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

The impact, time trends and potential for prevention of premature deaths in Canada were assessed. There were almost 100,000 deaths before age 75 in Canada during 1986 resulting in over 1.7 million potential years of life lost (PYLL). The three leading broad disease categories responsible for PYLL were cancer, injuries/violence and cardiovascular disease. In both sexes, coronary heart disease, car accidents, lung cancer and perinatal conditions ranked in the top 5 specific diseases responsible for PYLL; breast cancer (females) and suicide (males) also ranked in the top 5 conditions. Over the period 1969 to 1986, death rates among persons less than age 75 increased for 3 conditions among females and 11 conditions among males. Lung cancer and brain cancer death rates increased in both sexes, chronic obstructive pulmonary disease death rates increased among females only and death rates for suicide and 8 types of cancer increased among males only. Over the same period, death rates declined for 37 discrete disease categories among both females and males including particularly large improvements for coronary heart disease, stroke, car accidents and perinatal conditions. An estimated 50,000 or over 50% of all premature deaths per year are preventable through control of smoking, hypertension, elevated serum cholesterol, diabetes and alcohol abuse. About 6,000 premature deaths are avoidable through improvements in medical care.
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PMID:Premature deaths in Canada: impact, trends and opportunities for prevention. 225 55

We have studied 97 patients with dementia who have been discharged from our hospital and 106 inpatients with dementia who have been admitted during last two years in our hospital. The diagnosis of dementia was done according to the criteria of DSM-III. Based on their clinical course, neurological signs, Hachinski's ischemic score and neuroradiological findings, we divided patients into 4 groups, [senile dementia of the Alzheimer type (SDAT), vascular dementia (VD), unclassified dementia and other dementias which includes dementia with Parkinson's disease or motor neuron disease, etc.]. Concerning 70 demented patients who died during hospitalization, the average age of onset and the duration of illness of SDAT were 80.5 years old and 4.6 years respectively and those of VD were 77.6 years old and 2.7 years respectively. The common causes of death were pneumonia (50%) and cardiac failure (24%). Recurrence of cerebral vascular accident (CVA) was also another frequent cause of death in VD. The most common behavioral problems causing admission in patients of SDAT were aimless wandering, nocturnal delirium, illusion and hallucination. In VD, nocturnal delirium, aimless wandering, violence and abnormal monologue were most common causes of admission. The important causes degrading ADL of inpatients were fracture, especially fracture of the hip joint, pneumonia, intestinal bleeding and CVA. Concerning the increase of the population of over 75 years old, it will be suggested that the care and treatment of demented patients in this age group will become a major social problem.
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PMID:[Clinical and epidemiological studies on inpatients with dementia]. 238 92

For more than 30 years, clinical observations to link alcohol abuse and stroke have accumulated in several countries. Studies of general populations have indicated that the risk for stroke increases with increasing alcohol consumption. Studies of young victims of stroke where the classical risk factors of stroke are uncommon, have demonstrated that even occasional heavy drinking carries an increased risk for stroke. In particular, the increased occurrence of strokes during weekends, the very time of heavy alcohol consumption in non-alcoholics, supports this notion. Alcoholics seem to get their strokes at an earlier age than non-alcoholics. Paradoxically, the published evidence has implicated drinking in both ischemic and hemorrhagic strokes, which suggests that there may be more than one mechanism by which alcohol can increase the risk. Strokes seem to be precipitated during the alcohol intoxication itself rather than the following withdrawal syndrome, but the contributing mechanisms, except for bleedings caused by external violence, are unknown. Alcohol can produce fluctuations in platelet reactivity and untoward interactions with certain drugs, but it remains to be demonstrated that such effects are temporally related to the onset of ischemic and hemorrhagic strokes.
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PMID:What supports the role of alcohol as a risk factor for stroke? 331 65

The analysis concerns the two rural Italian cohorts of the Seven Countries Study and includes 1,712 men who, at the entry examination in 1960, were aged 40-59 years and whose 20-year follow-up examinations were complete for life status, dates, and causes of death. Excluded were 175 men because they lacked one or more of the risk factors selected for the study. A total of 517 deaths occurred in the remaining 1,537 men. The Cox proportional hazards regression model was applied with a forward procedure to include the entry risk factors in the model. First, total mortality was used as the endpoint. Then the risk factors identified as being related to total mortality were used to predict specific causes of death, i.e., coronary heart disease, stroke, cancer, violent death, and other causes. Blood pressure appeared as a nonspecific risk factor for all causes, including cancer and violence, forced expiratory volume and arm circumference appeared as nonspecific risk factors, smoking habits could not be easily classified, and cholesterol was definitely specific only for coronary deaths. Models for estimating survival probabilities from total mortality and from any of several causes of death are provided.
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PMID:Coronary risk factors and survival probability from coronary and other causes of death. 361 76

The association of frequency of alcohol consumption with the seven-year incidence of coronary heart-disease and with mortality both from all causes and from specific causes was examined in a cohort of 11 121 Yugoslav males aged 35-62 at the time of their initial examination. Consumption of alcohol seemed to be inversely related to incidence of coronary heart-disease morbidity and mortality, but not to risk of dying. Those consuming alcoholic beverages most frequently were at increased risk of death from stroke and accidents or violence. The frequency of alcohol consumption was associated with high blood-pressure and serum cholesterol levels. The associations with coronary heart disease and death from all causes could not be fully explained by these covariates.
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PMID:Frequency of alcohol consumption and morbidity and mortality: The Yugoslavia Cardiovascular Disease Study. 610 25

This is a further report on the mortality amongst men in the W.H.O. cooperative trial of the primary prevention of ischaemic heart disease (IHD) by clofibrate. Mean observation was 9.6 years, 5.3 in the trial and 4.3 afterwards; 911 deaths are recorded in 150 000 man-years. There were 25% more deaths in the clofibrate-treated group than in the comparable, high serum cholesterol, control group (p < 0.01), and there was an excess in the treated group in all the three participating centres. Mortality from all causes was higher in the treated group than in the high cholesterol controls during the trial, equal in the first two years after leaving the trial, but higher again after that. No particular disease accounted for the overall excess: the treated group had more deaths from IHD, stroke, cancer, and other major diseases though most of these differences were not individually significant. There was no excess in deaths due to accidents and violence. There was also a significant excess in the death rate from all causes, and from causes other than IHD, in the treated group compared with the second, low cholesterol, control group. No relationship could be shown between the excess mortality and cholesterol reduction, or the length of time on clofibrate. Explanation of the excess mortality is not apparent: a long term toxic effect of clofibrate, the possible consequences of reducing body cholesterol pools and, remotely, chance have all to be considered.
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PMID:W.H.O. cooperative trial on primary prevention of ischaemic heart disease using clofibrate to lower serum cholesterol: mortality follow-up. Report of the Committee of Principal Investigators. 610 15

Complete evaluation of older patients with mental changes always leaves us with a certain percentage whose condition can only be attributed to atherosclerosis. Little is being done for these patients because this generalized stenosis of the brain does not reverse with any known treatment. This writer has treated many such patients with hyperbaric oxygen (HBO), and presents this case history, along with regional cerebral blood flow (rCBF) studies, showing the type of changes which frequently occur. This case initially presented with symptoms of gross mental confusion, memory loss, both recent and remote, irrational speech and occasional violence. Although prior complete evaluations were concluded with no recommended treatment, the initial series of HBO treatment resulted in a well-functioning patient. This was maintained for four years with intermittent HBO. The patient then presented with acute stroke, total disorientation and confusion. He again became functional with HBO. A discussion of the mechanisms of HBO which might account for the changes is given.
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PMID:Generalized small-vessel stenosis in the brain. A case history of a patient treated with monoplace hyperbaric oxygen at 1.5 to 2 ATA. 688 86

Within the Seven Countries Study two Japanese cohorts of men aged 40-59 were enrolled, one from the farming village of Tanushimaru (n = 508) and the other from the fishing village of Ushibuka (n = 502), both located in Kyushu. Cardiovascular risk factors were measured at entry and 10 years later in the survivors. The 25-year death rate for all causes was 30% higher in Ushibuka than in Tanushimaru (p < 0.001) and higher also from specific causes except for violence. Baseline differences in the levels of age, blood pressure, serum cholesterol, smoking habits, body mass index and heart rate explained only 19% of the difference in all-cause mortality between the two towns. Multivariate models from data of the pooled cohorts showed that age was a significant predictor of coronary heart disease, stroke, cancer, all other causes and all-cause mortality. Cigarette smoking predicted coronary heart disease, cancer and all-cause mortality. Systolic blood pressure predicted coronary heart disease, stroke and all-cause mortality. Serum cholesterol, body mass index and heart rate predicted none of these five causes of death. Changes in systolic blood pressure during the first 10 years of follow-up were directly related to deaths between 10 and 25 years of follow-up, significantly improving the predictive power of the multivariate model. Changes in the other risk factors did not contribute, however, to improved prediction.
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PMID:The seven countries study in Japan. Twenty-five-year experience in cardiovascular and all-causes deaths. 759 38

Using Healthy People 2000 as the source document, regional task forces were formed at the request of the Health Promotion Section of the California Department of Health Services to set health promotion objectives and recommendations for the state's ethnic populations. The topics chosen by regional African-American task forces were (1) violence and abusive behavior, (2) physical activity and fitness, (3) nutrition, (4) tobacco, (5) educational and community-based programs, (6) cancer, and (7) heart disease and stroke. Objectives were expanded, linked together, and revised to meet felt needs. The regional task forces presented the first draft of the document for review at the Multiethnic Health Promotion Conference held in Sacramento, California, June 11 through 13, 1991. The expanded task force, including conference participants, amended the recommendations and ranked the topic areas in order of priority. The group also responded to the challenge of developing implementation strategies for the recommendations. We discuss the early stages of dissemination and implementation of the agenda among California African-American communities. American Indian, Asian/Pacific Islander, and Latino Task Forces have prepared similar documents, and each document will be used to prepare the Multiethnic Health Promotion Agenda for California. We summarize the process by which the papers were developed and provide detailed analysis of the African-American process.
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PMID:A model for implementing Healthy People 2000 objectives in African-American communities in California. 832 93

This study represents a first attempt to identify some of the clinical and pathoanatomical correlates of violent outbursts in patients with cerebrovascular accident. Subjects were selected from a population of patients hospitalized with acute stroke. Although we did not have behavioral measures of violent behavior, patients who reported having had violent outbursts were identified based on clinical ratings on a structured interview. Subjects were asked if they had experienced episodes of anger accompanied by behaviors ranging from shouting to violence during the time since their stroke. These patients were compared with controls matched for demographic variables. Violent patients had higher total Present State Exam and Hamilton-D scores. The percentage of patients with cognitive impairment in the angry outburst group (66%) was greater than the control group (22%). Outburst patients had a higher frequency of left-hemisphere lesions (46.7%) compared with controls (29.4%). When lesion volumes were statistically equated, proximity of lesion to the frontal pole was one of the factors related to the self-reported irritable/violent behavior. To determine whether depression explained our findings, we carried out two-way analyses of variance with angry outburst and major depression group membership as factors. Effects of left anterior lesion location and cognitive impairment on violence remained present. These findings suggest that the potential for anger and violence in patients with stroke has multiple clinical and neuropathological correlates, including greater cognitive impairment and left anterior hemisphere lesions.
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PMID:Self-reported aggressive behavior in patients with stroke. 899 58


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