Search Results (113)

Background/Objectives: Atherosclerotic cardiovascular diseases (ASCVDs) remain the leading cause of morbimortality worldwide. The objectives of this study were to update the prevalence rates of ASCVDs and to evaluate their relationship with cardiovascular–kidney–metabolic (CKM) disorders. Methods: This cross-sectional observational study included 6588 adults selected through a simple random population-based sample from the Health Service database of the Madrid Region (Spain). Adjusted prevalence rates were calculated by the direct method, according to Spanish population data from the National Institute of Statistics. The relationships of CKM disorders with coronary heart disease (CHD), stroke, peripheral arterial disease (PAD), and ASCVD were assessed by bivariate and multivariate analyses. Results: The age- and sex-adjusted prevalence rates among overall adults with CHD, stroke, PAD, and ASCVD were 3.8%, 3.0%, 1.8%, and 7.3%, respectively, and they reached 5.6%, 4.4%, 2.6%, and 10.8%, respectively, among people aged 40 years and older. The prevalence rates were higher in men than women aged over 40 years for CHD and ASCVD, between 50 and 69 years for stroke, and aged over 60 years for PAD. The mean ages of women and men with ASCVD were 74.9 and 70.2 years, respectively. Hypertension, heart failure (HF), hypercholesterolaemia, diabetes, low eGFR, atrial fibrillation (AF), prediabetes, and low HDL-c were independently associated with ASCVD, highlighting hypertension and HF for all of them, in addition to hypercholesterolaemia for CHD and stroke, and specifically, AF for stroke. Conclusions: More than one in ten people aged over 40 suffer from CHD, stroke, or PAD. Hypertension, HF, hypercholesterolaemia, diabetes, and low eGFR are the major CKM disorders associated with ASCVD. Full article

Objectives: The objective of this study was to examine the relationship between multimorbidity and root caries among older American adults. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) 2017–2020, a cross-sectional nationally representative survey of civilian noninstitutionalised Americans was used. The analysis included dentate adults aged 50 years and older. The presence of root caries or root restoration was assessed through clinical dental examinations. Multimorbidity was identified by the existence of five common and serious chronic diseases, namely, diabetes, cancer, coronary heart disease, chronic pulmonary disease and stroke. An aggregate variable of these five conditions was created. Logistic regression models were used to assess the association between multimorbidity and root caries (outcome), adjusting for sociodemographic factors and health behaviours. Results: The analysis included 3274 dentate participants (mean age: 63.6 years), 18.2% had root caries, while 14%. had multimorbidity (two or more conditions). The mean number of multimorbidities was 0.65. The count of multimorbidity was significantly associated with root caries, with odds ratios (OR) of 1.26 (95% Confidence Interval (CI): 1.03, 1.52) in a model adjusting for age, gender, ethnicity, income, and education. After additionally adjusting for dental visits and smoking, the association between multimorbidity and root caries lost statistical significance (OR 1.20, 95% CI: 0.97, 1.48). Conclusions: Individuals with greater numbers of chronic conditions appeared to have higher probabilities of having root caries. However, the significant association was eliminated after accounting for strong behavioural predictors of root caries. The higher level of root caries among those with multimorbidity could be attributed to xerostomia caused by being on multiple medications. The findings highlight the need for interventions to prevent root caries among those with multimorbidity. Full article

Background: This study examines the impact of Body Mass Index (BMI) on outcomes after mitral valve surgery via right minithoracotomy, an approach that may reduce wound complications in obese patients. Methods: Between January 2010 and December 2024, 1773 adult patients underwent minimally invasive mitral valve surgery at our institution. They were categorized into three groups: normal weight (BMI < 25, n = 942), overweight (BMI 25–30, n = 661), and obese (BMI > 30, n = 170). Results: The three groups exhibited significant differences, with a higher prevalence of hypertension, dyslipidemia, and diabetes (p < 0.001) in overweight and obese patients. Further-more, they had a greater incidence of preoperative atrial fibrillation (p < 0.001), prior stroke (p = 0.023), chronic obstructive pulmonary disease (p = 0.002), and elevated preoperative creatinine levels (p < 0.001). and their euroscore II was significantly higher (p = 0.040). In-hospital mortality and major complications were similar across groups, except for drainage output in the first 24 h (p = 0.002) and ICU stay (p = 0.022), both resulting higher in the overweight and obese patients. We employed inverse probability of treatment weighting (IPTW) to create three well-matched groups. Following IPTW, postoperative outcomes remained comparable across groups. However, obese patients exhibited a higher incidence of postoperative atrial fibrillation (p = 0.037) and required pacemaker implantation more frequently (p < 0.001). Conclusions: Our findings suggest that obesity does not increase the risk of mortality or major adverse events after minimally in-vasive mitral valve surgery. This approach may offer a less invasive alternative for obese patients, potentially reducing the risk of wound complications associated with conventional surgery. Full article

Multimorbidity poses significant challenges for resource-constrained healthcare systems, particularly in low and middle income countries where specific combinations of chronic conditions may differentially impact function. This cross-sectional study examined multimorbidity patterns and associations with functioning among 165 adults attending semi-rural primary healthcare facilities in South Africa. Participants completed performance-based measures (handgrip strength, five-times sit-to-stand test, step test and exercise prescription tool [STEP] maximum oxygen consumption) and self-reported function (12-item WHODAS 2.0). Exploratory factor analysis identified three multimorbidity patterns: HIV-hypercholesterolaemia-obesity (Pattern 1), hypertension-anaemia-lung disease (Pattern 2), and stroke-heart disease-hypercholesterolaemia (Pattern 3). Pattern 1 was associated with reduced aerobic capacity (β = −6.41, 95% CI: −9.45, −3.36) and grip strength (β = −0.11, 95% CI: −0.14, −0.07). Pattern 2 showed associations with mild (β = 1.12, 95% CI: 0.28, 1.97) and moderate (β = 1.48, 95% CI: 0.53, 2.43) self-reported functional problems and reduced grip strength (β = −0.05, 95% CI: −0.09, −0.003). Pattern 3 was associated with all self-reported impairment levels, with the strongest association for severe impairment (β = 2.16, 95% CI: 0.32, 4.01). These findings highlight the convergence of infectious and non-communicable diseases in this setting. Simple clinical measures like grip strength and self-reported function may hold potential as screening or monitoring tools in the presence of disease patterns, warranting further research. Full article

Introduction: Muscle weakness is one of the main consequences following a stroke, leading to significant alterations in gait and other daily activities. Isokinetic muscle strengthening of the lower limb is considered to be an effective complement to conventional treatment to improve these functional limitations. The objective of this systematic review was to analyze isokinetic lower limb strengthening protocols and their effects on muscle strength, gait, and mobility in post-stroke patients compared to conventional physiotherapy or other strengthening methods. Methods: A systematic review of randomized controlled trials (RCTs) from the last 10 years was conducted. Studies analyzing the effects of isokinetic lower limb muscle strengthening compared to conventional physiotherapy or other strengthening methods on muscle strength, gait parameters, and mobility in post-stroke adults were selected. The quality and risk of bias of the studies were evaluated using the PEDro scale, the Oxford Level of Evidence scale, and the Cochrane Review Manager tool. Results: Six studies met the eligibility criteria. For knee–ankle strength, gait speed, and mobility, isokinetic strengthening demonstrated significant improvements compared to conventional physical therapy. When compared to other strengthening methods, isokinetic training was more effective for hip–knee strength and mobility, while closed kinetic chain isokinetic strengthening showed greater benefits for gait speed. Additionally, in the early post-stroke phase, isokinetic training showed greater improvements, while the chronic phase demonstrated more variable results. The methodological quality of the studies was acceptable–good. Conclusions: Isokinetic muscle strengthening significantly improves muscle strength, gait speed, and mobility in post-stroke adults compared to conventional physical therapy, offering additional benefits over other strengthening methods. Further research is needed to evaluate its long-term effectiveness, optimize protocols, and explore the impact of treatment timing. Full article

Background: Immersive virtual reality (imVR) has shown promise for upper limb stroke rehabilitation (ULSR). However, optimal implementation and treatment modalities remain unclear. This systematic review and meta-analysis aimed to evaluate imVR’s efficacy in ULSR and determine optimal treatment parameters. Methods: A systematic review and meta-analysis of randomized controlled trials (RCTs), comparing imVR to conventional rehabilitation (CR) in adult stroke patients, was conducted. Databases including, the Web of Science, Scopus, and PubMed, were searched. Meta-regression further explored the relationship between intervention duration, frequency, and outcomes. Results: Twenty-three studies were included in the systematic review, representing 395 patients, with thirteen incorporated into the meta-analysis. imVR showed statistically significant improvements in the Fugl–Meyer Assessment Upper Extremity (FMA-UE) Scale (mean difference (MD) = 3.04, 95% CI [1.46; 4.62], p < 0.001) and the Box and Block Test (BBT) (MD = 2.85, 95% CI [0.70; 4.99], p = 0.009) compared to CR, but not in the Action Research Arm Test (ARAT) (MD = 3.47, 95% CI [−0.22; 7.15], p = 0.06). However, these improvements did not reach clinically significant thresholds (7 points for FMA-UE and 6 points for BBT). Clinical subgroup analysis showed significant improvements for both subacute (standardized mean difference (SMD) = 0.92, 95% CI [0.48; 1.36], p = 0.002) and chronic (SMD = 0.69, 95% CI [0.03; 1.35], p = 0.03) stroke stages. Meta-regression indicated that there was a significant positive relationship between the intervention duration and upper limb improvement. Conclusions: imVR demonstrates potential for improving upper limb motor function following stroke, particularly with longer intervention durations and individual session lengths for chronic stroke. However, the improvements observed were not clinically significant, highlighting the need for further research with larger sample sizes and standardized outcome measures to determine optimal treatment protocols. Full article

Background/Objectives: This study explored factors influencing self-rated health (SRH) among community-dwelling older adults to better support its use in health screening and provide an alternative for older adults who may have difficulty working with lengthy assessment scales. Methods: The participants were 8379 individuals aged 65 years or older from the 2020 Elderly Survey. Data were collected in South Korea between September and November 2020. Descriptive statistics were calculated, and independent samples t-tests, a Kruskal–Wallis test, and weighted multiple regression analysis were conducted using IBM SPSS for Windows ver. 23.0. SRH factors, such as illness, daily living performance, nutritional status, depression, and cognitive impairment, were analyzed. Results: The greater the number of chronic conditions (β = −0.21, p < 0.001), the higher the dependence on activities of daily living and instrumental activities of daily living (β = −0.05, p = 0.002; β = −0.13, p < 0.001), the higher the depression score (β = −0.22, p < 0.001), the more severe the cognitive impairment (β = −0.04, p < 0.001), and the worse the SRH. Conclusions: Participants with high-risk medical conditions, such as cancer, stroke, and depression, thought their health was poor. However, they did not consider hypertension, malnutrition, and abnormal BMI as significantly affecting their health status. Therefore, these factors should be considered when measuring SRH in older adults. Full article

Background/Aim: Currently, there are limited evidence-based protocols for improving upper extremity (UE) motor function after stroke. The Keys protocol, a distributed form of constraint-induced movement therapy (CIMT), delivers CIMT components in fewer hours per day over an extended period, fitting outpatient rehabilitation schedules and third-party payor models. This pilot study aimed to assess the effectiveness of the Keys protocol in enhancing UE capacity and performance poststroke. Methods: Ten adults with chronic stroke (>6 months) participated in an 8-week intervention. The protocol included 22 supervised training sessions (1.5 h each): 4 days/week for 4 weeks, 2 days/week for weeks 5–6, and 1 day/week for weeks 7–8. Participants wore a restraint mitt on the less-affected UE during waking hours and used an adapted transfer package. Outcome measures included the Motor Activity Log (MAL), Wolf Motor Function Test (WMFT), Stroke Impact Scale (SIS), and Zung Depression Scale, assessed pre-treatment, mid-treatment (4 weeks), and posttreatment. Results: Significant improvements were observed in SIS Strength, ADLs/IADLs, Mobility, and Hand Function domains, exceeding MCID thresholds. Memory and Communication domains improved significantly at the 3-month follow-up. WMFT performance times improved, with fewer incomplete tasks. MAL scores for Amount of Use and Quality of Movement increased across all time points. Depressive symptoms significantly decreased posttreatment. Conclusions: The Keys protocol effectively improves UE use, motor function, mood, and quality of life, with the greatest gains observed mid-intervention. These findings support its feasibility and potential for outpatient stroke rehabilitation (ClinicalTrials.gov Registration: NCT05311384). Full article

Background: Gait disturbances characterized by asymmetries in lower limb strength and gait patterns are frequently observed in stroke patients, which increases gait variability and fall risk. However, the extent to which lower limb strength asymmetry influences gait asymmetry and variability in this population remains unclear. Methods: This cross-sectional study included 84 participants, comprising stroke survivors and age- and sex-matched healthy older adults. A portable dynamometer was used to assess lower limb strength, and inertial measurement units to analyze gait parameters. Asymmetry indices were used to quantify strength and gait asymmetries. Statistical analyses included Pearson correlations and stepwise regression to examine the relationships among lower limb strength asymmetry, gait asymmetry, and gait variability. Results: Stroke survivors exhibited significantly greater lower limb strength and gait asymmetries than healthy older adults (p < 0.001). Knee extension (KE) strength asymmetry was a significant predictor of increased gait variability in stroke survivors (R² = 0.448, p < 0.001) but not in healthy controls. Moreover, longer poststroke duration was associated with greater asymmetry in KE strength (r = 0.42, p < 0.05) and double support time (r = 0.45, p < 0.05). Conclusions: Lower limb strength asymmetry, specifically in knee extensors, is a critical determinant of gait asymmetry and variability in stroke survivors. The association between poststroke duration and increased asymmetry indicates the progressive nature of these impairments. These findings emphasize the importance of targeted interventions to reduce strength asymmetry and address chronic impairments in poststroke rehabilitation to improve gait stability and reduce fall risk. Full article

Background/Objectives: Colorectal cancer (CRC) is the second leading cause of cancer-related deaths globally. Screening for cancer helps to prevent comorbid conditions among individuals with chronic medical conditions, such as stroke. The gold standard for CRC screening is colonoscopy. Stroke is the fifth leading cause of death in the United States and a leading cause of long-term disability. This study examined the prevalence of screening colonoscopy among individuals who reported ever having had a stroke (stroke survivors). Methods: The 2022 Behavioral Risk Factor Surveillance System (BRFSS) data were analyzed for the weighted prevalence and odds of screening colonoscopy uptake among adults aged 45 years and older, based on having had a stroke and socioeconomic status. Results: Almost 6% (n = 16,371) of the adults included in the analysis (N = 285,329) reported having had a stroke, and the weighted prevalence of screening colonoscopy for this group was 73.3% compared to 67.8% for those without stroke. Stroke survivors were 1.3 times more likely to have had a screening colonoscopy compared to those without a history of stroke. Higher odds of screening colonoscopy uptake were observed among stroke survivors that were older than 45–49 years old, with high school or greater than high school education. Stroke survivors that were multiracial and without health insurance coverage had lower odds of screening colonoscopy uptake compared to those that were white and had health insurance coverage, respectively. Conclusions: Though adult stroke survivors, compared to those without a stroke, are more likely to report having had a screening colonoscopy, differences in screening colonoscopy uptake were observed among subgroups of this population based on sociodemographic status. Tailored interventions are needed for increasing screening colonoscopy uptake among disadvantaged subgroups. Full article

With shifts in lifestyle and dietary patterns, obesity has become an increasing health issue among younger demographics, particularly affecting young adults. This trend is strongly associated with a heightened risk of developing chronic diseases, especially cardiovascular conditions. However, conventional health monitoring systems are often limited to basic parameters such as heart rate, pulse pressure (PP), and systolic blood pressure (SBP), which may not provide a comprehensive assessment of cardiac health. This study introduces an intelligent heart health monitoring system that leverages the Internet of Things (IoT) and advanced sensor technologies. By incorporating IoT-based sensors, this system aims to improve the early detection and continuous monitoring of cardiac function in young obese women. The research employed a TERUMO ES-P2000 to measure blood pressure and a PhysioFlow device to assess noninvasive cardiac hemodynamic parameters. Through precise sensor data collection, the study identified key indicators for monitoring cardiovascular health. Machine learning models and big data analysis were utilized to predict cardiac index (CI) values based on the sensor-derived inputs. The findings indicated that young obese women showed significant deviations in blood pressure (SBP and PP) and cardiac hemodynamic metrics (SVI, EDV, and ESV) at an early stage. The implementation of signal processing techniques and IoT sensors enhanced the CI prediction accuracy from 33% (using basic parameters like heart rate, PP, and SBP) to 66%. Moreover, the integration of extra sensor-based parameters, such as Stroke Volume Index (SVI) and Cardiac Output (CO), along with the use of color space transformations, successfully improved the prediction accuracy of the original data by 36.68%, increasing from 53.33% to 90.01%. This represents a significant improvement of 30.01% compared to the existing technology’s accuracy of 60%. These results underscore the importance of utilizing sensor-derived parameters as critical early indicators of cardiac function in young obese women. This research advances smart healthcare through early cardiovascular risk assessment using AI and noninvasive sensors. Full article

(1) Background: Older adults with chronic stroke may experience compromised upper airway functions due to stroke-related changes and aging. This study aimed to evaluate the functional capacity of the upper airway in older adults with chronic stroke. (2) Methods: A total of 44 patients (22 in each group) were included in the study. The respiratory assessment involved measuring forced vital capacity, forced expiratory volume in one second, maximum voluntary ventilation, and peak cough flow. The voice assessment recorded intensity, frequency, shimmer, and the harmonics-to-noise ratio during a monologue task. Additionally, the maximum phonation time of /a/ and /s/ was recorded. The swallowing assessment included the Eating Assessment Tool—10 and the Swallowing Quality of Life questionnaire. (3) Results: Significant differences were found in the experimental group compared to the control group in maximum voluntary ventilation (44.59 ± 15.61 vs. 58.50 ± 28.08, p = 0.049) and peak cough flow (173.64 ± 101.09 vs. 291.59 ± 176.58, p = 0.009). Additionally, the experimental group showed poorer results than the control group in monologue intensity (66.60 ± 3.72 vs. 114.72 ± 63.09, p = 0.001), the harmonics-to-noise ratio (9.08 ± 2.06 vs. 10.26 ± 1.59, p = 0.042), and the maximum phonation time of /s/ (4.36 ± 1.67 vs. 8.09 ± 4.07, p < 0.001). Patients with stroke also had significantly lower values for swallowing efficiency and safety compared to the control group (7.05 ± 8.44 vs. 2.23 ± 4.14, p = 0.021) and reported poorer quality of life related to swallowing difficulties (185.50 ± 23.66 vs. 200.32 ± 19.60, p = 0.029). (4) Conclusions: Older adults with chronic stroke exhibited significantly reduced cough strength, voice intensity, maximum phonation time, and swallowing function compared to controls. Full article

Background: This study aimed to investigate the relationship between food insecurity and physical- and mental-health-related quality of life in adults with diabetes. Methods: Using two years of national Medical Expenditure Panel Survey data (2016–2017), we investigated the relationship between food insecurity and physical-health-related (PCS) and mental-health-related (MCS) quality of life in adults with diabetes. PCS and MCS were measured with the Short-Form 12 health survey and food insecurity was measured with the USDA 10-item adult scale. Analyses were weighted to represent the US adult population. Adjusted linear regression models, including covariates of age, gender, education, race/ethnicity, marital status, region, poverty level, employment status, health insurance, and comorbidities were used. Results: After adjustment, food-insecure adults with diabetes maintained significantly lower quality of life compared to food-secure adults with diabetes (PCS: −3.44, 95%CI −4.63, −2.25; MCS: −5.37, 95%CI −6.68, −4.06). This drop in PCS was larger than the drop for chronic conditions, including arthritis (−3.77, 95%CI −5.02, −2.52), emphysema (−2.82, 95%CI −5.12, −0.53), stroke (−2.63, 95%CI −4.11, −1.15), cancer (−2.59, 95%CI −4.00, −1.17), and heart attack (2.58, 95%CI 4.68, 0.48). Similarly, the drop for MCS was larger than for chronic pain (−2.37, 95%CI −3.24, −1.50) and arthritis (−1.31, 95%CI −2.28, −0.33). Conclusions: Food insecurity was associated with a significant reduction in both physical- and mental-health-related quality of life in adults with diabetes, with a magnitude of effect greater than adjusted estimates for the drop in quality of life for key chronic conditions. Addressing food insecurity through integration of social and medical care may lead to improvements in quality of life for adults with diabetes. Full article

Chronic sialorrhea is a condition characterized by excessive drooling, often associated with neurological and neuromuscular disorders such as Parkinson’s disease, cerebral palsy, and stroke. Despite its prevalence, it remains underdiagnosed and poorly understood, leading to a lack of comprehensive data on patient demographics, clinical characteristics, and treatment patterns. This study aimed to help fill these existing gaps by analyzing real-world data using Optum’s de-identified Clinformatics^® Data Mart Database. Patients were required to have a diagnosis indicative of sialorrhea plus evidence of sialorrhea treatment between 1/1/2007 and 5/31/2022. Two cohorts were analyzed: patients with evidence of newly diagnosed sialorrhea and associated treatment, and sialorrhea patients initiating incobotulinumtoxinA. Clinical characteristics, comorbidities, symptoms, and treatment utilization were described before and after diagnosis and incobotulinumtoxinA initiation. No formal statistical comparisons were performed. Patients were predominantly aged 65 or older, male, and non-Hispanic white. Parkinson’s disease and cerebral palsy were the most common comorbidities among adults and children, respectively. Treatment patterns suggest that anticholinergics are more commonly used than botulinum toxin therapy. The findings offer valuable information for improving diagnosis and treatment approaches and suggest a need for further research into treatment effectiveness, safety, and disease burden. Full article

Background and Objectives: Atrial fibrillation (AF) is the most frequent arrhythmia and the main cause of hospital admissions for cardioembolic stroke. The SIMETAP research project aims to update the prevalence rates of cardiovascular, renal, or metabolic factors and to evaluate their respective associations with factors that could be related. The present study aims to assess the AF prevalence rates in an adult population and its association with cardiovascular–kidney–metabolic (CKM) factors. Materials and Methods: This cross-sectional observational study was conducted in a primary care setting, with a population-based random sample of 6588 people aged 18.0–102.8 years. Crude and adjusted prevalence rates of AF were calculated. The associations of CKM factors with AF were assessed using bivariate and multivariate analysis. Results: The age- and sex-adjusted prevalence rates of AF were 2.9% in the overall adult population, 6.1% in the population aged ≥50 years, and 12.9% in the population aged ≥70 years, with no significant differences by sex. AF prevalence in the population under 50 years of age barely reached 1‰. Heart failure (HF), hypertension, chronic kidney disease (CKD), stroke, low HDL-cholesterol, and prediabetes were independent CKM factors associated with AF in the overall population, as were the same factors, except prediabetes, in the population ≥50 years old (p < 0.001). High or very high vascular risk was present in 92.4% [95% CI: 89.1–95.7]) of the population with AF. Conclusions: The adjusted prevalence rate of AF in the population aged 50 years or older was 6.1%, twice that of the overall adult population and half that of the population aged 70 years or older. The main independent CKM factors associated with AF were HF, stroke, CKD, hypertension, and low HDL-cholesterol. Full article