The impact of the UK COVID-19 pandemic on patient-reported health outcomes after stroke: a retrospective sequential comparison

BACKGROUND AND PURPOSE: The COVID-19 pandemic and related social isolation measures are likely to have adverse consequences on community healthcare provision and outcome after acute illnesses treated in hospital, including stroke. We aimed to evaluate the impact of the COVID-19 pandemic on patient-reported health outcomes after hospital admission for acute stroke. METHODS: This retrospective study included adults with acute stroke admitted to the University College Hospital NHS Foundation Trust Hyperacute Stroke Unit. We included two separate cohorts of consecutively enrolled patients from the same geographical population at two time points: 16th March-16th May 2018 (pre-COVID-19 pandemic); and 16th March-16th May 2020 (during the COVID-19 pandemic). Patients in both cohorts completed the validated Patient Reported Outcomes Measurement Information System-29 (PROMIS-29 version 2.0) at 30 days after stroke. RESULTS: We included 205 patients who were alive at 30 days (106 admitted before and 99 admitted during the COVID-19 pandemic), of whom 201/205 (98%) provided patient-reported health outcomes. After adjustment for confounding factors, admission with acute stroke during the COVID-19 pandemic was independently associated with increased anxiety (β = 28.0, p < 0.001), fatigue (β = 9.3, p < 0.001), depression (β = 4.5, p = 0.002), sleep disturbance (β = 2.3, p = 0.018), pain interference (β = 10.8, p < 0.001); and reduced physical function (β = 5.2, p < 0.001) and participation in social roles and activities (β = 6.9, p < 0.001). CONCLUSION: Compared with the pre-pandemic cohort, patients admitted with acute stroke during the first wave of the COVID-19 pandemic reported poorer health outcomes at 30 day follow-up in all domains. Stroke service planning for any future pandemic should include measures to mitigate this major adverse impact on patient health

Role of fruit juice in achieving the 5-a-day recommendation for fruit and vegetable intake

Although there is strong evidence that consumption of fruit and vegetables is associatedwith a reduced rate of all-cause mortality, only a minority of the population consumes5 servings a day, and campaigns to increase intake have had limited success.This review examines whether encouraging the consumption of fruit juice might offera step toward the 5-a-day target. Reasons given for not consuming whole fruit involvepracticalities, inconvenience, and the effort required. Psychologically, what isimportant is not only basic information about health, but how individuals interprettheir ability to implement that information. It has been argued that fruit juice avoidsthe problems that commonly prevent fruit consumption and thus provides a practicalmeans of increasing intake and benefitting health through an approach with whichthe population can readily engage. Those arguing against consuming fruit juice emphasizethat it is a source of sugar lacking fiber, yet juice provides nutrients such asvitamin C, carotenoids, and polyphenols that offer health-related benefits. Actively encouragingthe daily consumption of fruit juice in public health policy could help populationsachieve the 5-a-day recommendation for fruit and vegetable intake