Diferencias de género en la calidad de vida a largo plazo tras un ictus: influencia del estado funcional y el estado de ánimo / Sex differences in long-term quality of life after stroke: Influence of mood and functional status

OBJETIVOS: Valorar la calidad de vida (CV) a largo plazo en pacientes que presentaron un ictus y analizar si existen diferencias entre sexos. MÉTODOS: Estudio descriptivo, observacional, transversal. El estudio fue aprobado por el Comité Ético. Se recogieron datos sociodemográficos, factores de riesgo, datos sobre la CV, el estado de ánimo y el estado funcional mediante escalas validadas. RESULTADOS: La muestra final obtenida fue de 124 pacientes. La edad media fue 71,30 años (DE: 11,99). En el estudio de la CV, las dimensiones que presentaron más problemas en el cuestionario EuroQol-5D fueron las de ansiedad/depresión (66,7%) y dolor/malestar (62,2%). Hubo diferencias significativas entre mujeres y hombres en las dimensiones movilidad y actividades cotidianas (p = 0,016 y p = 0,005). Y en el índice de salud del EQ-5D, también fue peor el resultado en mujeres que en hombres (0,45 ± 0,45 vs. 0,65 ± 0,38; p = 0,013). La CV se relacionó con la dependencia en las actividades básicas de la vida diaria (r = 0,326; p = 0,001) y con el estado de ánimo deprimido (r = -0,514; p < 0,0001). El modelo de predicción, para el índice del cuestionario de CV EQ-5D, estableció que el 72% de la puntuación obtenida en la CV estaría explicada por el estado funcional, la dependencia en las actividades de la vida diaria y el estado de ánimo, mientras que el estar casado aparece como factor protector. CONCLUSIÓN: La CV de los supervivientes a un ictus está afectada negativamente a largo plazo. Son las mujeres las que manifiestan una CV peor, sobre todo en las dimensiones de movilidad y actividades cotidianas

OBJECTIVE: To evaluate long-term quality of life (QoL) in patients who have experienced a stroke and to analyse differences in QoL between sexes. METHODS: We conducted a descriptive, cross-sectional, observational study to gather sociodemographic variables and risk factors; data were also obtained on QoL, mood, and functional status using validated scales. The study was approved by our centre's ethics committee. RESULTS: Our final sample included 124 patients; mean age was 71.30 ± 11.99 years. In the QoL study, the EuroQol-5D dimensions in which participants presented most problems were anxiety/depression (66.7%) and pain/discomfort (62.2%). We found significant inter-sex differences in the dimensions of mobility and usual activities (P = .016 and P = .005, respectively). Women also achieved substantially poorer EuroQoL-5D index values than men (0.45 ± 0.45 vs. 0.65 ± 0.38; P = .013). QoL was found to be associated with dependence for the activities of daily living (r = 0.326; P = .001) and depressed mood (r = -0.514; P < .0001). According to the predictive model for the EQ-5D index, 72% of the score on QoL items is explained by functional status, dependence for the activities of daily living (basic and instrumental), and depressed mood. Being married, in contrast, seems to be a protective factor. CONCLUSION: Stroke survivors have poor long-term QoL; this is more marked in women than in men, especially in the dimensions of mobility and usual activities

Sex differences in long-term quality of life after stroke: Influence of mood and functional status. / Diferencias de género en la calidad de vida a largo plazo tras un ictus: influencia del estado funcional y el estado de ánimo.

OBJECTIVE: To evaluate long-term quality of life (QoL) in patients who have experienced a stroke and to analyse differences in QoL between sexes. METHODS: We conducted a descriptive, cross-sectional, observational study to gather sociodemographic variables and risk factors; data were also obtained on QoL, mood, and functional status using validated scales. The study was approved by our centre's ethics committee. RESULTS: Our final sample included 124 patients; mean age was 71.30±11.99 years. In the QoL study, the EuroQol-5D dimensions in which participants presented most problems were anxiety/depression (66.7%) and pain/discomfort (62.2%). We found significant inter-sex differences in the dimensions of mobility and usual activities (P=.016 and P=.005, respectively). Women also achieved substantially poorer EuroQoL-5D index values than men (0.45±0.45 vs. 0.65±0.38; P=.013). QoL was found to be associated with dependence for the activities of daily living (r=0.326; P=.001) and depressed mood (r=-0.514; P<.0001). According to the predictive model for the EQ-5D index, 72% of the score on QoL items is explained by functional status, dependence for the activities of daily living (basic and instrumental), and depressed mood. Being married, in contrast, seems to be a protective factor. CONCLUSION: Stroke survivors have poor long-term QoL; this is more marked in women than in men, especially in the dimensions of mobility and usual activities.

[The impact of neurological and medical complications on the mortality and functional situation of acute stroke patients]. / Impacto de las complicaciones neurologicas y medicas sobre la mortalidad y situacion funcional de pacientes con ictus agudo.

INTRODUCTION: Stroke patients have a high risk of presenting complications, the appearance of which can condition the prognosis of the stroke. We studied the frequency and impact of the onset of several different complications on the early and mid-term prognosis of these patients. PATIENTS AND METHODS: We conducted an observation-based study of the patients admitted to a stroke unit. The complications that occurred while hospitalised were recorded, a distinction being drawn between neurological and medical complications. The study examined their influence, according to the subtype of stroke, on intra-hospital mortality and that at 90 days, as well as on the functional situation at 90 days, by analysing the clinical factors that are predictive for the appearance of complications. RESULTS: The sample consisted of 847 patients. Altogether, 29.5% of the patients presented complications, which were more frequent in haemorrhagic stroke (50.5% versus 26.6%; p < 0.0001). The most usual complications were of a neurological nature (21%). For both subtypes, the presence of complications was associated with a higher rate of mortality both in hospital (2.1% versus 12.6%; p < 0.0001) and at 90 days (5.7% versus 29.6%; p < 0.0001), and a lower probability of independence at 90 days (72.9% versus 30.4%; p < 0.0001). The severity of the stroke on admission revealed itself as the most powerful predictor of the onset of any type of complication. CONCLUSIONS: The appearance of complications during the acute phase of the stroke has an adverse influence on mortality and on the functional prognosis. The identification of predictive factors could reduce the impact upon the progress of acute stroke patients.

TITLE: Impacto de las complicaciones neurologicas y medicas sobre la mortalidad y situacion funcional de pacientes con ictus agudo.Introduccion. Los pacientes con ictus presentan un elevado riesgo de presentar complicaciones. Su aparicion puede condicionar el pronostico del ictus. Estudiamos la frecuencia y el impacto de la aparicion de diversas complicaciones en el pronostico precoz y a medio plazo en estos pacientes. Pacientes y metodos. Estudio observacional de los pacientes ingresados en una unidad de ictus. Se registraron las complicaciones durante su estancia, distinguiendose entre complicaciones neurologicas y medicas. Se estudio la influencia de estas segun subtipo de ictus en la mortalidad intrahospitalaria y a los 90 dias, y en la situacion funcional a los 90 dias, analizandose los factores clinicos predictores para la aparicion de complicaciones. Resultados. Muestra de 847 pacientes. Un 29,5% de los pacientes presento complicaciones, que fueron mas frecuentes en el ictus hemorragico (50,5% frente a 26,6%; p < 0,0001). Las complicaciones mas habituales fueron las neurologicas (21%). Para ambos subtipos, la presencia de complicaciones se asocio a mayor mortalidad intrahospitalaria (2,1% frente a 12,6%; p < 0,0001) y a 90 dias (5,7% frente a 29,6%; p < 0,0001), y menor probabilidad de independencia a 90 dias (72,9% frente a 30,4%; p < 0,0001). La gravedad del ictus al ingreso se mostro como el predictor mas potente en la aparicion de cualquier tipo de complicacion. Conclusiones. La aparicion de complicaciones durante la fase aguda del ictus influye de forma adversa en la mortalidad y en el pronostico funcional. La identificacion de factores predictores podria disminuir el impacto sobre la evolucion del paciente con un ictus agudo.

Situación funcional tras un ictus y experiencia acumulada de una unidad de ictus / Functional outcome of stroke and the cumulative experience of a stroke unit

Objetivo: Los pacientes con un ictus tienen más probabilidades de supervivencia e independencia si son atendidos en una unidad de ictus. La información disponible en nuestro entorno acerca de la influencia del aprendizaje sobre estos resultados es escasa. Analizamos la situación funcional y mortalidad en nuestros pacientes en función de la experiencia acumulada en una unidad de ictus. Pacientes y métodos: Estudio de cohortes retrospectivo de pacientes ingresados en una unidad de ictus. Diferenciamos 2 grupos según el año de ingreso: grupo A (julio 2007-diciembre 2009) y grupo B (enero 2010-diciembre 2011), analizando la evolución precoz en función de la puntuación en la escala de ictus del National Institute of Health y la mortalidad al alta y la situación funcional a medio plazo en función de la mortalidad y estado funcional según la escala Rankin a los 3 meses. Resultados: Se incluyó a 1.070 pacientes. No se obtuvo diferencias entre los grupos ni en la evolución favorable (68,3% vs. 63,9), ni en la mortalidad tanto hospitalaria (5,1% vs. 6,6%), como a los 90 días (12,8% vs. 13,1%), siendo mayor el porcentaje de independientes a los 90 días en el grupo B (56,3% vs. 65,5%: p = 0,03). El análisis multivariante ajustado por subtipo de ictus y tratamiento fibrinolítico mantuvo la asociación entre la independencia y el período de ingreso. Conclusiones: La probabilidad de independencia funcional de nuestros pacientes aumentó con la experiencia acumulada de nuestra Unidad de Ictus sin observarse diferencias en la mortalidad

Objective: Patients with acute stroke are more likely to survive and achieve independence if they are treated in a stroke unit. Available information in our setting is scarce. We analyse the outcomes of our patients on the basis of cumulative experience in a stroke unit. Patients and methods: A retrospective cohort study of patients admitted to a stroke unit. We differentiate between two groups according to the year of admission: group A (July 2007-December 2009) and group B (January 2010-December 2011), analysing early outcome based on the score on the National Institute of Health stroke salce and mortality at discharge, and medium-term outcome in terms of mortality and functional status according to the modified Rankin scale at three months. Results: A total 1070 patients were included. There were no differences between groups with respect to favourable outcome (68.3% vs 63.9), hospital mortality (5.1% vs 6.6%), or 90-day mortality (12.8% vs 13.1%). The percentage of patients who were independent at 90 days was greater in group B (56.3% vs 65.5%, P = .03). In the multivariate analysis adjusted for stroke subtype and fibrinolytic therapy, the association between patient independence and admission period remained present. Conclusions: The probability of functional independence in our patients increased alongside accumulated experience in our stroke unit with no differences in mortality

Functional outcome of stroke and the cumulative experience of a stroke unit.

OBJECTIVE: Patients with acute stroke are more likely to survive and achieve independence if they are treated in a stroke unit. Available information in our setting is scarce. We analyse the outcomes of our patients on the basis of cumulative experience in a stroke unit. PATIENTS AND METHODS: A retrospective cohort study of patients admitted to a stroke unit. We differentiate between two groups according to the year of admission: group A (July 2007-December 2009) and group B (January 2010-December 2011), analysing early outcome based on the score on the National Institute of Health stroke scale and mortality at discharge, and medium-term outcome in terms of mortality and functional status according to the modified Rankin scale at three months. RESULTS: A total 1070 patients were included. There were no differences between groups with respect to favourable outcome (68.3% vs 63.9), hospital mortality (5.1% vs 6.6%), or 90-day mortality (12.8% vs 13.1%). The percentage of patients who were independent at 90 days was greater in group B (56.3% vs 65.5%, P=.03). In the multivariate analysis adjusted for stroke subtype and fibrinolytic therapy, the association between patient independence and admission period remained present. CONCLUSIONS: The probability of functional independence in our patients increased alongside accumulated experience in our stroke unit with no differences in mortality.

Descripción de una serie de casos de cefalea hípnica. Diferenciación entre sexos / Description of a series of cases of hypnic headache. Differentiation between sexes

Introducción. La cefalea hípnica es un tipo infrecuente de cefalea primaria caracterizada por presentarse exclusivamentedurante el sueño y por despertar al paciente. El dolor es sordo (generalmente bilateral), no se asocia a signos autonómicosy suele aparecer a partir de los 50 años. Pacientes y métodos. Estudio prospectivo de 10 años de duración en el que se describe a los pacientes con cefalea hípnicaatendidos en la consulta monográfica de cefaleas. Se recogieron variables demográficas, de las características del dolor yla respuesta al tratamiento. Se compararon los datos en varones y mujeres. Resultados. Veinticuatro pacientes recibieron el diagnóstico de cefalea hípnica: 15 mujeres y 9 varones. No hubo diferenciasentre sexos en cuanto a la edad de inicio del dolor, el intervalo hasta el diagnóstico, el número de episodios al mes ni la duración del dolor. Los varones presentaban una intensidad de dolor (medida mediante la escala visual analógica)mayor que las mujeres. Tampoco existieron diferencias respecto a la presencia de hipertensión arterial ni de síndrome de apnea obstructiva del sueño. La respuesta a diferentes tratamientos sintomáticos y preventivos ha sido escasa y sin diferencias entre sexos.Conclusiones. La intensidad del dolor en las cefaleas hípnicas es mayor en los varones, aunque habría que corroborarlo en series más amplias. Se precisa avanzar en la fisiopatología de este tipo de cefalea para encontrar fármacos preventivos más eficaces (AU)

Introduction. Hypnic headache is an infrequent type of primary headache characterised by appearing almost exclusivelyduring sleep and by waking the patient up. The pain is dull (generally bilateral), is not associated to autonomic signs andusually appears from the age of 50 onwards. Patients and methods. A 10-year prospective study was conducted which describes the patients with hypnic headachewho were attended in a specialised headache clinic. Data collected include demographic variables, the characteristics of the pain and response to treatment. Data from males and from females were compared. Results. Twenty-four patients were diagnosed with hypnic headache: 15 females and 9 males. There were no differences between sexes as regards the age at onset of the pain, the time elapsed until diagnosis, the number of episodes per month or the amount of time the pain lasted. The males reported a more intense pain (measured by means of the analogical visual scale) than the females. Neither were there any differences in terms of the presence of arterial hypertension or obstructive sleep apnoea syndrome. Response to different symptomatic and preventive treatments was scarce and with no differences between sexes. Conclusions. The pain in hypnic headaches is more intense in males, although this needs to be corroborated in longer series. Further advances need to be made in the pathophysiology of this kind of headache so as to be able to find more efficient preventive pharmacological agents (AU)

Evolución y respuesta al tratamiento intravenoso con activador del plasminógeno tisular en relación con el hospital de derivación. Experiencia de una unidad de ictus de referencia / Development and response to intravenous treatment with tissue plasminogen activator with regard to referral hospitals. The experience of a stroke referral unit

Introducción. La administración del activador del plasminógeno tisular por vía intravenosa constituye un tratamiento seguro y eficaz en pacientes con un ictus isquémico agudo. El pronóstico depende de múltiples factores, siendo el intervalode tiempo desde el inicio del ictus hasta su administración uno de los de mayor impacto. Pacientes y métodos. Estudio prospectivo observacional de los pacientes que recibieron fibrinólisis intravenosa en nuestra unidad de ictus entre junio de 2007 y diciembre de 2010. Los pacientes se dividieron en dos grupos: los que acudieron directamente a urgencias de nuestro hospital y los que fueron derivados desde otros centros hospitalarios de Extremadura. Se compararon las características basales, la respuesta al tratamiento y la evolución entre ambos grupos. Resultados. Los pacientes que procedían de fuera de nuestra área de salud se caracterizaban por ser mayoritariamente varones, con ictus tipo TACI, y presentaban una mayor puntuación en la National Institutes of Health Stroke Scale (NIHSS).El tiempo hasta la administración de la fibrinólisis fue menor en los pacientes de nuestra área de salud. La NIHSS al alta fue mayor en pacientes que venían de otra área de salud, pero no hubo diferencias en la escala Rankin a los tres mesesni en la mortalidad. Conclusiones. Los pacientes sometidos a fibrinólisis que provienen de otro centro hospitalario obtienen al alta una puntuaciónen la NIHSS mayor. Esto probablemente se debe a un sesgo en la selección de los pacientes, derivando mayoritariamentevarones, con una peor situación clínica al ingreso y que reciben el tratamiento en un período significativamente mayor desde el inicio de los síntomas (AU)

Introduction. The intravenous administration of tissue plasminogen inhibitor is a safe and effective treatment for patients with an acute ischaemic stroke. The prognosis depends on a number of factors, the time that elapses between the onsetof the stroke and its administration being one of those with the greatest impact. Patients and methods. This is a prospective observational study of the patients who received intravenous fibrinolysis in our stroke unit between June 2007 and December 2010. The patients were divided into two groups, a distinction being made between those who went directly to A&E at our hospital and those who were referred from other hospitals in Extremadura. The baseline characteristics, response to treatment and development in each group were compared. Results. The patients who came from outside our health district were mainly males, with a TACI-type stroke and theypresented higher scores on the National Institutes of Health Stroke Scale (NIHSS). The time elapsed prior to administration of the fibrinolysis was shorter in the patients from our health district. The NIHSS score on discharge was higher in patientswho came from another health district, but there were no differences in the Rankin scale at three months or in themortality rate. Conclusions. Patients submitted to fibrinolysis who come from another hospital score higher on the NIHSS on discharge.This is probably due to a bias in the selection of the patients, since those referred are mainly males, who have a poorer clinical situation on admission and receive treatment in a significantly longer time interval following the onset of symptoms (AU)

Smoking as a precipitating factor for migraine: a survey in medical students.

Our aim was to analyse the relationship between migraine and smoking in medical students. Medical students who had already received teaching on migraine were asked to answer an ad hoc questionnaire. A total of 361 students filled in the questionnaire: 245 (68%) were women. International Headache Society criteria were fulfilled by 58 (prevalence of migraine 16%) students. A total of 74 (20%) were current smokers: 21 males (18% of men were smokers) and 53 females (22% smokers). Within those 58 students with migraine, 17 (29%) smoke: only 2 were males (14% of males with migraine smoked) while the remaining 15 were females (34% of women with migraine smoked). Within those 17 students who were smokers and migraineurs, 12 (71%) thought that smoking worsens migraine and 10 (59%) that smoking precipitates attacks. The minimum number of cigarettes which subjectively precipitates attacks was 5. Migraine prevalence in the 20s in Spain is 16%. Our data obtained in medical students suggest that smoking can be a precipitating factor for migraine attacks, as the prevalence of active smoking is one-third higher in migraineurs and as there seems to be a relationship between the number of cigarettes and the development of migraine attacks.