Meta-analysis of risk factors associated with suicidal ideation after stroke

Background Over the past decade, increasing attention has been paid on post stroke suicide (PSS), which is one of complications of stroke. The rates of stroke and suicide are relatively high, especially in Asian populations. Thus, a deeper understanding of the prevalence and epidemiological impact of suicide after stroke is urgently needed. Clinical diagnosis and prevention of PSS are at the incipient stage, but the risk factors responsible for the occurrence of PSS in different regions and stages of the disease remain largely unknown. The present meta-analysis aimed to determine the incidence of PSS at different stages and time courses, and to identify the underlying risk factors for PSS. Methods We systematically searched the Cochrane library, Embase, PubMed, CNKI and Web of Science databases from their inception until April 2019.The research articles reporting on the risk factor for PSS were screened and included in the meta-analysis. The data from the included studies were extracted according to the predefined criteria. Results A total of 12 studies (n = 2,693,036) were included for meta-analyses. Of these studies, 7 reporting suicide prevalence were meta-analyzed. The pooled estimate of suicidal ideation rates after stroke was 12%, which could be influenced by multiple risk factors, including sex, smoking, depression, sleep disorders, previous stroke and low household income. Studies conducted in Asia demonstrated higher suicide prevalence (approximately 15%) compared to other regions. Smoking, low family income, depression, heart disease and sleep disorders were important risk factors for PSS. When compared to PSS of more than 1 year, the incidence of suicide within 1 year after stroke was more likely to be statistically significant. It was found that 4 out of every 1000 stroke survivors tended to commit suicide. The results of this meta-analysis showed that depression (OR = 2.32; p < 0.01) was significantly associated with suicidal ideation, regardless of stroke duration. Conclusion PSS is one of the common complications of stroke. Despite some limitations, we successfully identified the risk factors associated with suicidal ideation after stroke. Notably, depression was significantly associated with suicidal ideation, regardless of stroke duration. Targeting this risk factor may be helpful to improve stroke patient care and prevent suicidal ideation after stroke. Future research will be carried out to assess whether suicidal ideation or thoughts and actual suicide attempts are strongly predictive of suicide deaths after stroke (Registration No. CRD42019128813).

Complications of Stroke

Stroke is one of the leading causes of disability and mortality and can cause a serious socioeconomic burden. Some of the comorbidities and secondary complications of stroke can threaten the patient's life or cause serious pain or negatively affect the patient's involvement in rehabilitation or worsen daily life activities or make it difficult to bring the patient into the community and workplace. This chapter focuses on the symptoms and signs, diagnosis, and management of these comorbidities and complications. It highlights diagnosis and treatment of cardiac problems, sleep disorders, deep vein thrombosis, pulmonary embolism, dysphagia, malnutrition, and pneumonia. Depression, central post-stroke pain, upper limb problems after stroke, spasticity, bladder dysfunction are also discussed in this chapter.

Stroke Rehabilitation and Occupational Therapy in Low Resource Settings

The long-term complications of stroke interfere with function, and the level of disability varies based on the type of stroke, location, and the extent of damage. Rehabilitation services are important in the recovery of stroke patients, but not all survivors have access to the services especially in low resourced settings where accessibility and economic challenges are the major barriers. Inadequate fulfilment of stroke survivors’ rehabilitation needs contribute to poor functional outcomes and slow recovery. The objectives of this chapter is therefore to give an overview of stroke and stroke rehabilitation with specific emphasis on occupational therapy, discuss the activities and areas of participation considered important by stroke patients, stroke patients’ needs and perceived fulfilment of these needs in order to provide targeted interventions. Data to inform the chapter is based on research done in a low resource setting. The perceived important activities and participation areas, and the needs of stroke patients are discussed in light of literature on the subject and findings from the studies done in Zimbabwe.

Differences in the Characteristics of Ischemic and Haemorrhage Stroke Patients with Mechanical Phlebitis

Introduction: One of the complications of stroke patients receiving intravenous therapy is mechanical phlebitis. The purpose of this study was to analyze the differences characteristic of stroke patients who experienced mechanical phlebitisMethods: This study was used a comparative descriptive method with a documentation study design. The subjects of this study were stroke patients who experienced mechanical phlebitis from January 2018 until September 2020. The sampling method used total sampling with 92 samples. Data analysis using Chi-squared test.Results: Gender (p = 0.020) had a significant difference with the incidence of mechanical phlebitis in stroke patients. Characteristics of age (p=0.511), history of hypertension (p=0.058), diabetes mellitus (p=0.503), pneumonia (p=0.164), and stroke (p= 0.160) did not have a significant difference with the incidence of mechanical phlebitis in stroke patients.Conclusion: There are differences in gender characteristics in stroke patients who experience mechanical phlebitis.

Effect of Community Education Program on Stroke Symptoms and Treatment on School and College Students from South India: A Longitudinal Observational Study

Community awareness regarding stroke signs, risk factors, and actions that help reduce the risk and complications of stroke is poorly addressed, as it is thought to be the best approach to control and prevent stroke. Aim: To establish the awareness of stroke and its management among high school and college students using an educational intervention. A questionnaire was administered to students from five high schools and four colleges with different areas of focus, (arts, science and commerce), types (public, semi-public and private), and economic locations before and after an educational lecture on stroke. The lecture covered the following elements: stroke definition, signs, risk factors, actions, time window for thrombolytic therapy, and types of rehabilitation interventions. This study included 1036 participants, of whom 36.3% were male and 56.4% were high school students, and the mean age was 17.15 ± 1.29 (15–22) years. Before the lecture, 147 participants were unaware of a single sign of stroke, and 124 did not know the risk factors. After the intervention, 439 participants knew four signs of stroke, and 196 knew 12 risk factors. Female students had better knowledge about stroke signs (odds ratio (OR), 3.08; 95% confidence interval (95% CI), 2.15–4.43). Hypertension (52.7%) and weakness (59.85%) were the most known signs and risk factors. The proportion of students who selected traditional medicine as the mode of treatment decreased from 34.75% to 8.59% after the lecture. Other rehabilitation methods (e.g., physical therapy, occupational therapy, speech therapy and counseling) were chosen by more than 80% of the students. The results of the current study showed that the awareness on stroke risk factors and management among the school and college students can be significantly improved with regular educational interventions, and therefore stroke can be prevented to some extent.

Changes in kinesiostabilogram parameters and movement speed of stroke patients while increasing their physical activity due to the use of biofeedback method

Balance disorders are complications of stroke survivors. Aim of this study was the establish effectiveness of the biofeedback approach. In this intervention study 245 patients with early diagnosis of acute disturbance of cerebral circulation (ADCC) were examined. Patients able to move independently were treated by standard conservative ADCC therapy on an outpatient approach, but they continued to have problems with coordination of movement in upright position. Then they were submitted to an increasing physical activity based on five sessions of biofeedback, i.e., a complex rehabilitation of patients with motor pathology "Trust-M" according to TU 9442-001-63704475-2010. Mobility rates were assessed using a web camera. Patients' quality of life was evaluated by SF-36 questionnaire and the Hospital Anxiety and Depression Scale (HADS). All parameters were recorded before and after 5 sessions of biofeedback. After treatment, the stability indicators improved and all patients showed a significant increase in motion rate and quality of life. At the same time, the severity of pain and of depression and anxiety decreased. Negative correlations of average strength between the quadrant and patient HADS scaling rates were obtained. In conclusion, our work shows effectiveness of the biofeedback technique for correcting coordination in stroke survivors.

Lactic Dehydrogenase to Albumin Ratio Is Associated With the Risk of Stroke-Associated Pneumonia in Patients With Acute Ischemic Stroke

Background: Stroke-associated pneumonia (SAP) is one of the common complications of stroke patients. Higher lactic dehydrogenase (LDH) and lower albumin levels were associated with SAP, but the contribution of the LDH to albumin ratio (LAR) to the risk of SAP in acute ischemic stroke (AIS) patients remained unclear.Methods: A total of 3173 AIS patients were included in this study, divided into SAP (n = 417) and non-SAP groups (n = 2756). Characteristics were compared between these two groups. The receiver operating characteristic curves (ROC) were used to evaluate the discrimination ability of the LAR, LDH, and albumin levels in predicting SAP. Logistic regression analysis was furtherly adopted to estimate the association between LAR and SAP. We also used the restricted cubic spline (RCS) to clarify the relationship between LAR and the risk of SAP.Results: LAR in the SAP group was significantly higher than that of the non-SAP group (8.75 ± 4.58 vs. 6.10 ± 2.55, P &lt; 0.001). According to the results of ROC, LAR had the highest prognostic accuracy compared to LDH and albumin (P &lt; 0.05). Besides, the logistic regression model showed that higher LAR (LAR &gt; 6.75) were more vulnerable to SAP (OR, 2.80; 95% CI, 2.18–3.59, P &lt; 0.001), controlling the confounders. The RCS model showed that there was a non-linear relationship between LAR and the risk of SAP.Conclusion: High LAR was associated with an increased risk of SAP in patients with AIS. LAR may be a potential predictor for the incidence of SAP. Appropriate prevention measures were needed in patients with high LAR (LAR &gt; 6.75).

Research Progress of Acupuncture and Moxibustion in Treating Constipation After Stroke

Constipation is one of the common gastrointestinal complications of stroke, which not only affects the quality of life of patients, but also easily induces and aggravates the primary disease and delays the recovery of the disease. At present, most of the treatments for constipation after stroke are oral medicine and enema, but the curative effect is poor and unstable. Acupuncture has the advantages of simple operation, remarkable effect, high patient acceptance and a little toxic effect. It is one of the non-drug treatment ways to prevent and treat constipation after stroke, as well as widely used in the treatment of constipation after stroke. Therefore, the clinical research on acupuncture treatment of constipation after stroke in recent years is summarized to provide reference for the subsequent clinical treatment of constipation after stroke.

Aspiration Pneumonia in Adults Hospitalized With Stroke at a Large Academic Hospital in Zambia

Introduction:Preventing complications of stroke such as post-stroke aspiration pneumonia (PSAP) may improve stroke outcomes in resource-limited settings. We investigated the incidence and associated mortality of PSAP in Zambia.Methods:We conducted a prospective cohort study of adults with stroke at University Teaching Hospital (Lusaka, Zambia) between 12/2019-3/2020. NIH Stroke Scale, Glasgow Coma Scale, Modified Rankin Scale scores, and nine indicators of possible PSAP were collected serially over each participant’s admission. PSAP was defined as ≥4 indicators present, and possible PSAP as 2-3 present. T-tests and chi-square tests were used to compare clinical parameters across PSAP groups. Logistic regression was used to assess the relative effects of age, sex, PSAP status, and initial stroke severity on inpatient mortality.Results:We enrolled 125 participants. Mean age was 60±16 years, 61% were female, 55% of strokes were ischemic, and baseline NIH Stroke Scale was 19.7±8.7. Thirty-eight (30%) had PSAP, and 32 (26%) had possible PSAP. PSAP was associated with older age and more adverse stroke severity scores. Fifty-nine percent of participants with PSAP died, compared to 39% with possible PSAP and 8% with no PSAP. PSAP status independently predicted inpatient mortality after controlling for age, sex, and initial stroke severity. Swallow screening was not performed for any participant.Conclusion:PSAP is common and life-threatening in Zambia, especially among older participants with severe stroke presentations. PSAP was associated with significantly increased mortality independent of initial stroke severity, suggesting that interventions to mitigate PSAP may improve stroke outcomes in Zambia and other resource-limited settings.

USE OF THERAPEUTIC EXERCISES FOR POST-STROKE CORRECTION OF SWALLOWING

Dysphagia (Greek. Dys + phagein ­­– eat, swallow) ­– is a violation of swallowing, in which there is a feeling of discomfort or difficulty in transporting the food bolus from the mouth to the stomach. Because the disorder of the act of swallowing in stroke is usually of neurogenic origin and is defined by a number of neurologic disturbances and dysfunctions, it is better to use the term "neurogenic dysphagia" for patients with acute disturbance of cerebral circulation. The urgency of this problem is especially emphasized in the development of a set of therapeutic exercises for such socially important disease as acute cerebrovascular accident. One of the formidable complications of stroke is a violation of the act of swallowing. This leads to a significant reduction in quality of life increasing the risk of secondary complications, which, in turn, significantly increases the likelihood of death. Violation of the act of swallowing is observed in 26–45% of patients due to acute ischemic stroke. Dysphagia leads to the development of life-threatening complications such as aspiration pneumonia, dehydration, and significantly reduces the quality of life of such patients. Thus, the correction of the act of swallowing by means of physical rehabilitation after brain injury is a very important task of the rehabilitologist. For a long time, speech therapy was the only method of rehabilitation of dysphagia; now we can widely use therapeutic exercises to restore the functions of facial muscles and masticatory muscles. Screening for swallowing disorders allows us to assess the function of the masticatory muscles in five stages, which makes it possible to develop a more individual and thorough set of therapeutic exercises after each stage of the screening study. Depending on the phase of swallowing in which disorders are observed, we have developed an individual set of therapeutic exercises that will be performed by the patient in each of the five stages of the screening study, if the patient could not overcome this stage.