A population-based study of the prevalence of fatigue after transient ischemic attack and minor stroke.

BACKGROUND AND PURPOSE: Fatigue is common after stroke and can be attributable to the increased physical effort associated with severe neurological deficits; however, its presence in those with little motor deficit raises the possibility of confounding by other factors, such as comorbidity, anxiety, and medication. To control for such factors and determine the extent of stroke-specific fatigue, we compared patients with minor stroke who had little or no residual neurological deficit with patients with TIA; both groups had undergone similar investigations and treatment. METHODS: The prevalence of fatigue 6 months after TIA or minor stroke was assessed in consecutive patients using the Chalder fatigue scale in a population-based incidence study (Oxford Vascular Study). Patients were included if they were independent in self-care Barthel Index (>or=18/20) and without major cognitive impairment (Mini-Mental State Examination >or=24/30). Stroke severity at baseline was assessed with the National Institute of Health Stroke Scale (NIHSS). Other potential causes of fatigue were assessed including anxiety, depression, recent life events, medication, and abnormalities in biochemistry or hematologic tests. RESULTS: Seventy-six participants had minor stroke (mean age, 74.1 years; 42 men) and 73 had TIA (mean age, 72.5 years; 40 men). At 6-month follow-up, median Barthel Index score was 20 (interquartile range, 20-20) in both groups. However, fatigue was more common after stroke than TIA (56% vs 29%; OR, 3.14; 95% CI, 1.51-6.57; P=0.0008). This difference was present both in patients with modified Rankin score of 0 at 6 months (23.8% vs 10.3%) and patients with modified Rankin score >or=1 (69.2% vs 48.6%), and remained more frequent in stroke patients after adjustment for potential confounders. Within the group of patients with stroke, the prevalence of fatigue increased with initial stroke severity (87% NIHSS >or=4 vs 48% NIHSS

The relative effect of size at birth, postnatal growth and social factors on cognitive function in late childhood.

PURPOSE: To investigate if fetal, head, and somatic postnatal growth are independent predictors of cognition and estimate their relative importance compared to the effect size of social factors on cognitive function at 10 years. METHODS: Longitudinal population-based data from the birth questionnaire and the 5- and 10-year sweeps of the 1970 British Birth Cohort Study were used, including 11,244 subjects. Multiple linear regression and structural equation modeling were used in the statistical analysis. Standardized coefficients were used to measure and compare effect sizes. RESULTS: Fetal growth, head, and somatic postnatal growth were significant independent predictors of cognition at age 10. These associations remained even among children born within the normal birth-weight range and those who did not experience neonatal problems. Effect of head size on cognition was greater than the effect of birth weight. Weight at 10 had a small negative effect on cognition. Gestational age was not directly associated with cognitive function, but it had a weak indirect effect. Parent's socioeconomic status was strongly associated with child's cognitive function. CONCLUSION: Although effect sizes of prenatal and postnatal growth on cognition are modest compared with the strong effect size of social factors, they might have greater impact at the population level, since most children are born without low birth weight.