Abstract TP439: Occurrence (Incidence and Prevalence) Rate of Delirium and Risk Factors in Acute Stroke - Cross-sectional Study

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Terence J Quinn ◽  
Robert Shaw ◽  
Martin Taylor-Rowan
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Acute Stroke ◽  
Cognitive Assessment ◽  
University Hospital ◽  
Initial Assessment ◽  
Cognitive Assessments ◽  
Cross Sectional ◽  
Post Stroke ◽  
Cognitive Problems

Introduction: Guidelines recommend screening all stroke admissions for cognitive impairment. Delirium may be an important contributor to cognitive problems, but available data are limited by potential selection biases and imperfect delirium assessment. We aimed to describe robust estimates of delirium occurrence (incidence and prevalence) and risk factors in an acute stroke unit (ASU). Methods: We collected data from sequential admissions to our University Hospital ASU over a 20 week period (Feb-July 2016). The only exclusion was where the clinical team felt that any form of assessment was inappropriate. We aimed to perform cognitive assessments at 48 hours post stroke. Cognitive assessments were based on mini Montreal Cognitive Assessment (m-MoCA) and GP-Cog informant interview to assess for pre-stroke dementia. We assessed for delirium based on DSM-V criteria. We described univariable and multivariable associations with delirium occurrence. Results: Across the study period, 184 strokes were admitted; median age 71 years (IQR:61-79). Some form of cognitive assessment was available for 178 (97%). In total. 152 had evidence of cognitive impairment on m-MOCA, 55 (31%) met criteria for delirium and 25 (15%) had pre-stroke dementia. Significant univariable associations with delirium were:age and pre-existing cognitive decline. On logistic regression:age, history of drug or alcohol misuse and pre-stroke mRS were all independently associated with delirium. Discussion: In an unselected ASU population a substantial proportion will have cognitive impairment based on screening. Delirium is common and contributes to this cognitive problems seen in acute stroke. Independent associations with delirium occurrence were identified but were non-modifiable. Our results have implications for policy and practice. As post-stroke cognitive impairment is multifactorial, screening delirium and pre-existing cognitive issues should form part of the initial assessment.

scholarly journals Pre-Stroke Frailty Is Independently Associated With Post-Stroke Cognition: A Cross-Sectional Study

2019 ◽  
Vol 25 (05) ◽  
pp. 501-506 ◽  
Author(s):  
Martin Taylor-Rowan ◽  
Ruth Keir ◽  
Gillian Cuthbertson ◽  
Robert Shaw ◽  
Bogna Drozdowska ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Cognitive Assessment ◽  
Frailty Index ◽  
Multiple Regression Model ◽  
Montreal Cognitive Assessment ◽  
Stroke Severity ◽  
Stroke Patients ◽  
Cross Sectional ◽  
Post Stroke

AbstractObjective: Post-stroke cognitive impairment is common, but mechanisms and risk factors are poorly understood. Frailty may be an important risk factor for cognitive impairment after stroke. We investigated the association between pre-stroke frailty and acute post-stoke cognition. Methods: We studied consecutively admitted acute stroke patients in a single urban teaching hospital during three recruitment waves between May 2016 and December 2017. Cognition was assessed using the Mini-Montreal Cognitive Assessment (min=0; max=12). A Frailty Index was used to generate frailty scores for each patient (min=0; max=100). Clinical and demographic information were collected, including pre-stroke cognition, delirium, and stroke-severity. We conducted univariate and multiple-linear regression analyses with covariates forced in (covariates included were: age, sex, stroke severity, stroke-type, pre-stroke cognitive impairment, delirium, previous stroke/transient ischemic attack) to investigate the association between pre-stroke frailty and post-stroke cognition. Results: Complete data were available for 154 stroke patients. Mean age was 68 years (SD=11; range=32–97); 93 (60%) were male. Median mini-Montreal Cognitive Assessment score was 8 (IQR=4–12). Mean Frailty Index score was 18 (SD=11). Pre-stroke cognitive impairment was apparent in 13/154 (8%) patients. Pre-stroke frailty was significantly associated with lower post-stroke cognition (Standardized-Beta=−0.40; p<0.001) and this association was independent of covariates (Unstandardized-Beta=−0.05; p=0.005). Additional significant variables in the multiple regression model were age (Unstandardized-Beta=−0.05; p=0.002), delirium (Unstandardized-Beta=−2.81; p<0.001), pre-stroke cognitive impairment (Unstandardized-Beta=−2.28; p=0.001), and stroke-severity (Unstandardized-Beta=−0.20; p<0.001). Conclusions: Pre-stroke frailty may be a moderator of post-stroke cognition, independent of other well-established post-stroke cognitive impairment risk factors. (JINS, 2019, 25, 501–506)

scholarly journals Age-Related Risk Factors at the First Stroke Event

2020 ◽  
Vol 9 (7) ◽  
pp. 2233 ◽  
Author(s):  
Raúl Soto-Cámara ◽  
Jerónimo J. González-Bernal ◽  
Josefa González-Santos ◽  
José M. Aguilar-Parra ◽  
Rubén Trigueros ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Stroke ◽  
Sedentary Lifestyle ◽  
Smoking Habit ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Cerebrovascular Event ◽  
Stroke Event ◽  
Cross Sectional ◽  
Age Related

(1) Background: Stroke is a multifactorial disease, which can affect individuals at any age. Risk factors (RFs) associated with the first stroke event have been well identified; however, the influence of these RFs on the patient’s age needs to be studied. (2) Objective: This study aimed to examine the effect of modifiable RFs on the age at which a stroke occurs. (3) Methods: A cross-sectional study was conducted on patients admitted consecutively with a first-ever acute stroke at the Burgos University Hospital (Spain). Data on sociodemographic and clinical parameters were collected (high blood pressure (HBP), smoking habit, diabetes mellitus (DM), dyslipemia, abdominal obesity, sedentary lifestyle, alcohol consumption, and cardiovascular diseases). The possible associations between RFs and age were studied using univariate and multivariate regression analyses and a decision tree. (4) Results: A total of 436 patients with a mean age of 75.39 years (standard deviation (SD) ± 12.67) were included. HBP and overweight/obesity were the most prevalent stroke RFs. Being an active smoker (OR 21.48; 95% confidence interval (CI) 8.80–52.41), having a sedentary lifestyle (OR 3.24; 95% CI 1.97–5.31), being an excessive alcohol drinker (OR 2.36; 95% CI 1.45–3.84), or being overweight or obese (OR 1.95; 95% CI 1.14–3.34) increased the risk of having an acute cerebrovascular event in individuals aged 75 years or below. However, a personal history of HBP (OR 0.40; 95% CI 0.24–0.67) was significantly associated with a greater likelihood of having an acute stroke in individuals aged more than 75 years. (5) Conclusions: This study showed that the modifiable RFs strongly influence the first stroke event in patients aged below 75 years, which will be useful in guiding different prevention strategies.

Screening for Cognitive Disorders in Elderly Diabetics

2017 ◽  
Vol 41 (S1) ◽  
pp. S673-S673
Author(s):  
I. Baat ◽  
I. Abida ◽  
S. Omri ◽  
S. Ellouze ◽  
F. Hadj Kacem ◽  
...  
Keyword(s):  
Risk Factors ◽  
Type 2 Diabetes ◽  
Cognitive Impairment ◽  
Cognitive Decline ◽  
Cognitive Disorders ◽  
University Hospital ◽  
High Rate ◽  
Diabetic Patients ◽  
Cross Sectional

IntroductionOld people with diabetes are more likely to develop cognitive impairment, Alzheimer's disease and vascular dementia. However, the determinants of the association between diabetes and cognitive impairments are only partially known.ObjectivesTo evaluate cognitive disorders in elderly diabetic patients and to identify risk factors of cognitive impairment in this population.MethodsIt was a cross-sectional study. It involved outpatients aged 65 and older, who were followed for diabetes in the endocrinology department at the Hedi Chaker University Hospital in Sfax (Tunisia), from October 1 to December 31, 2015. For each patient, we collected sociodemographic, clinical and therapeutic data. We used the Montreal Cognitive Assessment (MoCA) to identify mild cognitive decline (score < 26/30).ResultsWe identified 70 patients, all with type 2 diabetes. The average age was 66.8 years. The sex ratio (M: F) was 0.7. The mean duration of diabetes was 14.76 years. The average MoCA score was 20.68 ± 6. Forty patients (57%) had cognitive decline. The cognitive impairment was statistically correlated with female sex (P = 0.02), low level of education (P = 0.00), high levels of glycated hemoglobin (Hb A1c ≥ 7%) (P = 0.00), presence of hypoglycemic episodes (P = 0.05) and presence of dyslipidemia (P = 0.00).ConclusionOur study confirmed the high rate of cognitive decline in older type 2 diabetes patients. The profile of subjects at risk was consistent with the literature: poorly controlled diabetes, severe recurrent hypoglycaemia and associated dyslipidemia. Acting on these risk factors would prevent cognitive decline and therefore progression to dementia.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Christophe Millien ◽  
Anatole Manzi ◽  
Arlene M. Katz ◽  
Hannah Gilbert ◽  
Mary C. Smith Fawzi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mixed Methods ◽  
Black Women ◽  
Uterine Fibroids ◽  
Mixed Methods Study ◽  
University Hospital ◽  
Gynecologic Surgery ◽  
Cross Sectional ◽  
Women's Lives

Abstract Background Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women’s lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life. Methods A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. Results Of 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3. Anemia was the most frequent complication— 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1–10.9, p = < 0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6–12.4, p = 0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6–13.6, p = 0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR = 0.3, 95% CI: 0.1–0.9, p = 0.021) and (AOR = 0.2, 95% CI: 0.1–0.97, p = 0.044), respectively. The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women’s lives. The poverty cycle of uterine fibroids emerged. Conclusions A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.

scholarly journals Burnout Syndrome during Residency Training in Jordan: Prevalence, Risk Factors, and Implications

2021 ◽  
Vol 18 (4) ◽  
pp. 1557
Author(s):  
Abdullah Nimer ◽  
Suzan Naser ◽  
Nesrin Sultan ◽  
Rawand Said Alasad ◽  
Alexander Rabadi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Working Hours ◽  
Cross Sectional Study ◽  
University Hospital ◽  
Burnout Syndrome ◽  
Online Questionnaire ◽  
Cross Sectional ◽  
Factors Associated ◽  
Resident Physicians ◽  
Healthcare Professions

Burnout syndrome is common among healthcare professions, including resident physicians. We aimed to assess the prevalence of burnout among resident physicians in Jordan, and a secondary aim was to evaluate the risk factors associated with the development of burnout syndrome in those residents, including gender, working hours, psychological distress, training sector, and specialty. In this cross-sectional study, 481 residents were recruited utilizing multistage stratified sampling to represent the four major health sectors in Jordan. Data were collected using an online questionnaire, where the Copenhagen Burnout Inventory (CBI) was used to assess the prevalence of burnout. The prevalence, group differences, and predictors of burnout were statistically analyzed using STATA 15. Overall, 373 (77.5%) residents were found to have burnout. Factors associated with higher levels of burnout were psychological stress (β = 2.34, CI = [1.88–2.81]), longer working hours (β = 4.07, CI = [0.52–7.62], for 51–75 h a week, β = 7.27, CI = [2.86–11.69], for 76–100 h a week and β = 7.27, CI = [0.06–14.49], for >100 h a week), and obstetrics/gynecology residents (β = 9.66, CI = [3.59–15.73]). Conversely, medical sub-specialty residents, as well as private and university hospital residents, had lower burnout levels. We concluded that decreasing the workload on residents, offering psychological counseling, and promoting a safety culture for residents might help in mitigating burnout consequences.

scholarly journals Two dominant patterns of low anterior resection syndrome and their effects on patients’ quality of life

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Min Jung Kim ◽  
Ji Won Park ◽  
Mi Ae Lee ◽  
Han-Ki Lim ◽  
Yoon-Hye Kwon ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Risk Factors ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
University Hospital ◽  
Postoperative Treatment ◽  
Low Anterior Resection Syndrome ◽  
Cross Sectional ◽  
Anterior Resection Syndrome

AbstractTo identify low anterior resection syndrome (LARS) patterns and their associations with risk factors and quality of life (QOL). This cross-sectional study analyzed patients who underwent restorative anterior resection for left-sided colorectal cancer at Seoul National University Hospital, Seoul, Republic of Korea. We administered LARS questionnaires to assess bowel dysfunction and quality of life between April 2017 and November 2019. LARS patterns were classified based on factor analyses. Variable effects on LARS patterns were estimated using logistic regression analysis. The risk factors and quality of life associated with dominant LARS patterns were analyzed. Data of 283 patients with a median follow-up duration of 24 months were analyzed. Major LARS was observed in 123 (43.3%) patients. Radiotherapy (odds ratio [OR]: 2.851, 95% confidence interval [95% CI]: 2.504–43.958, p = 0.002), low anastomosis (OR: 10.492, 95% CI: 2.504–43.958, p = 0.001), and complications (OR: 2.163, 95% CI: 1.100–4.255, p = 0.025) were independently associated with major LARS. LARS was classified into incontinence- or frequency-dominant types. Risk factors for incontinence-dominant LARS were radiotherapy and complications, whereas those for frequency-dominant LARS included low tumor location. Patients with incontinence-dominant patterns showed lower emotional function, whereas those with frequency-dominant patterns showed lower global health QOL, lower emotional, cognitive, and social functions, and higher incidence of pain and diarrhea. Frequency-dominant LARS had a greater negative effect on QOL than incontinence-dominant LARS. These patterns could be used for preoperative prediction and postoperative treatment of LARS.

scholarly journals Potential intravenous drug incompatibilities in a pediatric unit

2016 ◽  
Vol 14 (2) ◽  
pp. 185-189 ◽  
Author(s):  
Karla Dalliane Batista Leal ◽  
Ramon Weyler Duarte Leopoldino ◽  
Rand Randall Martins ◽  
Lourena Mafra Veríssimo
Keyword(s):  
Risk Factors ◽  
University Hospital ◽  
Intravenous Drug ◽  
Penicillin G ◽  
Cross Sectional ◽  
Relative Risks ◽  
Related Risk ◽  
Student’S T ◽  
Level Of Significance ◽  
Student’S T Test

ABSTRACT Objective To investigate potential intravenous drug incompatibilities and related risk factors in a pediatric unit. Methods A cross-sectional analytical study conducted in the pediatric unit of a university hospital in Brazil. Data on prescriptions given to children aged 0-15 years from June to October 2014 were collected. Prescriptions that did not include intravenous drugs and prescriptions with incomplete dosage regimen or written in poor handwriting were excluded. Associations between variables and the risk of potential incompatibility were investigated using the Student’s t test and ANOVA; the level of significance was set at 5% (p<0.05). Relative risks were calculated for each drug involved in potential incompatibility with 95% confidence interval. Results A total of 222 children participated in the study; 132 (59.5%) children were male and 118 (53.2%) were aged between 0 and 2 years. The mean length of stay was 7.7±2.3 days. Dipyrone, penicillin G and ceftriaxona were the most commonly prescribed drugs. At least one potential incompatibility was detected in about 85% of children (1.2 incompatibility/patient ratio). Most incompatibilities detected fell into the non-tested (93.4%), precipitation (5.5%), turbidity (0.7%) or chemical decomposition (0.4%) categories. The number of drugs and prescription of diazepam, phenytoin, phenobarbital or metronidazole were risk factors for potential incompatibility. Conclusion Most pediatric prescriptions involved potential incompatibilities, with higher prevalence of non-tested incompatibilities. The number of drugs and prescription of diazepam, phenobarbital, phenytoin or metronidazole were risk factors for potential incompatibilities.

scholarly journals Schizophrenic patients’ cognitive functions in relation to their metabolic profile: a cross-sectional, comparative study on an Egyptian sample

2020 ◽  
Vol 27 (1) ◽  
Author(s):  
Dalia Hegazy Ali ◽  
Doha Mostafa Elserafi ◽  
Marwa Abdel Rahman Soltan ◽  
Mohamed Fikry Eissa ◽  
Hanan Ahmed Zein ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Cognitive Abilities ◽  
Metabolic Profile ◽  
Fasting Blood Glucose ◽  
The Body ◽  
Close Monitoring ◽  
Outpatient Services ◽  
Cross Sectional ◽  
Early Management

Abstract Background Patients with schizophrenia suffer from diffuse cognitive impairment and high prevalence of cardiovascular metabolic risks, associated with poor clinical outcomes. We aimed in this study to test the presence of cognitive impairment in a sample of patients with schizophrenia, and evaluate its possible relations to patients’ metabolic profile. We recruited forty patients diagnosed with schizophrenia and their matched controls from the inpatient departments and outpatient services from January to December 2016. Schizophrenia diagnosis was confirmed by the ICD10 criteria checklist. Symptoms profile and severity were assessed by the Positive and Negative Syndrome Scale. Cognitive profile was assessed through (1) Trail Making Test, Parts A and B and (2) Wechsler Memory Scale-Revised Visual Reproduction Test. Metabolic profile was assessed by measuring the body mass index, fasting blood glucose, and lipid profile. SPSS (V. 22.0, IBM Corp., USA, 2013) was used for data analysis. Results The patients group had a significantly higher means in the speed of processing, executive function, attention, and working memory scores on TMT-A (p = 0.0), TMT-B (p = 0.00), and WMS-R (p = 0.029) and significantly higher FBG levels (p = 0.00). Correlation studies showed that the increase in patients’ age, illness duration, treatments, number of hospitalizations, number of episodes and of ECT sessions received, symptoms severity, and deficits in cognitive function scores was associated with higher BMI and FBG. Conclusions Patients with schizophrenia have a higher prevalence of cognitive impairment and vascular risk factors than the general population. Close monitoring and early management of these risk factors can promote better cognitive abilities and overall functions.

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