Browsing by Subject "stroke"
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Item Beneficial hispanic stroke mortality: An exploration of potential explanatory factors(2009-06-11) Bret Howrey; James S. Goodwin; Mukaila Raji; Ken Ottenbacher; Karl Eschbach; Jean Freeman; David Espino; Daniel FreemanStroke mortality rates are reported to be lower for Hispanics than non-Hispanic Whites. This project investigates factors that contribute to this lower rate in three ways: 1) examine the role of immigrant status in stroke incidence and mortality, 2) investigate the impact of cause of death ambiguity, and 3) examine the role of misreport of ethnicity on death certificates. \r\nIn examining the effect of immigrant status I used the Hispanic Established Populations for the Epidemiologic Study of the Elderly (EPESE) and the East Boston EPESE. This research compares baseline health characteristics of immigrants with native-born respondents. Additionally, I examine differences in stroke mortality, as well as the risk of stroke between waves. In both EPESE samples significant differences in demographics and co-morbidities existed at baseline between immigrants and the US born. However, the odds of stroke mortality or having a stroke during follow-up were not significantly different for immigrants and the US born in either the East Boston or Hispanic data. \r\n To examine the impact of cause of death coding and misreport of ethnicity on death certificates, I used national vital registration data for the years 1989-1991 and 1999-2002, including foreign and US born Hispanics and non-Hispanic Whites. Hispanic deaths were adjusted for misclassification of ethnicity on the death certificate. These data were linked to census estimates and 5% census samples for the corresponding time periods, allowing for estimates of the foreign born population. Adjustment for nativity and death certificate misclassification removed the stroke mortality advantage for US born Hispanic men, but not women. After adjustment, US born Hispanic men and women have higher rates of mortality from subarachnoid stroke than Whites (RR 1.27 and 1.27 respectively), but lower rates of mortality from Ischemic (RR 0.85 and 0.79 respectively) and chronic effects of stroke (RR 0.95 and 0.79 respectively). \r\n These results suggest that health benefits immigrants receive do not continue in older age with regards to stroke. Additionally, after adjustment for misclassification, the lower stroke mortality advantage for Hispanic men disappears, while an advantage still remains for Hispanic women. Part of the previously reported advantage is a combination of imprecise measurement and data quality.\r\nItem Change in positive emotion and recovery of functional status following stroke rehabilitation in older adults(2010-04-26) Gary Steven Seale; Glenn V. Ostir, Ph.D.; Yong-fang Kuo, Ph.D.; Timothy R. Elliott, Ph.D.; Kenneth J. Ottenbacher, Ph.D.; Beatriz C. Abreu, Ph.D.Stroke is a leading cause of disability in the United States and represents a major public health challenge. Recovery of functional status following stroke is a primary focus for rehabilitation, and is an important health outcome linked to independence, life satisfaction and quality of life. Among factors associated with recovery of functional status following stroke is positive emotion. In elderly populations, positive emotion has been shown to be protective of stroke and has been associated with functional recovery following stroke. However, most studies examining the relationship between positive emotion and recovery of functional status evaluate positive emotion at a single time point, and over relatively brief follow-up periods. Some studies report positive emotion may be a dynamic process and can change over brief periods of time. Not clear is whether positive emotion continues to change over longer time periods and whether change in positive emotion can influence recovery of functional status post stroke. \r\nThe purpose of this study was to examine change in positive emotion over a 12-month follow-up period and to determine whether change in positive emotion was associated with recovery of functional status following rehabilitation for first time stroke in an elderly, ethnically diverse patient population. This secondary analysis of data was collected on 990 older adults with first time stroke admitted to one of 20 acute medical rehabilitation facilities in the United States between 2005 and 2006. Data were examined at discharge from acute medical rehabilitation, and at 3-month and 12-month follow-up. The 12-month follow-up sample was comprised of 684 non-Hispanic whites, non-Hispanic blacks, and Hispanics aged 55 or older with first time stroke. \r\nKey findings of this study included: 1) positive emotion changed over the 12-month follow-up period with the majority of change occurring between discharge and 3-month follow-up, 2) of the patients who demonstrated change in positive emotion, more demonstrated an increase in positive emotion over the 12-month follow-up as compared to no change or a decline, 3) change in positive emotion was significantly associated with recovery of functional status post stroke after controlling for important sociodemographic characteristics and clinical measures known to impact recovery after stroke, including depressive symptoms.\r\nChange in positive emotion can occur over relatively long periods of time (i.e., 12 months) and this change is associated with recovery of functional status post stroke. \r\nItem Change in positive emotion and recovery of functional status following stroke rehabilitation in older adults(2010-04-26) Gary Steven Seale; Glenn Ostir, PhD; Yong-fang Kuo, PhD; Timothy R. Elliott, PhD; Kenneth Ottenbacher, PhD; Beatriz C. Abreu, PhDStroke is a leading cause of disability in the United States and represents a major public health challenge. Recovery of functional status following stroke is a primary focus for rehabilitation, and is an important health outcome linked to independence, life satisfaction and quality of life. Among factors associated with recovery of functional status following stroke is positive emotion. In elderly populations, positive emotion has been shown to be protective of stroke and has been associated with functional recovery following stroke. However, most studies examining the relationship between positive emotion and recovery of functional status evaluate positive emotion at a single time point, and over relatively brief follow-up periods. Some studies report positive emotion may be a dynamic process and can change over brief periods of time. Not clear is whether positive emotion continues to change over longer time periods and whether change in positive emotion can influence recovery of functional status post stroke. \r\nThe purpose of this study was to examine change in positive emotion over a 12-month follow-up period and to determine whether change in positive emotion was associated with recovery of functional status following rehabilitation for first time stroke in an elderly, ethnically diverse patient population. This secondary analysis of data was collected on 990 older adults with first time stroke admitted to one of 20 acute medical rehabilitation facilities in the United States between 2005 and 2006. Data were examined at discharge from acute medical rehabilitation, and at 3-month and 12-month follow-up. The 12-month follow-up sample was comprised of 684 non-Hispanic whites, non-Hispanic blacks, and Hispanics aged 55 or older with first time stroke. \r\nKey findings of this study included: 1) positive emotion changed over the 12-month follow-up period with the majority of change occurring between discharge and 3-month follow-up, 2) of the patients who demonstrated change in positive emotion, more demonstrated an increase in positive emotion over the 12-month follow-up as compared to no change or a decline, 3) change in positive emotion was significantly associated with recovery of functional status post stroke after controlling for important sociodemographic characteristics and clinical measures known to impact recovery after stroke, including depressive symptoms.\r\nChange in positive emotion can occur over relatively long periods of time (i.e., 12 months) and this change is associated with recovery of functional status post stroke. \r\nItem Effects of post-stroke depression on cognitive and linguistic recovery(2010-05) Amoroso, Jill; Harris, Joyce L.; Marquardt, Thomas P.The aim of this paper is to explore the relationship between functional recovery from stroke and depression. Stroke leads to depression both directly (through the location of the lesion) and indirectly (through decreased functional status and aphasia secondary to stroke). Consequently, depression may limit functional recovery and recovery from aphasia. The relationship between decreased functional status post-stroke and depression appears to be bidirectional and mutually-reinforcing (decreased functional status leads to depression and depression limits functional recovery). Similarly, the relationship between aphasia recovery and depression is likely bidirectional and mutually reinforcing. Antidepressants may be useful in disrupting these relationships and thereby improving functional recovery from stroke.