This cross-sectional study examined neurobiologic correlates of depression in ischemic stroke patients. Depression severity was measured with a standardized scale (Center for Epidemiologic Studies Depression Scale; CES-D). Eighty-two patients (53.1% male, mean (± SD) age 71.9 ± 14.2 years, mean (± SD) National Institutes of Health Stroke Scale (NIHSS) score 4.6±4.7, mean (± SD) CES-D score 12.6 ± 10.8) were recruited. A linear regression controlling for age and stroke severity (NIHSS) determined that the kynurenine to tryptophan ratio (β= -0.105, p=0.369) was not significantly associated with CES-D (primary hypothesis) (overall model R2=0.069, F3,73=1.805, p=0.154). Secondary analyses suggested one instance of cytokines favouring inflammatory states in mild depressive symptomatology; IFN-Ɣ/IL-10 (OR, 2.17; 95% CI, 1.02-4.64, p=0.045). For the most part however, inclusion of cytokines and neuroimaging correlates such as atrophy, lesion location and white matter changes were non-significant. Longitudinal studies are necessary to identify the possible neurobiologic correlates of depressive symptoms post-stroke.

This cross-sectional study examined neurobiologic correlates of depression in ischemic stroke patients. Depression severity was measured with a standardized scale (Center for Epidemiologic Studies Depression Scale; CES-D). Eighty-two patients (53.1% male, mean (± SD) age 71.9 ± 14.2 years, mean (± SD) National Institutes of Health Stroke Scale (NIHSS) score 4.6±4.7, mean (± SD) CES-D score 12.6 ± 10.8) were recruited. A linear regression controlling for age and stroke severity (NIHSS) determined that the kynurenine to tryptophan ratio (β= -0.105, p=0.369) was not significantly associated with CES-D (primary hypothesis) (overall model R2=0.069, F3,73=1.805, p=0.154). Secondary analyses suggested one instance of cytokines favouring inflammatory states in mild depressive symptomatology; IFN-Ɣ/IL-10 (OR, 2.17; 95% CI, 1.02-4.64, p=0.045). For the most part however, inclusion of cytokines and neuroimaging correlates such as atrophy, lesion location and white matter changes were non-significant. Longitudinal studies are necessary to identify the possible neurobiologic correlates of depressive symptoms post-stroke.

Stroke is the second most common cause of death worldwide and the commonest cause of dependency, creates a huge societal burden and is responsible for billions of pounds in health and social care costs. About 30% of strokes occur in individuals with a previous transient ischaemic attack (TIA) or minor stroke. Effective prevention would minimise the consequences. However, the diagnosis of TIA is difficult, particularly by non-experts. About 50% of patients with a suspected TIA or minor stroke have atypical TIAs or a non-vascular diagnosis (TIA/minor stroke mimics). Although there is some evidence that non-specific Transient Neurological Attacks (TNAs) have an increased risk of acute vascular events, the evidence is still both thin and controversial. The aim of my thesis has been to evaluate the burden of TIA/minor stroke mimics, TNAs and all acute cerebrovascular events among all referrals from the general population to a TIA clinic; to determine the reliability of clinical diagnosis of TIA and non-specific TNA; to improve the classification of non-specific TNAs; and to predict the risk of stroke and other major vascular events after a non-specific TNA and TNA syndromes. I have collected and analysed data from a population-based study, the Oxford Vascular Study (OXVASC). OXVASC is an ongoing prospective, population-based incidence study of all vascular diseases in all territories in Oxfordshire, UK, which started in 2002. The study population comprises approximately 92,728 individuals registered with nine GP practices and uses multiple overlapping methods of "hot" and "cold" pursuit to identify patients with acute vascular events. The research described in this thesis has several clinically relevant findings which can contribute to improving the diagnosis and treatment of patients with suspected TIAs. First, I highlighted that TIA/minor stroke mimics (mimics) were responsible for one quarter of all suspected TIAs, had similar short- and long-term risk of acute cardiac events as did TIAs, and that the majority (70%) of mimics were complex neurological conditions. Second, I showed that TIA/minor ischaemic strokes are each more common than major ischaemic strokes and that TIA/minor ischaemic stroke patients together had two-thirds of all recurrent strokes and two-thirds of all myocardial infarctions and sudden cardiac deaths. Moreover, the 10 years' cumulative risk of stroke in patients with TIA, minor stroke and major stroke was very high and the risk of death among all cerebrovascular events was greater than 50%. Third, I found that the crude incidence rate of TNAs per 1000 people in OXVASC was slightly higher than the crude incidence rate of TIAs (0.73 versus 0.67) and increased with age. In addition, I reported that among TNA syndromes, transient isolated vertigo, unilateral sensory symptoms, migraine-aura like events and transient confusion had high incidence rates, whereas transient total paralysis and transient speech arrest had low incidence rates. Fourth, I showed that about one-third of TIAs seen in the first 10 years of OXVASC did not fulfil the classical criteria (NINDS-negative TIA) and had the same short- and long-term risk of stroke as NINDS-positive TIAs. Fifth, although the 90 days stroke risk after a TNA was lower than after a NINDS-positive TIA, in the post 90 days up to 10 years period the risk of recurrent stroke was not significantly different between the two groups. Sixth, the risks of stroke were higher than expected in the background population in all TNA categories (focal-TNA, non-focal TNA and focal plus non-focal TNA) and all TNA syndromes (isolated brainstem syndrome, migraine-like syndrome, isolated sensory syndromes, isolated visual disturbance, isolated speech disturbance, transient confusion and transient unresponsiveness) except transient amnesia. Moreover, non-focal TNAs and focal plus non-focal TNAs had a six times higher risk of stroke than expected and a similar risk to NINDS-positive TIAs. Finally, transient confusion and transient unresponsiveness had a relative risk of stroke nine times higher than expected and twice the risk of NINDS-positive TIAs.

Bakgrund: Stroke har visat sig påverka patientens kognitiva och fysiska hälsa negativt. Rollen som vårdgivare i hemmet kan komma som en chock för den vårdande partnern och beror på en hög fysisk samt psykisk vårdbörda. Detta kan resultera i en försämrad hälsa för den närstående. Syfte: Syftet med litteraturöversikten var att beskriva hur närstående upplevde situationen som vårdgivare till sin partner som drabbats av stroke. Metod: En litteraturöversikt valdes där sexton vetenskapliga artiklar har inkluderats. Resultat: Litteraturöversiktens resultat speglade till stor del närstående kvinnors upplevelser av att vårda sin partner som drabbats av stroke. I analysen framträdde sju teman; Information, Hemsituation, Ekonomi, Fysisk- och psykisk ohälsa, Förlorad självständighet, Relationer och Socialt stöd. Slutsats: Närstående upplevde att de inte fick tillräckligt med information, stöd eller uppföljning från vårdpersonal, vilket påverkade deras fysiska- och psykiska hälsa. Stödgrupper upplevdes av de anhöriga som positivt och bidrog till bättre förutsättningar för den vårdgivande rollen. / Background: Suffering from stroke has proven to negatively affect the patient in manners of cognitive and physical health. The new situation may become of a chock to the caring spouse due to increased physical and psychological caring obligation that may result in deteriorated health for the spouse. Aim: The aim of this study was to describe how relatives experienced the situation as a care provider for their partner who has suffered a stroke. Method: A literature review that included sixteen scientific articles. Result: The results of the literature review largely reflected female relative’s experiences of caring for their partner who had suffered a stroke. The analysis revealed seven headlines; Information, Situation at home, Economy, Physical- and psychological illness, Lost independence, Relationships and Social support. Conclusion: Relatives experienced that they did not receive enough information, support and follow-up from health care professionals, which affected their physical- and psychological health. Support groups were experienced by relatives as positive and contributed to better conditions for the caregiving role.

Bakgrund: Stroke är den tredje största dödsorsaken i Sverige och drabbar ca 30 000 människor årligen. Att återvända hem efter en sjukhusvistelse är ofta mycket efterlängtad av strokeöverlevare. Men förhoppningen att återgå till sina normala liv är inte alltid kopplat till verkligheten. Forskning visar att många strokeöverlevare är oförberedda på vad de nya begränsningar och förlorade förmågor innebär för dem i hemmet. Syfte: Att undersöka vilka medgångar och motgångar som strokepatienter mött efter utskrivning från sjukhus till hemmet, för att undersöka hur sjuksköterskan kan hjälpa patienter som drabbats av en stroke att förbereda sig för att klara sig i den dagliga hemmiljön. Metod: Litteraturöversikt baserat på 10 vetenskapliga kvalitativa originalartiklar publicerade i PubMed och Cinahl från 2000. Artiklarna granskades utifrån SBUs kvalitetsgranskningsmall. Resultat: Resultatet visade att flera av de svårigheter som uppkommer i hemmet kunde minskas med insatser att skapa realistiska förväntningar genom praktiska övningar samt att coacha strokeöverlevare inför återkomst till hemmet. Ur de motgångar som framkom skapades kategorierna; rädslan att vara en börda, familjen som ett hinder, livet saktade ner, sjukhus vs hemmet, existentiella och sociala konsekvenser. Interaktionen med sjuksköterskorna var viktigt både innan utskrivning och i hemsjukvården då bemötandet kunde försämra och förbättra deltagarnas förväntningar på rehabilitering. Information, meningsfulla relationer samt att finna mening i det lilla kunde hjälpte deltagarna att hantera vardagen bättre. Slutsats: Hur förberedda strokeöverlevare är inför utskrivning påverkar hur de hanterar de motgångar de möter i sin hemmiljö. Resultaten visar vikten av att de strokedrabbade får stöd att skapa realistiska förväntningar för sin vardag.

Stroke is the second most common cause of death worldwide and the leading cause of long-term neurological disability. In the UK, stroke accounts for approximately 6% of total National Health Service and Social Services expenditure. The burden of stroke is predicted to increase because of the ageing population. Whilst effective primary prevention is important, about 30% of strokes occur in individuals with a previous transient ischaemic attack (TIA) or minor stroke. Recent prospective studies have shown a high early risk of recurrent stroke in the days after TIA or minor stroke. The prompt use of preventative strategies has been shown to be highly effective in reducing this early risk of recurrence and there is now a consensus in favour of rapid access services and urgent secondary prevention after TIA. However, there are several areas where clinical practice still needs to be improved, including delays in seeking medical attention, the reliability of clinical diagnosis of TIA in the acute phase, prediction of stroke recurrence risk and the control of risk factors, particularly blood pressure (BP), in longer-term secondary prevention. My thesis will focus on these clinically important areas. I have used data from a population-based study; the Oxford Vascular Study (OXVASC). OXVASC is a prospective, population-based incidence study of vascular disease in all territories in Oxfordshire, UK, which started in 2002 and is ongoing. The study population comprises approximately 91 000 individuals registered with nine general practices and uses multiple overlapping methods of “hot” and “cold” pursuit to identify all patients with acute vascular events. The research described in this thesis has several clinically useful findings which address areas for improvement during the patient journey after TIA and minor ischaemic stroke. First, I have highlighted that despite public education campaigns, about 70% of patients still fail to correctly recognise TIA or minor stroke symptoms and about 30% delay seeking medical attention for over 24 hours. Second, I have shown that recurrent TIA within 7-days is not associated with a greater stroke risk than after a single TIA, other than in the capsular warning syndrome. Third, in patients with definite posterior circulation TIA or stroke, preceding transient isolated “brainstem” symptoms occur in 26%, which has implications for the current diagnostic criteria for TIA. Fourth, I have shown that the Face Arm and Speech Test does not reliably identify patients at high early risk of recurrent stroke after TIA and minor stroke and has limited potential to improve access to care. Fifth, I have shown that outpatient management of clinic-referred minor stroke is feasible and may be as safe as inpatient care. Sixth, that stroke recurrence risk after minor stroke is delayed compared with TIA, and is high during the subacute phase despite current best medical treatment. Seventh, I have assessed Bluetooth- based home BP monitoring after TIA or minor stroke as a way of achieving better BP control and shown that this method is feasible, irrespective of age, and patient satisfaction is high. Finally, I have studied the late outcomes after TIA and stroke in OXVASC in comparison with a similar cohort from the 1980’s. I have shown that the age and sex specific later risk of recurrent stroke after TIA and stroke in Oxfordshire has fallen. However, the risk of fatal recurrent stroke remains high in contrast with the risk of fatal cardiac events which is low.

Bakgrund: Stroke är en av de vanligaste orsakerna till funktionsnedsättningar och död i Sverige. De flesta som fått en stroke blir beroende av stöd från sina anhöriga. Anhöriga bör delta i vården av den som fått stroke för att underlätta i deras tillvaro. Syfte: Att beskriva upplevelsen av att vara anhörig till en människa som har fått stroke. Metod: En litteraturstudie med tio kvalitativa vetenskapliga artiklar med beskrivande syntes. Resultat: Först kände de anhöriga en osäkerhet över situationen, en känsla av kaos uppstod och de var oroliga inför framtiden. Sedan kände de anhöriga sig ensamma i tillvaron, de upplevde brist i stödet från hälso- och sjukvården samt obehag över det stora ansvaret som nu följde. De anhöriga började sedan acceptera framtiden, de kände tacksamhet över sin livssituation och de började omprioritera sitt liv. Slutsats: Genom att låta sjuksköterskor ta del av de anhörigas upplevelser kan de ge bättre och mer anpassad information och stöd individuellt till de anhöriga. Detta skulle ge patienten ett bättre stöd och minska onödigt lidande. / Background: In Sweden, Stroke is one of the most common causes to disability and death. Stroke can provide serious consequences and most of patients need to be helped by their close family members. It is important for close family members to be involved in the care of patients who have had a stroke to facilitate the life. Aim: To describe the experience of being a close family member of a person who has had a stroke. Method: A literature review based on ten qualitative scientific articles with descriptive synthesis. Result: At first, close family members felt the uncertainty of the situation because of a sense of chaos and worries about future. At second, they felt loneliness in life because they experienced a lack of support from health care and overwhelming responsibility that followed. Lastly, the family members accepted the future because they felt gratitude for their lives and they began to re-prioritize their life. Conclusion: By allowing nurses to take more knowledge of the family members' experience, they can understand why it is important to provide better and more detailed and individual support to the family members. This would give the patient a better support and reduce unnecessary suffering.

No description available.

Bakgrund: Stroke är en av Sveriges folksjukdomar och den främsta anledningen till att vuxna personer drabbas av funktionsnedsättningar. Sjukdomen innebär en stor omställning för patienten då den medför en förändrad vardag. Det är en av många faktorer som påverkar patientens livskvalitet. Rehabilitering och stöd från interdisciplinärt team och närstående är viktiga delar för snabbare återhämtning. Syfte: Syftet var att beskriva patienters upplevelser av vardagslivet efter stroke. Metod: Metoden var en litteraturöversikt baserad på kvalitativa artiklar som analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i tre huvudkategorier; förändrad tillvaro, förändrad identitet och behov av hjälp framåt. Patienterna upplevde en förändrad vardag på grund av de omständigheter stroke gav. Hemmet och anhöriga var två viktiga faktorer för att patienterna skulle känna trygghet. Fysiska och psykiska förändringar till följd av stroke gjorde att patienterna upplevde sin kropp som främmande. De fick lära sig att tolka sin nya kropp vilket upplevdes påfrestande. De behövde verktyg för att kunna hantera sin nya vardag och den förändrade kroppen vilket de erhöll från det interdisciplinära teamet. Konklusion: Patienternas upplevda livskvalitet påverkades negativt på grund av livsomställningarna efter stroke. Vad som gav mening och sammanhang blev tydligare för patienterna och att återgå till sitt ”gamla jag” var något som patienterna prioriterade högt. Viktigt för återhämtningen var det sociala och professionella stödet. De bildade tillsammans ett säkerhetsnät för patienten och möjliggjorde en meningsfull framtid. / Background: Stroke is one of the most common diseases in Sweden and the primary reason why adults get disabilities. Stroke means a great conversion for the patient which leads to a changed everyday life. There are many factors that affects the patients’ quality of life. Rehabilitation and support from the interdisciplinary team and family are important for efficiency of the recovery. Aim: The aim of this study was to describe patients’ experiences of everyday life after stroke. Method: The method was a literature review based on qualitative studies and were analyzed with qualitative content analysis. Results: The analyses resulted in three main catagories; changed living, changed identity and needs of help forward. Patients experienced a changed living because of the circumstances their stroke gave them. Their home and closest family were two main factors for the patients to feel safe. Because of the stroke patients received a new body that meant both physical and psychological changes. The patients got to learn their new body which was experienced as demanding. Patients needed tools to be able to handle their new everyday life and changed body, which they received from the interdisciplinary team. Conclusion: Patients experienced that their quality of life was affected negativly because of the life adjusment after the stroke. What gave the patients meaning and connection became more clear after the stroke, to revert the ”old me” were highly priotitized. The social and profesional support was important for the rehabilitation. Together they created a saftey net for the patient and enabled a meaningful future.

The stroke rate in Virginia is above the national rate. Stroke results in poor quality health, morbidity, and mortality. This quantitative epidemiological study was conducted to investigate whether a significant association exists between stroke and (a) socioeconomic and (b) neighborhood factors among people who were admitted to Virginia hospitals between 2010 and 2015. An ecological design, including ecosocial theory, was used to examine associations between environmental factors and stroke. Data (746 census output areas) were acquired using patients' billing zip codes from the Virginia Health Information System in combination with socioeconomic and neighborhood data by Zip Code Tabulation Area from the U.S. Census Bureau and the U.S. Food and Drug Administration. Results of linear regression analysis showed a significant association between stroke hospitalization rate and educational attainment, per capita income, and Gini coefficient for income distribution. Also, a significant association emerged between stroke and neighborhood risk factors such as food access, Walkability Index, and population density. Findings from a one-way ANOVA showed a significant geographic difference in stroke hospitalization rate with the highest stroke rate in eastern Virginia and the lowest stroke rate in northern Virginia. Results may help stakeholders, policymakers, and public health agencies design, prioritize, and implement community-based prevention programs to reduce stroke rates in Virginia.