Trends and regional inequalities in mortality from stroke in the context of health care reform in Lithuania

Background and objective: The objective of the study was to analyze mortality from stroke in Lithuania the context of health care reform with particular interest in urban/rural and regional inequalities. Based on the analysis of trends in mortality, and to detection of break-points over two decades of socioeconomic transition, it focused on the challenges in stroke care provision. Materials and methods: The analysis covered the entire country. Information on deaths from 1991 to 2012 was gathered from death certificates held by the Lithuanian Department of Statistics. The join point analysis was used to identify the best-fitting points, wherever a statistically significant change in mortality occurred. Age-standardized mortality rates were calculated for 60 municipalities of Lithuania. Results: The positive break-points in mortality from stroke were registered in 2007 for females and 2008 for males, when the increasing trends reversed to the declining. More positive changes occurred in urban areas, where stroke mortality is lower compare to rural since 1996.Considerable inequalities were disclosed among administrative regions of Lithuania: ratio between the highest and the lowest rates in different municipalities reached 4.88 for males and 3.35 for females. Conclusions: There are good reasons to expect the favorable stroke mortality trends observed will follow the same direction in the future. Stroke centers are growing up in their competence while networking is also under the development. The new strategies in stroke care should result not only in the declining mortality rates and numbers of severely handicapped stroke patients, but also in diminishing regional and urban/rural inequalities

Prevalence of smell impairments and substantia nigra hyperechogeneicity in Lithuanians, born in 1964

Objectives: to determine the prevalence of smell impairments and changes in substantia nigra (SN) echogeneicity on TCS in healthy adult population and to evaluate the link between the two. Methods: 295 subjects – 59% women and 41% men, born in 1964 (aged 48,42 ± 0,04 at the moment of the study) , participating in a population study “Connection between genetic and lifestyle risk factors for chronic disease risks since childhood” were screened for smell impairments, using Sniffin’ Sticks 12 test, as well as for SN echogeneicity changes using TCS. They all underwent neurological examination with focus on extrapyramidal signs and none was found to have PD at the moment of the study. Results: sufficient acoustic temporal bone window allowed complete TCS results to be obtained in 90.5% of cases. In 6.1% of examined cases unilateral or bilateral enlargement of SN area (hiperechogeneicity) was detected (using the cutoff value of 0.26 cm²). In additional 18.8% of cases SN area was found to be marginal unilateraly or bilaterally (0.20-0.26 cm²). 24.1% of participants had at least mild hiposmia. Changes in SN echogeneicity correlated positively with smell impairments (p<0.05). 9.8% of participants were found to have both - smell and SN echogeneicity impairments. Conclusions: almost ¼ of the studied population was found to have at least mild smell impairments. In similar proportion of cases hyperechogeneicity of SN was detected. A positive correlation between those symptoms was observed

The factors influencing the functional state recovery in cerebral stroke patients during the second rehabilitation stage

The aim of the study was to determine the functions influencing the recovery of the motor and cognitive functions and general functional state in cerebral stroke patients during the second rehabilitation stage, and their prognostic value. The contingent and methods. The studied contingent consisted of 226 cerebral stroke patients: 109 men and 117 women who had undergone the second stage rehabilitation in Viršužiglis Rehabilitation Hospital, a branch institution of Hospital of Kaunas University of Medicine. The mean age of the patients was 67.8±10.4 years. The greatest proportion of the patients (88.5%) was with cerebral infarction. The mean duration of rehabilitation was 38.8±8.9 days. The functional state of the patients was assessed by functional IndependenceMeasure; the cognitive function, by the short mental function study method; the severity of the stroke, in accordance with the National Institutes of Health Stroke Scale. The prognostic value of the factors was evaluated by the logistic regression method. A study analyzed the influence of patient’s gender, age, social factors, clinical symptoms and signs, risk factors for stroke, comorbities, the character and localization of the stroke, and psychoemotional state on the recovery of capacities related to motor and cognitive functions, and restoration of general functional state. Results. During the second stage of rehabilitation, the score of the functional state of the patients assessed by the Functional Independence Measures significantly improved from 65.9±20.3 to 93.5±20.9 (P&lt;0.0001). At the end of rehabilitation, good efficacy of rehabilitation was determined in 64.2% of the rehabilitees; moderate, in 19.4%; insufficient, in 16.4%. In prognosing insufficient recovery of general functional state during the second stage of rehabilitation, the following factors had a significant influence: extremity hemiplegia, disturbed cognitive functions, urination impairment, joint and heart diseases. In cases of insufficient recovery of capacities linked with motor function in the second stage of rehabilitation, exerted extremity hemiplegia, neglect of the affected side of the body, urination impairments, joint and heart disorders had a significant influence, whereas localization of the stroke lesion in the left hemisphere of the brain, impairment of cognitive functions (disturbance of speech and perception), urination disturbances – on the insufficient recovery of capacities related to cognitive functions. Conclusion. Insufficient efficacy of rehabilitation of the rehabilitees with cerebral stroke in the second stage of rehabilitation was influenced by impairment of motor and cognitive functions, urination disturbancies, and comorbidities. In forming individualized inpatient rehabilitation programs and prognosing the further health care of patients with cerebral stroke, it is important to pay attention to factors, influencing insufficient efficacy of rehabilitation

Development of the Lithuanian version of Sniffin’ Sticks 12 Odor Identification Test

Background: Evaluation of smell function is essential especially in cases of gradual deterioration, e.g., in neurodegenerative diseases, where rates of unawareness of the disorder are high and the importance of screening for olfactory dysfunction is increasing. To date, none of the tests for evaluation of olfactory dysfunction has been validated in Lithuania. The aim of the study was to develop a Lithuanian version of Sniffin’ Sticks 12 (SS12) odor identification test. Materials and Methods: The study was performed in 4 stages. The first stage included translation and back-translation from German, pilot group testing and language adaptation of the original SS12 test. In the second stage a survey group of 99 subjects was questioned for familiarity with the descriptors, used in the original version of the test. In the third stage after replacement of the least familiar distracters, a modified version of SS12 was created. Original and modified versions of SS12 were tested on 112 and 119 healthy subjects accordingly. The fourth stage of the study proved necessary as neither of the two SS12 versions turned out to be valid. After another round of replacement of the misleading distracters the second modified version of SS12 was created and it was tested on 115 healthy subjects. Results: Unsatisfactory correct identification rates of less than 75 percent in the same one item (lemon) were observed using both original and modified SS12 versions. With the second modification of distracters of SS12, identification of lemon increased significantly and overcame 75 percent. The decrease of SS12 scores in relation to age was ascertained in the study sample. Gender and smoking status did not prove to be independent predictors of SS12 scores in multiple linear regression analysis. Conclusion: The study presents an olfactory testing tool, which is adapted and modified culturally for use in the Lithuanian population

Effectiveness of the Second-Stage Rehabilitation in Stroke Patients With Cognitive Impairment

The aim of this study was to evaluate the recovery of functional status and effectiveness of the second-stage rehabilitation depending on the degree of cognitive impairment in stroke patients. Material and Methods. The study sample comprised 226 stroke patients at the Viršužiglis Hospital of Rehabilitation, Hospital of Lithuanian University of Health Sciences. Functional status was evaluated with the Functional Independence Measure, cognitive function with the Mini-Mental Status Examination scale, and severity of neurologic condition with the National Institutes of Health Stroke Scale. The patients were divided into 4 study groups based on cognitive impairment: severe, moderate, mild, or no impairment. Results. More than half (53%) of all cases were found to have cognitive impairment, while patients with different degree of cognitive impairment were equally distributed: mild impairment (18%), moderate impairment (17%), and severe impairment (18%). Improvement of functional status was observed in all study groups (P&lt;0.001). In the patients with moderate and severe cognitive impairment, cognitive recovery was significantly more expressed than in other study groups (P&lt;0.001). Insufficient recovery of functional status was significantly associated with hemiplegia (OR, 11.15; P=0.015), urinary incontinence (OR, 14.91; P&lt;0.001), joint diseases (OR, 5.52; P=0.022), heart diseases (OR, 4.10; P=0.041), and severe cognitive impairment (OR, 15.18; P&lt;0.001), while moderate and mild cognitive impairment was not associated with the recovery of functional status. Conclusions. During the second-stage rehabilitation of stroke patients, functional status as well as cognitive and motor skills were improved both in patients with and without cognitive impairment; however, the patients who were diagnosed with severe or moderate cognitive impairment at the beginning of second-stage rehabilitation showed worse neurological and functional status during the whole second-stage rehabilitation than the patients with mild or no cognitive impairment

Factors influencing outcomes in patients with stroke

Outcomes of stroke result in long-term disability in most of the patients. It has been confirmed by scientific studies that rehabilitation can improve functional status and quality of life of poststroke patients. The effectiveness of rehabilitation and the outcomes often differ among patients. For effective utilization of the rehabilitation resources, it is important to prognosticate the possible outcomes of the disorder. Recently, studies are performed with the aim to determine and evaluate factors possibly influencing functional recovery in poststroke patients and helping to distinguish patients with good outcome from those with poor outcome. Age, gender, initial severity of the stroke, functional status at admission to hospital, urinary incontinence, impairment in cognitive function, unilateral neglect syndrome are most often analyzed in scientific studies as factors determining the outcomes of the disorder

Long-term risk of myocardial infarction after a first-ever stroke

Purpose. To examine the incidence of myocardial infarction during the first three years after a first-ever stroke. Material and methods. Both Kaunas community-based stroke register and ischemic heart disease register served at the primary source of data. The methods used for data collection were those applied by the World Healt Organisation (WHO) for the WHO MONICA project. During 1986 to 1994, 2531 patients aged 25 to 64 years with a first-ever stroke were registered and followed-up for three years for the information on the firstever acute myocardial infarction or death from ischemic heart disease. Actuarial life tables were used to analyze risk of myocardial infarction. Results. During the study period, 58 patients with the first-ever acute myocardial infarction that occurred among the first-ever stroke survivors were identified. Fifty-three first-ever ischemic stroke survivors (39 (73.6%) men and 14 (26.4%) women, (p=0.07)) experienced their first-ever myocardial infarction. The cumulative risk of suffering an acute myocardial infarction was 3.5% (95% confidence interval 2.6 to 4.4%) by 3 years: in male ischemic stroke survivors this risk accounted for 4.3% (95% confidence interval 3.0 to 5.6%) and in female \u96 2.3% (95% confidence interval 1.1 to 3.5%). The risk was the highest one early after ictus in the ischemic stroke survivors: 0.5% (95% confidence interval 0.2 to 0.8%) by 3 months (men \u96 0.7% (95% confidence interval 0.2 to 1.2%), women \u96 0.3% (95% confidence interval 0.0 to 0.7%)). Conclusion. The risk of myocardial infarction is the highest early after the first stroke, although due to relatively small number of cases confidence intervals were too wide to reach a statistical significance