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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Reducing health risk factors in childhood is a critical component of well-child pediatric care. Risks to eventual adult health status must be considered with equal importance as risks to the child's immediate health. Heart disease, cancer and stroke risk begins in childhood, when risk factors, especially obesity and positive family history, may easily be identified. Obese children (and those at high risk of obesity based on parental obesity) constitute a special group of children for whom chronic disease risk factor evaluation is of particular importance. This is based on observations that cardiovascular risk factors tend to aggregate among obese children (similar to adults), particularly with respect to elevated blood pressure, elevated serum cholesterol and triglycerides, and decreased cardiovascular response to exercise. In addition, many obese adolescents adopt cigarette smoking with the notion that it may aid weight reduction, thereby compounding their risk status. Risk reduction in childhood can be successfully approached both through school-based programs incorporating risk evaluation with health education curricula, or by relatively simple office- or clinic-based procedures designed to evaluate and track risk status over time. Such practices, though not currently prevalent, are increasingly being incorporated into routine pediatric care, especially following the American Association of Pediatrics Nutrition Committee's recommendations with respect to children with positive family histories for early coronary events.
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PMID:Nutrition intervention and health risk reduction in childhood: creating healthy adults. 657 Nov 57

Hypertension is the most common chronic disease in the West Indies, and is a major health problem today being among the 10 most common causes of death in the English-speaking territories of the region. Most patients have essential hypertension. Renal failure, stroke, and cardiac failure are the most common complications, myocardial infarction being relatively uncommon in black patients. While an earlier report from the Caribbean suggested that beta-blockers were not effective for treating black hypertensives, recent experience with these drugs show that they are useful particularly when administered along with a diuretic. Beta-blockers may be required in higher doses than those commonly recommended for patients in Europe and North America, but even small doses of thiazide diuretics are effective in lowering the blood pressure of West Indian hypertensives. West Indians show a combination of personalistic, naturalistic, and modern medical beliefs, which need to be understood in order to mount effective programmes for the management of hypertension in the community.
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PMID:Hypertension in the West Indies. 664 70

An analysis of the effects of diabetes and generalized atherosclerosis on death due to ischemic heart disease or stroke was conducted using multiple cause mortality statistics. Specifically, all U.S. deaths in 1969 were classified into two groups on the basis of whether diabetes or generalized atherosclerosis was mentioned anywhere on the death certificate. Then race and sex specific analyses were made of ischemic heart disease deaths (or alternately of stroke deaths) using modified life table techniques for each group (one with the specified chronic disease and one without). Comparisons were made of mortality due to the acute circulatory events (ischemic heart disease or stroke) in the two groups to determine the implications of the chronic disease for the progression of the circulatory disease events. It was found, according to expectations, that diabetes and generalized atherosclerosis play very different roles in deaths due to stroke and ischemic heart disease.
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PMID:Mortality of the chronically impaired. 738 60

For the analysis of the impact of major chronic diseases on a population, a life table model is proposed in which the age at death due to specific cause (chronic disease) is postponed. Even though many of the major causes of death related to intrinsic aging processes are impossible to eliminate, these causes might be significantly delayed or retarded. To illustrate the use of this model, the effects of a delay of 5, 10, and 15 years in deaths due to three chronic degenerative diseases (cancer, ischemic heart disease, and stroke) are calculated for specific race-sex components of the U.S. population in 1969. These calculations show that even moderate delays in the progression of major chronic diseases will yield a sizable portion of the total gain in longevity that would be available if the diseases were totally eliminated. Thus, they demonstrate that a life table model based on cause delay provides a more biomedically plausible representation of the health impact of a chronic disease on a population than does the cause elimination life table model. Additionally, the cause-delay model provides a mechanism for incorporating the likely effects of medical innovation on survival.
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PMID:Mortality model based on delays in progression of chronic diseases: alternative to cause elimination model. 743 13

The frontal lobe is the largest lobe of the brain, and it is thus commonly involved in stroke. Moreover, almost one in five strokes is limited to the prerolandic areas. This high frequency of anatomical involvement is in sharp contrast with the apparent rarity of clinical frontal dysfunction in stroke. It is remarkable that frontal behavioral syndromes have been rather uncommonly reported in patients with stroke as compared to patients with other diseases, such as brain tumor. This fact is paradoxical, because an acute process (stroke) is expected to yield more clinical dysfunction than a more chronic disease (tumor). A volume effect may be the main factor leading to this phenomenon. Another interesting aspect of frontal strokes is the contribution of so-called 'silent' strokes, the recurrence of which may nevertheless lead to intellectual decline and compromise recovery from another stroke with more specific neurologic dysfunction. The contribution of stroke to understanding of frontal lobe dysfunction is important, because of the focal nature of this disease, and great opportunity for clinical-topographic classification correlations. One of the first modern attempts to develop a clinical-topographic classification of frontal lobe lesions came from the school of Luria, who tried to delineate three main types of frontal lobe syndromes (premotor syndrome, prefrontal syndrome, medial-frontal syndrome). Recent anatomic correlates using MRI make it possible to improve this classification. We suggest considering six main clinical-anatomic frontal stroke syndromes: (1) prefrontal; (2) premotor; (3) superior medial; (4) orbital-medial; (5) basal forebrain; (6) white matter. Finally, another fascinating topic relates to frontal lobe symptomatology due to stroke sparing the frontal cortex or white matter. This occurs mainly in three instances: lenticulo-capsular stroke, caudate stroke, and thalamic stroke. Studies using blood flow or metabolism measurements suggest that diaschisis (frontal lobe dysfunction from a remote lesion) may play a role. We believe that this is more likely to be related to dynamic interruption of complex circuitry than to static frontal lobe deactivation.
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PMID:Frontal stroke syndromes. 785 50

As the national movement for health care reform gives priority to activities that will achieve better and more efficient delivery of health care services, the cost-effectiveness of services will need to be calculated in some type of standard fashion. Although the cost-effectiveness of preventing and controlling acute diseases (for example, through mass immunization programs) has been well appreciated, less attention has been paid to the chronic diseases, which, in fact, account for the majority of illness and death in the United States today. This paper uses prevention of a common chronic disease, stroke, as a model to illustrate how cost savings measures may be developed and used to guide public policy.
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PMID:Preventing strokes: considerations for developing health policy. 791 82

Based on a systematic review of over 20 cohort studies, a clear association exists, for both men and women, between particularly low cholesterol levels and the rate of non-coronary mortality. The excess in women appears mainly confined to non-cancer causes, particularly respiratory and digestive diseases, while there is also an excess of deaths from cancer seen in men with low cholesterol levels. Higher mortality rates from trauma, haemorrhagic stroke and cirrhosis have also been observed. Much of this association is known to be as a consequence of the disease with a fall in cholesterol levels seen after developing a variety of inflammatory diseases. However, the excess risk of non-coronary heart disease deaths is still apparent by excluding deaths within five years suggesting that effect-cause is not the only explanation. Confounding still remains the most likely explanation for the association with an underlying chronic disease or risk factor causing both the low cholesterol and the fatal event. However, there is still the possibility that some of the increased risk is due to the low cholesterol. This makes it important that appropriately controlled trials of both drug and dietary interventions demonstrate net clinical benefit among those with low levels of coronary risk before cholesterol-lowering strategies are adopted more widely in these groups.
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PMID:Low cholesterol and risk of non-coronary mortality. 800 49

Chronic diseases such as coronary heart disease and diabetes mellitus are uncommon in Eskimos. Total cholesterol levels are generally low, whereas HDL cholesterol levels are higher than those in an age- and sex-matched Danish population. It is frequently assumed that this is mainly due to their dietary pattern, especially with its high content of n-3 polyunsaturated fatty acids, derived from fish and other seafoods. Dietary surveys have shown that the intake of n-3 polyunsaturated fatty acids in Eskimos is about 14 g/day, whereas it is 3 g/day in Denmark and about 0.2 g/day in the United States. However, the Eskimo diet also differs from the Western diet in other aspects, especially in the intake of saturated fatty acids which is low (9 energy-%). The intake of dietary cholesterol is rather high because of the large consumption of seafood. Individually based studies are better suited to disentangle the health effects of different nutrients, inasmuch as confounding factors can be taken into account. Several cohort studies have now shown that the consumption of 1-2 fish meals per week is associated with a reduction in the risk of coronary heart disease. Recently, similar results concerning glucose intolerance and stroke were also reported. These combined data suggest that a diet low in saturated fatty acids, in combination with a low or moderate level of fish consumption, may be of importance in the prevention of diseases such as coronary heart disease, ischemic stroke, and diabetes mellitus.
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PMID:Epidemiologic studies on Eskimos and fish intake. 835 76

Hypertension is the most common chronic disease in the United States and, untreated, results in disability or death due to stroke, heart failure or kidney failure. Fortunately the results of hypertension can be avoided to a large extent by proper treatment. One treatment which is effective in some cases is the restriction of dietary NaCl intake. This review considers the role of dietary NaCl in the genesis, therapy and prevention of hypertension. Most people can eat as much NaCl as they like; they have good kidneys which, within about 24 hours, excrete the NaCl as fast as it is taken in and nothing happens to blood pressure. A few, especially those with kidney disease, do not excrete it as fast as it is taken in and blood pressure rises. They are "salt sensitive". Once hypertension is established, the proportion who are "NaCl sensitive" is much higher. About 60% of people with hypertension respond to a high NaCl intake with a rise in pressure and to NaCl restriction with a fall in pressure and reduction in the need for antihypertensive medication. These are the same people that respond to diuretics with a fall in blood pressure. Many are black and elderly and have low plasma renin activity (low-renin hypertension) but some have normal or high plasma renin activity (normal or high-renin hypertension). Evidence suggests that very early they have a subtle kidney defect which causes them to excrete NaCl and water more slowly, e.g., even before they become hypertensive, black and elderly subjects excrete intravenously administered NaCl more slowly than white and young subjects. How does NaCl retention raise blood pressure? One possibility is that the NaCl retention causes water retention which releases a digitalis-like substance that increases the contractile activity of heart and blood vessels. Another is that the sodium itself penetrates the vascular smooth muscle cell, causing it to contract. "Salt sensitive" hypertension also responds to increased potassium and calcium intakes, perhaps in part because they increase NaCl urinary excretion.
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PMID:Role of dietary salt in hypertension. 852 21

In spite of national interest in gender differences in the presentation and management of chronic disease, limited information is available about possible gender differences in the receipt of thrombolytic therapy after acute myocardial infarction (AMI). As part of an ongoing community-based study of AMI, we examined gender differences in the receipt of thrombolytic therapy among 2885 patients with confirmed AMI. The study sample consisted of 1680 males and 1205 females with validated AMI who were admitted to 16 hospitals in the Worcester, Massachusetts, metropolitan area in four study periods between 1986 and 1991. During the years under study, 24.4% of men and 14.4% of women received thrombolytic therapy. Increases over time in the use of thrombolytic therapy were seen in both men (13.9% in 1986; 31.6% in 1991) and women (3.2% in 1986; and 19.0% in 1991). After controlling for a variety of factors that might affect use of thrombolytic agents, younger age, absence of a history of either congestive heart failure or stroke, and experiencing a Q-wave AMI were associated with receipt of thrombolytic therapy in both men and women; having an anterior AMI also was associated with use of thrombolytic agents in men. Women without as compared with those with a history of angina pectoris were significantly more likely to receive thrombolytics. Men who had Medicare insurance were significantly less likely to receive thrombolytics than were men with other types of health insurance. When this analysis was restricted to patients who were seen in area-wide hospitals within 6 hours of the onset of symptoms suggestive of AMI, similar factors were associated with the receipt of thrombolytic agents in men and women. The results of this community-wide study suggest a marked increase over the 5-year study period in the use of thrombolytic therapy in both men and women, with a greater relative increase observed in women. A relatively similar profile of patients likely to receive thrombolytic therapy was seen in both men and women.
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PMID:Gender differences and factors associated with the receipt of thrombolytic therapy in patients with acute myocardial infarction: a community-wide perspective. 855 18


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