Kvaliteta života bolesnika poslije moždanog udara: šestomjesečna samoprocjena tjelesnog i mentalnog zdravlja

The purpose of this prospective study was to determine the quality of life and resocialization of post-stroke patients in the Osijek-Baranya County during six months. The study included 161 patients (82 men and 79 women) having sustained their first ever acute stroke and being treated at University Department of Neurology, Osijek University Hospital Center in Osijek. The Health Survey SF-36 questionnaire was used for self-evaluation of the patients’ physical and mental health. Initial assessment was carried out in the acute phase of the disease and follow-up assessments were carried out 30, 90 and 180 days post-stroke in patient homes. The mean value of physical health measured by SF was 46.1 on initial measurement, 37.8 on second, 44.3 on third and 53.0 on fourth measurement. The mean value of mental health was 48.0 on initial measurement, 36.6 on second, 44.0 on third and 48.5 on fourth measurement. The median of total physical health and mental health on all measurements was higher in men than in women. Comparison of the quality of life areas and the items measured by SF-36 questionnaire according to sex and measurements showed statistically significant differences on all four measurements in women for all items except for social function (p=0.669). In men, statistically significant differences between the measurements were only recorded for the item of physical activity (p=0.013). Stroke significantly impairs the quality of life of affected people. The study showed that the poorest results were recorded 30 days of the onset of symptoms, while recovery was achieved in six months. Patients affected by stroke who stayed with their families considered their physical and mental health better than before stroke.Cilj ove prospektivne studije bio je utvrditi kvalitetu života i stupanj resocijalizacije bolesnika nakon moždanog udara (MU) u Osječko-baranjskoj županiji tijekom šest mjeseci. Istraživanjem je obuhvaćen 161 bolesnik, 82 muškarca i 79 žena, s prvim u životu akutnim MU koji je liječen na Klinici za neurologiju Kliničkog bolničkog centra Osijek. Za samoprocjenu tjelesnog i mentalnog zdravlja upotrijebljen je Health Survey SF-36. Prvo mjerenje učinjeno je u akutnoj fazi bolesti, a kontrolne su procjene izvedene 30, 90 i 180 dana nakon MU u kući bolesnika. Medijan SF-36 za tjelesno zdravlje iznosio je: prvo mjerenje 46,1; drugo 37,8; treće 44,3; četvrto 53,0. Mentalno zdravlje: prvo mjerenje 48,0; drugo 36,6; treće 44,0; četvrto 48,5. Kod muškaraca je medijan za ukupno tjelesno zdravlje i mentalno zdravlje po mjerenjima bio veći negoli kod žena. Usporedba područja i stavaka kvalitete života mjerenih pomoću SF-36 u odnosu na spol i mjerenja pokazala je značajnu razliku u sva četiri mjerenja kod žena po svim stavkama osim u socijalnoj funkciji (p=0,669). Kod muškaraca je značajna razlika između mjerenja zabilježena samo kod stavke tjelesne aktivnosti (p=0,013). MU značajno narušava kvalitetu života oboljelih. Istraživanje pokazuje kako su najlošiji rezultati dobiveni 30 dana od pojave simptoma i da se oporavak postiže za šest mjeseci. Bolesnici koji ostaju u svojim obiteljima bolje procjenjuju svoje tjelesno i mentalno zdravlje

Epidemiology of Stroke

Epidemiološki podaci pokazuju daje moždani udar (MU) jedan od najvažnijih uzroka morbiditeta i letaliteta, a vodeći uzrok invaliditeta u svijetu i u nas. Populacijske neuroepidemiološke studije MU-a važne su za utvrđivanje morbiditeta (incidencije i prevalencije) i mortaliteta, te dugoročnog ishoda ove bolesti. Bolničke studije omogućuju procjenu ranoga letaliteta i kratkoročnoga ishoda MU-a. U epidemiološkim istraživanjima MU-a nužno je primjenjivati međunarodno prihvaćene standarde. Iako su podaci o epidemiologiji MU-a u našoj zemlji zastarjeli i nepotpuni, studije provedene na bolničkom materijalu u zadnjih petnaestak godina daju određenu sliku aktualnoga stanja i ukazuju na nepovoljne trendove u obolijevanju i umiranju od ove bolesti. Postojeći sustav zbrinjavanja bolesnika s MU-om ne zadovoljava potrebe i nije u skladu sa suvremenim trendovima u Europi i svijetu. Postoji realna potreba reorganizacije toga sustava po uzoru na druge zemlje u Europi, koje imaju slične probleme i epidemiološke pokazatelje.Epidemiological data show that stroke is one of the leading causes of death and long-term disability in most industrialized populations, as well as in our country. Community-based studies are important for the establishment of both morbidity (incidence and prevalence) and mortality and long-term outcome of stroke. Hospital-based studies enable the assessment of case fatality and short-term outcome of stroke. In epidemiological researches of stroke it is necessary to use internationally accepted standards. Although results on stroke epidemiology in our country are outdated and incomplete, studies conducted on hospital material in the last 15 years show the current state and point to negative trends in having a stroke and dying from it. The existing system of health care for stroke patients does not satisfy the needs and is not in accordance with latest trends in Europe and in the world. There is a need of reorganization of the stroke health care system in Croatia and to prepare the national project of stroke prevention and treatment similar to those in other European countries with unfavourable epidemiological data

Raspodjela rizičnih čimbenika za moždani udar u istočnoj Hrvatskoj

The aim of this study was to determine the distribution of risk factors according to age, gender, subtypes and recurrence of stroke in eastern Croatia. The study included 250 acute stroke patients admitted to University Department of Neurology, Osijek University Hospital Centre in 2011. Patients were grouped according to age, gender, subtypes and recurrence of stroke. The study showed significant differences in the distribution of cigarette smoking, diabetes, cardiomyopathy and hyperuricemia according to patient age. According to gender, male patients had a significantly higher prevalence of smoking and alcohol abuse, whereas in female patients the prevalence of arterial hypertension, atrial fibrillation and hyperuricemia was significantly higher. Regarding stroke subtypes, significant differences were noticed in the prevalence of arterial hypertension, atrial fibrillation, cardiomyopathy and cerebral blood vessel stenosis. Atrial fibrillation was significantly more common in first-ever than in recurrent stroke. Study results identified the groups of patients requiring special attention regarding particular risk factors in eastern Croatia and emphasized the need of developing regional strategies of screening, prevention and holistic care for stroke patients.Cilj ovoga istraživanja bio je odrediti raspodjelu rizičnih čimbenika u bolesnika s moždanim udarom u istočnoj Hrvatskoj prema dobi, spolu, podtipovima i ponovnom javljanju. U istraživanje bilo je uključeno 250 bolesnika koji su pretrpjeli akutni moždani udar i primljeni su na Kliniku za neurologiju Kliničkoga bolničkog centra Osijek u 2011. godini. Bolesnici su podijeljeni prema dobi, spolu, podtipovima i ponovnom javljanju. Istraživanje je pokazalo značajne razlike u raspodjeli pušenja cigareta, dijabetesa, kardiomiopatije i hiperuricemije prema dobi bolesnika. Prema spolu, učestalost pušenja i zlouporabe alkohola bila je značajno veća kod muških bolesnika, dok je učestalost arterijske hipertenzije, atrijske fibrilacije i hiperuricemije bila značajno veća kod žena. Prema podtipovima moždanog udara, značajne razlike uočene su kod učestalosti arterijske hipertenzije, atrijske fibrilacije, kardiomiopatije i stenoze cerebralnih krvnih žila. Atrijska fibrilacija bila je značajno češća u prvom nego u ponovljenom moždanom udaru. Naši rezultati pokazuju koje skupine bolesnika u istočnoj Hrvatskoj zahtijevaju posebnu pozornost s obzirom na pojedine rizične čimbenike te naglašavaju potrebu osmišljavanja regionalnih strategija za probir, prevenciju i holističku brigu za oboljele od moždanog udara

Quality of Life of Patients after Stroke in County Osijek-Baranya

The purpose of this prospective study was to determine quality of life of patients after stroke in Osijek-Baranya County. The research included 161 patients (82 men and 79 women) who had their first acute stroke and were treated at Department of Neurology, Osijek University Hospital Center. The Barthel Index (BI) was used to assess functional deficiency and SS-QOL (Stroke-Specific Quality of Life) questionnaire was used for self-evaluation of patients’ physical and mental health. The first assessment was carried out in the acute phase of the disease, and control assessments 30, 90 and 180 days after the stroke. Mean Barthel Index score was higher at every successive measurement (55, 80, 95, 95). All BI items were statistically significant (Friedman, p<0.001) apart from dressing and bowel control. BI score indicated greater dependence in women in all assessments except for those taken 90 days after onset of symptoms (c2-test, p=0.111). Mean values of SS-QOL for physical health were: 105.2, 98.3, 105.7, 117.5 and for mental health: 64.24, 57.9, 64.3, 68.1. Statistically significant difference was present in men, both for physical health (Friedman p=0.009) and total SS-QOL (Friedman p=0.014), while in women there was no statistically significant difference between the measurements (Friedman p=0.719). The research showed that stroke has significant influence on basic and specific daily life activities and interferes with the quality of life of stroke patients. Women have lower level of independence. Patients who live with their families make better evaluation of their physical and mental health

Outcome of different stroke subtypes

Cilj: odrediti pokazatelje kratkoročnoga ishoda različitih podvrsta moždanoga udara. Metode: opservacijska, prospektivna, kohortna studija. Obuhvaćena je grupa od 130 bolesnika. Korištena klasifikacija za hemoragijski moždani udar: intracerebralna hemoragija i subarahnoidalna hemoragija; za ishemijski moždani udar: TOAST (Trial of ORG 10172 in Acute Stroke Treatment) klasifikacija. Stupanj onesposobljenosti procijenjen je uz pomoć modificirane Rankin skale. Rezultati: najčešća komplikacija moždanoga udara bila je uroinfekcija. Ispitanici s moždanim udarom malih krvnih žila imali su najmanje komplikacija, najmanji funkcionalni deficit i smrtnost, a ispitanici s intracerebralnom hemoragijom imali su najviše komplikacija, najveći funkcionalni deficit i smrtnost. Zaključak: rezultati potvrđuju varijacije u ishodu različitih podvrsta moždanoga udara.Aim: To determine indicators of short-term outcome of different stroke subtypes. Methods: An observational prospective cohort study. Group of 130 patients was studied. Classification used: Hemorrhagic stroke (Intracerebral hemorrhage (ICH), Subarachnoid hemorrhage (SAH)); Ischemic stroke: TOAST (Trial of ORG 10172 in Acute Stroke Treatment) classification. Degree of disability was assessed using the Modified Rankin Scale. Results: The most common stroke complication was urinary infection. Patients with small vessel stroke had the lowest rate of complications, functional deficit and case-fatality and patients with ICH had the highest rate of these indicators. Conclusion: Results confirm variations of outcome in different stroke subtype

Neurobiološke i kliničke posljedice posttraumatskog stresnog poremećaja

Thirty-two male patients, mean age 34.1±7.1, Croatian soldiers from 1991-1992 war, suffering from post-traumatic stress disorder (PTSD) diagnosed on the basis of psychiatric examination and use of graduation scales DSM III and LASC-01, were included in the study. In order to identify possible organic disorders, the patients were submitted to neuropsychological testing, laboratory testing, and hemodynamic testing of cerebral hemodynamics by the method of transcranial Doppler ultrasonography (TCD), and analysis of risk factors for cerebrovascular disease related to an unhealthy lifestyle. Neuropsychological examination showed mental deterioration which surpassed the allowable level in 21, impaired memory in 19, and significant mnestic control disorders in 30 and confabulation in 15 patients, while other tests pointed to an organic basis of the mental abnormalities observed (attention, visuomotor co-ordination). Laboratory analysis pointed to the following disturbances: elevated blood glucose in 3, cholesterol in 7 and triglycerides in 10 patients; decreased HDL in 10 and increased LDL in 6 patients; increased white blood cell count in 16 and increased erythrocyte sedimentation rate in 5 patients. TCD analysis revealed functional impairments of cerebral circulation in 16 patients, i.e. vasospasm in 11 and hypoperfusion in 5 patients. A significant presence of unhealthy lifestyle indicators was recorded, i.e. smoking in 30, alcoholism in 15, and physical inactivity and overweight in 10 patients each. Study results confirmed the correlation of mental and physical mechanisms in the occurrence of PTSD as well as the presence of organic indicators of the nervous system lesions, and psychosomatic and organic damage to other body systems. This small, uncontrolled pilot study suggested the need of a complex approach to patients with PTSD.Studijom su bila obuhvaćena 32 bolesnika, hrvatski branitelji iz Domovinskog rata 1991./1992., s dijagnozom posttraumatskog stresnog poremećaja (PTSP) postavljenom psihijatrijskim pregledom i primjenom ocjenskih ljestvica DSM III. i LASC-01. Svu su ispitanici bili muškog spola, srednje dobi 34,1±7.1 godina. Radi otkrivanja mogućih organskih poremećaja ispitanici su podvrgnuti neuropsihologijskim i laboratorijskim pretragama, hemodinamskom ispitivanju moždanog krvotoka metodom transkranijske doplerske sonografije (TCD) te analizi čimbenika rizika za cerebrovaskularnu bolest, koji se odnose na nezdrav način života. Neuropsihologijskim ispitivanjem nađena je mentalna deterioracija koja je prelazila dozvoljenu razinu u čak 21 bolesnika, oštećenje pamćenja u 19, značajne smetnje mnestičke kontrole u 30 te sklonost konfabuliranju u 15 bolesnika. Ostale su pretrage ukazivale na organsku podlogu zabilježenih mentalnih abnormalnosti (pozornost, vizuomotorna koordinacija). Laboratorijske pretrage ukazale su na sljedeće poremećaje: povišenu glukozu u krvi u 3, povišen kolesterol u 7, povišene trigliceride u 10, snižen HDL u 10, povišen LDL u 6, povišene leukocite u 16 i povišenu sedimentaciju eritrocita u 5 bolesnika. Analiza TCD pokazala je funkcionalne promjene moždane cirkulacije u 16 bolesnika (vazospazam u 11, a hipoperfuziju u 5 bolesnika). Zabilježen je značajan udjel pokazatelja nezdravog načina života: pušenje u 30, prekomjerne uporabe alkohola u 15, smanjene tjelesne aktivnosti u 10 te prekomjerne tjelesne težine u 10 bolesnika. Ispitivanje je potvrdilo povezanost psihičkih i tjelesnih mehanizama u nastanku sindroma PTSP-a, ali i prisutnost organskih pokazatelja oštećenja živčanog sustava te psihosomatskih i organskih oštećenja drugih tjelesnih sustava. Ova mala, nekontrolirana pokusna studija ukazala je na potrebu stalnog praćenja navedenih parametara, kao i multidisciplinarnog pristupa bolesniku s PTSP-om

Time of delay of stroke patients in Osijek region

Trombolitička terapija poboljšava ishod moždanoga udara (MU) kada se primijeni unutar 3 sata od nastupa simptoma. Cilj istraživanja bio je utvrditi koliko je prosječno vrijeme kašnjenja (VK) bolesnika na osječkom području. Prospektivno je bilježeno VK u 100 bolesnika liječenih na Klinici za neurologiju KBC Osijek. Prosječno je VK 502 minute. Unutar 3 sata stiglo je 53%, unutar 6 sati 66%, unutar 12 sati 79% i unutar 24 sata 90% oboljelih. Stanje još uvijek nije zadovoljavajuće i nužno je daljnje informiranje stanovništva i edukacija o simptomima MU-a.Thrombolytic therapy improves the outcome after ischemic stroke when applied within 3 hours from symptoms onset. The goal of study was to investigate the time of delay for acute stroke patients (pts) treated at Neurology clinic, University Hospital Centre Osijek. The mean time of delay was 502 minutes. 53% of pts arrived within 3 hours, 66% within 6 hrs, 79% within 12 hrs and 90% of pts within 24 hours. The situation is not yet satisfying and efforts to reduce time of delay and to educate population are necessary

Kvaliteta života bolesnika poslije moždanog udara: šestomjesečna samoprocjena tjelesnog i mentalnog zdravlja

The purpose of this prospective study was to determine the quality of life and resocialization of post-stroke patients in the Osijek-Baranya County during six months. The study included 161 patients (82 men and 79 women) having sustained their first ever acute stroke and being treated at University Department of Neurology, Osijek University Hospital Center in Osijek. The Health Survey SF-36 questionnaire was used for self-evaluation of the patients’ physical and mental health. Initial assessment was carried out in the acute phase of the disease and follow-up assessments were carried out 30, 90 and 180 days post-stroke in patient homes. The mean value of physical health measured by SF was 46.1 on initial measurement, 37.8 on second, 44.3 on third and 53.0 on fourth measurement. The mean value of mental health was 48.0 on initial measurement, 36.6 on second, 44.0 on third and 48.5 on fourth measurement. The median of total physical health and mental health on all measurements was higher in men than in women. Comparison of the quality of life areas and the items measured by SF-36 questionnaire according to sex and measurements showed statistically significant differences on all four measurements in women for all items except for social function (p=0.669). In men, statistically significant differences between the measurements were only recorded for the item of physical activity (p=0.013). Stroke significantly impairs the quality of life of affected people. The study showed that the poorest results were recorded 30 days of the onset of symptoms, while recovery was achieved in six months. Patients affected by stroke who stayed with their families considered their physical and mental health better than before stroke.Cilj ove prospektivne studije bio je utvrditi kvalitetu života i stupanj resocijalizacije bolesnika nakon moždanog udara (MU) u Osječko-baranjskoj županiji tijekom šest mjeseci. Istraživanjem je obuhvaćen 161 bolesnik, 82 muškarca i 79 žena, s prvim u životu akutnim MU koji je liječen na Klinici za neurologiju Kliničkog bolničkog centra Osijek. Za samoprocjenu tjelesnog i mentalnog zdravlja upotrijebljen je Health Survey SF-36. Prvo mjerenje učinjeno je u akutnoj fazi bolesti, a kontrolne su procjene izvedene 30, 90 i 180 dana nakon MU u kući bolesnika. Medijan SF-36 za tjelesno zdravlje iznosio je: prvo mjerenje 46,1; drugo 37,8; treće 44,3; četvrto 53,0. Mentalno zdravlje: prvo mjerenje 48,0; drugo 36,6; treće 44,0; četvrto 48,5. Kod muškaraca je medijan za ukupno tjelesno zdravlje i mentalno zdravlje po mjerenjima bio veći negoli kod žena. Usporedba područja i stavaka kvalitete života mjerenih pomoću SF-36 u odnosu na spol i mjerenja pokazala je značajnu razliku u sva četiri mjerenja kod žena po svim stavkama osim u socijalnoj funkciji (p=0,669). Kod muškaraca je značajna razlika između mjerenja zabilježena samo kod stavke tjelesne aktivnosti (p=0,013). MU značajno narušava kvalitetu života oboljelih. Istraživanje pokazuje kako su najlošiji rezultati dobiveni 30 dana od pojave simptoma i da se oporavak postiže za šest mjeseci. Bolesnici koji ostaju u svojim obiteljima bolje procjenjuju svoje tjelesno i mentalno zdravlje

Quality of Life of Patients after Stroke in County Osijek-Baranya

The purpose of this prospective study was to determine quality of life of patients after stroke in Osijek-Baranya County. The research included 161 patients (82 men and 79 women) who had their first acute stroke and were treated at Department of Neurology, Osijek University Hospital Center. The Barthel Index (BI) was used to assess functional deficiency and SS-QOL (Stroke-Specific Quality of Life) questionnaire was used for self-evaluation of patients’ physical and mental health. The first assessment was carried out in the acute phase of the disease, and control assessments 30, 90 and 180 days after the stroke. Mean Barthel Index score was higher at every successive measurement (55, 80, 95, 95). All BI items were statistically significant (Friedman, p<0.001) apart from dressing and bowel control. BI score indicated greater dependence in women in all assessments except for those taken 90 days after onset of symptoms (c2-test, p=0.111). Mean values of SS-QOL for physical health were: 105.2, 98.3, 105.7, 117.5 and for mental health: 64.24, 57.9, 64.3, 68.1. Statistically significant difference was present in men, both for physical health (Friedman p=0.009) and total SS-QOL (Friedman p=0.014), while in women there was no statistically significant difference between the measurements (Friedman p=0.719). The research showed that stroke has significant influence on basic and specific daily life activities and interferes with the quality of life of stroke patients. Women have lower level of independence. Patients who live with their families make better evaluation of their physical and mental health