Stroke Characteristics in a Cohort of Hmong American Patients.

Background Prior studies have indicated high rates of vascular risk factors, but little is known about stroke in Hmong. Methods and Results The institutional Get With The Guidelines (GWTG) database was used to identify patients discharged with acute ischemic stroke, intracerebral hemorrhage, or subarachnoid hemorrhage between 2010 and 2019. Hmong patients were identified using clan names and primary language. Univariate analysis was used to compare Hmong and White patients. A subarachnoid hemorrhage comparison was not conducted because of the small sample size. We identified 128 Hmong patients and 3084 White patients. Hmong patients had more prevalent hemorrhagic stroke (31% versus 15%; P<0.0016). In the acute ischemic stroke cohort, compared with White patients, Hmong patients were younger (60±13 versus 71±15 years; P<0.0001), presented to the emergency department almost 4 hours later; and had a lower thrombolysis usage rate (6% versus 14%; P=0.03496), worse lipid profile, higher hemoglobin A1C, similar stroke severity, and less frequent discharge to rehabilitation facilities. The most common ischemic stroke mechanism for Hmong patients was small-vessel disease. In the intracerebral hemorrhage cohort, Hmong patients were younger (55±13 versus 70±15 years; P<0.0001), had higher blood pressure, and had a lower rate of independent ambulation on discharge (9% versus 30%; P=0.0041). Conclusions Hmong patients with stroke were younger and had poorer risk factor control compared with White patients. There was a significant delay in emergency department arrival and low use of acute therapies among the Hmong acute ischemic stroke cohort. Larger studies are needed to confirm these observations, but action is urgently needed to close gaps in primary care and stroke health literacy.

Readmission to an Acute Care Hospital During Inpatient Rehabilitation After Stroke.

OBJECTIVE: The aim of the study was to identify causes for readmission to acute care of patients admitted to inpatient rehabilitation facility after stroke. DESIGN: The institutional Uniform Data System for Medical Rehabilitation database was used to identify stroke patients who experienced readmission to acute care and an equal number of age-/sex-matched group of patients who successfully completed their inpatient rehabilitation facility stay during 2005-2018. Retrospective chart review was used to extract clinical data. The two study groups were compared using univariate and multivariate analyses. RESULTS: The rate of readmission to acute care was 4.7% (n = 89; age = 65 ± 14 yrs; 37% female; 65% White; 73% ischemic stroke). The most common indications for transfer were neurological (31%) and cardiovascular (28%). Compared with control group, the readmission to acute care group had statistically higher rates of comorbid conditions, lower median (interquartile range) Functional Independence Measure score on inpatient rehabilitation facility admission (55 [37-65] vs. 64 [51-78], P < 0.001), and a higher rate of sedative/hypnotic prescription (82% vs. 23%, P < 0.001). CONCLUSIONS: Readmission to acute care is not common in our cohort. Patients who experienced readmission to acute care had higher medical complexity and were prescribed more sedative/hypnotic medications than the control group. Practitioners should be vigilant in patients who meet these criteria.

How time in the US and race/ethnicity shape food parenting practices and child diet quality.

Childhood obesity prevalence is high among children from immigrant/refugee households who live in high-income countries. Poor child dietary intake is a critical risk factor for elevated obesity prevalence and food parenting practices have been found to be associated with child dietary intake and eating behaviors. The main aim of this study was to examine the associations between migrants'/refugees' food parenting practices, the length of residence time in the US, race/ethnicity, and child diet quality. The current study included 577 families from three racial/ethnic groups that include mostly foreign-born parents (Latino, Hmong, and Somali/Ethiopian), and a comparison group of 239 non-Hispanic White families. Results showed that for Latino and Hmong parents, some food parenting practices varied by how long they had lived in the US. For example, more recently moved parents engaged in more non-directive (e.g., avoid buying sweets) practices compared with US-born parents. In contrast, Somali/Ethiopian parents engaged in different food parenting practices than White parents, regardless of time in the US. Results also showed that diet quality among Hmong children was lower if their parents were US-born compared to foreign-born. Future researchers may want to consider studying why some food parenting practices change when parents move to the US and explore whether there is a combination of food parenting practices that are most useful in promoting a healthful child's diet and weight among immigrant and refugee families.