The Association of Race and Sex with the Underuse of Stroke Prevention Measures
Underuse of effective stroke prevention measures has been demonstrated in the general population. Blacks and Hispanics are at increased risk of recurrent stroke relative to white non-Hispanics. More profound underuse of prevention measures may contribute to this disparity. In this study we attempted to compare the degree of underuse of diagnostic and treatment strategies in patients of these racial/ethnic groups with recent ischemic stroke.
At 4 participating urban hospitals, patient charts were reviewed with regard to the completeness of the diagnostic evaluation, discharge treatment regimen, and stroke risk factor and antithrombotic medication use at 6 months postdischarge.
Of 501 patients hospitalized with acute ischemic stroke, almost all received electrocardiograms and brain imaging, 75% had carotid artery evaluations, and 70% had serum lipid determinations. Blacks and women were less likely to have complete evaluations. At discharge, 88% of patients received antithrombotic medications and 89% of patients were prescribed antihypertensive medications appropriately, but only 65% were prescribed lipid-lowering medications appropriately, with blacks least likely to receive appropriate prescriptions. At 6 months poststroke, of the 200 patients with data available for evaluation, 72% exhibited underuse of at least one stroke prevention measure. Blacks (81.6%) were more likely to experience underuse than Hispanics (62.5%) or whites (66.7%). Women were more likely to receive incomplete inhospital evaluations and discharge regimens.
There is clinically important underuse of effective diagnostic and prevention measures in each of the groups studied, especially among blacks.
Available from: PubMed Central
- "However, other aspects of the diagnostic evaluation including imaging of brain, vessels, and heart did not show a racial difference . Tuhrim et al. reported that black stroke patients were less likely to receive complete diagnostic evaluations and less likely to receive appropriate secondary prevention measures . These racial disparities in evaluation and treatment may be explained by differences in insurance or socioeconomic status, patient mistrust of the medical system, and/or clinician bias. "
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ABSTRACT: Background. Previous studies have suggested that black populations have more small-vessel and fewer cardioembolic strokes. We sought to analyze racial differences in ischemic stroke subtype employing a comprehensive diagnostic workup with magnetic resonance-imaging-(MRI-) based evaluation including diffusion-weighted imaging (DWI).
Methods. 350 acute ischemic stroke patients admitted to an urban hospital with standardized comprehensive diagnostic evaluations were retrospectively analyzed. Ischemic stroke subtype was determined by three Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification systems. Results. We found similar proportions of cardioembolic and lacunar strokes in the black and white cohort. The only subtype category with a significant difference by race was “stroke of other etiology,” more common in whites. Black stroke patients were more likely to have an incomplete evaluation, but this did not reach significance. Conclusions. We found similar proportions by race of cardioembolic and lacunar strokes when employing a full diagnostic evaluation including DWI MRI. The relatively high rate of cardioembolism may have been underappreciated in black stroke patients when employing a CT approach to stroke subtype diagnosis. Further research is required to better understand the racial differences in frequency of “stroke of other etiology” and explore disparities in the extent of diagnostic evaluations.
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ABSTRACT: The quantification of ciliary activity depends on the detection and analysis of the rhythmic variation in light intensity of a microscope image induced by ciliary movement. This approach requires the simplification and optimization of signal contrast and waveform and its success depends on the photo-detection method, the microscope optics, and the type of cell preparation used. For beat frequency measurements, a single detector system consisting of a photomultiplier, phototransistor, or fiberoptic device is sufficient. For the analysis of ciliary metachrony, spatial information is essential and a system requires a multipoint detector such as a digital video camera. This chapter highlights the advantages and limitations of earlier techniques for measuring ciliary activity and describes the principles and methodology of an advanced high-speed digital video technique. Large light signal amplitude can be obtained from coordinated groups of active cilia of isolated or cultured cells with phase-contrast optics. The signal waveform needs to be simple and easily interpretable; however, cilia of isolated cells or epithelial sheets generally beat in a metachronal manner and this can result in a complicated signal waveform because of the orientation of the ciliary beat cycle with respect to the detector and the number of cilia simultaneously contributing to the signal. An improvement in signal waveform can be achieved by monitoring only the effective stroke by recording close to the ciliary tips. The chapter discusses quantification of ciliary metachronism and video techniques for measuring ciliary activity. The high-speed digital video photodetection technique discussed has a high temporal and spatial resolution that can be used for the measurement of ciliary beat frequency and metachrony. The combination of this technique with a fluorescence imaging system that can simultaneously measure intracellular ions or messengers provides a unique opportunity for investigation of the physiological control of ciliary activity.
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ABSTRACT: The paper discusses the requirements for the mobility protocol of
the-third generation mobile network. The mobility protocol is used to
transfer subscriber data between network elements and it forms the basis
for roaming. A modular network design is proposed where mobility is
managed independently of the access and backbone networks. The GSM MAP
protocol is found to provide a firm basis for evolution towards such a
platform. New GSM features involving development of MAP are described
and directions for further mobile application protocol (MAP) development
are identified. The intelligent network is envisaged to be a
corresponding platform for providing operator specific services
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