. We assessed awareness of stroke symptoms and response to a perceived stroke among young adults in the United States. Methods: Using data from the 2017 National Health Interview Survey, we assessed awareness of 5 common stroke symptoms and the knowledge of planned response (ie, calling emergency medical services) among young adults ( 〈 45 years) across diverse sociodemographic groups. Common stroke symptoms included: (1) numbness of face/arm/leg, (2) confusion/trouble speaking, (3) difficulty walking/dizziness/loss of balance, (4) trouble seeing in one/both eyes, and (5) severe headache. Results: Our study population included 24 769 adults, of which 9844 (39.7%) were young adults who were included in our primary analysis, and represented 107.2 million US young adults (mean age 31.3 [±7.5] years, 50.6% women, and 62.2% non-Hispanic White). Overall, 2718 young adults (28.9%) were not aware of all 5 stroke symptoms, whereas 242 individuals (2.7%; representing 2.9 million young adults in the United States) were not aware of a single symptom. After adjusting for confounders, Hispanic ethnicity (odds ratio, 1.96 [95% CI, 1.17–3.28] ), non-US born immigration status (odds ratio, 2.02 [95% CI, 1.31–3.11]), and lower education level (odds ratio, 2.77 [95% CI, 1.76–4.35] ), were significantly associated with lack of symptom awareness. Individuals with 5 high-risk characteristics (non-White, non-US born, low income, uninsured, and high school educated or lower) had nearly a 4-fold higher odds of not being aware of all symptoms (odds ratio, 3.70 [95% CI, 2.43–5.62]). Conclusions: Based on data from the National Health Interview Survey, a large proportion of young adults may not be aware of stroke symptoms. Certain sociodemographic subgroups with decreased awareness may benefit from focused public health interventions.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/STROKEAHA.120.031137
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1467823-8
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  • 5
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    Abstract P559: National Burden & Cardiovascular Risk Factor Profile of Stroke Among Young Adults in The United States
    Ovid Technologies (Wolters Kluwer Health) ; 2020
    In:  Circulation Vol. 141, No. Suppl_1 ( 2020-03-03)
    Details
    In: Circulation, Ovid Technologies (Wolters Kluwer Health), Vol. 141, No. Suppl_1 ( 2020-03-03)
    Abstract: Introduction: Stroke is a leading cause of death and disability worldwide. While most prevalent in elderly, it’s not uncommon in the non-elderly ( 〈 65), who also experience many more years of living with disability. In this study, we aimed to describe the scope and CVD determinants of stroke among young (18-44 years) adults in a US representative population. Methods: We analyzed the National Health Interview Survey (2012-2018), a nationally representative study sample. Stroke, as well as CVD risk factors (CRF) [diabetes, hypertension, ever-smoker, insufficient physical activity, obesity and high cholesterol] were self-reported. A CRF profile was then created, with the following categories: “Optimal”, “Average” and “Poor” (0-1, 2-3 & ≥ 4 CRFs, respectively). All analyses took into consideration the survey’s complex design. Results: The 2012-2018 survey population consisted of 224,638 adults ≥ 18 yrs, ≈ 242 million US adults annually. Overall 2.8% (≈ 7 million) reported ever having history of stroke, with 45% noted in the non-elderly ( 〈 65). Among non-elderly, 21% of stroke-history was allocated among the young (18-44 years) adults, translating to nearly 642,810 individuals reporting ever having history of stroke per year. The most common risk factors noted in these patients were insufficient physical activity (56%), current/past smoking (48%), obesity (45%), and hypertension (44%). Overall among the young ( 〈 45 years), stroke prevalence was 10-fold higher among those with poor (≈ 3.9 million young adults) vs optimal CRF profile (3.5% vs 0.3%, p 〈 0.001). Adjusting for demographics, all CVD risk were significantly associated with history of stroke, with participants with poor CRF reporting a 7-fold higher history of stroke (Table). Conclusion: More than half a million adults 18-44 years of age reported a history stroke in US. Individuals with sub-optimal CRF profiles are highly susceptible, and population-level strategies emphasizing cardiovascular health may significantly reduce risk of stroke among young adults in US.
    Type of Medium: Online Resource
    ISSN: 0009-7322 , 1524-4539
    URL: Article
    DOI: 10.1161/circ.141.suppl_1.P559
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2020
    detail.hit.zdb_id: 1466401-X
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  • 6
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    Social Determinants of Health and Cardiovascular Disease: Current State and Future Directions Towards Healthcare Equity
    Springer Science and Business Media LLC ; 2021
    In:  Current Atherosclerosis Reports Vol. 23, No. 9 ( 2021-09)
    Details
    In: Current Atherosclerosis Reports, Springer Science and Business Media LLC, Vol. 23, No. 9 ( 2021-09)
    Type of Medium: Online Resource
    ISSN: 1523-3804 , 1534-6242
    URL: Article
    DOI: 10.1007/s11883-021-00949-w
    Language: English
    Publisher: Springer Science and Business Media LLC
    Publication Date: 2021
    detail.hit.zdb_id: 2094154-7
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  • 7
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    Leveraging a health information exchange for analyses of COVID-19 outcomes including an example application using smoking history and mortality
    Public Library of Science (PLoS) ; 2021
    In:  PLOS ONE Vol. 16, No. 6 ( 2021-6-3), p. e0247235-
    Details
    In: PLOS ONE, Public Library of Science (PLoS), Vol. 16, No. 6 ( 2021-6-3), p. e0247235-
    Abstract: Understanding sociodemographic, behavioral, clinical, and laboratory risk factors in patients diagnosed with COVID-19 is critically important, and requires building large and diverse COVID-19 cohorts with both retrospective information and prospective follow-up. A large Health Information Exchange (HIE) in Southeast Texas, which assembles and shares electronic health information among providers to facilitate patient care, was leveraged to identify COVID-19 patients, create a cohort, and identify risk factors for both favorable and unfavorable outcomes. The initial sample consists of 8,874 COVID-19 patients ascertained from the pandemic’s onset to June 12 th , 2020 and was created for the analyses shown here. We gathered demographic, lifestyle, laboratory, and clinical data from patient’s encounters across the healthcare system. Tobacco use history was examined as a potential risk factor for COVID-19 fatality along with age, gender, race/ethnicity, body mass index (BMI), and number of comorbidities. Of the 8,874 patients included in the cohort, 475 died from COVID-19. Of the 5,356 patients who had information on history of tobacco use, over 26% were current or former tobacco users. Multivariable logistic regression showed that the odds of COVID-19 fatality increased among those who were older (odds ratio = 1.07, 95% CI 1.06, 1.08), male (1.91, 95% CI 1.58, 2.31), and had a history of tobacco use (2.45, 95% CI 1.93, 3.11). History of tobacco use remained significantly associated (1.65, 95% CI 1.27, 2.13) with COVID-19 fatality after adjusting for age, gender, and race/ethnicity. This effort demonstrates the impact of having an HIE to rapidly identify a cohort, aggregate sociodemographic, behavioral, clinical and laboratory data across disparate healthcare providers electronic health record (HER) systems, and follow the cohort over time. These HIE capabilities enable clinical specialists and epidemiologists to conduct outcomes analyses during the current COVID-19 pandemic and beyond. Tobacco use appears to be an important risk factor for COVID-19 related death.
    Type of Medium: Online Resource
    ISSN: 1932-6203
    URL: Article
    URL: Article
    URL: Article
    URL: Article
    DOI: 10.1371/journal.pone.0247235
    DOI: 10.1371/journal.pone.0247235.g001
    DOI: 10.1371/journal.pone.0247235.t001
    DOI: 10.1371/journal.pone.0247235.t002
    Language: English
    Publisher: Public Library of Science (PLoS)
    Publication Date: 2021
    detail.hit.zdb_id: 2267670-3
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  • 8
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    Clinical and Economic Profile of Homeless Young Adults with Stroke in the United States, 2002-2017
    Elsevier BV ; 2023
    In:  Current Problems in Cardiology Vol. 48, No. 8 ( 2023-08), p. 101190-
    Details
    In: Current Problems in Cardiology, Elsevier BV, Vol. 48, No. 8 ( 2023-08), p. 101190-
    Type of Medium: Online Resource
    ISSN: 0146-2806
    URL: Article
    DOI: 10.1016/j.cpcardiol.2022.101190
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2060920-6
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  • 9
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    Intravenous Bone Marrow Mononuclear Cells for Acute Ischemic Stroke: Safety, Feasibility, and Effect Size from a Phase I Clinical Trial
    Oxford University Press (OUP) ; 2019
    In:  Stem Cells Vol. 37, No. 11 ( 2019-11-01), p. 1481-1491
    Details
    In: Stem Cells, Oxford University Press (OUP), Vol. 37, No. 11 ( 2019-11-01), p. 1481-1491
    Abstract: Cellular therapy is a promising investigational modality to enhance poststroke recovery. We conducted a single-arm, phase I clinical trial to determine the safety and feasibility of intravenous (IV) administration of autologous bone marrow mononuclear cells (MNCs) after acute ischemic stroke (AIS). Patients with moderate severity of AIS underwent bone marrow harvest followed by IV reinfusion of MNCs within 24–72 hours of onset. A target dose of 10 million cells per kilogram was chosen based on preclinical data. Patients were followed up daily during hospitalization and at 1, 3, 6, 12, and 24 months for incidence of adverse events using laboratory, clinical (12 months), and radiological (24 months) parameters. The trial was powered to detect severe adverse events (SAEs) with incidences of at least 10% and planned to enroll 30 patients. Primary outcomes were study-related SAEs and the proportion of patients successfully completing study intervention. A propensity score-based matched control group was used for the estimation of effect size (ES) for day-90 modified Rankin score (mRS). There were no study-related SAEs and, based on a futility analysis, enrolment was stopped after 25 patients. All patients successfully completed study intervention and most received the target dose. Secondary analysis estimated the ES to be a reduction of 1 point (95% confidence interval: 0.33–1.67) in median day-90 mRS for treated patients as compared with the matched control group. Bone marrow harvest and infusion of MNCs is safe and feasible in patients with AIS. The estimated ES is helpful in designing future randomized controlled trials. Stem Cells  2019;37:1481–1491
    Type of Medium: Online Resource
    ISSN: 1066-5099 , 1549-4918
    URL: Article
    DOI: 10.1002/stem.3080
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
    detail.hit.zdb_id: 2030643-X
    detail.hit.zdb_id: 1143556-2
    detail.hit.zdb_id: 605570-9
    SSG: 12
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  • 10
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    Abstract TP10: Inflammatory And Neurodegenerative Gene Expression Changes Occur Long-term After ICH
    Ovid Technologies (Wolters Kluwer Health) ; 2022
    In:  Stroke Vol. 53, No. Suppl_1 ( 2022-02)
    Details
    In: Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
    Abstract: Objective: There is a high prevalence of progressive cognitive impairment in intracerebral hemorrhage (ICH) survivors. We sought to identify gene expression changes, in association with long-term neurodegeneration, among patients 12-24 months post-ICH. Methods: The Recovery and Outcomes from StrokE (ROSE) study prospectively recruits patients with spontaneous, supratentorial ICH, collecting baseline peripheral blood samples and MRI with diffusion tract imaging (DTI). The Recovery of StrokE-Longitudinal Assessment with Neuroimaging (ROSE-LAWN) study performs long term follow-up at 12-24 months on cases enrolled in ROSE. We report on the first five cases enrolled in the ROSE-LAWN study from December 2020 to March 2021. Controls were matched to an overall ICH population by age, sex, and race. RNA-sequencing, aligned to human genome assembly GRCh38, was tested for differential gene expression. Canonical pathway enrichment and network analyses were computed for differentially expressed genes using Ingenuity Pathway Analysis, STRING and MCODE. Results: RNA-seq analysis of 5 ICH cases [male, 80%; median age, 61 (45 - 73); black, 40%; ICH volume, 14.88cc ± 13.07] and 13 controls [male, 54%; median age, 74 (69 - 79); black, 15%] identified 554 differentially expressed genes (genomic control adjusted p 〈 0.01), of which 24 met the false discovery rate correction for multiple comparisons (FDR 〈 0.05). The most significant difference was observed in hypoxia up-regulated 1 ( HYOU1), a heat shock protein related gene (p = 2.64E-11). Pathway analysis identified enrichment of dopamine and serotonin receptor signaling (p = 8.74E-03, 2.23E-02), cell cycle regulation (p = 1.75E-02) and agranulocyte adhesion pathways (p = 2.18E-02). Comparison of baseline and follow-up MRI DTI demonstrated extensive cortical tract degeneration, beyond the initial injury. Conclusion: These results provide novel evidence of significant gene expression changes occurring years after the initial ICH. Despite resolution of the ICH, persistent inflammation may correlate with progressive neurodegeneration and subsequent cognitive impairment in ICH survivors. Future studies with greater sample sizes are supported by this work.
    Type of Medium: Online Resource
    ISSN: 0039-2499 , 1524-4628
    URL: Article
    DOI: 10.1161/str.53.suppl_1.TP10
    RVK:
    XA 10000
    Language: English
    Publisher: Ovid Technologies (Wolters Kluwer Health)
    Publication Date: 2022
    detail.hit.zdb_id: 1467823-8
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