Arterial ischaemic stroke from 2010-2015: Incidence, risk factors, atherosclerosis and 5-year outcome : The Norwegian Stroke in the Young Study, a three-generation research program

“Norwegian Stroke in the Young Study” (NOR-SYS) er en tre generasjoners studie, som har inkludert hjerneinfarkt pasienter i alderen mellom 15-60 år, og deres foreldre, partnere og voksne barn mellom 2010-2015 for å få kunnskap om risikofaktorer, aterosklerose og om kardiovaskulære hendelser i familier. Denne avhandlingen redegjør for deltakelsesratene til tre generasjoner, forekomst av hjerneinfarkt og utbredelsen av aterosklerose hos unge mennesker som ligger under ansvarsområde for Haukeland universitetssykehus i Bergen, Norge. Våre resultater av unge hjerneinfarkt pasienter ble sammenlignet med deres partnere som kontroller, og relatert til risikofaktorer og til 5-års utkom. Alle resultatene ble justert for alder og kjønn. Artikkel I beskrev aktiv deltakelse for 385 pasienter (96.5%), 260 kontroller (80.0%) og 414 (74.6%) voksne barn. Lavere deltakelsesrate var hos pasientforeldrene (55.2% fedre og 57.3% mødre), og enda lavere hos partnerforeldre (38.4% fedre og 40.2% mødre). Forekomst av hjerneinfarkt hos pasienter ≤49 år var 15.0 per 100.000 per år. Artikkel II presenterte utbredelse av aterosklerose i syv vaskulære områder, og relaterte det til 5-års utkom. Vi definerte ung alder ≤49 år og middelalder ≥50 år. Ca 50.0% av unge mannlige og 33.0% av unge kvinnelige pasienter hadde aterosklerose. Den totale utbredelsen av aterosklerose var kun høyere blant unge kvinnelige pasienter sammenlignet med unge kvinnelige kontroller. I løpet av en 5-års periode, fikk 13.7% pasienter og 4.1% kontroller nye vaskulære hendelser, med signifikante flere hendelser blant unge kvinnelige pasienter i forhold til unge kvinnelige kontroller. Ingen signifikant forskjell ble funnet i mortalitetsraten blant pasienter og kontroller (henholdvis på 5.5% og 3.5%). Justert for alder og kjønn, nye vaskulære hendelser var assosiert med iskjemisk elektrokardiogram (EKG), patologisk ankel-arm index, femoral intima-media tykkelse (fIMT) og antall vaskulære områder med aterosklerose (NAA) blant pasienter, og med abdominal aorta plakk, karotis intima-media tykkelse (cIMT), fIMT og NAA blant kontroller. Mortalitet var assosiert med økende alder, iskjemisk EKG og NAA blant pasienter, og med cIMT blant kontroller. Artikkel III beskrev total risikofaktorbyrde og relaterte det til aterosklerose. Risikofaktor var tilstede hos 96.4% unge mannlige pasienter og hos 94.3% unge kvinnelige pasienter. Risikofaktorbyrden var kun høyere blant unge kvinnelige pasienter sammenlignet med unge kvinnelige kontroller. Aterosklerosen var assosiert med høy alder, hypertensjon, diabetes mellitus og kroppsmasseindex i en kombinert analyse for pasienter og kontroller, justert for alder, kjønn og alle risikofaktorer.From 2010 to 2015, the three-generations Norwegian Stroke in the Young Study (NOR-SYS) included ischaemic stroke patients aged 15-60 years, and their parents, partners and adult offspring to gain more knowledge about vascular risk factors, atherosclerosis and cardiovascular events in families. This thesis explores the inclusion rates of three generations, incidence of ischaemic stroke and the prevalence of atherosclerotic disease at a young age in the well-defined patient population referred to Haukeland University Hospital, Norway. Our results were compared to the patients’ partners, serving as controls, and related to vascular risk factors and 5-year outcome after stroke. All results were age- and sex-adjusted. Paper I described active participation of 385 patients (96.5%), 260 controls (80.0%) and 414 (74.6%) adult offspring. The active participation rate for patients’ parents was low (55.2% fathers and 57.3% mothers), and the active participation rate for partners’ parents was even lower (38.4% fathers and 40.2% mothers). The mean annual incidence rate of young stroke patients ≤49 years was 15.0 per 100.000. Paper II presented the prevalence of atherosclerosis in seven vascular areas related to 5-year outcome. Young age was defined as ≤49 years and middle-aged was defined as ≥50 years. About 50% of young male patients, and about 33% of young female patients had prevalent atherosclerosis. Compared to controls, atherosclerosis was more prevalent only in young female patients. At 5-year follow up, 13.7% patients and 4.1% controls had experienced new cardiovascular events, and the occurrence rate was higher in young female patients than in young female controls. The mortality rate was low and did not differ between patients and controls (5.5% vs 3.5%). Adjusted for age and sex, the occurrence of new cardiovascular events were associated with ischaemic electrocardiogram (ECG), pathological ankle-arm index, femoral intima-media thickness (fIMT) and increased number of vascular areas with atherosclerosis (NAA) among patients, and with abdominal aorta plaques (AAP), carotid intima-media thickness (cIMT), fIMT and NAA among controls. Mortality was associated with higher age, ischaemic ECG and NAA with among patients, and with cIMT among controls. Paper III presented the total risk factor burden related to prevalence of atherosclerosis. In total, risk factors were present among 96.4% of young male patients and 94.3% of young female patients. Compared to controls, only young female stroke patients had a higher risk factor burden. Prevalent atherosclerosis was associated with age, hypertension, diabetes mellitus, smoking and body-mass index in a combined analysis for patients and controls, adjusted for age, sex, and all risk factors.Doktorgradsavhandlin

Verified Parental Cardiovascular Events for Young and Middle-Aged Ischaemic Stroke Patients and Controls

Nonmodifiable cardiovascular risk factors, like age and sex, are easily quantifiable. Due to immense technical progress in diagnostics and medical data storage, the aim of this study was to quantify, verify, and to compare parental cardiovascular events (CVE) as an additional nonmodifiable risk factor for young and middle-aged ischaemic stroke patients and controls. Methods. Information about parental CVE was first obtained by standardized questionnaires answered by 385 acute ischaemic stroke patients (15-60 years of age) and 260 controls. After consent to contact living and include deceased parents, patients and controls provided necessary personal identification of their parents. Thereafter, CVE were verified by standardized questionnaires answered by parents or medical records in case of deceased parents. Results. One hundred-and-nine (14.2%) of 770 patient parents vs. 128 (24.6%) of 520 control parents were not available for verification. Active participation was obtained for 229 (73.9%) of 310 patient parents vs.113 (58.2%) of 194 control parents. Medical record verification was obtained for 192 (54.7%) of 351 deceased patient parents, vs.103 (52.0%) of 198 deceased control parents. This study showed highest death rates of fathers (65.3% patient fathers and 57.6% control fathers) and highest numbers of CVE, especially myocardial infarction among patient fathers of patients aged 50-60 years. Discussion and Conclusion. Obtaining verified parental CVE as a nonmodifiable risk factor is still challenging, despite widely available digital medical information. To attain more accurate information on parental CVE, we recommend active involvement of family members in addition to medical record verification, especially for patients aged <50 years. Trial Registration. This trial is registered with NCT01597453publishedVersio

Young ischaemic stroke incidence and demographic characteristics - The Norwegian stroke in the young study - A three-generation research program

Introduction: Norwegian Stroke in the Young Study (NOR-SYS) is a three-generation research program of young ischaemic stroke. In this study, we assessed ischaemic stroke incidence, education and work status among young stroke patients. Furthermore, we evaluated the participation of family members for future validated information on hereditary cardiovascular events. Patients and methods: Patients aged 15–60 years with radiologically verified acute ischaemic stroke, admitted to Haukeland University Hospital in Bergen, Norway from 2010 to 2015, were included. Patients’ partners, common offspring ≥ 18 years and biological parents of patients and partners were invited to participate. Ischaemic stroke incidence was analysed with respect to year, age and sex using multiple logistic regression. Results: A total of 385 patients, 260 partners (80.0%) and 414 offspring (74.6%) were clinically examined. The mean annual ischaemic stroke incidence rate was 30.2 per 100,000. Incidence was higher in men, and the difference was accentuated with increasing age (p = 0.008). There was no sex difference in educational status (p = 0.104) in contrast to work status (p < 0.001) for patients. In all, 84.1% of men worked, and of these, 80.3% are fulltime. In all, 74.4% of women worked, and of these, 52.9% are fulltime. Parents participated by returning a questionnaire. For patients, 91 fathers (55.2%) and 142 mothers (57.3%) participated. For partners, 48 fathers (38.4%) and 68 mothers (40.2%) participated. Conclusion: The mean annual incidence rate of young stroke was 30.2 per 100,000, and the incidence rate was higher in men. Work status was high among both sexes. Active participation rates were high for patients, partners and offspring.acceptedVersio

The health seeking behaviour of elderly population in a poor-urban community of Karachi, Pakistan

OBJECTIVES: To presents socio-demographic characteristics and health seeking behaviour of elderly and to determine frequency of Diabetes Mellitus and Hypertension in elderly population of a poor peri-urban community in Karachi, Pakistan. METHODS: A cross-sectional study was conducted, targeting population aged 65 or above. A total of 438 respondents were interviewed after taking informed consent, between November 2005 and December 2005. Frequencies and Chi square values were calculated for different variables using SPSS 13.0. RESULTS: Total population surveyed comprised of 438 elderly, 158 (36%) women and 280 (63.9%) men. Mean age for the population was 71.44 +/- 7.74. A total of 238 (54.3%) elderly were found to be economically active. More than half (n = 269, 61.4%) of the elderly were found to be illiterate. Only 72 (16.4%) of the elderly population were Diabetic and 132 (30.1%) were Hypertensive. Common symptoms that prompted elderly of Azam Basti to seek health care were fever (61.2%), generalized body aches (43.4%) and cough (40.4%). Over half of the (n = 269, 61.4%) responders reported factors which deterred them from seeking health care, out of which 62% reported financial constraint as the commonest factor. Deterrence from seeking health care was associated with illiteracy (p = 0.001) and living alone (p = 0.06). CONCLUSION: The elderly population of this peri-urban community has financial constraints in seeking health care. Hypertension was found to be more prevalent among women as compared to men, ratio being 1:2. Less number of people knew they were diabetics; this might be attributed to ignorance and non-availability of investigations and screening

Prevalence of atherosclerosis and association with 5-year outcome: The Norwegian Stroke in the Young Study

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CPU and RAM Energy-based SLA-aware Workload Consolidation Techniques for Clouds

Cloud computing offers hardware and software resources delivered as services. It provides solutions for dynamic as well as ‘‘pay as you go’’ provision of resources. Energy consumption of these resources is high which leads to higher operational costs and carbon emissions in data centers. A number of research studies have been conducted on energy efficiency of data centers, but most of them concentrate on single factor energy consumption, i.e., energy consumed by CPU only, and energy consumption by Random Access Memory (RAM) is neglected. However, recently the focus has been turned towards impact of energy consumption by RAM on data centers. Studies have shown that RAM consumes about 25% of joint energy consumed by a server’s CPU and RAM. In this paper, two energy-aware virtual machine (VM) consolidation schemes are proposed that take into account a server’s capacity in terms of CPU and RAM to reduce the overall energy consumption. The proposed schemes are compared with existing schemes using CloudSim simulator. The results show that the proposed schemes reduce the energy cost with improved Service Level Agreement (SLA)

Vascular risk factors and staging of atherosclerosis in patients and controls: The Norwegian Stroke in the Young Study

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