Epidemiological analysis of hospitalisations due to recurrent stroke in the Silesian Province, Poland, between 2009 and 2015

Background and aim. There is a lack of recent epidemiological studies on recurrent stroke (RS) in Poland. The aim of this study was to analyse all hospitalisations related to RS in Silesia – an industrial region covering 12% of the Polish population.Material and methods. We carried out statistical analysis of data contained in stroke questionnaires transferred to the Polish National Health Fund by hospitals in Silesia, Poland, between 2009 and 2015.Results. In the analysed period, the number of RS hospitalisations in Silesia was 18,063 (22.2% of all acute strokes). The percentage of RS significantly decreased during the period under consideration (p < 0.001). The same observation concerned recurrent ischaemic stroke (RIS), but not recurrent haemorrhagic stroke (RHS). The median hospitalisation time was 14 days for RHS, and 11 days for RIS. Large-artery atherosclerosis and cardioembolisms were significantly more often recognised in RIS than in first-ever ischaemic stroke (FIS) (consecutively, 38.2% vs 36.0%, and 21% vs 18.1%; p < 0.001). The in-hospital mortality rate was significantly higher for RS than for first-ever stroke (18.4% vs 17.2%; p < 0.001). The same observation wasdone for RIS vs FIS (16.2% vs 13.9%; p < 0.001), and for RHS vs FHS (39.8% vs 36%; p = 0.004). The rtPA therapy was applied to 5.3% of FIS and 3.2% of RIS patients (p < 0.001).Conclusions. This is the first such comprehensive and long-term analysis of recurrent stroke in Silesia, Poland. It could help in the implementation of appropriate educational programmes, and thus help to improve the health status of society

Diagnostics, treatment and secondary prevention of ischemic stroke in the Silesian Province, Poland between 2009 and 2015

Background The available data on diagnostics and treatment of ischemic stroke (IS) in Poland come mainly from non-representative cohorts or are outdated. Objective Therefore, the current study was done to access the most recent data on IS in the industrial region that covers 12% of the country's population. Materials & methods Analysis of the data from stroke questionnaires, obligatory for all patients hospitalized due to acute stroke and administered by the National Health Fund (the only public health insurer in Poland) between 2009 and 2015 (n=81,193). Results The number of hospitalizations due to IS in the Silesian Province was 69,403 and constituted 85.5% of all stroke cases reported to the NHF between 2009 and 2015. Neuroimaging of the brain (CT/MRI) was performed in 68,696 (99%) subjects, while ultrasonography of extra- and/or intracranial arteries in 57,886 (83.4%). The rtPA therapy was applied in 3282 patients (4.7% of all IS subjects). The rate of patients treated with rtPA gradually increased (1.2% in 2009, 9.3% in 2015). Among all patients with IS, 57,636 (83.1%) subjects were administered antiplatelet drugs, 16,199 (23.3%) – oral anticoagulants, and 55,971 (80.7%) – antihypertensive drugs. Also, 2260 (3.3%) patients were referred for vascular intervention. In subjects with cardioembolic stroke etiology, 37.8% were treated with anticoagulants. Conclusions There has been observed a significant improvement in the quality of diagnosis and treatment of acute ischemic stroke during recent years. However, further actions are required both in terms of reperfusion treatment (thrombolysis and/or thrombectomy) and secondary prevention of stroke

Characteristics of hospitalizations due to acute stroke in the Silesian Province, Poland, between 2009 and 2015

Introduction The available data on acute stroke (AS) in Poland come mainly from non-representative cohorts or are outdated. Therefore, the current study was done to access the most recent data on AS in the industrial region that covers 12% (4.6mln) of the country's population. Objective To evaluate the epidemiological data of AS in the Silesian Province, Poland. Patients and methods Analysis of the data from stroke questionnaires, obligatory for all patients hospitalized due to AS and administered by the only public health insurer in Poland (the National Health Fund) between 2009 and 2015 (n=81,193). Results The annual number of hospitalizations due to AS in the analyzed period was between 239 and 259 per 100,000 inhabitants of the Silesian Province. Haemorrhagic stroke constituted 13.3%, ischaemic stroke – 85.5%, and unspecified stroke – 1.2%. The average age of patients was 71.6±12.2 years (M 68.2±11.9, F 74.8±11.9, P<0.05). The mean duration of hospitalization was 17±16 days for haemorrhagic stroke, and 14±11 days for ischaemic stroke. Large-artery atherosclerosis (36.1%) and cardioembolism (18.7%) constituted the main causes of ischaemic stroke. Overall hospital mortality for AS was 18% (haemorrhagic – 40.8%, ischaemic – 14.9%). A decreasing trend in mortality was observed in ischaemic but not in haemorrhagic stroke. In-hospital mortality was significantly higher in women than in men (P<0.05). Conclusions This comprehensive long-term analysis of the epidemiological situation related to AS in the industrial region of Poland should encourage further development of educational and treatment programmes for improvement in the health status of the population

Multiple sclerosis: oral health, behaviours and limitations of daily oral hygiene — a questionnaire study

Clinical rationale for the study. Neurological deficits and progressing disability in patients with multiple sclerosis (MS) may hamper daily oral hygiene, but their relations with oral problems have not yet been clearly determined.Aim of the study. The aim of this study was to identify the most significant dental problems and limitations of daily oral hygiene in Polish patients with MS.Material and methods. 199 patients with diagnosed MS (median age 37 years) treated in the neurological outpatient clinic were interviewed using a paper-based questionnaire. They provided answers on oral health, behaviours and the limitations of their daily oral hygiene. Clinical information regarding symptoms, MS phenotype, relapses, medication and degrees of disability was based on medical records.Results. The most frequent symptoms were dry mouth (43.2%) and bleeding from gums (28.1%). Dry mouth was more frequent in patients with secondary-progressive MS (SPMS) than relapsing-remitting MS (65.4% vs 41.3%, p = 0.023). Patients with bleeding from gums had had MS for a longer duration (median 6 vs 4 years, p = 0.002). Difficulties in daily oral hygiene were more frequent in patients with SPMS (24.0% vs 8.1%; p = 0.016). Greater proportions of patients with muscle weakness of limbs, imbalance or pain brushed their teeth irregularly. Frequent (i.e. at least every six months) visits to the dentist’s surgery were uncommon in patients with SPMS (12.0% vs 39.7%, p = 0.010).Conclusions and clinical implications. Dry mouth and bleeding from gums are more frequent in patients with longer lasting and more advanced types of MS. Daily oral hygiene and oral health self-control is limited in patients with MS, mainly due to motor deficits, balance problems and pain, and this becomes worse with disease duration. To minimise the burden of the disease, patients with MS require better education and improvement in their awareness regarding proper oral health control, such as the use of electric toothbrushes. In addition, patients with chronic and progressive disability from multiple sclerosis may benefit from better organised access to dental care

Subarachnoid Haemorrhage—Incidence of Hospitalization, Management and Case Fatality Rate—In the Silesian Province, Poland, in the Years 2009–2019

Little is known about the epidemiology of subarachnoid haemorrhage (SAH) in Poland, and until now no such research has been conducted for Silesia, which is the second largest province with circa 4.5 million inhabitants. Therefore, the current study was done to assess the data on SAH in the Silesian Province, Poland. The study was based on the data obtained from the administrative databases of the only public health insurer in Poland (the National Health Fund, NHF) from 2009 to 2019. The SAH cases were selected based on primary diagnosis coded in ICD-10 as I60. The total number of SAH cases was 2014 (41.8% men, 58.2% women). The number of SAH hospitalizations decreased from 199 in 2009 to 166 cases in 2019; p p p = 0.013). Despite the number of stroke units increasing, in-hospital mortality in SAH patients is high, and the number of vascular interventions seems insufficient. Better organization for care of SAH patients is needed in Poland