Neuroepidemiology
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Comparative Study
Stroke survival after discharge from an acute-care hospital.
Survival after a stroke is likely to be best for patients well enough to be sent home but the relative risk of dying if patients do not qualify for a home discharge has not been well studied. We investigated the survival prognosis after an initial stroke depending on the facility to which the patient was discharged after an acute initial stroke. ⋯ Mortality was greatest in the early months after discharge and decreased thereafter. Since the analysis was adjusted for age, sex, comorbidity, length of hospital stay, and number of neurological deficits, quality of care in a nursing home setting may account for the mortality difference but other factors such as social support network and living will instructions also need to be investigated.
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In 1992, the USA embargo on Cuba was tightened through the passage of the Cuban Democracy Act (CDA) that explicitly restricts food and medical supplies. The embargo has contributed to cause a number of public health problems in Cuba including: (1) an epidemic of more than 50,000 cases of optic and peripheral neuropathies in 1992-1993, resulting from dietary deficiency; (2) an epidemic of esophageal stenoses in toddlers who inadvertently drank liquid lye as a result of a soap shortage for which liquid lye was substituted; (3) an outbreak of Guillain-Barré syndrome in Havana, in June and July 1994, resulting from water contamination due to lack of chemicals for water treatment to eliminate Campylobacter sp.; (4) outbreaks of self-inflicted disease and injuries caused by rioting among Cubans detained at the US Naval base at Guantánamo Bay, and (5) a decline in medical practice standards and public health indicators in Cuba resulting from the enactment of the CDA, documented by the American Public Health Association in 1993 and confirmed in March 1997 by the American Association for World Health. Despite this evidence, the Cuban embargo remains a politically sensitive subject in the USA, resistant to public health concerns, as evidenced by the recent passage of the Helms-Burton Act. The public health effects of the CDA need to be reviewed with possible revocation or at least modification.
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Review Comparative Study
Dietary fat in the epidemiology of multiple sclerosis: has the situation been adequately assessed?
Epidemiological studies have demonstrated that environmental influences contribute to determining the risk of multiple sclerosis (MS). The nature of this influence has not been established, although infectious agents have received the most attention with relative neglect of alternative hypotheses. This paper critically reviews the evidence implicating dietary fat in altering susceptibility to MS. It is concluded that a dietary theory accords with current knowledge regarding MS as well as an infective theory and thus should not be dismissed in research examining the aetiology of MS.
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Comparative Study
Risk factors for Alzheimer's disease: the EURODEM collaborative re-analysis of case-control studies.
Case-control studies of risk factors for Alzheimer's disease have been hampered by low statistical power. Here, we present a collaborative analysis of 11 case-control studies of Alzheimer's disease. ⋯ The risk factors considered in this analysis were family history of dementia and related disorders, maternal age at index birth, head trauma, medical and psychiatric history and environmental exposures. This paper gives a brief overview of the findings of the re-analysis.
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The amyotrophic lateral sclerosis (ALS) severity scale has been developed to provide an ordinal staging system and a means of rapid functional assessment for patients with ALS. The scale allows an examiner to evaluate the symptoms of ALS numerically in four categories that describe speech, swallowing, lower extremity, and upper extremity abilities. ⋯ Speech ratings were correlated greater than 0.80 for objective speech measures. Rates of progression of the total score in a small group of patients ranged from -3.4 to -24.0 points/year with a mean of -11.3 points/year.