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Nguyen MTH, Sakamoto Y, Maeda T, Woodward M, Anderson CS, Catiwa J, Yazidjoglou A, Carcel C, Yang M, Wang X. Influence of Socioeconomic Status on Functional Outcomes After Stroke: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2024; 13:e033078. [PMID: 38639361 DOI: 10.1161/jaha.123.033078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/06/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND This review aimed to quantify the impact of socioeconomic status on functional outcomes from stroke and identify the socioeconomic status indicators that exhibit the highest magnitude of association. METHODS AND RESULTS We performed a systematic literature search across Medline and Embase from inception to May 2022, to identify observational studies (n≥100, and in English). Risk of bias was assessed using the modified Newcastle Ottawa Scale. Random effects meta-analysis was used to pool data. We included 19 studies (157 715 patients, 47.7% women) reporting functional outcomes measured with modified Rankin Scale or Barthel index, with 10 assessed as low risk of bias. Measures of socioeconomic status reported were education (11 studies), income (8), occupation (4), health insurance status (3), and neighborhood socioeconomic deprivation (3). Pooled data suggested that low socioeconomic status was significantly associated with poor functional outcomes, including incomplete education or below high school level versus high school attainment and above (odds ratio [OR], 1.66 [95% CI, 1.40-1.95]), lowest income versus highest income (OR, 1.36 [95% CI, 1.02-1.83]), a manual job/being unemployed versus a nonmanual job/working (OR, 1.62 [95% CI, 1.29-2.02]), and living in the most disadvantaged socioeconomic neighborhood versus the least disadvantaged (OR, 1.55 [95% CI, 1.25-1.92]). Low health insurance status was also associated with an increased risk of poor functional outcomes (OR, 1.32 [95% CI, 0.95-1.84]), although this was association was not statistically significant. CONCLUSIONS Despite great strides in stroke treatment in the past decades, social disadvantage remains a risk factor for poor functional outcome after an acute stroke. Further research is needed to better understand causal mechanisms and disparities.
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Affiliation(s)
- Mai T H Nguyen
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
- Centre of Epidemiology for Policy and Practice, National Centre for Epidemiology and Population Health Australian National University Canberra Australian Capital Territory Australia
| | - Yuki Sakamoto
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
- Department of Neurology Graduate School of Medicine, Nippon Medical School Tokyo Japan
| | - Toshiki Maeda
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
- Department of Preventive Medicine and Public Health, Faculty of Medicine Fukuoka University Fukuoka Japan
| | - Mark Woodward
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
- The George Institute for Global Health, School of Public Health, Imperial College London London United Kingdom
| | - Craig S Anderson
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
- Prince of Wales Clinical School University of New South Wales Sydney New South Wales Australia
- The George Institute China Registered Office of The George Institute for Global Health Australia Beijing China
| | - Jayson Catiwa
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
| | - Amelia Yazidjoglou
- Centre of Epidemiology for Policy and Practice, National Centre for Epidemiology and Population Health Australian National University Canberra Australian Capital Territory Australia
| | - Cheryl Carcel
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
| | - Min Yang
- Department of Neurology First Affiliated Hospital of Chengdu Medical College Chengdu China
| | - Xia Wang
- The George Institute for Global Health, The University of New South Wales Sydney New South Wales Australia
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de Geus EQJ, Milders MV, van Horn JE, Jonker FA, Fassaert T, Hutten JC, Kuipers F, Grimbergen C, Noordermeer SDS. A literature review of outcome and treatment options after acquired brain injury: Suggestions for adult offenders using knowledge from the general population. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2024. [PMID: 38527155 DOI: 10.1002/cbm.2334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 03/05/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Acquired brain injury (ABI) is a major health problem, often with negative effects on behaviour and mental health as well as cognition. Prevalence of ABI is exceptionally high among offenders and increases their re-offending risk. Information on risk factors for ABI and its outcomes among offenders that could guide effective treatment for them is, nevertheless, scarce and dispersed. However, there is a more substantial literature about the general population that could inform work with brain-injured offenders, especially when selecting for samples or subgroups with similar relevant characteristics, such as lower socio-economic status (SES), pre-injury lower tested intelligence score (<85) and pre-injury mental health problems. AIMS To explore brain injury data from non-offender samples of otherwise similar socio-economic and mental health and ability characteristics to offenders then, first, to describe their untreated outcomes and, secondly, outcomes after frequently used interventions in these circumstances, noting factors associated with their effectiveness. METHOD Three databases were systematically searched for the years 2010-2022; first, using terms for brain injury or damage and cognitive (dys)function, mental health or quality of life. Second, in a separate search, we used these terms and terms for interventions and rehabilitation. In the second review, studies were selected for clear, distinguishable data on age, sex, SES and lifestyle factors to facilitate inferences for offenders. A narrative analytical approach was adopted for both reviews. RESULTS Samples with characteristics that are typical in offender groups, including lower SES, lower pre-injury intelligence quotient (<85), prior cognitive impairments and prior mental health problems, had poorer cognitive and behavioural outcomes following ABI than those without such additional problems, together with lower treatment adherence. With respect to treatment, adequate motivation and self-awareness were associated with better cognitive and behavioural outcomes than when these were low or absent, regardless of the outcome measured. CONCLUSIONS More complex pre-injury mental health problems and social disadvantages typical of offenders are associated with poorer post-brain injury recovery. This paper adds to practical knowledge by bringing together work that follows specific outcome trajectories. Overall, succesful ABI-interventions in the general population that aim at pre-injury difficulties comparable to those seen among offenders, show that personalising injury-specific treatments and taking account of these difficulties, maximised positive outcomes.
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Affiliation(s)
- Esther Q J de Geus
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Maarten V Milders
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Frank A Jonker
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Altrecht, Vesalius, Amsterdam, The Netherlands
| | | | | | | | | | - Siri D S Noordermeer
- Faculty of Behavioural Sciences, Department of Clinical Neuro- and Development Psychology, Section of Clinical Neuropsychology, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Malcorra BLC, García AO, Marcotte K, de Paz H, Schilling LP, da Silva Filho IG, Soder R, da Rosa Franco A, Loureiro F, Hübner LC. Exploring Spoken Discourse and Its Neural Correlates in Women With Alzheimer's Disease With Low Levels of Education and Socioeconomic Status. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2024; 33:893-911. [PMID: 38157526 DOI: 10.1044/2023_ajslp-23-00137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
PURPOSE Early impairments in spoken discourse abilities have been identified in Alzheimer's disease (AD). However, the impact of AD on spoken discourse and the associated neuroanatomical correlates have mainly been studied in populations with higher levels of education, although preliminary evidence seems to indicate that socioeconomic status (SES) and level of education have an impact on spoken discourse. The purpose of this study was to analyze microstructural variables in spoken discourse in people with AD with low-to-middle SES and low level of education and to study their association with gray matter (GM) density. METHOD Nine women with AD and 10 matched (age, SES, and education) women without brain injury (WWBI) underwent a neuropsychological assessment, which included two spoken discourse tasks, and structural magnetic resonance imaging. Microstructural variables were extracted from the discourse samples using NILC-Metrix software. Brain density, measured by voxel-based morphometry, was compared between groups and then correlated with the differentiating microstructural variables. RESULTS The AD group produced a lower diversity of verbal time moods and fewer words and sentences than WWBI but a greater diversity of pronouns, prepositions, and lexical richness. At the neural level, the AD group presented a lower GM density bilaterally in the hippocampus, the inferior temporal gyrus, and the anterior cingulate gyrus. Number of words and sentences produced were associated with GM density in the left parahippocampal gyrus, whereas the diversity of verbal moods was associated with the basal ganglia and the anterior cingulate gyrus bilaterally. CONCLUSIONS The present findings are mainly consistent with previous studies conducted in groups with higher levels of SES and education, but they suggest that atrophy in the left inferior temporal gyrus could be critical in AD in populations with lower levels of SES and education. This research provides evidence on the importance of pursuing further studies including people with various SES and education levels. WHAT IS ALREADY KNOWN ON THIS SUBJECT Spoken discourse has been shown to be affected in Alzheimer disease, but most studies have been conducted on individuals with middle-to-high SES and high educational levels. WHAT THIS STUDY ADDS The study reports on microstructural measures of spoken discourse in groups of women in the early stage of AD and healthy women, with low-to-middle SES and lower levels of education. CLINICAL IMPLICATIONS OF THIS STUDY This study highlights the importance of taking into consideration the SES and education level in spoken discourse analysis and in investigating the neural correlates of AD. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24905046.
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Affiliation(s)
- Bárbara Luzia Covatti Malcorra
- Department of Linguistics, School of Humanities, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Alberto Osa García
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Québec, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Québec, Canada
| | - Karine Marcotte
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Québec, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Québec, Canada
| | - Hanna de Paz
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Hôpital du Sacré-Cœur de Montréal, Québec, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Québec, Canada
| | - Lucas Porcello Schilling
- Graduate Course in Medicine and Healthy Sciences, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Graduate Course in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Brain Institute of Rio Grande do Sul (InsCer)Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Institute of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Irênio Gomes da Silva Filho
- Graduate Course in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Ricardo Soder
- Graduate Course in Medicine and Healthy Sciences, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Brain Institute of Rio Grande do Sul (InsCer)Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Alexandre da Rosa Franco
- Center for Biomedical Imaging and Neuromodulation, The Nathan S. Kline for Psychiatric Research, Orangeburg, NY
- Center for the Developing Brain, Child Mind Institute, New York, NY
- Department of Psychiatry, NYU Grossman School of Medicine, New York
| | - Fernanda Loureiro
- Graduate Course in Biomedical Gerontology, School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Lilian Cristine Hübner
- Department of Linguistics, School of Humanities, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Institute of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- National Council for Scientific and Technological Development (CNPq), Brasília, DF, Brazil
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Buus SMØ, Schmitz ML, Cordsen P, Paaske Johnsen S, Andersen G, Simonsen CZ. Socioeconomic Inequalities in Functional Outcome After Reperfusion-Treated Ischemic Stroke. Stroke 2023; 54:2040-2049. [PMID: 37377030 DOI: 10.1161/strokeaha.123.043547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023]
Abstract
BACKGROUND We aimed to investigate whether socioeconomic status (SES) was associated with functional outcome in patients with ischemic stroke treated with reperfusion therapy (intravenous thrombolysis and/or thrombectomy). METHODS This nationwide cohort study included reperfusion-treated patients with ischemic stroke ≥18 years registered in the Danish Stroke Registry between 2015 and 2018. Functional outcome was determined by the modified Rankin Scale score 90 days after stroke. SES was defined by educational attainment, family income, and employment status before stroke. SES data were available from Statistics Denmark and linked on the individual level with data from the Danish Stroke Registry. Uni- and multivariable ordinal logistic regression was performed for each socioeconomic parameter individually (education, income, and employment) to estimate the common odds ratios (cORs) for lower 90-day modified Rankin Scale scores. RESULTS A total of 5666 patients were included. Mean age was 68.7 years (95% CI, 68.3-69.0), and 38.4% were female. Low SES was associated with lower odds for achieving lower 90-day modified Rankin Scale score: Low versus high education, cOR, 0.69 (95% CI, 0.61-0.79), low versus high income, cOR, 0.59 (95% CI, 0.53-0.67), and unemployed versus employed, cOR, 0.70 (95% CI, 0.58-0.83). Inequalities were reduced after adjusting for age, sex, and immigrant status, except for unemployed versus employed patients, adjusted cOR, 0.66 (95% CI, 0.54-0.80). No statistically significant differences remained after adjusting for potentially mediating variables (eg, stroke severity, prestroke modified Rankin Scale, and smoking). CONCLUSIONS Socioeconomic inequalities were observed in functional outcome after reperfusion treated ischemic stroke. In particular, prestroke unemployment was negatively associated with good functional outcome. A more adverse prognostic profile among patients with low SES appeared to explain the majority of these inequalities.
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Affiliation(s)
- Sine Mette Øgendahl Buus
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark (S.M.Ø.B., M.L.S., G.A., C.Z.S.)
| | - Marie Louise Schmitz
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark (S.M.Ø.B., M.L.S., G.A., C.Z.S.)
| | - Pia Cordsen
- Danish Center for Health Services Research, Aalborg University, Gistrup, Denmark (P.C., S.P.J.)
| | - Søren Paaske Johnsen
- Danish Center for Health Services Research, Aalborg University, Gistrup, Denmark (P.C., S.P.J.)
| | - Grethe Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark (S.M.Ø.B., M.L.S., G.A., C.Z.S.)
- Department of Clinical Medicine, Aarhus University, Denmark (G.A., C.Z.S.)
| | - Claus Ziegler Simonsen
- Department of Neurology, Aarhus University Hospital, Aarhus N, Denmark (S.M.Ø.B., M.L.S., G.A., C.Z.S.)
- Department of Clinical Medicine, Aarhus University, Denmark (G.A., C.Z.S.)
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Fitzhugh N, Rasmussen LR, Simoni AH, Valentin JB. Misuse of multinomial logistic regression in stroke related health research: A systematic review of methodology. Eur J Neurosci 2023; 58:3116-3131. [PMID: 37442794 DOI: 10.1111/ejn.16084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 06/13/2023] [Accepted: 06/17/2023] [Indexed: 07/15/2023]
Abstract
Multinomial logistic regression (MLR) is often used to model the association between a nominal outcome variable and one or more covariates. The results of MLR are interpreted as relative risk ratios (RRR) and warrant a more coherent interpretation than ordinary logistic regression. Some authors compare the results of MLR to ordinal logistic regression (OLR), irrespective of the fact that these estimate different quantities. We aim to investigate the time trends in the use and misuse of MLR in studies including stroke patients, specifically the extent to which (1) the results are denoted as anything other than RRR, (2) comparisons are made of results with results of OLR and (3) results have been interpreted coherently. Secondarily, we examine the use of model validation techniques in studies with predictive aims. We searched EMBASE and PubMed for articles using MLR on populations of stroke patients. Identified studies were screened, and information pertaining to our aims was extracted. A total of 285 articles were identified through a systematic literature search, and 68 of these were included in the review. Of these, 60 articles (88%) did not denote exponentiated coefficients of MLR as relative risk ratios but rather some other measure. Additionally, 63 articles (93%) interpreted the results of MLR in a non-coherent manner. Two articles attempted to compare MLR results with those of OLR. Nine studies attempted to use MLR for predictive means, and three used relevant validation techniques. From these findings, it is clear that the interpretation of MLR is often suboptimal.
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Affiliation(s)
- Nicholas Fitzhugh
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
- Danish Health Technology Council (Behandlingsrådet), Aalborg, Denmark
| | - Line Ryberg Rasmussen
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
| | - Amalie Helme Simoni
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
| | - Jan Brink Valentin
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Gistrup, Denmark
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Potter TBH, Tannous J, Pan AP, Bako A, Johnson C, Baig E, Kelly H, McCane CD, Garg T, Gadhia R, Misra V, Volpi J, Britz G, Chiu D, Vahidy FS. Stroke severity mediates the effect of socioeconomic disadvantage on poor outcomes among patients with intracerebral hemorrhage. Front Neurol 2023; 14:1176924. [PMID: 37384280 PMCID: PMC10293742 DOI: 10.3389/fneur.2023.1176924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 05/08/2023] [Indexed: 06/30/2023] Open
Abstract
Background Socioeconomic deprivation drives poor functional outcomes after intracerebral hemorrhage (ICH). Stroke severity and background cerebral small vessel disease (CSVD) burden have each been linked to socioeconomic status and independently contribute to worse outcomes after ICH, providing distinct, plausible pathways for the effects of deprivation. We investigate whether admission stroke severity or cerebral small vessel disease (CSVD) mediates the effect of socioeconomic deprivation on 90-day functional outcomes. Methods Electronic medical record data, including demographics, treatments, comorbidities, and physiological data, were analyzed. CSVD burden was graded from 0 to 4, with severe CSVD categorized as ≥3. High deprivation was assessed for patients in the top 30% of state-level area deprivation index scores. Severe disability or death was defined as a 90-day modified Rankin Scale score of 4-6. Stroke severity (NIH stroke scale (NIHSS)) was classified as: none (0), minor (1-4), moderate (5-15), moderate-severe (16-20), and severe (21+). Univariate and multivariate associations with severe disability or death were determined, with mediation evaluated through structural equation modelling. Results A total of 677 patients were included (46.8% female; 43.9% White, 27.0% Black, 20.7% Hispanic, 6.1% Asian, 2.4% Other). In univariable modelling, high deprivation (odds ratio: 1.54; 95% confidence interval: [1.06-2.23]; p = 0.024), severe CSVD (2.14 [1.42-3.21]; p < 0.001), moderate (8.03 [2.76-17.15]; p < 0.001), moderate-severe (32.79 [11.52-93.29]; p < 0.001), and severe stroke (104.19 [37.66-288.12]; p < 0.001) were associated with severe disability or death. In multivariable modelling, severe CSVD (3.42 [1.75-6.69]; p < 0.001) and moderate (5.84 [2.27-15.01], p < 0.001), moderate-severe (27.59 [7.34-103.69], p < 0.001), and severe stroke (36.41 [9.90-133.85]; p < 0.001) independently increased odds of severe disability or death; high deprivation did not. Stroke severity mediated 94.1% of deprivation's effect on severe disability or death (p = 0.005), while CSVD accounted for 4.9% (p = 0.524). Conclusion CSVD contributed to poor functional outcome independent of socioeconomic deprivation, while stroke severity mediated the effects of deprivation. Improving awareness and trust among disadvantaged communities may reduce admission stroke severity and improve outcomes.
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Affiliation(s)
| | - Jonika Tannous
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Alan P. Pan
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
| | - Abdulaziz Bako
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Carnayla Johnson
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Eman Baig
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Hannah Kelly
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
| | - Charles D. McCane
- Department of Neurology, Houston Methodist, Houston, TX, United States
| | - Tanu Garg
- Department of Neurology, Houston Methodist, Houston, TX, United States
- Department of Neurology, Weill Cornell Medicine, White Plains, NY, United States
- Department of Neurology, Houston Methodist Academic Institute, Houston Methodist, Houston, TX, United States
| | - Rajan Gadhia
- Department of Neurology, Houston Methodist, Houston, TX, United States
- Department of Neurology, Weill Cornell Medicine, White Plains, NY, United States
- Department of Neurology, Houston Methodist Academic Institute, Houston Methodist, Houston, TX, United States
| | - Vivek Misra
- Department of Neurology, Houston Methodist, Houston, TX, United States
- Department of Neurology, Weill Cornell Medicine, White Plains, NY, United States
- Department of Neurology, Houston Methodist Academic Institute, Houston Methodist, Houston, TX, United States
| | - John Volpi
- Department of Neurology, Houston Methodist, Houston, TX, United States
- Department of Neurology, Weill Cornell Medicine, White Plains, NY, United States
- Department of Neurology, Houston Methodist Academic Institute, Houston Methodist, Houston, TX, United States
| | - Gavin Britz
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
- Department of Neurology, Weill Cornell Medicine, White Plains, NY, United States
- Department of Neurology, Houston Methodist Academic Institute, Houston Methodist, Houston, TX, United States
- Department of Neurological Surgery, Houston Methodist Neurological Institute, Houston Methodist, Houston, TX, United States
| | - David Chiu
- Department of Neurology, Houston Methodist, Houston, TX, United States
- Department of Neurology, Weill Cornell Medicine, White Plains, NY, United States
- Department of Neurology, Houston Methodist Academic Institute, Houston Methodist, Houston, TX, United States
| | - Farhaan S. Vahidy
- Department of Neurosurgery, Houston Methodist, Houston, TX, United States
- Center for Health Data Science and Analytics, Houston Methodist, Houston, TX, United States
- Department of Neurology, Weill Cornell Medicine, White Plains, NY, United States
- Department of Neurology, Houston Methodist Academic Institute, Houston Methodist, Houston, TX, United States
- Department of Neurological Surgery, Houston Methodist Neurological Institute, Houston Methodist, Houston, TX, United States
- Department of Population Health Sciences, Weill Cornell Medicine, White Plains, NY, United States
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7
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Townsend SAM, Marcotte K, Brisebois A, Smidarle AD, Schneider F, Loureiro F, Soder RB, Franco ADR, Marrone LCP, Hübner LC. Neuroanatomical correlates of macrostructural receptive abilities in narrative discourse in unilateral left hemisphere stroke: A behavioural and voxel-based morphometry study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:826-847. [PMID: 36448625 DOI: 10.1111/1460-6984.12825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 10/29/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Little is known about story retelling and comprehension abilities in groups with lower levels of education and socio-economic status (SES). A growing body of evidence suggests the role of an extended network supporting narrative comprehension, but few studies have been conducted in clinical populations, even less in developing countries. AIMS To extend our knowledge of the impact of a stroke on macrostructural aspects of discourse processes, namely main and complementary information, in individuals with middle-low to low SES and low levels of education. Relationships were tested between the performance in story retell and comprehension and reading and writing habits (RWH). Also, the associations between retelling and comprehension measures and their structural grey matter (GM) correlates were explored. METHODS & PROCEDURES A total of 17 adults with unilateral left hemisphere (LH) chronic ischaemic stroke without the presence of significant aphasia and 10 matched (age, education and SES) healthy controls (HC) participated in the study. Retell and comprehension tasks were performed after listening or reading narrative stories. Voxel-based morphometry (VBM) analysis was conducted on a subgroup of nine individuals with LH stroke and the 10 matched controls using structural magnetic resonance imaging (MRI). OUTCOMES & RESULTS Retelling and comprehension abilities were not significantly different between LH and HC, nonetheless quantitively lower in LH. Exploratory correlations showed that retelling and comprehension abilities in both written and auditory modalities were correlated with naming abilities. At the neural level, written comprehension positively correlated with GM density of the LH, including areas in the temporal pole, superior and middle temporal gyrus as well as the orbitofrontal cortex, precentral and postcentral gyri. Auditory narrative comprehension was associated with GM density of the lingual gyrus in the right hemisphere. CONCLUSIONS & IMPLICATIONS The present results suggest that retelling and comprehension of auditory and written narratives are relatively well-preserved in individuals with a LH stroke without significant aphasia, but poorer than in HC. The findings replicate previous studies conducted in groups with higher levels of education and SES both at the behavioural and neural levels. Considering that naming seems to be associated with narrative retell and comprehension in individuals with lower SES and education, this research provides evidence on the importance of pursuing further studies including larger samples with and without aphasia as well as with various SES and education levels. WHAT THIS PAPER ADDS What is already known on this subject Story retell and comprehension of auditory and written discourse have been shown to be affected after stroke, but most studies have been conducted on individuals with middle to high SES and high educational levels. What this paper adds to existing knowledge The study reports on narrative retell and comprehension in both auditory and written modalities in groups of HC and individuals with LH brain damage, with low-to-middle SES and lower levels of education. What are the potential or actual clinical implications of this work? This study highlights the importance of taking into consideration the sociodemographic and RWH of patients when assessing discourse retell and comprehension in both auditory and written modalities. It also underlines the importance of including patients without significant aphasia following LH stroke to look at the effect of both stroke and aphasia on narrative comprehension and story retelling.
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Affiliation(s)
- Sabrine Amaral Martins Townsend
- School of Humanities (Linguistics Department), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
- University of Santa Cruz do Sul (UNISC), Postdoctoral Program in Linguistics-Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | - Karine Marcotte
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, QC, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Amelie Brisebois
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, QC, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Anderson Dick Smidarle
- School of Humanities (Linguistics Department), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda Schneider
- Federal Institute of Education, Science and Technology of Rio Grande do Sul (IFRS-Ibirubá), Bento Goncalves, Rio Grande do Sul, Brazil
| | - Fernanda Loureiro
- Institut of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Ricardo Bernardi Soder
- Brain Institute (InsCer), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Alexandre da Rosa Franco
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
- Center for Biomedical Imaging and Neuromodulation, The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
- Center for the Developing Brain, Child Mind Institute, New York, NY, USA
| | - Luiz Carlos Porcello Marrone
- Brain Institute (InsCer), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Neurology Center, Hospital São Lucas at Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
- Medicine School, Luteran University of Brazil (ULBRA), Porto Alegre, Rio Grande do Sul, Brazil
- Morphology Sciences Department, ICBS, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Lilian Cristine Hübner
- School of Humanities (Linguistics Department), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
- National Council for Scientific and Technological Development (CNPq), Federal Capital, Brasília, Brazil
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8
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Nayak A, Bhave AC, Misri Z, Unnikrishnan B, Mahmood A, Joshua AM, Karthikbabu S. Facilitators and barriers of community reintegration among individuals with stroke: a scoping review. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2023. [DOI: 10.1080/21679169.2022.2156599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Akshatha Nayak
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Aishwarya C. Bhave
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Zulkifli Misri
- Department of Neurology, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Amreen Mahmood
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
- Department of Health Professions, Manchester Metropolitan University, Manchester, UK
| | - Abraham M. Joshua
- Department of Physiotherapy, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Suruliraj Karthikbabu
- KMCH College of Physiotherapy, Kovai Medical Center Research and Educational Trust, Coimbatore, The Tamil Nadu Dr. M.G.R. Medical University, Chennai
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9
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Tao C, Yuan Y, Xu Y, Zhang S, Wang Z, Wang S, Liang J, Wang Y. Role of cognitive reserve in ischemic stroke prognosis: A systematic review. Front Neurol 2023; 14:1100469. [PMID: 36908598 PMCID: PMC9992812 DOI: 10.3389/fneur.2023.1100469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 01/26/2023] [Indexed: 02/24/2023] Open
Abstract
Objective This systematic review was performed to identify the role of cognitive reserve (CR) proxies in the functional outcome and mortality prognostication of patients after acute ischemic stroke. Methods PubMed, Embase, Web of Science, and Cochrane Library were comprehensively searched by two independent reviewers from their inception to 31 August 2022, with no restrictions on language. The reference lists of reviews or included articles were also searched. Cohort studies with a follow-up period of ≥3 months identifying the association between CR indicators and the post-stroke functional outcome and mortality were included. The outcome records for patients with hemorrhage and ischemic stroke not reported separately were excluded. The Quality In Prognosis Studies (QUIPS) tool was used to assess the quality of included studies. Results Our search yielded 28 studies (n = 1,14,212) between 2004 and 2022, of which 14 were prospective cohort studies and 14 were retrospective cohort studies. The follow-up period ranged from 3 months to 36 years, and the mean or median age varied from 39.6 to 77.2 years. Of the 28 studies, 15 studies used the functional outcome as their primary outcome interest, and 11 of the 28 studies included the end-point interest of mortality after ischemic stroke. In addition, two of the 28 studies focused on the interest of functional outcomes and mortality. Among the included studies, CR proxies were measured by education, income, occupation, premorbid intelligence quotient, bilingualism, and socioeconomic status, respectively. The quality of the review studies was affected by low to high risk of bias. Conclusion Based on the current literature, patients with ischemic stroke with higher CR proxies may have a lower risk of adverse outcomes. Further prospective studies involving a combination of CR proxies and residuals of fMRI measurements are warranted to determine the contribution of CR to the adverse outcome of ischemic stroke. Systematic review registration PROSPERO, identifier CRD42022332810, https://www.crd.york.ac.uk/PROSPERO/.
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Affiliation(s)
- Chunhua Tao
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China.,School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Yuan Yuan
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China.,Division of Satoyama Nursing and Telecare, Nagano College of Nursing, Komagane, Japan
| | - Yijun Xu
- Department of the Advanced Biomedical Research, Interdisciplinary Graduate School of Medicine, University of Yamanashi, Chuo, Japan
| | - Song Zhang
- Department of Biomedical Science and Institute of Bioscience and Biotechnology, Kangwon National University, Chuncheon-si, Gangwon-do, Republic of Korea
| | - Zheng Wang
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Sican Wang
- School of Nursing and School of Public Health, Yangzhou University, Yangzhou, China
| | - Jingyan Liang
- Department of Anatomy, Medical College, Yangzhou University, Yangzhou, China.,Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou University, Yangzhou, China
| | - Yingge Wang
- Department of Neurology, Affiliated Hospital of Yangzhou University, Yangzhou, China
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10
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Moraes MDA, Jesus PAD, Muniz LS, Baccin CA, Barreto ABM, Sales RS, Pires CGDS, Teles CADS, Mussi FC. Arrival time at a referral hospital and functional disability of people with stroke: a cohort study. SAO PAULO MED J 2023; 141:e2022510. [PMID: 37194766 DOI: 10.1590/1516-3180.2022.0510.r1.27022023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 02/27/2023] [Indexed: 05/18/2023] Open
Abstract
BACKGROUND Stroke is a major cause of death and functional disability worldwide. Knowledge of the associated factors is essential for defining education, management, and healthcare strategies. OBJECTIVE To analyze the association between arrival time at a neurology referral hospital (ATRH) and functional disability in patients with ischemic stroke 90 days after the event. DESIGN AND SETTING Prospective cohort study conducted at a public institution of higher education in Brazil. METHODS This study included 241 people aged ≥ 18 years who presented ischemic stroke. The exclusion criteria were death, inability to communicate without companions who could answer the research questions, and > 10 days since ictus. Disability was assessed using the Rankin score (mR). Variables for which associations showed a P value ≤ 0.20 in bivariate analysis were tested as modifiers between ATRH and disability. Significant interaction terms were used for multivariate analysis. Multivariate logistic regression analysis was performed with all variables, arriving at the complete model and adjusted beta measures. The confounding variables were included in the robust logistic regression model, and Akaike's Information Criterion was adopted to choose the final model. The Poisson model assumes a statistical significance of 5% and risk correction. RESULTS Most participants (56.0%) arrived at the hospital within 4.5 hours of symptom onset, and 51.7% presented with mRs of 3 to 5 after 90 days of ictus. In the multivariate model, ATRH ≥ 4.5 hours and females were associated with more significant disability. CONCLUSIONS Arrival at the referral hospital 4.5 hours after the onset of symptoms or wake-up stroke was an independent predictor of a high degree of functional disability.
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Affiliation(s)
- Mariana de Almeida Moraes
- MSc, PhD. Nurse and Adjunct Professor, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Pedro Antônio de Jesus
- MD, MSc, PhD. Adjunct Professor, Institute of Health Science, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Ludimila Santos Muniz
- MSc. Nurse, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | - Camila Antunes Baccin
- MSc, PhD. Nurse, Laboratório de Produção, Inovação e Pesquisa em Tecnologias e Informática em Saúde e Enfermagem (LAPETEC/GIATE), Universidade Federal de Santa Catarina (UFSC), Florianópolis (SC), Brazil
| | | | - Rilary Silva Sales
- Graduate Student, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
| | | | | | - Fernanda Carneiro Mussi
- MSc, PhD. Nurse and Full Professor, School of Nursing, Universidade Federal da Bahia (UFBA), Salvador (BA), Brazil
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11
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Schneider F, Marcotte K, Brisebois A, Townsend SAM, Smidarle AD, Soder RB, Marrone LCP, Hübner LC. Macrostructural Aspects in Oral Narratives in Brazilian Portuguese by Left and Right Hemisphere Stroke Patients With Low Education and Low Socioeconomic Status. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1319-1337. [PMID: 35302896 DOI: 10.1044/2021_ajslp-21-00205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Individuals with a stroke in either the left hemisphere (LH) or the right hemisphere (RH) often present macrostructural impairments in narrative abilities. Understanding the potential influence of low education and low socioeconomic status (SES) is critical to a more effective assessment of poststroke language. The first aim was to investigate macrostructural processing in low-education and low-SES individuals with stroke in the LH or RH or without brain damage. The second aim was to verify the relationships between macrolinguistic, neuropsychological, and sociodemographic variables. METHOD Forty-seven adults with LH (n = 15) or RH (n = 16) chronic ischemic stroke and 16 matched (age, education, and SES) healthy controls produced three oral picture-sequence narratives. The macrostructural aspects analyzed were cohesion, coherence, narrativity, macropropositions, and index of lexical informativeness and were compared among the three groups. Then, exploratory correlations were performed to assess associations between sociodemographic (such as SES), neuropsychological, and macrostructural variables. RESULTS Both the LH and the RH presented impairments in the local macrostructural aspect (cohesion), whereas the RH also presented impairments in more global aspects (global coherence and macropropositions). All five macrostructural variables correlated with each other, with higher correlations with narrativity. Naming was correlated with all macrostructural variables, as well as prestroke reading and writing habits (RWH), showing that higher naming accuracy and higher RWH are associated with better macrostructural skills. CONCLUSIONS The present results corroborate the role of the LH in more local processing and that of the RH in more global aspects of discourse. Moreover, this study highlights the importance of investigating discourse processing in healthy and clinical populations of understudied languages such as Brazilian Portuguese, with various levels of education, SES, and RWH.
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Affiliation(s)
- Fernanda Schneider
- Federal Institute of Education, Science and Technology of Rio Grande do Sul, Ibirubá, Brazil
- Linguistics Department, School of Humanities, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Karine Marcotte
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Québec, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Québec, Canada
| | - Amélie Brisebois
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Québec, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Québec, Canada
| | - Sabrine Amaral Martins Townsend
- Linguistics Department, School of Humanities, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- Postdoctoral Program in Linguistics, University of Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | - Anderson Dick Smidarle
- Linguistics Department, School of Humanities, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ricardo Bernardi Soder
- Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Lilian Cristine Hübner
- Linguistics Department, School of Humanities, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- National Council for Scientific and Technological Development, Brasília, Distrito Federal, Brazil
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12
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Wang Q, Zhang S, Wang Y, Zhao D, Chen X, Zhou C. The Effect of Dual Sensory Impairment and Multimorbidity Patterns on Functional Impairment: A Longitudinal Cohort of Middle-Aged and Older Adults in China. Front Aging Neurosci 2022; 14:807383. [PMID: 35462686 PMCID: PMC9028763 DOI: 10.3389/fnagi.2022.807383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/16/2022] [Indexed: 11/26/2022] Open
Abstract
Objective There is an urgent need to evaluate the contribution of several co-existing diseases on health. This study aims to explore the combined effect of dual sensory impairment (DSI) and multimorbidity patterns on functional impairment among middle-aged and older adults in China. Methods Data were from 10,217 adults aged 45 or older from four waves of the China Health and Retirement Longitudinal Study (CHARLS). Sensory impairments were self-reported measures. Multimorbidity patterns were identified by using k-means cluster analyses. Functional impairment was defined using activities of daily living (ADL) scale and instrumental activities of daily living (IADL) scale. Generalized estimating equation models were estimated to assess the effect of co-occurring DSI and multimorbidity on functional impairment. Results DSI prevalence was 50.4%, and multimorbidity prevalence was 37.7% at the baseline. The simultaneous presence of DSI and multimorbidity was associated with increased odds of ADL limitations (OR = 2.27, 95% CI: 2.11–2.43) and IADL limitations (OR = 1.89, 95% CI: 1.77–2.02). Five multimorbidity patterns were identified: the cardio-cerebrovascular pattern, the stomach-arthritis pattern, the respiratory pattern, the hepatorenal pattern, and the unspecified pattern. Compared to DSI only, DSI plus the hepatorenal pattern was most strongly associated with functional impairment (for ADL: OR = 2.70, 95% CI: 2.34–3.12; for IADL: OR = 2.04, 95% CI: 1.77–2.36). Conclusion Middle-aged and older adults with co-occurrence of DSI and multimorbidity are at increased risk of functional impairment, especially those with multimorbidity characterized by the hepatorenal pattern. These findings imply that integrated care for DSI and multimorbidity may be a potent pathway in improving functional status.
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Affiliation(s)
- Qiong Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Shimin Zhang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Yi Wang
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Dan Zhao
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, United States
- Department of Economics, Yale University, New Haven, CT, United States
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, China
- *Correspondence: Chengchao Zhou,
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13
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Ghoneem A, Osborne MT, Abohashem S, Naddaf N, Patrich T, Dar T, Abdelbaky A, Al-Quthami A, Wasfy JH, Armstrong KA, Ay H, Tawakol A. Association of Socioeconomic Status and Infarct Volume With Functional Outcome in Patients With Ischemic Stroke. JAMA Netw Open 2022; 5:e229178. [PMID: 35476065 PMCID: PMC9047646 DOI: 10.1001/jamanetworkopen.2022.9178] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
IMPORTANCE Long-term disability after stroke is associated with socioeconomic status (SES). However, the reasons for such disparities in outcomes remain unclear. OBJECTIVE To assess whether lower SES is associated with larger admission infarct volume and whether initial infarct volume accounts for the association between SES and long-term disability. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted in a prospective, consecutive population (n = 1256) presenting with acute ischemic stroke who underwent magnetic resonance imaging (MRI) within 24 hours of admission. Patients were recruited in Massachusetts General Hospital, Boston, from May 31, 2009, to December 31, 2011. Data were analyzed from May 1, 2019, until June 30, 2020. MAIN OUTCOMES AND MEASURES Initial stroke severity (within 24 hours of presentation) was determined using clinical (National Institutes of Health Stroke Scale [NIHSS]) and imaging (infarct volume by diffusion-weighted MRI) measures. Stroke etiologic subtypes were determined using the Causative Classification of Ischemic Stroke algorithm. Long-term stroke disability was measured using the modified Rankin Scale. Socioeconomic status was estimated using zip code-derived median household income and census block group-derived area deprivation index (ADI). Regression and mediation analyses were performed. RESULTS A total of 1098 patients had imaging and SES data available (mean [SD] age, 68.1 [15.7] years; 607 men [55.3%]). Income was inversely associated with initial infarct volume (standardized β, -0.074 [95% CI, -0.127 to -0.020]; P = .007), initial NIHSS (standardized β, -0.113 [95% CI, -0.171 to -0.054]; P < .001), and long-term disability (standardized β, -0.092 [95% CI, -0.149 to -0.035]; P = .001), which remained significant after multivariable adjustments. Initial stroke severity accounted for 64% of the association between SES and long-term disability (standardized β, -0.063 [95% CI, -0.095 to -0.029]; P < .05). Findings were similar when SES was alternatively assessed using ADI. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that lower SES is associated with larger infarct volumes on presentation. These SES-associated differences in initial stroke severity accounted for most of the subsequent disparities in long-term disability in this study. These findings shift the culpability for SES-associated disparities in poststroke disability from poststroke factors to those that precede presentation.
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Affiliation(s)
- Ahmed Ghoneem
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Michael T. Osborne
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Shady Abohashem
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Nicki Naddaf
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Tomas Patrich
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Tawseef Dar
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Amr Abdelbaky
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Adeeb Al-Quthami
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Jason H. Wasfy
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Katrina A. Armstrong
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Hakan Ay
- Anithoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston
- Takeda Pharmaceutical Company Limited, Cambridge, Massachusetts
| | - Ahmed Tawakol
- Cardiovascular Imaging Research Center, Massachusetts General Hospital and Harvard Medical School, Boston
- Cardiology Division, Massachusetts General Hospital and Harvard Medical School, Boston
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
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14
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Ganesh A, Ospel JM, Marko M, van Zwam WH, Roos YBWEM, Majoie CBLM, Goyal M. From Three-Months to Five-Years: Sustaining Long-Term Benefits of Endovascular Therapy for Ischemic Stroke. Front Neurol 2021; 12:713738. [PMID: 34381418 PMCID: PMC8350336 DOI: 10.3389/fneur.2021.713738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background and Purpose: During the months and years post-stroke, treatment benefits from endovascular therapy (EVT) may be magnified by disability-related differences in morbidity/mortality or may be eroded by recurrent strokes and non-stroke-related disability/mortality. Understanding the extent to which EVT benefits may be sustained at 5 years, and the factors influencing this outcome, may help us better promote the sustenance of EVT benefits until 5 years post-stroke and beyond. Methods: In this review, undertaken 5 years after EVT became the standard of care, we searched PubMed and EMBASE to examine the current state of the literature on 5-year post-stroke outcomes, with particular attention to modifiable factors that influence outcomes between 3 months and 5 years post-EVT. Results: Prospective cohorts and follow-up data from EVT trials indicate that 3-month EVT benefits will likely translate into lower 5-year disability, mortality, institutionalization, and care costs and higher quality of life. However, these group-level data by no means guarantee maintenance of 3-month benefits for individual patients. We identify factors and associated “action items” for stroke teams/systems at three specific levels (medical care, individual psychosocioeconomic, and larger societal/environmental levels) that influence the long-term EVT outcome of a patient. Medical action items include optimizing stroke rehabilitation, clinical follow-up, secondary stroke prevention, infection prevention/control, and post-stroke depression care. Psychosocioeconomic aspects include addressing access to primary care, specialist clinics, and rehabilitation; affordability of healthy lifestyle choices and preventative therapies; and optimization of family/social support and return-to-work options. High-level societal efforts include improving accessibility of public/private spaces and transportation, empowering/engaging persons with disability in society, and investing in treatments/technologies to mitigate consequences of post-stroke disability. Conclusions: In the longtime horizon from 3 months to 5 years, several factors in the medical and societal spheres could negate EVT benefits. However, many factors can be leveraged to preserve or magnify treatment benefits, with opportunities to share responsibility with widening circles of care around the patient.
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Affiliation(s)
- Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada
| | | | - Martha Marko
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Wim H van Zwam
- Department of Radiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | | | | | - Mayank Goyal
- Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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15
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Characterizing the performance of emergency medical transport time metrics in a residentially segregated community. Am J Emerg Med 2021; 50:111-119. [PMID: 34340164 DOI: 10.1016/j.ajem.2021.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/03/2021] [Accepted: 07/05/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To derive and characterize the performance of various metrics of emergency transport time in assessing for sociodemographic disparities in the setting of residential segregation. Secondarily to characterize racial disparities in emergency transport time of suspected stroke patients in Austin, Texas. DATA SOURCES We used a novel dataset of 2518 unique entries with detailed spatial and temporal information on all suspected stroke transports conducted by a public emergency medical service in Central Texas between 2010 and 2018. STUDY DESIGN We conducted one-way ANOVA tests with post-hoc pairwise t-tests to assess how mean hospital transport times varied by patient race. We also developed a spatially-independent metric of emergency transport urgency, the ratio of expected duration of self-transport to a hospital and the measured transport time by an ambulance. DATA COLLECTION/EXTRACTION We calculated ambulance arrival and destination times using sequential temporospatial coordinates. We excluded any entries in which patient race was not recorded. We also excluded entries in which ambulances' routes did not pass within 100 m of either the patient's location or the documented hospital destination. PRINCIPAL FINDINGS We found that mean transport time to a hospital was 2.5 min shorter for black patients compared to white patients. However, white patients' transport times to a hospital were found to be, on average, 4.1 min shorter than expected compared to 3.4 min shorter than expected for black patients. One-way ANOVA testing for the spatially-independent index of emergency transport urgency was not statistically significant, indicating that average transport time did not vary significantly across racial groups when accounting for variations in transport distance. CONCLUSIONS Using a novel transport urgency index, we demonstrate that these findings represent race-based variation in spatial distributions rather than racial bias in emergency medical transport. These results highlight the importance of closely examining spatial distributions when utilizing temporospatial data to investigate geographically-dependent research questions.
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16
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Schneider F, Marcotte K, Brisebois A, Townsend SAM, Smidarle AD, Loureiro F, da Rosa Franco A, Soder RB, Nikolaev A, Marrone LCP, Hübner LC. Neuroanatomical Correlates of Macrolinguistic Aspects in Narrative Discourse in Unilateral Left and Right Hemisphere Stroke: A Voxel-Based Morphometry Study. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:1650-1665. [PMID: 33844609 DOI: 10.1044/2020_jslhr-20-00500] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Background A growing body of literature has demonstrated the importance of discourse assessment in patients who suffered from brain injury, both in the left and right hemispheres, as discourse represents a key component of functional communication. However, little is known about the relationship between gray matter density and macrolinguistic processing. Purpose This study aimed to investigate this relationship in a group of participants with middle-low to low socioeconomic status. Method Twenty adults with unilateral left hemisphere (n = 10) or right hemisphere (n = 10) chronic ischemic stroke and 10 matched (age, education, and socioeconomic status) healthy controls produced three oral narratives based on sequential scenes. Voxel-based morphometry analysis was conducted using structural magnetic resonance imaging. Results Compared to healthy controls, the left hemisphere group showed cohesion impairments, whereas the right hemisphere group showed impairments in coherence and in producing macropropositions. Cohesion positively correlated with gray matter density in the right primary sensory area (PSA)/precentral gyrus and the pars opercularis. Coherence, narrativity, and index of lexical informativeness were positively associated with the left PSA/insula and the superior temporal gyrus. Macropropositions were mostly related to the left PSA/insula and superior temporal gyrus, left cingulate, and right primary motor area/insula. Discussion Overall, the present results suggest that both hemispheres are implicated in macrolinguistic processes in narrative discourse. Further studies including larger samples and with various socioeconomic status should be conducted. Supplemental Material https://doi.org/10.23641/asha.14347550.
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Affiliation(s)
- Fernanda Schneider
- Federal Institute of Education, Science and Technology of Rio Grande do Sul, Ibirubá, Brazil
- Linguistics Department, School of Humanities, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Karine Marcotte
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Québec, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Québec, Canada
| | - Amelie Brisebois
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Québec, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Québec, Canada
| | - Sabrine Amaral Martins Townsend
- Linguistics Department, School of Humanities, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- Postdoctoral Program in Linguistics, University of Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | - Anderson Dick Smidarle
- Linguistics Department, School of Humanities, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernanda Loureiro
- São Lucas Hospital (Speech and Language Service), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandre da Rosa Franco
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY
- Center for Biomedical Imaging and Neuromodulation, The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY
- Center for the Developing Brain, Child Mind Institute, New York, NY
| | - Ricardo Bernardi Soder
- Brain Institute (InsCer), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandre Nikolaev
- School of Languages and Cultures, The University of Sheffield, United Kingdom
| | | | - Lilian Cristine Hübner
- Linguistics Department, School of Humanities, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- National Council for Scientific and Technological Development, Brasília, Federal District, Brazil
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Matos I, Fernandes A, Maso I, Oliveira-Filho J, de Jesus PA, Fraga-Maia H, Pinto EB. Investigating predictors of community integration in individuals after stroke in a residential setting: A longitutinal study. PLoS One 2020; 15:e0233015. [PMID: 32421731 PMCID: PMC7233578 DOI: 10.1371/journal.pone.0233015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/26/2020] [Indexed: 12/15/2022] Open
Abstract
Aim To identify potential predictors of community integration in individuals after stroke using a residential setting-based strategy. Method A prospective cohort of post-stroke individuals was recruited from the Stroke Unit of the Roberto Santos General Hospital (UAVC-HGRS). All included individuals were aged over 18 years, received a diagnosis of ischemic stroke confirmed by neuroimaging and resided in the city of Salvador (Bahia, Brazil). Following discharge from the stroke unit, the individuals themselves, or their responsible parties, were contacted by telephone to schedule a home visit no less than three months after discharge. All subjects were examined in their homes, at which time the Community Integration Questionnaire (CIQ) was also applied. A robust linear regression model was used to assess community reintegration using CIQ score as the outcome variable. Results A total of 124 individuals effectively fulfilled the eligibility criteria: 51.6% were females, the median (IQR) age was 63(53–69) years, 82.3% were non-white, 53.2% were married, the median (IQR) of years of schooling was 6 (4–12) and family income averaged two minimum monthly wages. Investigated individuals presented a median (IQR) NIH Stroke Scale (NIHSS) score of 7 (4–12). Multivariate linear regression identified the following independent predictors of community integration: age (β = -0.095; 95% CI = -0.165 to -0.025; p = 0.008), diabetes mellitus (β = -2.348; 95% CI = -4.125 to -0.571; p = 0.010), smoking habit (β = -2.951; 95% CI = -5.081 to -0.821; p = 0.007), functional capacity upon hospital discharge (β = 0.168; 95% CI = 0.093 to 0.242; p = <0.001) and stroke severity (β = -0.163; CI = -0.318 to -0.009); p = 0.038). Conclusions Regardless of length of time since stroke, individuals present restrictions that compromise their reintegration into their respective communities. The demographic, clinical and functional factors identified herein as potential predictors should be considered when conducting regular follow-up, as well as in the rehabilitation of individuals after stroke with the purpose to identify the interventions necessary to optimize their reintegration into the community.
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Affiliation(s)
- Isabela Matos
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Adriana Fernandes
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
| | - Iara Maso
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
- Roberto Santos General Hospital, Salvador, Brazil
| | | | - Pedro Antônio de Jesus
- Roberto Santos General Hospital, Salvador, Brazil
- Federal University of Bahia, Bahia, Brazil
| | | | - Elen Beatriz Pinto
- Motor Behavior and Neurorehabilitation Research Group, Bahiana School of Medicine and Public Health, Salvador, Brazil
- * E-mail:
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Lowry CA, Jin AY. Improving the Social Relevance of Experimental Stroke Models: Social Isolation, Social Defeat Stress and Stroke Outcome in Animals and Humans. Front Neurol 2020; 11:427. [PMID: 32477259 PMCID: PMC7240068 DOI: 10.3389/fneur.2020.00427] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/22/2020] [Indexed: 01/05/2023] Open
Abstract
The outcome of ischemic stroke varies across socioeconomic strata, even among countries with universal health care. Emerging evidence suggests that psychosocial aspects of low socioeconomic status such as social isolation and social defeat stress interact with, and contribute to, stroke pathophysiology. However, experimental investigations of stroke rarely account for such socioeconomic influences. Social isolation in stroke survivors is associated with increased infarction volume, increased risk of post-stroke depression, and worse long-term functional outcome. Social defeat is thought to contribute significantly to chronic stress in low socioeconomic status groups and is associated with poor health outcomes. Chronic stress is also associated with worse post-stroke functional outcome and greater disability even after accounting for stroke severity, vascular risk factors, and access to acute stroke care. Experimental stroke studies which incorporate social isolation or social defeat stress have shown that both tissue and functional stroke outcome is affected by the increased expression of TNF-α and IL-6, increased glucocorticoid production, and suppression of the protooncogene bcl-2. This review explores the consequences of social isolation and social defeat stress on stroke, preclinical stroke models that have been used to investigate these factors, and possible molecular mechanisms underlying the influence of socioeconomic disparities on stroke outcome.
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Affiliation(s)
- Chloe A Lowry
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada
| | - Albert Y Jin
- Centre for Neuroscience Studies, Queen's University, Kingston, ON, Canada.,Department of Medicine, Queen's University, Kingston, ON, Canada.,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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Karlsson S, Ziegert K, Kristén L. Perspectives on equal health and well-being. Int J Qual Stud Health Well-being 2018; 13:1679589. [PMID: 31713470 PMCID: PMC8843385 DOI: 10.1080/17482631.2019.1679589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Staffan Karlsson
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Kristina Ziegert
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Lars Kristén
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
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