Post-stroke Hyperglycemia in Non-diabetic Ischemic Stroke is Related With Worse Functional Outcome: A Cohort Study

Objective@#To investigate long-term and serial functional outcomes in ischemic stroke patients without diabetes with post-stroke hyperglycemia. @*Methods@#The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) is a large, multi-center, prospective cohort study of stroke patients admitted to participating hospitals in nine areas of Korea. From KOSCO, ischemic stroke patients without diabetes were recruited and divided into two groups: patients without diabetes without (n=779) and with post-stroke hyperglycemia (n=223). Post-stroke hyperglycemia was defined as a glucose level >8 mmol/L. Functional assessments were performed 7 days and 3, 6, and 12 months after stroke onset. @*Results@#There were no significant differences in baseline characteristics between the groups, except in the age of onset and smoking. Analysis of the linear correlation between the initial National Institutes of Health Stroke Scale (NIHSS) score and glucose level showed no significant difference. Among our functional assessments, NIHSS, Fugl-Meyer Assessment (affected side), Functional Ambulatory Category, modified Rankin Scale, and Korean Mini-Mental State Examination (K-MMSE) showed statistically significant improvements in each group. All functional improvements except K-MMSE were significantly higher in patients without post-stroke hyperglycemia at 7 days and 3, 6, and 12 months. @*Conclusion@#The glucose level of ischemic stroke patients without diabetes had no significant correlation with the initial NIHSS score. The long-term effects of stress hyperglycemia showed worse functional outcomes in ischemic stroke patients without diabetes with post-stroke hyperglycemia.

Factors Associated with Changes in Functional Independence after Six Months of Ischemic Stroke

The aim of this study is to investigate the changes in functional independence and their associated factors during the first 6 months to 1 year after stroke onset. This study is the interim results of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 1,011 participants were included and classified into 3 subgroups according to changes in the Korean version of Modified Barthel Index (K-MBI) scores that occurred between 6 months to 1 year after stroke onset: the improved group (IG), with scores that increased 5 points or more; the stationary group (SG), with the K-MBI score changes ranging from −4 to +4 points; and the declined group (DG), with the K-MBI scores that decreased 5 points or more. Ordinal logistic regression analyses were used to assess the factors influencing changes in the K-MBI score. Among 1,011 patient, 436 patients (43.1%), 398 patients (39.4%) and 117 patients (17.5%) were classified into the IG, SG, and DG, respectively. Obesity and Geriatric Depression Scale score were significant influencing factors for changes in the K-MBI scores. Obesity showed a positive influence on the K-MBI score, while depression showed a negative influence.

Factors Associated to Returning Home in the First Year after Stroke

The objective of this study was to investigate factors affecting the return home one year after a stroke. The subjects of this study consisted of patients who participated in a large-scale multi-objective cohort study of initial stage stroke patients who were admitted to 9 representative hospitals in Korea. We analyzed the distribution of the subjects who had experienced stroke a year earlier by distinguishing the group who returned home and the other group that was hospitalized in rehabilitation hospitals. Based on this distribution, we evaluated the demographic, environmental, clinical, and psychological factors that can affect the return home. Overall, there were 464 subjects in the ‘Return home’ group and 99 subjects in the ‘Rehabilitation hospitalization’ group. job status, inconvenient housing structures, residential types, diagnosis, Functional Ambulation Categories, modified Rankin Scale, Korea-Modified Barthel Index, Function Independence Measure, Fugl-Meyer Assessment, Korean version of Mini-Mental State Examination, Korean version of Frenchay Aphasia Screening Test, Psychosocial Well-being Index-Short Form, Geriatric Depression Scale-Short Form, EuroQol-five Dimensional showed a significant difference between the 2 groups one year after the stroke. The factors affecting the return home one year after a stroke include functional status, activities of daily living, cognition, depression, stress, quality of life, job status. It is expected that factors affecting the rehabilitation of patients with stroke can be considered as basic data for establishing rehabilitation goals and treatment plans.

Indicators Related to Cardiopulmonary Resuscitation According to Occupation Among Family Members of Coronary Heart Disease Patients / 전남의대학술지

This study aimed to evaluate differences in cardiopulmonary resuscitation (CPR)-related indicators among families of community-dwelling coronary heart disease (CHD) patients according to their occupation. A total of 6,867 family members living with CHD patients were selected for analysis from the 2016 Korea Community Health Survey. Respondents’ occupations were classified into managers and professionals (MP), clerks (CL), service and sales workers (SSW), agricultural/forestry/fishery workers (AFFW), mechanical and manual laborers (MML), and homemakers and unemployed (HU). The adjusted odds ratio (aOR) for awareness of CPR in the MP (3.82), SSW (1.73), and MML (1.29) groups were higher than that in HU (reference), while the CL (1.42) and AFFW (1.04) groups showed no significant difference compared to HU. The aORs for experience with CPR education and manikin-assisted CPR training were higher among the MP (4.00 and 3.94), CL (2.61 and 2.26), SSW (2.02 and 1.91), and MML (1.99 and 1.69) groups than in HU, and only AFFW (1.22 and 1.18) showed no difference from HU. Finally, the aOR for self-efficacy in CPR performance was significantly higher among the MP (3.17), CL (1.64), SSW (1.87), and MML (1.44) groups than in HU. However, there was no significant difference between AFFW (1.22) and HU in self-efficacy in CPR performance. To improve the survival rate of CHD patients through successful CPR at the pre-hospital stage during cardiac arrest, it is important to increase the ability of family members of CHD patients to perform CPR, especially among those in AFFW and HU occupations.

Factors Associated to Returning Home in the First Year after Stroke

The objective of this study was to investigate factors affecting the return home one year after a stroke. The subjects of this study consisted of patients who participated in a large-scale multi-objective cohort study of initial stage stroke patients who were admitted to 9 representative hospitals in Korea. We analyzed the distribution of the subjects who had experienced stroke a year earlier by distinguishing the group who returned home and the other group that was hospitalized in rehabilitation hospitals. Based on this distribution, we evaluated the demographic, environmental, clinical, and psychological factors that can affect the return home. Overall, there were 464 subjects in the ‘Return home’ group and 99 subjects in the ‘Rehabilitation hospitalization’ group. job status, inconvenient housing structures, residential types, diagnosis, Functional Ambulation Categories, modified Rankin Scale, Korea-Modified Barthel Index, Function Independence Measure, Fugl-Meyer Assessment, Korean version of Mini-Mental State Examination, Korean version of Frenchay Aphasia Screening Test, Psychosocial Well-being Index-Short Form, Geriatric Depression Scale-Short Form, EuroQol-five Dimensional showed a significant difference between the 2 groups one year after the stroke. The factors affecting the return home one year after a stroke include functional status, activities of daily living, cognition, depression, stress, quality of life, job status. It is expected that factors affecting the rehabilitation of patients with stroke can be considered as basic data for establishing rehabilitation goals and treatment plans.

Factors Associated with Changes in Functional Independence after Six Months of Ischemic Stroke

The aim of this study is to investigate the changes in functional independence and their associated factors during the first 6 months to 1 year after stroke onset. This study is the interim results of the Korean Stroke Cohort for Functioning and Rehabilitation. A total of 1,011 participants were included and classified into 3 subgroups according to changes in the Korean version of Modified Barthel Index (K-MBI) scores that occurred between 6 months to 1 year after stroke onset: the improved group (IG), with scores that increased 5 points or more; the stationary group (SG), with the K-MBI score changes ranging from −4 to +4 points; and the declined group (DG), with the K-MBI scores that decreased 5 points or more. Ordinal logistic regression analyses were used to assess the factors influencing changes in the K-MBI score. Among 1,011 patient, 436 patients (43.1%), 398 patients (39.4%) and 117 patients (17.5%) were classified into the IG, SG, and DG, respectively. Obesity and Geriatric Depression Scale score were significant influencing factors for changes in the K-MBI scores. Obesity showed a positive influence on the K-MBI score, while depression showed a negative influence.

Factors Associated to Returning Home in the First Year after Stroke

The objective of this study was to investigate factors affecting the return home one year after a stroke. The subjects of this study consisted of patients who participated in a large-scale multi-objective cohort study of initial stage stroke patients who were admitted to 9 representative hospitals in Korea. We analyzed the distribution of the subjects who had experienced stroke a year earlier by distinguishing the group who returned home and the other group that was hospitalized in rehabilitation hospitals. Based on this distribution, we evaluated the demographic, environmental, clinical, and psychological factors that can affect the return home. Overall, there were 464 subjects in the ‘Return home’ group and 99 subjects in the ‘Rehabilitation hospitalization’ group. job status, inconvenient housing structures, residential types, diagnosis, Functional Ambulation Categories, modified Rankin Scale, Korea-Modified Barthel Index, Function Independence Measure, Fugl-Meyer Assessment, Korean version of Mini-Mental State Examination, Korean version of Frenchay Aphasia Screening Test, Psychosocial Well-being Index-Short Form, Geriatric Depression Scale-Short Form, EuroQol-five Dimensional showed a significant difference between the 2 groups one year after the stroke. The factors affecting the return home one year after a stroke include functional status, activities of daily living, cognition, depression, stress, quality of life, job status. It is expected that factors affecting the rehabilitation of patients with stroke can be considered as basic data for establishing rehabilitation goals and treatment plans.

Impact of Functional Status on Noncardioembolic Ischemic Stroke Recurrence Within 1 Year: The Korean Stroke Cohort for Functioning and Rehabilitation Study

BACKGROUND AND PURPOSE: Few studies have investigated the relationship between the specific functional factors potentially associated with functional level and stroke recurrence. We conducted a study of patients with noncardioembolic ischemic stroke (NCIS) to determine the functional factors affecting recurrence within the first year. METHODS: In total, 568 first-ever NCIS patients (age=65.1±17.4 years, mean±SD) were analyzed in a multicenter, prospective cohort study registered from August 2012. Demographic characteristics, past medical history, comorbidities, laboratory data, stroke features in neuroimaging, acute treatments, and medications at discharge were assessed. Functional factors reflecting gross functional impairment, ambulatory function, motor function, activities of daily living, cognition, language ability, swallowing function, mood, and quality of life were comprehensively evaluated in face-to-face assessments using standardized tools at the time of discharge. RESULTS: The cumulative incidence of stroke recurrence in NCIS was 6.0% (n=34) at 1 year. The period from admission to discharge was 34.4±7.0 days. The independent predictors of stroke recurrence within 1 year in multivariate Cox proportional-hazards regression analyses were 1) age [per-year hazard ratio (HR)=1.04, 95% confidence interval (CI)=0.97–1.06, p=0.048], 2) Charlson Comorbidity Index higher than 2 (HR=1.72, 95% CI=1.26–2.22, p=0.016), 3) modified Rankin Scale score of 3 or more at discharge (HR=1.56, 95% CI=1.22–1.94, p=0.032), and 4) Functional Ambulation Category of 3 or less at discharge (HR=2.56, 95% CI=1.84–3.31, p=0.008). CONCLUSIONS: In addition to patient age, moderate-to-severe functional impairment requiring the help of others (especially for ambulation) at the time of discharge and the severity of comorbidity were independent predictors of stroke recurrence within 1 year of the first NCIS.

Health Indicators Related to Disease, Death, and Reproduction / 예방의학회지

One of the primary goals of epidemiology is to quantify various aspects of a population’s health, illness, and death status and the determinants (or risk factors) thereof by calculating health indicators that measure the magnitudes of various conditions. There has been some confusion regarding health indicators, with discrepancies in usage among organizations such as the World Health Organization the, Centers for Disease Control and Prevention (CDC), and the CDC of other countries, and the usage of the relevant terminology may vary across papers. Therefore, in this review, we would like to propose appropriate terminological definitions for health indicators based on the most commonly used meanings and/or the terms used by official agencies, in order to bring clarity to this area of confusion. We have used appropriate examples to make each health indicator easy for the reader to understand. We have included practical exercises for some health indicators to help readers understand the underlying concepts.

Erratum to: Impact of Functional Status on Noncardioembolic Ischemic Stroke Recurrence Within 1 Year: The Korean Stroke Cohort for Functioning and Rehabilitation Study

At the request of the author, the author's alphabetical affiliation and address should be as follow.

Health Indicators Related to Disease, Death, and Reproduction / 예방의학회지

One of the primary goals of epidemiology is to quantify various aspects of a population’s health, illness, and death status and the determinants (or risk factors) thereof by calculating health indicators that measure the magnitudes of various conditions. There has been some confusion regarding health indicators, with discrepancies in usage among organizations such as the World Health Organization the, Centers for Disease Control and Prevention (CDC), and the CDC of other countries, and the usage of the relevant terminology may vary across papers. Therefore, in this review, we would like to propose appropriate terminological definitions for health indicators based on the most commonly used meanings and/or the terms used by official agencies, in order to bring clarity to this area of confusion. We have used appropriate examples to make each health indicator easy for the reader to understand. We have included practical exercises for some health indicators to help readers understand the underlying concepts.

The Level of Diabetes Management of Agriculture, Forestry, and Fishery Workers / 農村醫學 地域保健

OBJECTIVES: The purpose of this study was to compare the diabetic management indicators between agriculture, forestry, and fishery workers (AFF) and other occupational adults (non-AFF) in community-dwelling diabetes. METHODS: The study population consisted of 22,127 diabetic population ≥19 years who participated in the 2015 Community Health Survey. Chi-square test and logistic regression analysis was used to compare the diabetic management indicators between AFF and non-AFF. Socioeconomic characteristics such as age, gender, education level, monthly household income, National Basic Livelihood Security status, and marital status was sequentially adjusted. RESULTS: Among total diabetic population, 3,712 people (16.8%) was AFF and 18,415 people (83.2%) was non-AFF. The fully-adjusted odds ratio [OR] (95% confidence interval [CI]) of current non-medical treatment (0.72, 0.66–0.79), measurement of hemoglobin A1c (0.61, 0.55–0.67), screening for diabetic retinopathy (0.76, 0.70–0.83), screening for diabetic nephropathy (0.75, 0.70–0.81), non-alcoholic or moderate drinking (0.70, 0.64–0.78), nutrition label reading (0.83, 0.71–0.98), low salt preference (0.85, 0.78–0.93), dental examination (0.60, 0.54–0.66), scaling experience (0.84, 0.77–0.93), regular toothbrushing (0.66, 0.58–0.76), and diabetes management education (0.84, 0.77–0.92) was significantly lower in AFF compared to non-AFF. In contrast, the fully-adjusted OR (95% CI) of AFF's low stress level (1.39, 1.26–1.52) and adequate sleep duration (1.22, 1.13–1.32) was significantly higher than non-AFF, which are better indicators of diabetic management in AFF. CONCLUSIONS: Overall, the level of diabetes management of AFF was not as good as that of non-AFF. In order to improve the level of diabetes management of AFF, a delicate diabetes intervention strategy considering the occupational characteristics of AFF will be needed.

Differences in agricultural activities related to incidence of scrub typhus between Korea and Japan / 한국역학회지

OBJECTIVES: The purpose of this study was to establish a basis for improving or strengthening the preventive strategy against scrub typhus in Korea by comparing and analyzing the difference of prevention behaviors contributing to the occurrence of scrub typhus in Japan and Korea. METHODS: The survey was carried out in Jeollabuk-do, which is a high risk and high incidence area, and Fukuoka Prefecture, which is a high risk and low incidence area. The study included 406 Korean farmers and 216 Japanese farmers. Data were collected through face-to-face surveys by interviewers who had completed standardized education. RESULTS: Korean farmers have a higher percentage of agricultural working posture that involved contact with weeds than Japanese farmers (p < 0.05). The frequency and proportion of weeding were lower in Korean farmers than in Japanese farmers (p < 0.05). The level of knowledge about scrub typhus was significantly higher among Korean farmers than among Japanese farmers (p < 0.05). Mostly, the behavior of agriculture work was more appropriate for Japanese farmers than for Korean farmers (p < 0.05). The total average level of agricultural work was lower in Korea than in Japan, lower in men than women, and lower in part-time farmers than full-time farmers (p < 0.05). CONCLUSIONS: This study suggests that it is reasonable to develop and provide a program that can improve the level of preventive behavior taking into consideration the characteristics of the subject in order to reduce the incidence of diseases in high-risk areas for scrub typhus.

Association between Stroke Status and Depression in a Community Setting: The 2014 Korea National Health and Nutrition Examination Survey

BACKGROUND AND PURPOSE: Previous studies have examined the risk factors for depression in stroke patients, but little information is available on the relationship between stroke status and depression in the community-dwelling general population. We evaluated the association between stroke status and depression using representative nationwide data. METHODS: In total, 3,487 subjects (aged ≥40 years) who participated in version VI-2 of the sixth Korea National Health and Nutrition Examination Survey (KNHANES) performed in 2014 were included. We compared the prevalence of depression in 120 community-dwelling stroke patients and 3,367 nonstroke controls using the nine-item Patient Health Questionnaire (PHQ-9). RESULTS: The prevalence of depression (PHQ-9 score ≥10) was 16.7% in stroke patients and 6.4% in controls. In the unadjusted model, depression was more common in stroke patients than in nonstroke controls [odds ratio (OR), 2.95; 95% confidence interval (CI), 1.79–4.86]. After adjusting for demographic characteristics, socioeconomic status, health-related behaviors, and comorbidities, stroke diagnosis was a significant risk factor for depression (OR, 1.85; 95% CI, 1.06–3.24). Specifically, a diagnosis of stroke in patients aged <60 years (OR, 3.82; 95% CI, 1.81–8.09) and the presence of stroke complications (OR, 2.77; 95% CI, 1.25–6.13) remained significant risk factors for depression even after adjusting for potential confounders. CONCLUSIONS: In a community setting, poststroke survivors had a higher prevalence of depression, and stroke was an independent risk factor for depression. Public psychosocial interventions are needed to improve the mental health care of community-dwelling stroke survivors.

Risk Factors and Functional Impact of Medical Complications in Stroke

OBJECTIVE: To determine the incidence and risk factors for medical complications in Korean patients suffering from stroke and the impact of such complications on post-stroke functional outcomes. METHODS: We assessed patients enrolled in a prospective cohort study. All recruited patients had suffered a first acute stroke episode and been admitted to nine university hospitals in Korea between August 2012 and June 2015. We analyzed patient and stroke characteristics, comorbidities, prevalence of post-stroke medical complications, and functional outcomes at time of discharge and 3, 6, and 12 months after stroke onset. RESULTS: Of 10,625 patients with acute stroke, 2,210 (20.8%) presented with medical complications including bladder dysfunction, bowel dysfunction, sleep disturbance, pneumonia, and urinary tract infection. In particular, complications occurred more frequently in older patients and in patients with hemorrhagic strokes, more co-morbidities, severe initial motor impairment, or poor swallowing function. In-hospital medical complications were significantly correlated with poor functional outcomes at all time points. CONCLUSION: Post-stroke medical complications affect functional recovery. The majority of complications are preventable and treatable; therefore, the functional outcomes of patients with stroke can be improved by providing timely, appropriate care. Special care should be provided to elderly patients with comorbid risk factors.

Differences in agricultural activities related to incidence of scrub typhus between Korea and Japan / 한국역학회지

OBJECTIVES: The purpose of this study was to establish a basis for improving or strengthening the preventive strategy against scrub typhus in Korea by comparing and analyzing the difference of prevention behaviors contributing to the occurrence of scrub typhus in Japan and Korea.METHODS: The survey was carried out in Jeollabuk-do, which is a high risk and high incidence area, and Fukuoka Prefecture, which is a high risk and low incidence area. The study included 406 Korean farmers and 216 Japanese farmers. Data were collected through face-to-face surveys by interviewers who had completed standardized education.RESULTS: Korean farmers have a higher percentage of agricultural working posture that involved contact with weeds than Japanese farmers (p < 0.05). The frequency and proportion of weeding were lower in Korean farmers than in Japanese farmers (p < 0.05). The level of knowledge about scrub typhus was significantly higher among Korean farmers than among Japanese farmers (p < 0.05). Mostly, the behavior of agriculture work was more appropriate for Japanese farmers than for Korean farmers (p < 0.05). The total average level of agricultural work was lower in Korea than in Japan, lower in men than women, and lower in part-time farmers than full-time farmers (p < 0.05).CONCLUSIONS: This study suggests that it is reasonable to develop and provide a program that can improve the level of preventive behavior taking into consideration the characteristics of the subject in order to reduce the incidence of diseases in high-risk areas for scrub typhus.

Effects of in-Person, in-Hospital Education for Stroke Patients by an Education-Specialized Nurse

BACKGROUND: We assessed the effects of customized in-hospital, in-person education provided by an education-specialized nurse in ischemic stroke patients. METHODS: All ischemic stroke patients who were hospitalized between April 2015 and December 2015 were included. They were provided with education about stroke by an education-specialized nurse during their hospital stay. The knowledge of stroke warning signs and appropriate responses was examined both before the in-hospital education and 3 months after discharge in 127 patients. RESULTS: The awareness of the following stroke warning signs increased significantly at 3 months after discharge compared to before receiving the education (all p values <0.001): sudden difficulty in speaking or in understanding speech (74.0→93.7%), sudden numbness or weakness (72.4→92.1%), sudden dizziness (71.7→89.8%), sudden severe headache (44.9→82.7%), and sudden visual impairment (38.6→69.3%). The proportion of patients with a good knowledge of stroke warning signs (defined as providing at least five correct answers) increased significantly, from 38.6% to 81.9%. Almost half of them (46.5%) correctly answered that they should call an ambulance first when someone shows stroke symptoms before receiving the education, with this proportion increasing to 68.5% at 3 months after discharge (p<0.001). The proportions of patients who understood the need for prompt treatment of stroke and the golden time window increased from 80.3% to 96.9% and from 66.1% to 86.6%, respectively (both p<0.001). The proportion of patients with knowledge of thrombolytic therapy for stroke also increased significantly after the in-hospital education, from 11.0% to 76.4% (p<0.001). CONCLUSIONS: In-hospital, in-person education was effective at increasing the understanding that patients have of stroke, even at 3 months after discharge. In-hospital education provided by an education-specialized nurse would be an effective intervention for increasing the likelihood of stroke patients reacting appropriately to stroke recurrence.

Continuous Abstinence Rates from Smoking Over 12 Months according to the Frequency of Participation in a Hospital-based Smoking Cessation Program among Patients Discharged after Acute Myocardial Infarction

BACKGROUND: This study evaluated the continuous abstinence rates from smoking at 12-month after a hospital-based smoking cessation program was applied for smokers hospitalized for acute myocardial infarction. METHODS: Among those who are hospitalized for acute myocardial infarction from January 2012 to December 2013, ninety-eight smokers agreed to quit smoking were eligible for follow up to 12 months. Each of them underwent six consecutive sessions (first during admission, the other 5 sessions after discharge) of behavioral modification, counseling for withdrawal symptoms, and anti-smoking advices by a trained nurse. Exhaled carbon monoxide measurements less than 6 ppm were used to confirm the smoking cessation status of each participant. RESULTS: Mean age of all participants was 55.2±10.8 years old, and their continuous abstinence rates at 1, 3, 6, 12 months were 63.3%, 49.0%, 43.9%, and 37.8% for each. The continuous abstinence rate from smoking after 12 months was 69.7% and significantly higher in those who completed the 6 sessions than 21.5% in those who completed 5 sessions or less (P<0.001). After adjustment for general and smoking-related characteristics, multivariate logistic regression analysis revealed that full participation relative to 5 or less participation was significantly associated with higher continuous abstinence rate from smoking at 12 months (odds ratio: 7.96; 95% confidence interval: 2.07-30.55). CONCLUSIONS: The consistency of participating in a hospital-based smoking cessation program, described herein, significantly improved success rates of smoking cessation in patients discharged after acute myocardial infarction. Hospital-based smoking cessation program based on education and counseling should be included as an important part of patient management for acute myocardial infarction.

Public Perception of the Concentration of Cardiac and Cerebrovascular Surgery to Metropolitan Hospitals

BACKGROUND: This study investigates the perception of the general public regarding the concentration to metropolitan, hospitals of cardiac and cerebrovascular surgeries, and the perceived public need for government policies to resolve this issue. METHODS: A total of 800 participants were recruited for our telephone interview survey. Quota sampling was performed, adjusting for age and sex, to select by various geographic regions. Sampling with random digit dialing was performed; we called the randomly generated telephone numbers and made three attempts for non-responders before moving on to a different telephone number. RESULTS: Our sample population was 818 participants, 401 men (49.0%) and 417 women (51.0%). Our data showed that 85.5% of participants thought that cardiac surgery and neurosurgery patients are concentrated in large hospitals in Seoul. The principle reason for regional patients to want to receive surgery at major hospitals in Seoul was because of poor medical standards associated with regional hospitals (87.7%). We found that a vast majority of participants (97.5%) felt that government policies are needed to even out the clustering of cardiac surgery and neurosurgery patients, and that this clustering may be alleviated if policies that can specifically enhance the quality and the capacity of regional hospitals to carry out surgeries are adopted (98.3%). CONCLUSION: Government policy making must reflect public desiderata, and we suggest that these public health needs may be partially resolved through government-designated cardiac and neurosurgery specialist hospitals in regional areas.

Prevalence Rate of Spasticity at 3 Months after Stroke in Korea: The Korean Stroke Cohort for Functioning and Rehabilitation (KOSCO) Study

The aim of this study was to investigate prevalence and risk factors associated with spasticity at 3 months after a first-ever stroke in Korean patients. This cohort study included consecutive patients with first-ever stroke who were admitted to 9 participated hospitals in different areas of Korea. The Modified Ashworth Scale (MAS), which defines spasticity as MAS > 1 in any of the examined joints was used to assess patients 3 months after stroke occurrence. The prevalence of spasticity was 7.3% (339 of 4,658 patients), 3 months after stroke onset. Spasticity was more frequent in upper extremity (6.7%) than lower extremity (4.3%). Severity of spasticity was as follows: 63.1%: MAS I, 23.3%: MAS I+, 9.4%: MAS II, 2.6%: MAS III, and 1.4%: MAS IV. Stroke type (hemorrhagic) (p < 0.05) were identified as correlated risk factors. Patients with spasticity scored higher with National Institute of Health Stroke Scale (NIHSS) and lower with modified Rankin Scale (mRS) than non-spastic patients (p < 0.001). This study showed 7.3% prevalence of spasticity in Korean first-ever stroke patients at 3 months, and identified those who carried higher risks of developing spasticity who would particularly benefit from preventive or therapeutic strategies. It would contribute to assessing spasticity in patients with first-ever stroke in Korea.