Acute phase predictors of subsequent psychosocial burden in carers of elderly stroke patients

The objective was to describe the psychosocial burden experienced by informal carers of elderly stroke victims, and to identify its predictors among baseline characteristics of the patients. From a prospective study of 171 elderly stroke patients admitted to a geriatric ward for rehabilitation in the acute phase, 68 patients living at home with a primary caregiver were identified 6 months after the stroke. At baseline, all the patients were assessed with respect to motor function, cognitive function, global handicap and activities of daily living, and after 6 months the caregivers were assessed, using the Relatives' Stress Scale. According to this, the most frequent impacts were worries that an accident might befall their relatives, that they had to reorganise their household routines and further, that their social life and ability to take holidays had been reduced. Impaired cognitive function was the only baseline patient characteristic that predicted a subsequent psychosocial burden on the carer. Special attention should be paid to elderly stroke patients initially assessed with impaired cognitive function and their caregivers.     

Sympathetic predominance of cardiovascular regulation during mild orthostatic stress in adolescents with chronic fatigue

Haemodynamic abnormalities have been documented in the chronic fatigue syndrome (CFS), indicating functional disturbances of the autonomic nervous system responsible for cardiovascular control. This study was designed to explore the pathophysiology in adolescent CFS-patients by analysing RR-interval (RRI) variability and diastolic blood pressure (DBP) variability during mild orthostatic stress, using an algorithm which accounts for non-stationary biosignals. A total of 27 adolescents with CFS and 33 healthy control subjects having equal age- and sex distribution underwent 15 min of 20 degrees head-up tilt (HUT). The spectral power densities of RRI and DBP were computed in the low-frequency (LF) band (0.04-0.15 Hz) and the high-frequency (HF) band (0.15-0.4 Hz) using an adaptive autoregressive algorithm to obtain a time-varying spectrum. RMSSD, a time domain index of RRI variability, was also computed. At rest, all indices of variability were similar in the two groups. During tilt, CFS patients had a larger increase in the LF/HF ratio (P相似文献   

Prognostic significance of micturition disturbances after acute stroke

OBJECTIVES: To investigate the prevalence, incidence, clinical types, and prognostic effect of micturition disturbances in acute stroke. DESIGN: Prospective observational study. SETTING: Geriatric department (stroke and rehabilitation unit) in a community hospital (acute phase); outpatient clinic, patients' own homes, or nursing homes (3 months follow-up). PARTICIPANTS: Three hundred fifteen patients (mean age 77) with acute first-ever or recurrent stroke consecutively admitted to the hospital stroke unit. MEASUREMENTS: Premorbid basic and instrumental activities of daily living (ADLs) and mental functioning; comorbidity; previous and actual micturition symptoms; stroke syndromes; medication use; and poststroke mobility, ADLs, and cognition. RESULTS: One hundred forty-seven patients (46%) had preexisting micturition disturbances (urinary incontinence (UI), n = 98; urgency/frequency, n = 37; voiding difficulties, n = 12). Seventy-eight developed new symptoms (UI, n = 65; urgency/frequency, n = 4; sustained retention, n = 9). There were two UI types: urge UI (n = 27) and UI with impaired awareness of bladder needs (IA UI, n = 38). In regression analyses, IA UI was the only micturition disturbance predicting mortality and need for nursing home care at 3 months (odds ratio (OR) = 27.5, 95% confidence interval (CI) = 7.0-108.2), together with poor mobility (OR = 8.2, 95% CI = 2.6-26.2), and partial or total anterior circulation stroke type (OR = 3.6, 95% CI = 1.4-9.0). CONCLUSION: New-onset poststroke UI with impaired awareness of bladder needs is a strong and independent risk factor for poor outcome at 3 months. This probably reflects more serious brain damage, affecting sustained attention and information processing. Valid clinical tools to detect such dysfunction in stroke victims are needed. Clinical classification of poststroke UI is likely to improve management.     

Early supported discharge of patients with acute stroke: a randomized controlled trial

Purpose: To evaluate the feasibility and effectiveness of early supported discharge (ESD) following acute stroke. Method: An ESD scheme was compared to conventional rehabilitation in a randomized controlled trial. All patients admitted with acute stroke were considered for inclusion. Eighty-eight (20.2%) were found to be eligible and 82 were randomized either to early supported discharge (n=42) or conventional rehabilitation (n=40). The primary outcome measure was the Nottingham Extended Activities of Daily Living Scale. The General Health Questionnaire, the Montgomery Aasberg Depression Rating Scale, mortality, placement and patient and carer satisfaction served as secondary outcome measures.

Results: Median length of stay was reduced from 31 days in the conventional hospital rehabilitation group to 22 days in the early supported discharge group (p=0.09). No differences were found regarding primary outcome. The General Health Questionnaire score showed a significant difference in favour of the early supported discharge group at three months (19.5/24, p =0.02), but not at six. At six months, the proportion of patients being dead or in institution showed a trend of being higher in the conventional rehabilitation group (OR 3.8, 95 % CI 0.8-23). Conclusions: Early supported discharge after stroke is feasible and it is possible that it has benefits compared with conventional rehabilitation.     

Is there any relationship between serum and urine neopterin and serum interferon‐γ levels in the activity of Behcet's disease?

Background  Behcet's disease (BD) is a chronic, inflammatory, multisystem vasculitic disorder. There is no reliable laboratory marker that indicates disease activity. Neopterin is an immunological marker of cellular immune activation, which is secreted by monocytes/macrophages as a result of interferon-gamma (IFN-γ) secretion by activated T lymphocytes.
Objective  We aimed to investigate serum and urine neopterin levels in BD patients.
Methods  Forty-five patients who were diagnosed according to the criteria of the International Study Group for BD and 45 age- and sex-matched healthy controls were enrolled in the study. Disease activity was considered by clinical findings. Serum and urine neopterin levels and serum IFN-γ levels were measured.
Results  The mean values of serum and urine neopterin levels were 12.68 ± 4.87 nmol/L and 167.53 ± 148.73 µmol/mol creatinine, respectively, in BD patients ( P =  0.000 and P  = 0.008, respectively), which were statistically significantly different from the control group. However, there was no significant statistical difference between serum and urine neopterin levels of the clinically active and inactive patients. It was also found that the mean value of serum IFN-γ levels was higher in healthy controls than in BD patients ( P =  0.000).
Conclusions  We conclude that serum and urinary neopterin measurement can not be used as a reliable laboratory marker as the BD patients' serum and urinary neopterin levels do not increase in the active stage even though these levels increase when compared to healthy controls.