Shahram Oveisgharan

Barthel index in a Middle-East country: translation, validity and reliability.

Background: In Iran, a Middle-East country, no disability scale has been translated and validated for use in stroke clinical trials. This study was designed to translate the Barthel Index and make its Persian translated form valid and reliable. Methods: All items of the Barthel Index were translated into Persian. Also, the Modified Rankin Scale (MRS) was also translated to Persian. Telephone interview was used as the method of data acquisition. Two interviewers were chosen for this means in order to accelerate data gathering and measure interrater agreement. Samples were selected from Isfahan Cardiovascular Research Center’s Stroke Registry Unit, a WHO collaborating center in the center of Iran. All the patients were registered as stroke or intracerebral hemorrhage (ICH). These patients were inhabitants of Isfahan Province who had suffered from stroke or ICH between 12 and 24 months before data acquisition. Chronbach’s alpha, test-retest reliability, concurrent validity with MRS, interrater agreement and item analysis were done for the translated questionnaire. Results: Translated questionnaires were filled by interview from 459 stroke patients. Their mean age was 68.11 ± 11.59 years. 243 of them were male (52.9%). Cronbach’s alpha was 0.9354. Spearman’s correlation coefficient between translated Barthel Index scores and MRS scores was –0.912. Spearman’s correlation coefficient between 2 scores, to determine test-retest reliability was 0.989. Concordance correlation to determine interrater agreement was 0.994. All corrected item–total correlations were greater than 0.5. Conclusions: The Persian translated version of the Barthel Index is a reliable and valid questionnaire for use in stroke clinical trials.

Stroke in Isfahan, Iran: Hospital Admission and 28-Day Case Fatality Rate

Background: In Isfahan, a city in the middle of Iran, a community intervention trial has been started for cardiovascular disease prevention and control via reducing its risk factors and improvement of relevant healthy behavior. A surveillance system was needed to monitor vascular diseases, especially stroke, during and following this community intervention program. Methods: A prospective study on hospitalized stroke patients was done in Isfahan, Iran, from 2000 to 2003. All hospitalized stroke events were recorded via a system adopted from the World Health Organization Monitoring Trends and Determinants in Cardiovascular Disease (MONICA) project, yet ignoring the MONICA age limitation. The age-adjusted hospital admission rate was calculated. Patients and/or their families were followed and asked regarding the patients’ survival status. Results: The age-adjusted hospital admission rate in Isfahan was increasing from 2000 to 2003 (rising from 84.16 to 103.23/100,000). The 28-day case fatality rates were nearly the same during these years and were about 32%. Ischemic stroke events made up the majority of cases (about 70%), and intracerebral hemorrhage events had the second highest prevalence (25%). Conclusions: This study showed that the stroke hospital admission rate might be increasing in Isfahan. A community-based stroke incidence study is needed to elucidate stroke epidemiology in Isfahan, Iran, as a Middle East country.

Effect of skin thickness on sensory nerve action potential amplitude

OBJECTIVE It has been shown that finger circumference negatively correlates with sensory nerve action potential amplitude (SNAP-A). Also fat people have lower sensory nerve amplitudes. Factors that cause electrodes displaced further away from underlying nerves, such as increased cutaneous and subcutaneous tissue, will lower SNAP-A. This study was designed to evaluate correlation between skin thickness and SNAP amplitude. METHODS Thirty-seven healthy 22-40-year-old subjects were selected. Nineteen (51.4%) were males and 18 (48.6%) were females, without significant difference between males and females regarding their ages. For all subjects, height and weight were measured. Anteroposterior and mediolateral diameters of the proximal phalanges of the index and little fingers and also finger circumferences were measured. Palmar digital skin thickness was measured in two ways: first with sonography machine, and second with skin fold caliper. Median and ulnar nerve sensory and motor conduction studies were performed. RESULTS In bivariate analysis, SNAP-A correlated negatively with female sex, height, anteroposterior diameter of the fingers, finger circumference and skin thickness measured by sonography, but in multiple regression analysis only skin thickness measured by sonography could predict SNAP-A. CONCLUSIONS This study demonstrates that among physiological factors of sex, height, BMI and also finger size measures, skin thickness is the best predictor of SNAP-A. SIGNIFICANCE In clinical practice, this effect must be taken into account when making determination of abnormality based on sensory nerve amplitude.

Do Cardiometabolic Risk Factors Relative Risks Differ for the Occurrence of Ischemic Heart Disease and Stroke

Background: The effects of the risk factors of ischemic heart disease (IHD) and stroke on the occurrence of these diseases differ between different populations. Objectives: To study the difference in the effects of different cardiovascular (CVD) risk factors on the incidence of IHD and stroke in an Iranian adult population. Patients and Methods: The Isfahan Cohort Study (ICS) is a longitudinal study that followed up 6323 subjects older than 35 years with no history of CVD since 2001. Of the original sample, only 5431 participants were contacted and followed up until 2011. The end points were the occurrence of IHD (defined as fatal and non-fatal myocardial infarction, unstable angina, and sudden cardiac death) and stroke. After 10 years of follow-up, 564 new cases of IHD and 141 new cases of stroke were detected. The relative risks (RRs) of cardiometabolic risk factors such as hypertension, diabetes, hypercholesterolemia, hypertriglyceridemia, high low-density lipoprotein cholesterol (LDL-C) level, low high-density lipoprotein cholesterol (HDL-C) level, current smoking, obesity, high waist-to-hip ratio, family history of CVD, and metabolic syndrome were compared between IHD and stroke patients. The ratio of relative risks (RRR) was calculated for comparing two RRs and estimated adjusted RRR was calculated by using generalized linear regression with a log link and binomial distribution. Results: The RRs of the occurrence of IHD and stroke in diabetic patients were 1.94 and 3.26, respectively, and the difference was statistically different (P = 0.016). The RR of high LDL-C was significantly higher for IHD than for stroke (P = 0.045), while all the other risk factors showed similar RRs for IHD and stroke, with no significant difference in their RRR, including hypertension. Diabetes and hypertension had the highest RRs for IHD, followed by diabetes, metabolic syndrome, and hypertension for stroke. Conclusions: The effect of diabetes mellitus on stroke was more significant than on IHD, and the effect of high LDL-C level was more significant on IHD than on stroke, other risk factors, including hypertension, have similar RRs for IHD and stroke. Health care professionals need more training regarding the RRs of these risk factors in the Iranian society, and health decision makers should consider it in their future policies.

Cardiovascular disease events and its predictors in women: Isfahan Cohort Study (ICS)

Introduction: As a lack of validated data about cardiovascular (CV) events and its risk factors (RFs) in women of Eastern Mediterranean region, we aimed to evaluate common predictors of CV events among Iranian women. Methods: Isfahan cohort study (ICS) is a prospective cohort that followed 6323 residents (51.3% women, aged 35-75 years) from three counties and their rural districts in central Iran. Common cardiovascular disease (CVD) RFs namely hypertension (HTN), diabetes mellitus, dyslipidemia, abdominal obesity, smoking, low apolipoproteins A ( apo-A) and high apolipoprotein B (apo-B) were evaluated. End points (CV events) were defined as fatal and nonfatal myocardial infarction, sudden cardiac death (SCD), unstable angina and stroke. Results: After 9 years of follow-up, 265 CV events were detected. The mean age of women with CV event was 57.6±10.9; about 8 years older than those without event. All CV RFs were significantly more prevalent in women with CV event except for low HDL cholesterol, overweight and low apo-A. HTN, diabetes, high triglyceride (TG), high LDL-C and obesity were significantly associated with CV events after adjustment for age, smoking and menopausal status (hazard ratios [95% CI]: 2.56 [1.93, 3.95], 2.43 [1.76, 3.35], 2.02 [1.49, 2.74], 1.59 [1.20, 2.11] and 1.49 [1.16-1.92], respectively), while low HDL cholesterol and abdominal obesity were not predictors for CV events (hazard ratios [95% CI]: 1.26 [0.96, 1.65], 1.71 [0.99, 2.96], respectively). Conclusion: In ICS, HTN, diabetes mellitus and high triglyceride are strong predictors for CV events in Iranian women. As almost all strong risk markers of CVD events are preventable, health policy makers have to give urgent consideration to make preventive public health strategies.

Contents Vol. 24, 2007

483 Third International Stroke Summit Wuhan, China, November 1–3, 2007 Chairpersons: Liu, X. (Nanjing); Kaste, M. (Helsinki); Zhang, S.; Zhang, J. (Wuhan); Chopp, M. (Detroit, Mich.); Li, C.; Chen, G. (Wuhan); Xu, G. (Nanjing) (available online only)