The Impact of Pre- and Post-Stroke Statin Use on Stroke Severity and Long-Term Outcomes: A Population-Based Cohort Study

Background: The benefit of statins on stroke incidence is well known. However, data on the relationship between pre- and post-stroke statin use, recurrence, and survival outcomes are limited. We aim to investigate the short- and long-term relationships between statin prescription, stroke recurrence, and survival in patients with first-ever ischemic stroke. Methods: Data were collected from the population-based South London Stroke Register for the years 1995–2015. Patients were assessed at the time of first ever stroke, 3 months, and annually thereafter. Data on vascular risk factors, treatments prescribed, sociodemographic characteristics, stroke subtype, survival, and stroke recurrence were collected. Cox proportional hazard analyses were used to assess the relationship of statin prescriptions pre- and post-stroke on stroke severity, long-term recurrence and survival. Results: Patients prescribed statins both pre- and post-stroke showed a 24% reduction in mortality (adjusted Hazard Ratio [aHR] 0.76, 0.60–0.97), those who were prescribed statins pre-stroke and then stopped post-stroke showed greater risk of mortality (aHR 1.85, 1.10–3.12) and stroke recurrence (aHR 3.25, 1.35–7.84) compared to those that were not prescribed statins at any time. No associations were observed between pre-stroke statin and severity of the initial stroke overall, though a protective effect against moderate/severe stroke (Glasgow Coma Scale ≤12) was observed in those aged 75+ years (aOR 0.70, 0.52–0.95). Conclusions: Statins play a significant role in improving the survival rates after a stroke. Adherence to the National Guidelines that promote statin treatment, primary and secondary prevention of stroke should be monitored and a focus for quality improvement programs.

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Abstract WMP53: Sex Differences n Long-term Mortality and Disability After Stroke: The International Stroke Outcomes Study

Stroke ◽

10.1161/str.47.suppl_1.wmp53 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Hoang T Phan ◽

Mathew J Reeves ◽

Leigh Blizzard ◽

Amanda Thrift ◽

Dominique Cadilhac ◽

...

Keyword(s):

Sex Differences ◽

Population Based ◽

Stroke Severity ◽

Related Factors ◽

Post Stroke ◽

Modifiable Factors ◽

Mortality Rate Ratio ◽

The Impact

Introduction: It is uncertain why women suffer worse long-term outcomes after stroke than men. We examined sex differences in mortality and disability 1 and 5 years after stroke and identified factors contributing to these differences. Methods: Individual patient data pooling study of incident strokes (ischemic and hemorrhagic) from 1987-2013 obtained from 12 population-based cohorts from Australasia, Europe, South America and the Caribbean. Data on socio-demographics, stroke-related factors and pre-stroke health were obtained for each patient and harmonized between studies. Poisson modelling estimated the mortality rate ratio (MRR) for women compared to men at 1 year (12 studies) and 5 years (7 studies) post-stroke. Log binomial regression estimated the relative risk (RR) of poor outcome (modified Rankin scale>2 or Barthel Index <20) for women compared to men at 1 year (9 studies) and 5 years (6 studies) after stroke. Multivariable models were adjusted for potential confounders including age, pre-stroke dependency, stroke severity and comorbidities. Results: A total of 16557 first-ever-stroke patients with follow-up data to 1 year and 12,839 with follow-up to 5 years were included. The pooled crude mortality was greater in women than men at 1-year (MRR 1.37 95% CI 1.27-1.48) and 5 years (MRR 1.25 95% CI 1.13-1.39). However, these sex differences were reversed after adjustment for confounders at both 1 year (MRR 0.94 95% CI 0.82-1.06) and 5-years post stroke (MRR 0.74 95% CI 0.66-0.84). Similarly, the pooled crude RR for disability after stroke was greater in women than men at 1-year (RR 1.28 95% CI 1.17-1.39 and 5-year (RR 1.32 95% CI 1.18-1.47), but these sex differences disappeared after adjustment at both 1 year (RR 1.08 95%CI 0.98-1.18) and 5-years post stroke (RR 1.08 95% CI 0.97-1.20). The key contributors to worse outcomes in women were greater age, pre-stroke dependency, severe strokes and atrial fibrillation (AF, mortality only) compared with men. Conclusion: Worse outcomes in women were mostly due to age and potentially modifiable factors of stroke severity and AF providing potential targets to reduce the impact of stroke in women.

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Abstract TMP45: Predicting Long-term Body Function, Activity & Participation After Stroke: The Prevailing Role of Cognition in Determining Functional Outcome

Stroke ◽

10.1161/str.48.suppl_1.tmp45 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Arunima Kapoor ◽

Krista Lanctot ◽

Mark Bayley ◽

Alex Kiss ◽

Richard Swartz

Keyword(s):

Cognitive Impairment ◽

Functional Outcome ◽

Stroke Severity ◽

Post Stroke ◽

Body Function ◽

Multiple Levels ◽

Multiple Domains ◽

Levels Of Functioning ◽

The Impact

Background: Stroke can impact multiple levels of function and result in complex disability. Few studies have examined limitations across the range of functions from body function to social participation, or explored the impact of post-stroke comorbidities, such as depression, obstructive sleep apnea (OSA) and cognition, on function, especially in the long-term. We aimed to determine post-stroke predictors of multiple levels of functioning approximately 2 years after a stroke, and to specifically evaluate the impact of depressive symptoms, OSA and cognitive impairment on outcome. Hypothesis: We hypothesized that in addition to traditional predictors of outcome–age and stroke severity–depression, OSA and cognitive impairment will predict functional outcome in multiple domains. Methods: Baseline assessment of depression, apnea and cognitive impairment with 2-year follow-up assessment of functional outcome to evaluate each of the three levels of functioning as stated in the WHO International Classification of Functioning: Body Function (Montreal Cognitive Assessment), Activity (modified Rankin) and Participation (Reintegration to Normal Living Index). Results: A total of 162 patients were enrolled at approximately 2 years and 5 months post-stroke. Forty one percent had activity limitations, 58% were cognitively impaired and 68% had restrictions in participation. Long-term activity limitation was predicted by greater age (OR = 0.95), stroke severity (OR = 1.69) and cognitive impairment (OR = 1.28) at baseline. Body function impairment was predicted by greater age (OR = 0.96), and cognitive impairment (OR = 1.49). Participation restriction was predicted by cognitive impairment (OR = 1.26). Conclusion: Baseline cognition predicts long-term function in multiple domains and is a better predictor of long-term participation than age or baseline stroke severity. In view of the widespread impact of post-stroke cognitive impairment on every level of functioning, routine post-stroke cognitive screening and target interventions are warranted. Greater attention to functional domains beyond activity could further optimize recovery and enhance outcome after stroke.

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Abstract 172: Medical and Demographic Predictors of Long-term Cognitive Outcomes of Pediatric Stroke

Stroke ◽

10.1161/str.48.suppl_1.172 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Alice A Holland ◽

Kimberly D Goodspeed ◽

Patricia Plumb ◽

Peter L Stavinoha ◽

Michael Dowling

Keyword(s):

Neurological Impairment ◽

Cognitive Outcomes ◽

Stroke Severity ◽

Pediatric Stroke ◽

Post Stroke ◽

Age Related ◽

Long Term Follow Up ◽

The Relationship

Introduction: Studies examining cognitive outcomes for pediatric stroke are sparse, and few account for stroke severity. The Pediatric Stroke Outcome Measure (PSOM) provides an objective, comprehensive rating of neurological impairment. This study investigated the relationship between initial PSOM score and long-term cognitive outcomes. It was hypothesized that greater severity of stroke (worse initial PSOM score) would predict lower IQ at long-term follow-up. Other factors considered were age at stroke and months post stroke. Age-related studies in broad cognitive outcomes for pediatric stroke are sparse and somewhat inconsistent in findings. It was hypothesized that severity of stroke would be more relevant than age of stroke for long-term cognitive outcomes. Methods: PSOM scores at initial visit and IQ scores at long-term follow-up (M=3.77 years) were obtained for 84 survivors of pediatric stroke ages 4:0-25:6 (M=11:5 years; 37 females). A one-sample t-test was conducted to compare mean IQ to the normative sample. To examine the hypotheses, all variables of interest (PSOM, age at stroke, and months s/p) were entered into a stepwise regression equation. Results: Mean IQ for the sample was 84.77 (SD=17.26), significantly below average relative to healthy norms ( t =-8.088, p =.000). PSOM scores ranged 0-5.5 (median/mode=1.0). The regression was significant ( F =8.798; p =.000), with both PSOM score ( b =-.350; t [80]=-3.483; p =.001) and months post stroke ( b =-.355; t [80]=-3.005; p =.004) significantly contributing to the model, but not age at stroke. Conclusions: PSOM was more relevant than age at stroke in predicting long-term cognitive outcomes, and greater stroke severity was associated with lower IQ at follow-up. Finding suggest that initial PSOM score and greater time since stroke may be more relevant to long-term cognitive outcomes than age at stroke. The present study lends validity to using the PSOM both as a marker of functional severity of stroke and a potential indicator of relative risk for poorer long-term cognitive outcomes. Better predictors of cognitive outcomes for pediatric stroke are greatly needed in order to facilitate earlier intervention/rehabilitation and improve the efficacy of such efforts.

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Abstract TP171: Differences Between Men and Women in Long-term Participation Restriction After Stroke: The International Stroke Outcomes Study (INSTRUCT)

Stroke ◽

10.1161/str.48.suppl_1.tp171 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Hoang T Phan ◽

Leigh Blizzard ◽

Mathew J Reeves ◽

Amanda G Thrift ◽

Dominique Cadilhac ◽

...

Keyword(s):

Meta Analysis ◽

Population Based ◽

Stroke Severity ◽

Participation Restriction ◽

Related Factors ◽

Physical Independence ◽

Individual Participant ◽

The Difference ◽

The Impact

Introduction: As women suffer worse functional outcomes of stroke than men, they may also face more challenges with community reintegration but data are scarce. We examined sex differences in participation after stroke and which factors might account for these disparities. Methods: INSTRUCT is an individual participant data pooling study of incident strokes obtained from 13 population-based cohorts worldwide. Two of the cohorts (Melbourne ’96-‘99 and Auckland ’02-‘03) included assessment of participation at 5 years after stroke using the London Handicap Scale (LHS). The LHS is used to assess the individual’s perspective of their involvement in life situations including orientation (person’s awareness of surroundings), physical independence, mobility, occupation, social interaction and economic self-efficiency. The total score ranges from 0 (worst disadvantage) to 100 (no disadvantage). Linear regression was used to compare LHS total scores and sub-domains for women compared to men. Study-specific multivariable models incorporated adjustment for socio-demographics, stroke-related factors, pre-stroke health and post-stroke factors were combined using random-effects meta-analysis. Results: At 5 years after stroke, there were data on participation for 351/592 (59%) of survivors in Melbourne and 266/881 (30%) of survivors in Auckland. Women suffered greater participation restriction than men (total LHS, pooled mean difference, MD -5.55 [95% CI -8.47, -2.63]). The magnitude of the difference attenuated after adjusting for covariates (pooled MD -2.48 [-4.99, 0.03]). Significant confounders in study-specific models included age, stroke severity, pre-stroke dependency and pre-stroke dementia for Melbourne; and age, stroke severity and pre-stroke dependency for Auckland. In sub-dimensions, women had greater restriction than men in mobility, physical independence and occupation. Additionally, women in Melbourne experienced poorer social integration and orientation than men. Conclusion: Greater restriction in participation after stroke among women than men was mostly attributable to their advanced age and greater pre-stroke dependency. Interventions targeting participation could reduce the impact of stroke in women.

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Risk Attitude and Corporate Investment under Output Market Uncertainty: Evidence from The Mekong River Delta, Vietnam

Journal of Economics and Development ◽

10.33301/2016.18.02.04 ◽

2016 ◽

pp. 59-70

Author(s):

Ninh Le Khuong ◽

Nghiem Le Tan ◽

Tho Huynh Huu

Keyword(s):

Negative Relationship ◽

Risk Attitude ◽

Business Strategies ◽

Risk Averse ◽

Market Uncertainty ◽

Firm Investment ◽

Output Market ◽

The Impact ◽

The Relationship

This paper aims to detect the impact of firm managers’ risk attitude on the relationship between the degree of output market uncertainty and firm investment. The findings show that there is a negative relationship between these two aspects for risk-averse managers while there is a positive relationship for risk-loving ones, since they have different utility functions. Based on the findings, this paper proposes recommendations for firm managers to take into account when making investment decisions and long-term business strategies as well.

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Effects of long-term anti-seizure medication monotherapy on all-cause death in patients with post-stroke epilepsy: a nationwide population-based study in Taiwan

BMC Neurology ◽

10.1186/s12883-021-02241-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Chia-Yu Hsu ◽

Chun-Yu Cheng ◽

Jiann-Der Lee ◽

Meng Lee ◽

Bruce Ovbiagele

Keyword(s):

Valproic Acid ◽

Ischemic Stroke ◽

Cox Regression ◽

Population Based ◽

Primary Diagnosis ◽

Research Database ◽

Post Stroke ◽

Risk Of Death ◽

Index Stroke

Abstract Objective We aim to compare the effect of long-term anti-seizure medication (ASM) monotherapy on the risk of death and new ischemic stroke in patients with post-stroke epilepsy (PSE). Patients and methods We identified all hospitalized patients (≥ 20 years) with a primary diagnosis of ischemic or hemorrhagic stroke from 2001 to 2012 using the National Health Insurance Research Database in Taiwan. The PSE cohort were defined as the stroke patients (1) who had no epilepsy and no ASMs use before the index stroke, and (2) who had epilepsy and ASMs use after 14 days from the stroke onset. The patients with PSE receiving ASM monotherapy were enrolled and were categorized into phenytoin, valproic acid, carbamazepine, and new ASM groups. We employed the Cox regression model to estimate the unadjusted and adjusted hazard ratios (HRs) with 95 % confidence intervals (CIs) of death and new ischemic stroke within 5 years across all groups, using the new ASM group as the reference. Results Of 6962 patients with PSE using ASM monotherapy, 3917 (56 %) were on phenytoin, 1623 (23 %) on valproic acid, 457 (7 %) on carbamazepine, and 965 (14 %) on new ASMs. After adjusting for confounders, compared with new ASM users, phenytoin users had a higher risk of death in 5 years (HR: 1.64; 95 % CI: 1.06–2.55). On the other hand, all ASM groups showed a similar risk of new ischemic stroke in 5 years. Conclusions Among patients with PSE on first-line monotherapy, compared to new ASMs, use of phenytoin was associated with a higher risk of death in 5 years.

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Association between physical exercise and stroke recurrence among first-ever ischemic stroke survivors

Scientific Reports ◽

10.1038/s41598-021-92736-5 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Lisha Hou ◽

Mier Li ◽

Ju Wang ◽

Yawen Li ◽

Qianwen Zheng ◽

...

Keyword(s):

Ischemic Stroke ◽

Exercise Duration ◽

Stroke Recurrence ◽

Stroke Survivors ◽

Face To Face ◽

Baseline Information ◽

Exercise Type ◽

The Relationship

AbstractThe relationship between exercise and stroke recurrence is controversial. This study was designed to test whether an association exists between exercise and ischemic stroke recurrence in first-ever ischemic stroke survivors. Data were collected from January 2010 to June 2016. Baseline information was obtained during face-to-face interviews, and follow-up phone interviews were conducted every 3 months. Exercise type, frequency, intensity, and duration were recorded. Discrete-time survival analysis was used to determine the relationship between exercise and stroke recurrence. 760 first-ever ischemic stroke survivors who were able to exercise were enrolled. After adjusting for covariates, patients who exercised 3.5–7 h per week and more than 7 h per week had a lower relapse risk than patients who did not exercise (3.5–7: OR 0.415; > 7: OR 0.356). Moreover, if the fluctuation of exercise duration was over 4 h, the patients had a higher risk of stroke recurrence than those with variability of less than 2 h (OR 2.153, P = 0.013). Stroke survivors who engage in long-term regular mild exercise (more than 5 sessions per week and lasting on average 40 min per session) have a lower recurrence rate. Irregular exercise increases the risk of stroke recurrence.

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Environmental Management, Green Innovation, and Social–Open Innovation

Journal of Open Innovation Technology Market and Complexity ◽

10.3390/joitmc7010089 ◽

2021 ◽

Vol 7 (1) ◽

pp. 89

Author(s):

Pham Thu Huong ◽

Jacob Cherian ◽

Nguyen Thi Hien ◽

Muhammad Safdar Sial ◽

Sarminah Samad ◽

...

Keyword(s):

Environmental Management ◽

Stock Exchange ◽

Advanced Technology ◽

Green Innovation ◽

Social Image ◽

Whole Process ◽

Corporate Environmental Management ◽

The Impact ◽

The Relationship

The present study aims to determine the impact of green innovation (GI) on the overall performance of an organization while keeping the variable of environmental management (EM) as a moderator. We used a dataset consisting of four data years, from 2014 to 2017, of A-share companies listed on the Shanghai Stock Exchange (SSE). The concept of green innovation refers to the use of advancements in technology that enable savings in energy, along with the recycling of waste material. When advanced technology is utilized in the production process, the products are referred to as green products and the whole process of adopting such technologies and product design is referred to as “Corporate Environmental Management”. Such innovations improve the overall financial performance of companies as it enables them to improve their social image by reducing their carbon footprint and ensures their long-term sustainability. The main issue is the limited focus and attention given to the topic, from the perspective of companies. This research focuses on the impact of green innovation and the importance of environmental management for the sustainability of companies. Our findings suggest that the relationship between green innovation and the performance of the company is positive and verifies the existence of moderating effects of environmental management on the relationship between green innovation and firm performance. Implications are given to academia and practitioners.

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Abstract WP314: Frequency and Characteristics of Hemiplegic Shoulder Pain - A Population-Based Assessment

Stroke ◽

10.1161/str.44.suppl_1.awp314 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Zoe A Allen ◽

Keyword(s):

Visual Analogue Scale ◽

Shoulder Pain ◽

Analogue Scale ◽

External Rotation ◽

South Australia ◽

Population Based ◽

Active Movement ◽

Range Of Movement ◽

Stroke Incidence ◽

Post Stroke

Background: Shoulder pain is common complication of stroke with multiple aetiological mechanisms but there are few population-based studies of the clinical profile, frequency and impact of the disorder. Objectives: To determine the frequency and characteristics of hemiplegic shoulder pain in the first year after stroke. Methods: Data on any shoulder pain were obtained in patients registered in a population-based stroke incidence study undertaken in a defined area of the western suburbs of Adelaide, South Australia, over a 12-month period to July 2010. Subjective (any, onset, severity [visual analogue scale] and aggravating factors) and three objective (modified Neer test, passive hand-behind-neck, and passive external rotation) measures of pain were undertaken at baseline, and 4 and 12 months post-stroke. Results: Among 301 stroke patients, shoulder pain data were available for 198 (66%), as 62 had died prior to the 4 month assessment and 41 either refused or were unavailable for assessment. Information on shoulder pain was available from 198 stroke survivors at baseline, 156 at 4 months and 148 at 12 months. Overall, 10% reported shoulder pain at baseline, whilst 21% reported pain at both follow-up assessments, so that overall approximately one third (27%) of patients reported some shoulder pain during 12 months post-stroke. The median pain score (visual analogue scale = 40) was highest at 4 months, and the characteristics varied from mild and prominent at rest (including night) in the early weeks, to being more associated with limited range of movement and aggravated by active movement towards 12 months, suggesting increasing musculoskeletal contributions to pain over time. Objective passive range of motion tests were associated with higher frequencies of pain than were elicited by self-reports. Conclusions: The frequency of post-stroke shoulder pain was similar to other population-based studies, suggesting limited progress in prevention and management of this complication. As the disorder is most common and severe after hospital-discharge, targeted protocols may facilitate identification and management.

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ISSUES OF THE RELATIONSHIP BETWEEN THE STATE BUDGET AND ECONOMIC GROWTH IN UZBEKISTAN

Innovation in the economy ◽

10.26739/2181-9491-2021-7-1 ◽

2021 ◽

Vol 4 (7) ◽

pp. 4-19

Author(s):

Akmal Baltayevich Allakuliev ◽

Keyword(s):

Economic Growth ◽

The State ◽

Rate Of Return ◽

State Budget ◽

Macroeconomic Shocks ◽

Dynamic Correlations ◽

Short And Long Term ◽

The Impact ◽

The Relationship

The article examines the interaction of the country's GDP with the state budget in the short and long term, the impact of the macro-fiscal mechanism on the country's economic growth on the example of Uzbekistan.The aim of the study is to identify dynamic correlations between the country's state budget expenditures and the economic growth of the macro-fiscal mechanism in the short and long term, as well as to analyze the approximation or rate of return of GDP and the state budget to equilibrium during various macroeconomic shocks. and hesitation.The scientific novelties of the research are:

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