Characteristics of depressed and nondepressed women with physical disabilities

OBJECTIVES: To describe the characteristics of depressed versus nondepressed women with disabilities. DESIGN: Survey. SETTING: Women were recruited through private and public health clinics and various community organizations. PARTICIPANTS: A sample of 443 predominantly ethnic-minority women, ages 18 to 83 years, with physical disabilities. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Beck Depression Inventory-II (BDI-II). RESULTS: Approximately half (51%) of the sample had scores in the mildly depressed range or higher on the BDI-II. Women classified as depressed were more likely to have multiple sclerosis, to be younger, or to have a shorter duration of disability. Only 44% of the women with scores exceeding the BDI-II cutoff for significant depressive symptomatology had received recent treatment for depression, with Hispanic women being the least likely to report receiving treatment. Depressed women reported significantly more health conditions, reflecting common symptoms of depression, conditions linked with depression in the general population, conditions known to be secondary to the primary condition, and conditions known to be common side effects of medications. Depression was not related to functional limitations. CONCLUSIONS: Depression is a serious mental health problem facing many women with physical disabilities that does not appear to be adequately addressed by health care professionals.     

Gender differences in stroke care decision-making

BACKGROUND: Women are less likely than men to receive some stroke care interventions. It is not known whether gender differences in patient preferences explain some of the observed variations in stroke care delivery. METHODS: Outpatients with and without a history of cerebrovascular disease were recruited from stroke, vascular, and general internal medicine ambulatory clinics between September 2002 and October 2003. Self-administered surveys described hypothetical scenarios, and participants were asked if they would accept therapy with thrombolysis for acute ischemic stroke or carotid endarterectomy for secondary stroke prevention. The surveys also included questions on sociodemographic factors and decision-making preferences. RESULTS: A total of 586 patients (45% women) completed the survey. Women were less likely than men to accept thrombolysis (79% vs. 86%, P=0.014), even after adjustment for other factors (adjusted odds ratio [OR] 0.58, 95% confidence interval [CI] 0.37-0.92). Women and men were equally likely to accept carotid endarterectomy (82% vs. 84%, P=0.502), even after adjustment for other factors (adjusted OR 0.94, 95% CI 0.58- 1.53). Women were less confident in their decisions, were more risk averse, and would have preferred more information to assist them in their decision-making. CONCLUSIONS: No gender differences were found in patient preferences for carotid surgery. However, we observed gender differences in patient preferences for thrombolysis and in general attitudes toward stroke care decision-making. Health care providers should be aware that, compared with men, women may be more concerned about risks and may require more information before they make a decision.     

Predictors of health promotion behavior in women without prior history of coronary heart disease.

The purpose of this study was to determine health promotion behavior (HPB) and the best predictors of HPB in women without prior history of coronary heart disease (CHD). The sample included 119 women aged between 35 and 60 years who had no prior CHD history. The women were asked to complete a self-administered survey regarding their demographic data, personal CHD risk factors, HPB, CHD knowledge, and perceived benefits and barriers to CHD risk factor modification. The women in this study did not practice HPB regularly and had low CHD knowledge levels, a high perception level of benefits, and a moderate level of perceived barriers to CHD risk modification. Backward multiple regression analysis demonstrated that smoking history, family history of CHD, CHD knowledge levels, and perceived barriers to CHD risk modification were the best predictors of HPB in women without CHD. Women with fewer perceived barriers to CHD risk modification, higher CHD knowledge levels, and no smoking history or family history of CHD were more likely to practice HPB.     

Transoesophageal echocardiography should be considered in patients with ischaemic stroke or transient ischaemic attack

BACKGROUND AND PURPOSE: In this present study, we tried to find out if there is a subgroup of patients that should not undergo transoesophageal echocardiography (TEE) after an ischaemic stroke or transient ischaemic attack (TIA). METHODS: A total of 441 consecutive unselected patients with ischaemic stroke or TIA suitable for anticoagulation were examined with TEE in the acute phase. The patients were divided into five subcategories according to their rhythm, age and the findings in carotid sonography, and into two groups according to the presence of clinical risk factors for ischaemic stroke or TIA. RESULTS: From the 441 studied patients, 60 (14%) had chronic or paroxysmal atrial fibrillation (AF) and 381 (86%) were in sinus rhythm (SR). Of the patients in SR, 46 (12%) were below 50 years old. The carotid sonography was conducted in 240 patients above 50 years old and in SR, and <50% internal carotid artery (ICA) stenosis was found in 194 (81%) patients and > or =50% ICA in 46 (19%) patients. Potential cardiac sources of embolism were found in patients both with AF or in SR (70% versus 46%), both below and above 50-year-old patients in SR (37% versus 47%), both in over 50-year-old patients in SR with <50% ICA stenosis and > or =50% ICA stenosis (41% versus 61%) and in patients in SR either without or with clinical risk factors for ischaemic stroke or TIA (43% versus 51%). On the basis of the TEE study, oral anticoagulation was started in 36 (9%) patients in SR. CONCLUSION: These results support TEE in patients with ischaemic stroke or TIA who are candidates for receiving oral anticoagulation.     

Sex difference in the antiplatelet effect of aspirin in patients with stroke

BACKGROUND: There is substantial interpatient variability in response to aspirin after an ischemic stroke or transient ischemic attack (TIA), as assessed by ex vivo effects of aspirin on platelet aggregation. The factors contributing to this variability are not well defined. OBJECTIVE: To determine whether demographic, social, or clinical characteristics are associated with ex vivo response to aspirin in patients with a history of stroke or TIA. METHODS: Eighty-one patients who were taking aspirin for secondary stroke prevention and underwent ex vivo platelet aggregation studies were identified. The medical records of eligible patients were reviewed by clinicians who specialize in the management of stroke patients. Characteristics were compared between 45 patients who had a complete response to aspirin and 36 patients who exhibited an incomplete (partial) response to aspirin based on the results of platelet aggregation testing. RESULTS: The median (range) aspirin dose was similar in complete (325; 81-1950 mg/day) and partial (325; 81-1300 mg/day) responders. There was no association between aspirin response and age, race, body mass index, medical history, smoking status, or use of statin or hormone replacement therapy. However, sex was significantly associated with response to aspirin, with more women in the partial versus complete responder group (75% vs 49%; p = 0.02). CONCLUSIONS: Our data suggest that aspirin may be less effective at inhibiting platelet aggregation in women compared with men who have a history of ischemic stroke or TIA.     

CA1-02: Women's Perception of Cardiovascular Disease Risk Varies by Hypercholesterolemia History: Making Effective Nutritional Choices

Background/Aims Younger women underestimate personal cardiovascular disease (CVD) risk. The impact of individual risk factors, in particular hypercholesterolemia, on perceived CVD risk is unknown. Hypercholesterolemia represents a challenging risk factor for younger women as unfavorable lipid profiles at younger ages are better predictors of future CVD risk than more contemporaneous profiles, hypercholesterolemia in pregnancy places offspring at-risk for atherosclerotic plaque development, and most lipid-lowering drugs are contraindicated during pregnancy. We evaluated perceived CVD risk by hypercholesterolemia status among women and we examined if this varies by age. Methods Women in this secondary data analysis were participants in the Making Effective Nutritional (MENU) Choices randomized controlled intervention trial aimed at increasing fruit and vegetable consumption through an online program. Participants were health plan members, ages 21 to 65 years, from five HMORN sites. All measures were self-reported from pre-intervention surveys. History of hypercholesterolemia was defined as previous diagnosis of high cholesterol or lipid-lowering treatment. Perceived risk of CVD was measured using an ordinal scale (5 choices ranging from not at all to extremely likely). The association of hypercholesterolemia with perceived risk of CVD was estimated using Bayesian proportional odds models. Women with pre-existing CVD were excluded. Results The analytic sample consisted of 1,614 women; 358 (22.2%) with hypercholesterolemia. Women with hypercholesterolemia were older, had larger BMI, were more likely to be African-American and to currently smoke (all P<0.01). Among hypercholesterolemic women, 137 (38.3%) ranked themselves as having no to little risk of CVD. After adjustment for race, age and BMI, women with hypercholesterolemia had a mean increase in perceived CVD risk of 1.2 (95% CI posterior mean = 0.6, 1.7; P=0.001) compared to women without hypercholesterolemia. There was no evidence that age moderated the effect of hypercholesterolemia on perceived CVD risk (interaction P=0.69). Discussion In general, women with hypercholesterolemia rated their overall risk of CVD higher than women without this history, suggesting that women recognize hypercholesterolemia as a CVD risk factor. However, our findings reveal an important knowledge gap in nearly 40% of women with hypercholesterolemia did not perceive themselves at risk of CVD.     

青年脑卒中危险因素分析

目的 探讨青年脑卒中的危险因素。方法 对203例青年脑卒中患者(≤45岁)的病史(高血压、糖尿病和心脏病史、短暂性脑缺血发作(TIA)史、血脂异常史及家族史)及嗜好(吸烟、饮酒)进行回顾性分析。结果 高血压病为青年脑卒中(尤其是脑出血)的主要危险因素，而糖尿病、心脏病和TIA史并非青年脑卒中的主要危险因素。约50％的青年脑卒中患者有家族史及吸烟饮酒史。结论 高血压是青年脑卒中的主要危险因素。高密度脂蛋白降低、吸烟、饮酒及家族史等与青年脑卒中的发病有一定关系。     

Secondary conditions and women with physical disabilities: a descriptive study

OBJECTIVE: To examine secondary conditions and their relationship to life satisfaction in women with physical disabilities. DESIGN: Survey research. SETTING: Metropolitan Philadelphia. PARTICIPANTS: Women aged 18 to 65 years with self-reported functional limitations associated with neurologic, neuromuscular, brain, sensory, arthritic, spinal cord, orthopedic, or other chronic conditions. MAIN OUTCOME MEASURES: Secondary conditions, health status, functional status, and life satisfaction. RESULTS: In the past year, an average of 12 +/- 6.1 (SD) secondary conditions were experienced. Fatigue, mobility, physical deconditioning, spasticity, and joint pain were reported most frequently, followed by depression, chronic pain, access problems, weight problems, and isolation. In comparing women with multiple sclerosis (MS) and those with other disabling conditions, women with MS had higher secondary conditions problem index (SCPI) scores for bladder, bowel, and sexual dysfunction than women in the mixed disability group. Other secondary conditions with the highest SCPI scores remained similar. Self-reported emotional health status and SCPI scores were the only significant predictors of life satisfaction. CONCLUSION: Secondary conditions influence health status and quality of life for women with physical disabilities. Despite differences among disability groups in terms of the type of secondary conditions, common secondary conditions experienced by most women may be amenable to non-disability-specific health promotion programs.     

The effect of diabetes combined with stroke on disability,self-rated health,and mortality in older Mexican Americans: results from the Hispanic EPESE

OBJECTIVE: To examine how diabetes in combination with stroke affects functional activities of daily living (ADLs) and instrumental activities of daily living (IADLs), self-rated health, and 5-year mortality in elderly Mexican Americans with or without other comorbid conditions. DESIGN: Longitudinal study. SETTING: Five southwestern states. PARTICIPANTS: A total of 3050 subjects of age 65 years or older, of whom 23% had diabetes and 6% had a stroke. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: ADL and IADL disabilities, self-rated health, and 5-year mortality. RESULTS: Subjects with both diabetes and stroke but without other comorbid conditions had almost 18 times higher risk of having any ADL disability (odds ratio [OR]=18.8; 95% confidence interval [CI], 3.3-105.2) and 10 times higher risk of having any IADL disability (OR=10.6; 95% CI, 1.1-101.5), compared with subjects without either of the 2 conditions. The risk of disability was further increased if the subject had a comorbid condition (hypertension, heart attack, cancer, hip fracture, arthritis). The risk of fair or poor self-rated health was 3.5 (95% CI, 1.4-8.6) and the hazard ratio for 5-year mortality was 2.4 (95% CI, 1.7-3.4) in people with both diseases. CONCLUSIONS: Diabetes and stroke in combination is strongly associated with a higher risk of disabilities, poor self-rated health, and 5-year mortality in elderly Mexican Americans. The effect on outcomes appears to follow an additive model. Information on disability risk and morbidity and mortality should be useful to rehabilitation professionals in discharge planning and allocation of therapy resources.     

Usefulness of the SCORE index as a predictor of osteoporosis in women with disabilities

BACKGROUND: Osteoporosis is widely recognized as a common health problem among older women. It has also recently been identified as common in both pre- and postmenopausal women with disabilities. Although several clinical indices have been developed to identify nondisabled women likely to have low bone mineral density (BMD) when tested, studies that have tested the usefulness of these clinical indices have excluded women with disabilities. Thus, the usefulness of these indices in predicting low BMD and osteoporosis in women with disabilities is unknown. PURPOSE: This study examined the ability of one of these indices, the Simple Calculated Osteoporosis Risk Estimation (SCORE), to identify women with disabilities likely to have low BMD on screening. SAMPLE/DATA COLLECTION: Women with disabilities (N = 307) responded to the six-item SCORE index and underwent peripheral BMD screening. The sensitivity, specificity, and accuracy of the SCORE index in predicting BMD with the criterion of a T-score of 相似文献   

Predictors of poor coronary heart disease knowledge level in women without prior coronary heart disease

PURPOSE: The purpose of this study was to measure coronary heart disease (CHD) knowledge levels in women without a history of CHD and to determine predictors of poor CHD knowledge in these women. DATA SOURCES: The sample included 120 women between the ages of 35 and 60, who had no CHD history. Women were asked to complete self-administered surveys including demographic data, personal CHD risk factors, and a CHD Knowledge Test. CONCLUSIONS: Women lack CHD knowledge. Low educational level, normal serum lipids, high body mass index (BMI), and lack of access to a nurse practitioner (NP) were predictors of poor CHD knowledge levels in women without CHD history. IMPLICATIONS FOR PRACTICE: Women who had access to an NP were more likely to have higher CHD knowledge. In an attempt to decrease the morbidity and mortality associated with CHD, NPs may be able to improve CHD knowledge in women, particularly in those with lower educational level, normal serum lipids and higher BMI.     

Prothrombotic conditions, oral contraceptives, and the risk of ischemic stroke

BACKGROUND: The role of inherited prothrombotic conditions, including factor V Leiden (FV G1691A), prothrombin G20210A, and the methylenetetrahydrofolate reductase (MTHFR) C677T genotype, in the pathogenesis of ischemic stroke is not well established. The effects of these factors may be potentiated by the use of oral contraceptives, analogous to observations in venous thrombosis. METHODS: Patients (n = 193) were women aged 20-49 years with ischemic stroke. Controls (n = 767) were women without arterial thrombosis stratified for age, calendar year of the index event, and residence. The relative risk of ischemic stroke was estimated with unconditional logistic regression, adjusted for stratification variables. FINDINGS: Factor V Leiden and MTHFR 677TT were more common in patients than in controls [odds ratio (OR): 1.8; 95% confidence interval (CI): 0.9-3.6 respectively OR: 1.5; 95% CI: 0.9-2.6]. The frequency of prothrombin G20210A was similar in cases and controls. Carriers of FV Leiden using oral contraceptives had a 11.2-fold (95% CI: 4.3-29.0) higher risk of ischemic stroke than women without either risk factor. Women with MTHFR 677TT using oral contraceptives had a 5.4-fold (95% CI: 2.4-12.0) higher risk than women without these risk factors. INTERPRETATION: These data suggest that carriers of FV Leiden or MTHFR 677TT who use oral contraceptives have an increased risk of ischemic stroke. When these findings are confirmed, a cost-effectiveness analysis should indicate whether ischemic stroke could be prevented with genetic testing before the start of oral contraceptives.     

北京市某社区中老年人对短暂性脑缺血发作认知情况的研究

目的调查北京市某社区中老年人对短暂性脑缺血发作的认识和了解程度，为健康教育提供依据。方法采用便利抽样的方法抽取北京市某社区的300名中老年人，自设问卷进行调查。结果①300名研究对象中，81名表示发生过类似短暂性脑缺血发作症状，占27．00％；但只有12名曾被医生明确诊断为短暂性脑缺血发作，占4．00％。41名有脑卒中后遗症，占13．67％；其中有26名在发生脑卒中前有过类似短暂性脑缺血发作症状的发生，占63．41％。②192名没有听说过短暂性脑缺血发作这种疾病，占64．00％；181名不知道短暂性脑缺血发作发生后如果不及时治疗发生脑卒中的风险性很高，占60．33％。③227名有发生短暂性脑缺血的危险因素，占75．67％。结论公众对短暂性脑缺血发作的了解很少，短暂性脑缺血发作还没有引起人们足够的重视，说明脑卒中相关的一级预防工作还存在缺陷，提示护士和其他医疗卫生工作者应通过各种途径加大宣传力度，提高全民对短暂性脑缺血发作的认识和了解，为及早控制脑血管疾病创造条件。     

Differences in Mexican American and Non-Hispanic White Veterans'' Homocysteine Levels

PURPOSE: To compare homocysteine (Hcy) levels and possible modulatory factors, such as nutrient or supplement intake, between Mexican American and Non-Hispanic White (NHW) male military veterans scoring at high- versus low-risk for stroke. DESIGN: A cross-sectional survey with a high and low stroke risk biomarkers substudy. METHODS: Voluntary participants were Mexican American (n=109) and NHW (n=120) veteran outpatients 54 to 85 years of age at a Southwestern Veterans Administration (VA) medical center. Measures included food frequency, health history, and stroke risk scale derived from the Framingham Study. Biomarker subgroups, 30 Mexican American and 30 NHW, half of each group scoring high or low on stroke risk, who were tested for morning fasting blood levels of Hcy, B12, and folate. FINDINGS: In the cross-sectional study (n=229), nutrient intake was comparable between ethnic groups. In the substudy, Mexican Americans (n=30) with high or low stroke risk scores and NHW (n=30) with high stroke risk scores had elevated Hcy levels (12.5; 11.9; 11.4 micromol/L respectively) compared to NHW veterans with low stroke risk scores (7.8 micromol/L) even after controlling for age, education, folate, diabetes, and smoking pack-years (p=.001). Mexican Americans compared to NHW were significantly more likely to be in the preclinical (17% versus 3% >10 micromol/L) and clinical ranges (69% versus 35% >15 micromol/L) for Hcy. CONCLUSIONS: Mexican Americans showed higher levels of Hcy whether they scored high or low for stroke, and greater representation in clinical and preclinical Hcy ranges compared to NHW veterans. The Framingham-derived, predominantly NHW population-based stroke risk measure might require ethnically relevant stroke risk factors for Mexican Americans.     

Assessing risk of myocardial infarction and stroke: new data from the Prospective Cardiovascular Münster (PROCAM) study

OBJECTIVES: Based on the data of the Prospective Cardiovascular Münster (PROCAM) study, a prospective study of men and women at work in the north-west of Germany, we aimed (i) to develop a refined scoring scheme for calculating the risk of acute coronary events among adult and elderly men and women; and (ii) to generate a new scoring scheme for calculating the risk of ischaemic stroke or transient ischaemic attack (TIA). METHODS: The coronary risk score was derived from a Weibull function using data from 18 460 men and 8515 women who were recruited before 1996 and had a mean follow-up period of 12+/-6 years. The stroke score was derived using a Cox proportional hazards model using data of 5905 men and 2225 women aged 35-65 years with at least 10 years of unbroken follow-up. RESULTS: The coronary risk score was based on 511 major coronary events, 462 (168 fatal, 294 non-fatal) in men and 49 (18 fatal, 31 non-fatal) in women and included the risk factors LDL cholesterol, HDL cholesterol, systolic blood pressure, smoking status, triglycerides and diabetes mellitus status. It was accurate in both sexes over an age range from 20 to 75 years with an area under the receiver-operating characteristics (ROC) curve of 0.82. The stroke score was based on 85 cerebral ischaemic events (21 TIAs, 64 ischaemic strokes) and included the risk factors age, sex, diabetes mellitus status, smoking status and systolic blood pressure. It had an area under the ROC curve of 0.78 and identified a high-risk group comprising only 4% of the study population that contained 31% of all cerebral ischaemic events. CONCLUSION: Both new PROCAM risk scores provide simple and effective ways to assess the risk of acute coronary events and ischaemic stroke in the general population and will improve the ability of physicians to target measures in an effort to prevent these potentially devastating conditions.     

Transient ischemic attack: reviewing the evolution of the definition, diagnosis, risk stratification, and management for the emergency physician

A transient ischemic attack (TIA) is an episode of reversible neurologic deficit caused by temporary focal central nervous system hypoperfusion. TIA is a medical emergency. Because patients with TIA in the emergency department (ED) have a high risk for stroke within the next 48 hours, it is imperative for the clinician to recognize this golden opportunity to prevent a disabling stroke. This article reviews our conceptual understanding of TIA, its definition, diagnosis, ways to stratify stroke risk, the acute management and disposition in the ED, and the potential future role of diagnostic biomarkers.     

Breast cancer screening barriers and disability

There is evidence that early detection from breast cancer screening is an effective means to reduce overall mortality from breast cancer. Findings from multiple research studies suggest that women with chronic disabling conditions are less likely to participate in breast cancer screening due to the multiple barriers they face. Barriers include those related to finances, environment, physical limitations, health carers' attitudes and lack of knowledge, and psychosocial issues. The purpose of this article is to provide an overview of the existing evidence of the barriers to breast cancer screening experienced by women with physical disabilities. Rehabilitation nurses that work with women who have chronic disabling conditions can be instrumental in eliminating these barriers to breast cancer screening through their efforts to promote health which is consistent with the philosophy of maximizing the health potential and quality of life of these women whose needs are often overlooked.