新疆地区急性脑卒中患者临床特征的性别差异研究

目的探讨新疆地区不同性别急性脑卒中患者临床特点的差异性。方法前瞻性连续登记新疆生产建设兵团医院自2008年6月～2011年7月收治的急性脑卒中患者971例,其中男性598例,女性383例,收集相关临床资料,并对所有患者进行长期随访,比较男女脑卒中患者一般资料、卒中类型、牛津郡社区脑卒中分型(OC-SP分型)、相关并发症、及预后方面的不同。结果新疆地区急性脑卒中患者临床类型存在性别差异(P=0.017),急性脑梗死及脑出血男性比例高于女性,短暂性脑缺血发作(TIA)患者女性比例高于男性;男性患者在高血压构成比(P<0.001)、房颤(P=0.011)、吸烟(P<0.001)、酗酒(P<0.001)、凝血酶原时间(PT)(P=0.039)、血红蛋白含量(HGB)(P<0.001)、肌酐值(P=0.001)高于女性患者,而女性患者在心脏瓣膜病(P=0.002)、糖尿病(P=0.013)、高密度脂蛋白(HDL)(P<0.001)、低密度脂蛋白(LDL)(P<0.001)、总胆固醇(CHE)(P<0.001)高于男性;OCSP分型男女性患者无显著差异;急性脑卒中相关并发症方面,女性患者泌尿系感染(P<0.001)、电解质紊乱(P=0.005)高于男性;基线严重程度评分Glasgow昏迷量表(GCS评分)、斯堪的那亚卒中量表(SSS评分)、美国国立卫生院脑卒中量表(NIHSS评分)与一个月及2年的Barthel指数(BI)和改良的Rankin量表(MRS评分)无明显差异。结论新疆地区不同性别间急性脑卒中临床类型、相关危险因素及卒中相关并发症存在差异,基线严重程度评分及临床预后无明显差异。     

Gender issues in acute stroke thrombolysis

We systematically reviewed the literature to explore gender issues in acute stroke thrombolysis. The literature is inconsistent regarding the influence of gender on the timing of presentation to hospital, decision-making and utilization of acute thrombolysis among ischemic stroke patients, and hence any reported gender bias may be site-specific. Without treatment with thrombolysis, female stroke patients have a poorer clinical outcome compared to their male counterparts. Although some studies show that women have better clinical outcomes than men following intravenous thrombolysis, no gender difference is seen in others. Post-hoc analyses of relatively small studies show higher recanalisation rates in women than men following intravenous thrombolysis, and no gender difference in recanalisation rates following intra-arterial thrombolysis. Future thrombolytic trials should consider the effects of gender on both surrogate and clinical outcomes.     

内蒙古鄂尔多斯地区脑卒中危险因素的性别差异研究

目的探讨鄂尔多斯地区不同性别脑卒中危险因素的差异性。方法分析鄂尔多斯市中心医院2007年1月至2012年6月收治的首次急性脑卒中患者856例,其中男性519例(年龄54⁷5岁,平均年龄64.26±10.25岁),女性337例(年龄5775岁,平均年龄64.26±10.25岁),女性337例(年龄57⁷6岁,平均年龄66.68±9.64岁),比较男女患者危险因素、卒中类型。结果近5年多来鄂尔多斯地区女性脑卒中患者平均年龄大于男性(P=0.027),而男性患者人数比例高于女性(P=0.029);男女患者均以急性脑梗死为主(P=0.012,P=0.014);急性脑梗死及脑出血男性比例均高于女性,TIA患者女性比例高于男性;男性患者在高血压构成比(P=0.025)、心房纤颤(P=0.009)、吸烟(P<0.001)、饮酒(P<0.001)、血红蛋白含量(P=0.017)、同型半胱氨酸(P=0.013)、低密度脂蛋白(P=0.021)及总胆固醇(P=0.024)高于女性,而女性患者在心脏瓣膜病(P=0.013)、糖尿病(P=0.026)高于男性。结论鄂尔多斯地区首次急性脑卒中患者在发病年龄、常见危险因素及临床类型等方面存在性别差异。     

Gender differences in self-report of recovery after stroke: the Northern Manhattan Study

We compared subjective responses to simple questions after stroke with interviewer-assessed stroke outcome measures. Among those in the highest functional category, women were more likely to report incomplete recovery and greater need for help than men. Among these women, depressed mood was associated with a response of a need for help despite a good functional recovery. Self-reported responses in stroke outcome assessments require further validation by gender and may need to consider the confounding effects of depression.     

Rural-urban differences in acute stroke management practices: a modifiable disparity

Acute stroke management practices in rural areas of the United States are suboptimal, which creates an unacceptable health disparity between urban patients with stroke and their rural counterparts. The existing gap between urban and rural stroke care may widen in the future as more urban-tested interventions are incorporated into the treatment of acute stroke. We conducted a PubMed search to identify all the articles published from 1997 to 2007 that addressed acute stroke, paramedics, ambulances, emergency services, and interhospital transportation pertaining to the US rural, urban, or nonurban environment. We review herein the problems and potential solutions that exist in 3 aspects of the current rural stroke care system: prehospital care, rural local hospital emergency department care, and interhospital transfer of patients and subsequent reception at a larger tertiary care institution, which often involve long distances and considerable time. We conclude that the current gap in rural-urban stroke management practices could be overcome with a comprehensive strategy that addresses the existing issues, including further education of rural caregivers, remote support from tertiary care institutions, and implementation of future acute clinical trials that test the rural strategies to stroke care.     

Middle cerebral artery occlusive disease: The New England medical center stroke registry.

To analyze the clinical features, vascular lesions, and infarct distribution in Asian and white patients with middle cerebral artery (MCA) territory ischemia, we studied age, sex, race, risk factors, angiographic, and neuroimaging findings among patients in the New England Medical Center Stroke Registry. We included patients with well-defined intrinsic occlusive lesions of the MCAs and patients with embolic MCA territory infarcts. Among 695 patients in the stroke registry, 89 (12.8%) qualified. They had 28 MCA intrinsic stenoses, 17 MCA embolic occlusions (cardiogenic or unknown origin), and 44 carotid artery (CA) stenoses or occlusions. MCA intrinsic disease patients were more often Asians and women, and more often had hypertension. Asians were older than whites. Coronary artery disease (27%), peripheral vascular disease (20.5%), and smoking (39%) were more common in CA disease patients. The most common site of MCA intrinsic stenosis (78%) and embolic occlusion (59%) was the mainstem MCA. Infarcts in patients with MCA intrinsic disease mostly involved the striatocapsular area (61%). Infarcts in patients with MCA embolic occlusion (75%) and CA disease (43%) most often involved the parietal lobe. In our hospital, most patients with MCA intrinsic disease are Asians and women and have hypertension and striatocapsular infarctions. Asian patients are usually older than white patients. The most common site of vascular lesions is the mainstem MCA.     

Gender differences in learning and adjustment problems in school: results of a longitudinal study

Results of a community study suggest that boys entering school had more problems with aggression and information processing than did girls. Later differences in learning and adjustment largely reflected the high proportion of boys among children receiving psychological services. Girls who received psychological services were less likely than boys to get special education help.     

Gender differences in psychiatric and medical comorbidity with post-traumatic stress disorder

BackgroundPost-traumatic stress disorder (PTSD) is associated with significant personal and societal burden. The present study examines the gender-specific differences in this burden in terms of the co-occurrence of psychiatric disorders and medical conditions with PTSD in the general population of France.MethodsThe study is based on a cross-sectional general population survey of 21,879 adults. Trained interviewers used a computer-assisted telephone interviewing system to administer the Composite International Diagnostic Interview-Short Form to screen for psychiatric disorders and medical conditions in the previous 12 months.ResultsOne third of those with moderately severe PTSD (35.3%) and half of those with severe PTSD (54.2%) suffered from comorbid depression. The prevalence of anxiety disorders and substance use disorders was also greater among severe cases of PTSD. Chronic back or neck problems, frequent or severe headaches, arthritis or rheumatism and hypertension were highly prevalent among adults with PTSD. Adjusting for gender, age, education, employment and marital status, moderately severe and severe PTSD diagnoses were associated with significantly greater odds of comorbid psychiatric disorders and medical conditions. With few exceptions, the pattern of gender differences in psychiatric and medical morbidity among those with moderate or severe PTSD were similar to differences observed among those without PTSD.ConclusionsThe findings highlight the burden of co-occurring psychiatric and medical conditions among PTSD sufferers in France and suggest the need for careful consideration of comorbidity in the assessment and service planning for PTSD.