Neuroepidemiology
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We examined trends in incidence of stroke of any nature (ischemic and/or hemorrhagic) in subjects with a hospital diagnosis of nonvalvular atrial fibrillation or flutter in Denmark from 1980 to 2002 by sex, age and conditions of comorbidity. ⋯ We observed a modest decrease in risk of stroke in subject with atrial fibrillation in Denmark during calendar years 1980-2002. However, we could not control for any changes in diagnostic performance, admission practice, and medical management of patients with atrial fibrillation.
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Campaigns within Australia and internationally have sought to increase awareness of the emergent nature of stroke. For these initiatives to be effective it is important to gather information about delay in seeking treatment and the reasons given for the delay by people with stroke. The purpose of this study was to examine delay in seeking treatment in people with an evolving stroke or TIA and identify clinical, behavioral and demographic factors that contributed to the delay. ⋯ The message about the emergent nature of stroke may be helping to improve delay times. However, there are still many people who delay greater than 3 h after symptom onset. It is important to direct education programs to those with known risk factors for stroke and their families, who often make the decision to call an ambulance.
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This paper examines 10-year trends in traumatic brain injury (TBI)-related hospitalization rates for active duty US Army personnel in the 1990s. It does this within the context of various factors, including enhanced injury prevention policies and changed hospital admission practices, that may have affected TBI hospitalization rates. It also compares TBI hospitalization rates in the Army to those from an age-comparable segment of the US civilian population over this time period. ⋯ The incidence of TBI-related hospitalization in the active duty US Army decreased markedly (75%) during the 1990s. As a result, most of the Army's TBI hospitalization rates were lower than civilian rates by the late 1990s. Effective injury prevention and changes in the Army population were two of the factors that likely contributed to the decrease in rates for all TBI severity levels, while changes in hospital admission practices likely contributed to the disproportionate decrease in the Army's rates for mild TBI.
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Delirium continues to be under-recognized despite use of rating scales with apparently high inter-rater reliability. We analyzed the inter-reliability data of published rating scales for delirium using a standard questionnaire to evaluate if the inter-rater reliability was assessed rigorously. ⋯ This suggests that the reported reliability may be spuriously high, which may have implications on the ability of clinicians to discriminate delirium from other causes of cognitive impairment in practice. The methodology of assessing inter-rater reliability of delirium scales needs to improve and reliability should be evaluated when the settings of administration change substantially.
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To evaluate the survival of patients with amyotrophic lateral sclerosis (ALS) in an Italian population and to assess the effects of selected prognostic indicators on survival. ⋯ Survival of ALS patients in the present sample was slightly longer than previously reported. Better palliative care and supportive treatment may explain the difference. Older age and the presence of definite ALS at diagnosis are poor prognostic predictors.