-
1.
Meta-analysis of Cardiovascular Events and Related Biomarkers Comparing Survivors Versus Non-survivors in Patients With COVID-19.
Shoar, S, Hosseini, F, Naderan, M, Mehta, JL
The American journal of cardiology. 2020;:50-61
-
-
Free full text
-
Abstract
Since the emergence of the coronavirus disease 19 (COVID-19), a number of studies have reported the presence of cardiovascular diseases in affected patients and linked them with a higher risk of mortality. We conducted an online search in Medline/PubMed to identify original cohorts comparing data between survivors and non-survivors from COVID-19. The presence of cardiovascular events and related biomarkers were compared between the 2 groups. Data on 1,845 hospitalized patients with COVID-19 were pooled from 12 comparative studies. The overall mortality rate in relation to COVID-19 was 17.6%. Men aged > 50 years old were more likely to die from COVID-19. Significant co-morbidities contributing to mortality were hypertension, diabetes mellitus, smoking, a previous history of cardiovascular disease including chronic heart failure, and cerebrovascular accidents. A significant relationship was observed between mortality and patient presentation with dyspnea, fatigue, tachycardia, and hypoxemia. Cardiovascular disease-related laboratory biomarkers related to mortality were elevated serum level of lactate dehydrogenase, creatine kinase, brain natriuretic peptide, and cardiac troponin I. Adverse cardiovascular disease-related clinical events preceding death were shock, arrhythmias, and acute myocardial injury. In conclusion, severe clinical presentation and elevated biomarkers in COVID-19 patients with established risk factors can predict mortality from cardiovascular causes.
-
2.
Active and sedentary bouts in people after stroke and healthy controls: An observational study.
Hassett, L, Ada, L, Hellweg, S, Paul, S, Alzahrani, M, Dean, C
Physiotherapy research international : the journal for researchers and clinicians in physical therapy. 2020;(3):e1845
Abstract
BACKGROUND AND PURPOSE Understanding how both active and sedentary time is accumulated in people after stroke may help to better target interventions to reduce stroke recurrence. This study aimed to determine the difference between stroke and healthy controls in (a) time spent in sedentary and active behaviour, (b) frequency of short and long active and sedentary bouts and (c) time spent in short and long active and sedentary bouts. METHODS Analysis of secondary outcomes from a cross-sectional study. Participants were 42 community-dwelling people after stroke and 21 age-matched healthy controls. An activity monitor was used to collect free-living active and sedentary behaviour. Total active (standing and walking) and sedentary (lying, reclining and sitting) time was calculated in minutes per day. Bouts were categorized as short (<5 min, 5-15 min, 15-30 min) or long (>30 min). The frequency of and time spent in each bout were calculated. RESULTS Relative to wear time, the stroke group spent 10% (95% confidence interval [CI] 3 to 17) more time in sedentary behaviour and had fewer long active bouts than the healthy controls. The stroke group spent 7% (95% CI 1-13) less time in long active bouts and 11% (95% CI 2-20) more time in long sedentary bouts than the healthy controls. CONCLUSIONS Community-dwelling people after stroke spent less time in active behaviour and accumulated more sedentary time in bouts longer than 30 min compared with healthy controls. Increasing active time and breaking up long sedentary time warrants investigation in people after stroke.
-
3.
Sexual dysfunction after stroke-A biopsychosocial perspective.
Na, Y, Htwe, M, Rehman, CA, Palmer, T, Munshi, S
International journal of clinical practice. 2020;(7):e13496
Abstract
OBJECTIVES Poststroke sexual dysfunction (PSSD) is widespread and underrecognised, affecting over half of stroke patients with significant effects on a patients' quality of life. We reviewed the postulated factors contributing to PSSD and explore the underrecognition by presenting a questionnaire study as well as examining existing literature. METHODS A literature search between January 1980 and December 2019 in electronic databases such as EMBASE, MEDLINE and PubMed was conducted. The questionnaire study involved all adult stroke patients attending the outpatient clinic over a 6-month period, containing multiple choice and open questions relating to prevalence, impact and provision provided for patients with PSSD. FINDINGS Poststroke sexual dysfunction is unlikely attributed solely to the physical effects of stroke. We present a biopsychosocial model summarising the wide range of factors which can contribute to PSSD. Less than 10% of patients receive any advice despite 90% of patients hoping for advice relating to sexual dysfunction in stroke. INTERPRETATION AND IMPLICATIONS A multidisciplinary, proactive involvement in screening and managing PSSD is required to successfully manage a commonly forgotten complication of stroke. As part of the wider theme of managing lifestyle factors poststroke (eg, smoking, driving advice, dietary advice, alcohol), the 'sexual function aspect' of patients' lives must not be ignored.
-
4.
Utility of neutrophil-to-lymphocyte ratio to identify long-term survivors among HCC patients treated with sorafenib.
Casadei-Gardini, A, Dadduzio, V, Rovesti, G, Cabibbo, G, Vukotic, R, Rizzato, MD, Orsi, G, Rossi, M, Guarneri, V, Lonardi, S, et al
Medicine. 2020;(22):e19958
-
-
Free full text
-
Abstract
Sorafenib is the first multikinase inhibitor demonstrating a survival benefit for patients suffering from advanced hepatocellular carcinoma (HCC). However, 1 issue remains open: what is the factor able to predict which patients will be long survivors?In the present study, we harnessed the potential of conditional survival, aiming at estimating the probability that a patient receiving sorafenib survives for more than 3 years.The present multicentric study was conducted on a cohort of 438 HCC patients. The primary end point was conditional overall survival. Kaplan-Meier survival analysis was used to calculate conditional overall survival probabilities at 3 years.The 3-year conditional survival of patients without disease progression highlights that NLR and ECOG are the factors that most accurately predict the probability of long survival. The 3-year conditional survival of patients with disease progression showed a medium effect size for HCV status, alpha-fetoprotein and NLR at all time-points. Macro-vascular portal vein invasion, extra hepatic disease, and BCLC we have a large effect size at 6 months and a medium effect size at 12 and 24 months.Our findings support the use of baseline NLR for the identification of patients with a higher probability of long-survival. NLR should be used as a stratification factor in the forthcoming clinical trials on the drugs for the advanced HCC now in pipeline.
-
5.
Consequences of holocaust on physical health of survivors: bibliography review.
Horáčková, K, Ševčovičová, A, Hrstka, Z, Moravcová, M, Lásková, M, Derňarová, Ľ
Central European journal of public health. 2020;(3):237-244
Abstract
OBJECTIVE Period of elderly age preordains the occurrence of many health issues. People deported during World War II to concentration camps suffered from malnutrition, lack of sleep, physical and mental exhaustion. Recently, the health condition of Holocaust survivors is often complicated as a result of physical punishments and different torture methods as well as mental hardships which they had suffered during deportation. The consequences often have psychosomatic nature thus the survivors are often receivers of health care. The topic of bibliography review is based on the need to objectivize and systematically evaluate subjective health issues of Holocaust survivors in connection with trauma related to the stay in a concentration camp. The aim is to offer a review of effects of the Holocaust on health of different body systems for survivors in concentration camps and Jewish ghettos in the course of World War II. METHODS To map the subjective problems of Holocaust survivors, evidence-based medicine (EBM) method has been used with the help of scientific database PubMed, CINAHL Plus with full text, ProQuest and other sources with specific key words and Boole operators. Prognostic type of clinical/review questions has been selected for the bibliography review, which is trying to predict the probability of relation or output of illness/condition and based on diseases or symptoms seriousness to find out expectancy for treatment/improvement of care. RESULTS 175 studies have been found in basic search with the use of key words both in English and in Czech language. The search has not been time-limited. The advanced search has focused on different body systems and health damage due to Nazi experiments. Fourteen studies have been used to complete the study. The research results have confirmed the significant effect of Holocaust trauma on body condition of the survivors. The reasons of this condition were insufficient nutrition, unsuitable and harmful hygienic, living and working conditions and brutality of the guards. According to the research, these factors have impacted all organ systems, mainly locomotion and cardiovascular ones. The results have shown a more frequent occurrence of osteoporosis, fractures of long bones and corresponding chronical pain of people of Jewish origin who had gone through different forms of torture during World War II. Other present symptoms include gastrointestinal problems, tumors mainly in the area of colorectum and lungs. Moreover, the stay in concentration camps had influence on women's menstrual cycle. CONCLUSION The studies of Holocaust effects are an example of the influence of an extreme mental and physical burden on the body condition of the survivors' health. The results of the studies have shown a wide range of the effects also in mental and social areas.
-
6.
Effect and efficacy of lifestyle interventions as secondary prevention.
Liljehult, J, Christensen, T, Molsted, S, Overgaard, D, Mesot Liljehult, M, Møller, T
Acta neurologica Scandinavica. 2020;(4):299-313
-
-
Free full text
-
Abstract
INTRODUCTION Improvements in health behaviour are often recommended as part of secondary prevention in patients with stroke and transient ischaemic attack. However, there is a lack of knowledge as to how this is applied in clinical practice. AIM: In this systematic review and meta-analysis, we examined the effect of counselling or educational intervention directed at individual or multiple behavioural risk factors on blood pressure and other reported outcomes. METHODS PubMed, Embase, PsycInfo, CINAHL, Scopus and Web of Science were systematically searched. Meta-analyses were conducted on all outcome measures if appropriate. A qualitative analysis of the content of the interventions was conducted to review which elements the interventions consisted of. RESULTS Twenty-nine randomized controlled trials were identified. Fourteen reported effects on systolic blood pressure, and pooled results showed a significant beneficial effect (n = 2,222; -3.85 mmHg [95%CI -6.43; -1.28]). The effect was greatest in the four interventions which included supervised training (n = 174; -9.83 mmHg [95%CI -16.56; -3.09]). CONCLUSION Modifying health behaviour in stroke survivors might have a moderate beneficial effect on blood pressure, especially if the intervention includes supervised physical training.
-
7.
A Pilot Randomized Controlled Trial Testing the Feasibility and Acceptability of a SystemCHANGE Intervention to Improve Medication Adherence in Older Adult Stroke Survivors.
Wessol, JL, Russell, CL, Olds, KE
The Journal of neuroscience nursing : journal of the American Association of Neuroscience Nurses. 2019;(5):259-265
Abstract
BACKGROUND Adhering to an antithrombotic medication regimen is essential to reducing recurrent stroke in adult stroke survivors. The purpose of this study was to evaluate the feasibility and acceptability of the SystemCHANGE (SC) and attention control (AC) intervention in older adult, nonadherent ischemic stroke patients. METHODS A pilot randomized controlled trial was conducted to determine the feasibility and acceptability of an SC versus AC intervention in older adult, nonadherent stroke survivors in the management of antithrombotic medication. Participants were masked to group assignment. Stroke survivors 50 years or older, taking at least 1 once-a-day antithrombotic medication, were recruited from a Midwest Comprehensive Stroke Center-affiliated neurology office. They were screened electronically using the Medication Event Monitoring System for 2 months to determine baseline medication adherence. Nonadherent stroke survivors (medication adherence < 0.97) were randomized to SC or AC intervention and monitored for 3 months. SC focused on redesigning the interpersonal environmental system and daily routines. The AC group was provided education materials on stroke that consisted of stroke risk factor reduction, stroke facts, rehabilitation, and nutrition with the primary investigator. Participation and intervention experience interviews were evaluated for themes. RESULTS Thirty participants were recruited: median age was 64 years, 46.7% of them were male, and they took an average of 7.77 (SD, 3.191; range, 3-15) prescribed medications. The number of over-the-counter medications taken (excluding aspirin) on a regular basis averaged 1.9 (SD, 0.8; range, 1-4). Two participants were nonadherent and were randomized to the 2 arms. Both participants had positive feedback and were not inconvenienced by their participation in the study. Neither participant voiced concerns about the intervention, survey demands, time requirement, or completing the surveys on the primary investigator's laptop. CONCLUSION The SC and AC intervention protocols were feasible and acceptable to the participants in this study. Additional pilot testing is needed to further evaluate the intervention and its effect on medication adherence in this population.
-
8.
Holocaust Survival and the Long-term Risk of Cardiovascular Disease in the Elderly.
Kagansky, N, Knobler, H, Stein-Babich, M, Voet, H, Shalit, A, Lindert, J, Knobler, HY
The Israel Medical Association journal : IMAJ. 2019;(4):241-245
Abstract
BACKGROUND Reports of longevity in Holocaust survivors (HS) conflict with excess prevalence of chronic diseases described among them. However, data on their long-term risk of cardiovascular diseases (CVD) are limited. Clinical data on large representative groups of HS who were exposed to severe persecution are also limited. OBJECTIVES To determine the prevalence of CVD and the risk factors in a large cohort of elderly HS compared to elderly individuals who were not exposed to the Holocaust (NHS). METHODS CVD prevalence rates and risk factors data from the computerized system of the central district of Clalit Health Services, the largest Israeli health maintenance organization (HMO) in Israel were evaluated in a retrospective observational study. The study was comprised of 4004 elderly HS who underwent direct severe persecution. They were randomly matched by identification numbers to 4004 elderly NHS. RESULTS HS were older than NHS and 51% of them were older than 85 years. The prevalence rate of ischemic heart disease (IHD) was significantly higher among HS. HS underwent significantly more cardiac interventions (20% vs. 15.7%, P < 0.05). HS status was an independent risk factor for increased IHD and for more coronary interventions. CONCLUSIONS Despite having a higher prevalence of CVD, a substantial number of HS live long lives. This finding may imply both unique resilience and ability to cope with chronic illness of the survivors as well as adjusted medical services for this population. These findings may help in planning the treatment of other mass trauma survivors.
-
9.
Hoarding among Jewish Holocaust Survivors: Moving Toward a Theoretical Model.
Porat-Katz, BS, Johnson, TW, Katz, I, Rachman-Elbaum, S
The Israel Medical Association journal : IMAJ. 2018;(11):670-673
Abstract
BACKGROUND Previously described as a subcategory of obsessive compulsive disorder (OCD), hoarding disorder was added to the fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-V) as a stand-alone diagnosis for the first time. The first formal research in the 1990s surprisingly found no connection between material deprivation early in life and hoarding; however, later studies linked early traumatic life experiences with hoarding. Subsequent familial studies demonstrated a genetic predisposition for hoarding. Emerging evidence suggests a link between a post-traumatic stress disorder (PTSD) and hoarding in Jewish Holocaust survivors. OBJECTIVES To evaluate the literature on PTSD among Jewish Holocaust survivors for associations between PTSD and hoarding. METHODS A systematic search of selected databases, including PubMed, Google Scholar, NCBI, Psych Info, and EBSCO Host was conducted from 1 March 2017 to 15 July 2018 using the following search terms: hoarding, hoarding disorder, obsessive compulsive disorder, OCD, compulsive hoarding, Jewish Holocaust survivors, Shoa, post-traumatic stress disorder, and PTSD. Inclusion criteria included peer reviewed research published on adults in English since 1990. Because no publications linking hoarding and PTSD in Jewish Holocaust survivors were found, references in retained papers were also searched for any relevant published work. RESULTS Seven articles linking PTSD and hoarding were identified for this review. However, no articles were found linking PTSD and hoarding in Jewish Holocaust survivors. CONCLUSIONS A relationship between PTSD and hoarding in Jewish Holocaust survivors is conceivable and should be explored to effectively diagnose and care for affected individuals.
-
10.
Long-term renal function and hypertension in adult survivors of childhood sarcoma: Single center experience.
Schiavetti, A, Pedetti, V, Varrasso, G, Marrucci, O, Celani, C, Andreoli, G, Bonci, E
Pediatric hematology and oncology. 2018;(3):167-176
Abstract
AIM: Little data is available on long-term renal impairment in survivors from childhood sarcoma. We investigated the prevalence of renal impairment and hypertension after very long-term follow-up in survivors who reached adulthood after treatment for childhood sarcoma. METHODS A cross-sectional single center study was performed. Outcomes included estimating glomerular filtration rate (eGFR), albuminuria, glycosuria, serum phosphate and magnesium, tubular reabsorption phosphate (TRP), chronic kidney disease (CKD) according to the "Kidney Disease: Improving Global Outcomes" (KDIGO) guidelines and blood pressure (BP). RESULTS Out of 87 > 5-year sarcoma survivors, 30 adults (10F/20M, median age at diagnosis 9 years, median age at investigation 26 years, median follow-up 16 years, mean 19 years) were identified. Renal impairment was detected in four cases (13.3%); three of these fulfilled the criteria for CKD. Among the adult survivors, a subgroup of 15 cases (50%) had received ifosfamide without confounding factors such as a diagnosis of genito-urinary rhabdomyosarcoma or administration of other potentially nephrotoxic chemotherapy (platinum-based drugs or methotrexate); no renal dysfunction was detected in this subgroup. In the whole cohort of sarcoma survivors, hypertension was diagnosed in four cases (13.3%); BP was significantly correlated with body mass index [p .014]. CONCLUSION In our series of adult survivors treated for a diagnosis of sarcoma in their childhood, the prevalence of CKD was 10%. We found survivors treated with ifosfamide as the only nephrotoxic agent did not present glomerular or tubular toxicity at long term follow-up, but further studies including a larger number of cases are required to confirm it.