In Saskatchewan, stroke is the third leading cause of death as well was the major cause of adult disability. Once a person suffers a stroke or transient ischemic attack (TIA), they are at high risk for having a secondary (or recurrent) stroke. Despite this knowledge, secondary stroke prevention is often overlooked in the care of stroke/TIA patients. With the vision of decreasing the incidence and impact of stroke in Saskatchewan, the Saskatchewan Integrated Stroke Strategy (SISS) was recently implemented. The purpose of this study is to begin the development of an evaluation measurement system for the SISS based on the guidelines and measures from the Canadian Stroke Strategy (CSS) specifically pertaining to secondary stroke prevention.<p> This multi-year cross-sectional study is an analysis of de-identified health data derived from linkage of administrative and laboratory data. Select indicators from the CSS Performance Measurement Manual involving medications use for secondary stroke prevention (antihypertensives, antilipidemics, anticoagulants) and intermediate health outcomes (serum LDL cholesterol, INR) are calculated. Regression is used to quantify the association of patient demographic and socioeconomic characteristics and geographic location of care with receipt of guideline-recommended secondary stroke prevention. The target population is Saskatchewan residents who have been hospitalized for a stroke or TIA between April 1, 2001 and March 31, 2008.<p> The results of this study indicated that secondary stroke prevention in Saskatchewan is sub-optimal in the management of hypertension, dyslipidemia, and atrial fibrillation. Although there has been some improvement over the time period, a significant number of patients are not taking the recommended medications at discharge from acute care. Similarly, a considerable number of patients are not receiving the appropriate laboratory tests within the year following their stroke event. Through regression analysis it was revealed that a number of correlates (ie. age, income, on medication before the stroke event) were significantly associated with receiving these specific elements of secondary stroke prevention, suggesting potential differences in provision of care. Finally, regional differences in secondary stroke prevention were found for a number of the outcomes, which may indicate differences in care throughout the province.<p> The findings of this study serve as a baseline for evaluation of the impact of the Saskatchewan Integrated Stroke Strategy in the area of secondary stroke prevention. The results make apparent the fact that secondary stroke prevention in Saskatchewan can be improved, and that there is much opportunity for future research in this area.

In Saskatchewan, stroke is the third leading cause of death as well was the major cause of adult disability. Once a person suffers a stroke or transient ischemic attack (TIA), they are at high risk for having a secondary (or recurrent) stroke. Despite this knowledge, secondary stroke prevention is often overlooked in the care of stroke/TIA patients. With the vision of decreasing the incidence and impact of stroke in Saskatchewan, the Saskatchewan Integrated Stroke Strategy (SISS) was recently implemented. The purpose of this study is to begin the development of an evaluation measurement system for the SISS based on the guidelines and measures from the Canadian Stroke Strategy (CSS) specifically pertaining to secondary stroke prevention.<p> This multi-year cross-sectional study is an analysis of de-identified health data derived from linkage of administrative and laboratory data. Select indicators from the CSS Performance Measurement Manual involving medications use for secondary stroke prevention (antihypertensives, antilipidemics, anticoagulants) and intermediate health outcomes (serum LDL cholesterol, INR) are calculated. Regression is used to quantify the association of patient demographic and socioeconomic characteristics and geographic location of care with receipt of guideline-recommended secondary stroke prevention. The target population is Saskatchewan residents who have been hospitalized for a stroke or TIA between April 1, 2001 and March 31, 2008.<p> The results of this study indicated that secondary stroke prevention in Saskatchewan is sub-optimal in the management of hypertension, dyslipidemia, and atrial fibrillation. Although there has been some improvement over the time period, a significant number of patients are not taking the recommended medications at discharge from acute care. Similarly, a considerable number of patients are not receiving the appropriate laboratory tests within the year following their stroke event. Through regression analysis it was revealed that a number of correlates (ie. age, income, on medication before the stroke event) were significantly associated with receiving these specific elements of secondary stroke prevention, suggesting potential differences in provision of care. Finally, regional differences in secondary stroke prevention were found for a number of the outcomes, which may indicate differences in care throughout the province.<p> The findings of this study serve as a baseline for evaluation of the impact of the Saskatchewan Integrated Stroke Strategy in the area of secondary stroke prevention. The results make apparent the fact that secondary stroke prevention in Saskatchewan can be improved, and that there is much opportunity for future research in this area.

Stroke, which has an increasing incidence with age, causes an irreversible brain damage which may lead to impairment, disability and decreased life satisfaction or death. Risk factors for death, recurrent stroke and myocardial infarction, were analyzed in 409 stroke patients treated at the Stroke Unit, Department of Medicine, Umeå University Hospital, between Jan. 1, 1978 and Dec. 31, 1982. The causes of death were related with the time of survival. In fully co-operable (n=62) 4-6 year stroke survivors, the occurrence of motor and perceptual impairments, of self-care (ADL) disability and of self-reported decreased life satisfaction due to stroke was determined. The probability of survival was 77% three months after stroke, 69% after one year, and 37% after five years. Multivariate statistical analysis indicated that impairment of consciousness was the most important risk factor for death followed by age, previous cardiac failure, diabetes mellitus, intracerebral hemorrhage and male sex. During the first week, cerebrovascular disease (90%) was the most dominant primary cause of death, from the second to the fourth week pulmonary embolism (30%), bronchopneumonia during the second and third months and cardiac disease (37%) later than three months after stroke. The risk of recurrence was 14% during the first year after stroke and the accumulated risk of stroke recurrence after 5 years was 37% after stroke. The estimated probability of myocardial infarction was 7% at one year and 19% at 5 years. High age and a history of cardiac failure increased the risk of recurrent stroke. The risk of myocardial infarction was associated with high age, angina pectoris and diabetes mellitus. The highest risk of epilepsy was found between 6 and 12 months after stroke. Motor impairment prevailed in 36% of the long-term survivors, perceptual impairments in up to 57% and decreased ADL-capacity in 32%. As regards ecological perception, perceptual function variables were distinctly grouped into low and high level perception which together with motor function explained 71% of the variance of self-care ADL. While levels of global and of domain specific variables of life satisfaction appeared stable in clinically healthy reference populations aged 60 and 80 years, the stroke had produced a decrease in one or more aspects of life satisfaction for 61% of the long-term survivors. Although significantly associated with motor impairments and ADL disability, these changes could not only be attributed to physical problems. / <p>S. 1-48: sammanfattning, s. 49-114: 5 uppsatser</p> / digitalisering@umu

Σκοπός είναι να ερευνηθεί αν οι μετρήσεις του Πάχος του Ενδοθηλίου των Κοινών Καρωτίδων (ΠΕΚΚΑ) σε ασθενείς με Αγγειακό Εγκεφαλικό Επεισόδιο (ΑΕΕ) σχετίζονται με την άμεση ή μακροπρόθεση έκβαση του ΑΕΕ, με την μελλοντική εμφάνιση νοητικής έκπτωσης ή κατάθλιψης και με την υποτροπή του ΑΕΕ. ΜΕΘΟΔΟΙ: 284 ασθενείς με πρώτο ισχαιμικό ΑΕΕ που υποβλήθηκαν σε υπερηχογραφική μέτρηση του ΠΕΚΚΑ στην οξεία φάση, παρακολουθήθηκαν για ένα χρόνο. Η άμεση έκβαση εκτιμήθηκε κατά την έξοδο, ενώ η μακροπρόθεσμη έκβαση, η νοητική και συναισθηματική κατάσταση εκτιμήθηκαν μετά από 12 μήνες. Επίσης καταγράφηκαν οι υποτροπές στη διάρκεια του πρώτου χρόνου. ΑΠΟΤΕΛΕΣΜΑΤΑ: το ΠΕΚΚΑ δε συσχετιζόταν με την άμεση ή μακροπρόθεσμη έκβαση του ΑΕΕ ούτε με την ύπαρξη κατάθλιψης ένα χρόνο αργότερα. Αντίθετα, αυξημένες τιμές ΠΕΚΚΑ σχετίζονταν σημαντικά και ανεξάρτητα τόσο με την ύπαρξη νοητικής έκπτωσης 12 μήνες αργότερα όσο και με τoν κίνδυνο υποτροπής του ΑΕΕ κατά τη διάρκεια του πρώτου χρόνου. ΣΥΜΠΕΡΑΣΜΑ: οι μετρήσεις του ΠΕΚΚΑ αμέσως μετά από ισχαιμικό ΑΕΕ μπορεί να χρησιμεύουν στην αναγνώριση ασθενών με αυξημένο κίνδυνο για μελλοντική νοητική έκπτωση ή υποτροπή του ΑΕΕ. / Thesis objective is to investigate whether the measurements of Common Carotid Artery Intima Media Thickness (CCA-imt) in patients with acute stroke are associated with the stroke outcome, either short term or long term, with the future development of post stroke cognitive impairment and post stroke depression and with stroke recurrences within the first year after the stroke. METHODS: 284 consequent patients with first ever ischaemic stroke that underwent carotid ultrasonographic measurement of CCA-imt in the acute phase, were followed-up for one year. The short-term outcome was assessed at discharge. The long-term outcome and the presence of cognitive impairment and depressive symptoms were assessed 12 months later. The number of recurrences within the first year was also recorded. RESULTS: CCA-imt values were not associated with the short- or long-term stroke outcome or the presence of depression one year after the ictus. On the contrary, increased CCA-imt values were significantly and independently associated with cognitive impairment and with the risk of recurrence during the first year. CONCLUSION: measurements of CCA-imt right in the acute phase after an ischaemic stroke can help with the identification of patients in higher risk for future cognitive impairment and stroke recurrence.