Risultati per: Follow-up dopo colonscopia e polipectomia

Objectives
To determine the frequency of post-traumatic complaints and recovery rate of non-hospitalised patients with minor head injury (MHI) and their relationship with demographic and injury characteristics. We also evaluated the differences between patient groups in this least severe category of brain and head injury.

Design
Prospective cohort follow-up study.

Setting
Patients admitted to the emergency department (ED) of a tertiary hospital in the Netherlands.

Participants
242 patients with MHI (n=100 with head injury only and n=142 with mild traumatic brain injury (mTBI)) discharged home directly after evaluation at the ED.

Outcome measures
The primary outcome measure was incomplete recovery at 3 months measured by the Glasgow Outcome Scale-Extended score

Objectives
To clarify non-alcoholic fatty liver disease (NAFLD) prevalence, risk factors and clinical outcome in an exemplary Chinese population, a cohort of company employees was followed up for 11 years.

Design
Retrospective cohort study.

Setting
Between 2006 and 2016 in Ning bo, China.

Participants
13 032 company employees.

Results
Over 11 years, the prevalence of NAFLD increased from 17.2% to 32.4% (men 20.5%–37% vs women 9.8%–22.2%). Male peak prevalence was between 40 and 60 years of age, whereas highest prevalence in women was at an age of 60 years and older. Logistic and Cox regression revealed 16 risk factors, including body mass index (BMI), albumin, white blood cell, triglycerides (TG), high-density lipoprotein, glutamyl transpeptidase, alanine transaminase, creatinine, urea acid, glucose, systolic blood pressure, diastolic blood pressure, blood sedimentation, haemoglobin, platelet and apolipoprotein B2 (p

Objectives
High socioeconomic status (SES) has been linked to high referral for cardiac rehabilitation (CR). However, the impact of SES on CR utilisation from enrolment to completion is unclear. The objective of this study was to examine whether indicators of SES are associated with not taking up and dropout from CR.

Design
A population-based, follow-up study.

Setting
Hospitals and primary healthcare centres in the Central Denmark Region.

Participant
Patients diagnosed with ischaemic heart disease (IHD) in the hospital and referred for rehabilitation in the primary healthcare setting from 1 September 2017 to 31 August 2018 (n=2018).

Variables
Four SES indicators (education, disposable family income, occupation and cohabitant status) were selected because of their established association with cardiovascular health and CR utilisation. Patients were followed up regarding no uptake of or dropout from CR in the primary healthcare setting.

Statistical methods
The associations between the four SES indicators and either no uptake or dropout from CR were analysed using logistic regression with adjustment for age, sex, nationality and comorbidity.

Results
Overall, 25% (n=507) of the referred patients did not take up CR and 24% (n=377) of the participators dropped out the CR. All adjusted ORs, except one (education/dropout) demonstrated that low SES compared with high are statistically significantly associated with higher odds of not taking up CR and dropout from CR. The ORs ranged from 1.52, 95% CI 1.13 to 2.04 (education/no uptake) to 2.36, 95% CI 1.60 to 3.46 (occupation/dropout).

Conclusions
This study highlights that indicators of SES are important markers of CR utilisation following hospitalisation for IHD.

Introduction
People who experience transient ischaemic attack (TIA) and minor stroke have limited follow-up despite rapid specialist review in hospital. This means they often have unmet needs and feel abandoned following discharge. Care needs after TIA/minor stroke include information provision (diagnosis and stroke risk), stroke prevention (medication and lifestyle change) and holistic care (residual problems and return to work or usual activities). This protocol describes a feasibility study and process evaluation of an intervention to support people after TIA/minor stroke. The study aims to assess the feasibility and acceptability of (1) the intervention and (2) the trial procedures for a future randomised controlled trial of this intervention.

Methods and analysis
This is a multicentre, randomised (1:1) feasibility study with a mixed-methods process evaluation. Sixty participants will be recruited from TIA clinics or stroke wards at three hospital sites (England). Intervention arm participants will be offered a nurse or allied health professional-led follow-up appointment 4 weeks after TIA/minor stroke. The multifaceted intervention includes: a needs checklist, action plan, resources to support management of needs, a general practitioner letter and training to deliver the intervention. Control arm participants will receive usual care. Follow-up will be self-completed questionnaires (12 weeks and 24 weeks) and a clinic appointment (24 weeks). Follow-up questionnaires will measure anxiety, depression, fatigue, health related quality of life, self-efficacy and medication adherence. The clinic appointment will collect body mass index, blood pressure, cholesterol and medication. Assessment of feasibility and acceptability will include quantitative process variables (such as recruitment and questionnaire response rates), structured observations of study processes, and interviews with a subsample of participants and clinical staff.

Ethics and dissemination
Favourable ethical opinion was gained from the Wales Research Ethics Committee (REC) 1 (23 February 2021, REC reference: 21/WA/0036). Study results will be published in peer-reviewed journals and presented at conferences. A lay summary and dissemination strategy will be codesigned with consumers. The lay summary and journal publication will be distributed on social media.

Trial registration number
ISRCTN39864003.

Background
Little is known of physical activity behaviour among adults with a disability and/or chronic disease during and up to 1 year post-rehabilitation. We aimed to explore (1) dose characteristics of physical activity behaviour among adults with physical disabilities and/or chronic diseases during that period, and (2) the effects of personal characteristics and diagnosis on the development of physical activity over time.

Methods
Adults with physical disabilities and/or chronic diseases (N=1256), enrolled in the Rehabilitation, Sports and Active lifestyle study, were followed with questionnaires: 3–6 weeks before (T0) and 14 (T1), 33 (T2) and 52 (T3) weeks after discharge from rehabilitation. Physical activity was assessed with the adapted version of the Short Questionnaire to ASsess Health enhancing physical activity. Dose characteristics of physical activity were descriptively analysed. Multilevel regression models were performed to assess physical activity over time and the effect of personal and diagnosis characteristics on physical activity over time.

Results
Median total physical activity ranged from 1545 (IQR: 853–2453) at T0 to 1710 (IQR: 960–2730) at T3 min/week. Household (495–600 min/week) and light-intensity (900–998 min/week) activities accrued the most minutes. Analyses showed a significant increase in total physical activity moderate-intensity to vigorous-intensity physical activity and work/commuting physical activity for all time points (T1–T3) compared with baseline (T0). Diagnosis, age, sex and body mass index had a significant effect on baseline total physical activity.

Conclusion
Physical activity is highly diverse among adults with physical disabilities and/or chronic diseases. Understanding this diversity in physical activity can help improve physical activity promotion activities.

Background
Gestational weight gain (GWG) is an important indicator of fetal well-being during pregnancy. Inadequate or excessive GWG could have undesirable effects on birth weight. However, information regarding the influence of GWG on birth weight is lacking from the Ethiopian setting.

Objective
This study aimed to determine the influence of GWG and other maternal-related factors on birth weight in Addis Ababa, Ethiopia.

Design and methods
A cohort of pregnant women who received the first antenatal care before or at 16 weeks of gestation in health centres in Addis Ababa were followed from 10 January 2019 to 25 September 2019. Data were collected using a structured questionnaire and medical record reviews. We conducted a multivariable linear regression analysis to determine the independent effect of gestational weight on birth weight.

Results
Of the 395 women enrolled in the study, the participants’ pregnancy outcome was available for 329 (83.3%). The mean birth weight was 3130 (SD, 509) g. The proportion of low birth weight (

Introduction
Multimorbidity, defined as the co-occurrence of two or more long-term medical conditions, is an increasing public health concern worldwide causing enormous burden to individuals, healthcare systems and societies. The most effective way of decreasing the burden caused by multimorbidity is to find tools for its successful prevention but gaps in research evidence limit capacities to develop prevention strategies. The aim of the MOLTO study (Multimorbidity – identifying the most burdensome patterns, risk factors and potentials to reduce future burden) is to provide novel evidence required for cost-effective prevention of multimorbidity by defining the multimorbidity patterns causing the greatest burden at the population level, by examining their risk and protective factors and by estimating the potentials to reduce the future burden.

Methods and analysis
The MOLTO study is based on the data from the Finnish population-based cross-sectional (FINRISK 2002–2012, FinHealth 2017 the Migrant Health and Well-being Study 2010–2012) and longitudinal (Health 2000/2011) health examination surveys with individual-level link to administrative health registers, allowing register-based follow-up for the study participants. Both cross-sectional and longitudinal study designs will be used. Multimorbidity patterns will be defined using latent class analysis. The burden caused by multimorbidity as well as risk and protective factors for multimorbidity will be analysed by survival analysis methods such as Cox proportional hazards and Poisson regression models.

Ethics and dissemination
The survey data have been collected following the legislation at the time of the survey. The ethics committee of the Hospital District of Helsinki and Uusimaa has approved the data collection and register linkages for each survey. The results will be published as peer-reviewed scientific publications.

Stroke, Ahead of Print. Background:Evidence suggests a link between depressive symptoms and risk of subsequent stroke. However, most studies assess depressive symptoms at only one timepoint, with few examining this relationship using repeatedly measured depressive symptoms. This study aimed to examine the relationship between depressive symptom trajectories and risk of incident stroke.Methods:This prospective cohort included 12 520 US individuals aged ≥50 years enrolled in the Health and Retirement Study, free of stroke at study baseline (1998). We used the 8-item Center for Epidemiologic Studies Depression scale to assess depressive symptoms (high defined as ≥3 symptoms; low

Stroke, Ahead of Print. Background:The aim of this study is to investigate the temporal dynamics of small vessel disease (SVD) and the effect of vascular risk factors and baseline SVD burden on progression of SVD with 4 neuroimaging assessments over 14 years in patients with SVD.Methods:Five hundred three patients with sporadic SVD (50–85 years) from the ongoing prospective cohort study (RUN DMC [Radboud University Nijmegen Diffusion Tensor and Magnetic Resonance Cohort]) underwent baseline assessment in 2006 and follow-up in 2011, 2015, and 2020. Vascular risk factors and magnetic resonance imaging markers of SVD were evaluated. Linear mixed-effects model and negative binomial regression model were used to examine the determinants of temporal dynamics of SVD markers.Results:A total of 382 SVD patients (mean [SD] 64.1 [8.4]; 219 men and 163 women) who underwent at least 2 serial brain magnetic resonance imaging scans were included, with mean (SD) follow-up of 11.15 (3.32) years. We found a highly variable temporal course of SVD. Mean (SD) WMH progression rate was 0.6 (0.74) mL/y (range, 0.02–4.73 mL/y) and 13.6% of patients had incident lacunes (1.03%/y) over the 14-year follow-up. About 4% showed net WMH regression over 14 years, whereas 38 out of 361 (10.5%), 5 out of 296 (2%), and 61 out of 231 (26%) patients showed WMH regression for the intervals 2006 to 2011, 2011 to 2015, and 2015 to 2020, respectively. Of these, 29 (76%), 5 (100%), and 57 (93%) showed overall progression across the 14-year follow-up, and the net overall WMH change between first and last scan considering all participants was a net average WMH progression over the 14-year period. Older age was a strong predictor for faster WMH progression and incident lacunes. Patients with mild baseline WMH rarely progressed to severe WMH. In addition, both baseline burden of SVD lesions and vascular risk factors independently and synergistically predicted WMH progression, whereas only baseline SVD burden predicted incident lacunes over the 14-year follow-up.Conclusions:SVD shows pronounced progression over time, but mild WMH rarely progresses to clinically severe WMH. WMH regression is noteworthy during some magnetic resonance imaging intervals, although it could be overall compensated by progression over the long follow-up.

Stroke, Ahead of Print.

Stroke, Volume 53, Issue Suppl_1, Page ATMP104-ATMP104, February 1, 2022. Background:Our prior study showed that Atrial Fibrillation (AFib) and not Left Atrial Dilatation (LAD) was associated with ischemic stroke (IS) in a cross-sectional analysis. We sought to validate these findings in a prospective 5-year follow up study.Methods:Patients with transthoracic ECHO (TTE) completed from March-September 2016 were selected. We obtained new diagnoses of Afib and IS over the interval period of 5 years (2016-21). Regression models were used to analyze LAD, Afib and other covariates as they relate to IS, as well as the association of baseline LAD to subsequent AFib.Results:There were 7988 subjects analyzed. Of those we excluded; 578 had IS before 2016 and an additional 249 patients had no follow-up data. Of the remaining 7161, mean age was 65, 54% females, 52% Caucasian, 43% African American, 9% developed new AFib and 3% had a new IS during follow-up. The median follow-up was 47 months. Also, 54% patients had a normal LA, 13% were mildly, 13% were moderately and 20% were severely dilated, of which 6, 11, 13 and 15% were found to have new AFib, respectively (p

Stroke, Volume 53, Issue Suppl_1, Page A56-A56, February 1, 2022. Objective:We aimed to evaluate which factors contributed to acute ischemic stroke (AIS) following up in stroke clinic post hospitalization.Methods:Single center retrospective analysis of AIS patients from January 2016 to April 2021. Patients were excluded if: died during index hospitalization, discharged to hospice or had incomplete data. We evaluated our primary outcome: factors contributing to patients attending post-discharge appointments and secondary outcome: factors contributing to patients scheduling post-discharge appointments utilizing binomial stepwise logistic regression models. Subgroup analysis compared latency to be seen in follow-up clinic between patients who had an appointment scheduled at discharge compared to those who did not using a Mann-Whitney test.Results:Out of 7960 AIS patients, 2734 were included in this study, 2130 (77.9%) of those patients scheduled an appointment post-discharge, whereas 1649 (60.3%) attended an appointment post-discharge. Patients were more likely to attend a follow-up appointment if scheduled while hospitalized, OR=3.48 [95%CI, 2.94-4.14], p

Stroke, Volume 53, Issue Suppl_1, Page ATP62-ATP62, February 1, 2022. Introduction:Although SSRIs are no longer widely prescribed for post-stroke motor recovery, fluoxetine demonstrated beneficial effects on post-stroke depression (PSD). Given potential side effects of SSRIs, targeted initiation among individuals at highest risk for PSD warrants consideration. While previous studies have identified stroke severity and psychiatric history as factors associated with PSD, the predictability of PSD remains unknown. The purpose of this study is to investigate inpatient predictive factors to better identify individuals who might derive the most benefit from targeted initiation of SSRIs.Methods:All adult patients presenting to our tertiary academic stroke center with acute ischemic stroke between 2016-2020 were enrolled in a prospectively-collected stroke registry. Patients were seen 4-6 weeks post-discharge and a subset were administered the PHQ-9 (Patient Health Questionnaire-9) to screen for PSD (PHQ-9 ≥5). Demographics, history of depression, stroke severity, and inpatient PHQ-9 scores were abstracted. Logistic regression was used to determine factors associated with PSD and an ROC analysis determined the predictability of PSD in the inpatient setting.Results:307 individuals were administered the PHQ-9 at follow-up. This group was younger with less severe strokes, but had no difference in history of depression or inpatient PHQ-9 scores than those without follow-up screening. The mean age of the cohort was 65.5 years; 52% were female. Individuals with history of depression (OR=4.22, 95% CI: 2.40-7.42), inpatient depression (OR=2.82, 95% CI: 1.80-4.43), higher stroke severity (OR=1.05, 95% CI: 1.01-1.10), and those living alone (OR=1.86, 95% CI: 1.01-3.40) had increased odds of PSD at follow-up. Marital status, employment, and outpatient therapy were not associated PSD. The ROC curve using a positive inpatient PHQ-9 achieved an area under the curve (AUC) of 0.62 (95% CI:0.57-0.67), while the AUC was 0.69 (0.64-0.74) after adding history of depression.Conclusion:History of depression and a positive inpatient PHQ-9 appear to be most strongly associated with long-term PSD. Initiating SSRIs only in those individuals at higest risk for PSD may help reduce the burden of stroke recovery in this targeted population.

Stroke, Volume 53, Issue Suppl_1, Page AWP108-AWP108, February 1, 2022. Background:Current guidelines for recanalization treatment are based on the time window between symptom onset and treatment in addition to ischemic core and perfusion lesion volumes by computed tomography perfusion imaging (CTP). Linear growth of infarction is commonly assumed.The aim was to test, whether measured follow-up infract volume (FIV) could be approximated from the linear growth model (eFIV) based on CTP baseline infarct growth rate.We assumed the infarct growth to stop, when recanalization was achieved or when the eFIV reached the volume of the perfusion lesion (Tmax >6s volume).Methods:All consecutive stroke code patients from 11/2015-9/2019 transferred to Helsinki University Hospital as candidates for endovascular treatment (EVT) were screened; patients with large vessel occlusion (LVO), EVT, CTP and known time of symptom onset were included to study.The infarct growth rate was calculated by dividing the CTPcoreby the time from symptom onset to baseline imaging.eFIV was calculated by infarct growth rate multiplied with the time from baseline imaging to recanalization or follow-up imaging. We assumed a performance of +/- 19% for the accuracy of the CTPcoreassessment. FIV was measured from the 24h non-enhanced computed tomography images. Recanalization was defined as modified Treatment in Cerebral Infarction (mTICI) scale as successful (TICI 2b or 3) or futile (TICI 0,1,2a).Results:Out of 5234 patients, 48 had LVO and EVT, CTP imaging and known time of symptom onset (Figure 1). In 40/48 (83%) patients, infarct growth was not within the 19% margins of linear growth. eFIV exceeded FIV in 25/42 patients with successful recanalization (median absolute difference 25 mL,7-73).Conclusions:eFIV from linearly approximated growth model did not support linear growth of the infarct.

Stroke, Volume 53, Issue Suppl_1, Page ATP205-ATP205, February 1, 2022. Introduction:Neutrophil-lymphocyte ratios (NLRs) can be used to assess inflammatory status, with higher NLRs indicating inflammation and physiologic stress. NLRs after ischemic stroke have been shown to predict both short- and long-term outcomes.Methods:This was a retrospective study of adult patients admitted to a high-volume stroke center in 1/1/2018-12/31/2020 for ischemic stroke who underwent endovascular therapy (ET). The primary outcomes were successful reperfusion (TICI score ≥2B), favorable discharge NIH Stroke Scale/Score (NIHSS≤4), and favorable discharge and 3-month modified Rankin Scale (mRS≤2) scores. The primary predictor was neutrophil-lymphocyte ratio (NLR), measured at admission and throughout the hospital stay, as well as change in NLR between admission and post-ET. Logistic regression and generalized estimating equations assessed associations between NLRs and the outcomes.Results:The study included 131 patients, with a median admission NIHSS of 13 and median discharge NIHSS of 1. Almost all patients (94%) achieved successful reperfusion, and only 2 (1.5%) developed symptomatic ICH. The median discharge mRS was 3, and the median 3-month mRS was 2. The median admission NLR was 6.5 (range 0.8-18.0), and the median NLR change (admission to first post-ET) was 0.0 (range -13.8 to 12.0). Each 1-unit increase in admission NLR was associated with a 19% decreased odds of successful perfusion, 16% decreased odds of favorable discharge NIHSS, 15% decreased odds of favorable discharge mRS, and 14% decreased odds of favorable 3-month mRS. Higher post-ET NLRs on various days were also associated with decreased odds of favorable outcomes (Table 1).Conclusions:Admission and select follow-up NLRs were predictive of successful reperfusion and condition at discharge and at 3-months post-discharge in this patient population. These results show that NLRs, a readily available biomarker, can identify individuals at risk for poor outcomes after ET.