도시 중년 성인이 인지하는 뇌졸중 생활습관 위험요인과 뇌졸중 인식

송희영,허혜경,박소미 대한임상건강증진학회 2012 Korean Journal of Health Promotion Vol.12 No.1

Background: Modifying risk factors and improving stroke awareness in the general community have been emphasized for preventing stroke. This study aimed to explore modifiable lifestyle risk factors and the awareness of stroke and to compare scores for stroke knowledge according to lifestyle risk factors and recognition of important indicators among adults in urban areas. Methods: A cross-sectional study was conducted with a total of 196 participants aged 40 to 65 selected by a convenient sampling of community cultural centers, churches, and recreational groups. Participants completed a structured questionnaire including general characteristics, risk factors of stroke, and awareness of stroke including general knowledge, risk factors, reactions to warning symptoms, and knowledge on personal risk factors of stroke such as body weight, blood pressure, blood sugar, and cholesterol level. Results: Less than 30% of the participants engaged in regular physical activity and low fat diet and 33% of the participants were classified as having 'higher' level of knowledge on stroke. Knowledge on their personal risk factors of stroke were generally poor. Scores for knowledge on stroke were not different for lifestyle risk factors and knowing whether their body weight and blood pressure level were within normal limits. Meanwhile, scores for knowledge on stroke were significantly higher among those knowing whether their blood sugar and cholesterol level were within normal limits. Conclusions: There is a need to improve stroke awareness among community adults by providing more targeted information on warning symptoms, risk factors of stroke, and important indicators of major conditions related to stroke and their contribution to stroke prevention. 연구배경: 본 연구는 지역사회 성인에서 뇌졸중의 생활습관 위험요인 분포와 뇌졸중의 경고증상, 위험요인 및 뇌졸중 발생 시 대처 그리고 뇌졸중 위험질환 관련 주요 지표인 혈압, 체중, 혈당 및 혈중 콜레스테롤에 대한 개인의인지를 포함한 뇌졸중에 대한 인식을 확인하고자 시도되었다. 방법: 본 연구는 횡단적 서술조사 연구로 연구대상자는선정기준에 따라 두 개의 중소도시 지역에서 연구의 목적을 이해하고 참여에 동의한 196명(평균 연령 44.81세)을 편의표집 하였다. 연구자 소속 대학의 연구윤리위원회의 승인을 거친 후 대상자에게 참여자 권리 보호에 대해 설명후 동의서에 서명하도록 하였다. 일반적 특성과 뇌졸중의위험요인, 뇌졸중의 정의와 경고증상, 위험요인 및 발생 시대처, 그리고 뇌졸중 위험질환 관련 지표인 혈압, 체중, 혈당 및 혈중 콜레스테롤에 대한 인지를 묻는 구조화된 설문지를 배부하고 자가보고 하도록 하였다. 결과: 대상자 중 30% 이하에서 현재 규칙적인 신체활동과 저지방 식이를 하고 있었고 뇌졸중 지식은 평균 16.42점으로 대상자 중 33%가 뇌졸중의 정의, 경고증상 및 위험요인을 잘 알고 있는 ‘높은’ 지식 집단이었다. 체중, 혈당및 혈중 콜레스테롤의 정상 범주 여부에 대해서 대부분의대상자들이 모른다고 응답하였고 일반적 특성, 뇌졸중 위험요인, 혈압과 체중 인지 여부에 따른 지식의 차이는 유의하지 않았다. 자신의 혈당과 혈중 콜레스테롤이 정상 범주에 속하는지를 알고 있는 대상자에서 뇌졸중 지식이 유의하게 높았다. 결론: 본 연구는 지역사회 성인에서 규칙적 신체활동과저지방 식이조절을 증진하고 뇌졸중 경고증상, 위험요인및 뇌졸중 위험요인 관련 주요 지표에 대한 인지를 보완하여 뇌졸중 인식의 증진이 필요함을 제시하고 있다. 이를위해 지역사회 중년 성인 대상으로 개인의 혈당과 혈중 콜레스테롤과 같은 주요 지표와 뇌졸중 위험과의 관련성을포함한 뇌졸중 인식과 다양한 생활습관 위험요인 조절을 증진할 수 있는 중재의 개발 및 효과검증 연구가 필요하다.

The Comparison of Risk Factors for Ischemic Stroke or Intracranial Hemorrhage in Korean Stroke Patients

Sun-Young Choi,Ji-In Kim,Shin-Woo Hwang 대한의생명과학회 2018 Biomedical Science Letters Vol.24 No.4

Stroke is a leading cause of death in the Korean population and remains a major health burden worldwide. The two main pathologic types of stroke are ischemic stroke and intracranial hemorrhage (ICH), but comparisons of risk factors for these have been limited. We under took a nationwide population-based study to analyze the relationship between these risk factor sand ischemic stroke and ICH. From January 2003 to December 2013, a total of 37,561 patients with newly diagnosed ischemic stroke or ICH were identified using the National Health Insurance Service data base as the study population. Multivariable logistic regression analysis was used to determine the association between baseline risk factors and presentation with ICH versus ischemic stroke. The incidence of ischemic stroke showed an increasing rend every year, while there was no significant change in the incidence of ICH. Of the several risk factors associated with stroke, old age (OR 2.35, 95% CI 2.12~2.49, P < 0.001) was more closely associated with ischemic stroke than ICH, whereas renal disease (OR 0.74, 95% CI 0.55~0.99, P = 0.04) and carotid disease (OR 0.25, 95% CI 0.17~0.35, P < 0.001) were more strongly associated with ICH. In addition, diabetes mellitus, dyslipidemia, hypertension, ischemic heart disease and male sex was associated with an increased risk of ischemic stroke. Old age was more strongly associated with ischemic stroke than ICH, while carotid stenosis and renal impairment were more closely associated with ICH risk. Classic risk factors for stroke have considerably different associations with the two main pathologic types of stroke.

뇌졸중의 위험요인에 대한 환자-대조군 연구

백인경 ( In Kyoung Baek ),김윤식 ( Yoon Sik Kim ) 대전대학교 한의학연구소 2013 혜화의학회지 Vol.22 No.1

The purpose of this case-control study was to show the relationship between risk factor(Sex, Age, Martial Status, Educational Periods, Family history, Variables of Obesity, Smoking Status, Drinking Status, Past History, Blood Test) and the incidence of stroke. Methods: 788 stroke patients were enrolled as the case group and 450 non-stroke patients as control group from Sep.2006 to Dec.2010. Patients were hospitalized within 30 days after the onset of stroke. Risk factors and warning signs were obtained from personal interview by oriental medicine doctors who used CRF. Results: 1. Age was found to have significant relation with stroke(p<.0001). 2. Martial status(p<.0001, OR=0.44) and educational periods(p<.0001) were both significant risk factor for stroke. 3. As a result of reviewing the influence of family history, it was found to have no significant relation with stroke. Stroke was found to have significant relation with stroke(OR=1.50). 4. Female waist circumference(WC, p<.0001) and female waist-hip circumference ratio(WHR, p<.0001) were risk factors for stroke. On the other hand, male WC and male WHR showed no significant influence on stroke occurrence as an independent risk factor. 5. Both smoking status(p<.0001, current smoker OR=8.95) and drinking status(p<.0001, current drinker OR=2.50, former drinker OR=2.82) were significant risk factors for stroke. 6. As a result of reviewing the influence of past history, transient ischemic attack(p<.0001, OR=8.46), hypertension(p<.0001, OR=4.72), hyperlipidemia(0.0064), diabetes mellitus(p<.0001, OR=3.34), stroke(p<.0001, OR=50.26) were significant risk factors. On the other hand, ischemic heart disease(p=0.2332) was found to have no significant relation with stroke. 7. Increase of WBC, RBC, Platelet, TG, FBS and Cl- level were significant risk factor of stroke, On the other hand, decrease of Hgb, Hct, AST, HDL-chol, LDH, Na+ and K+ level were significant risk factor of stroke. T-chol and ALT level showed no significant influence on stroke occurrence.

닫힌 사슬운동과 슬링운동프로그램 병행이 뇌졸중 편마비환자의 균형과 보행 및 등속성근기능에 미치는 영향

조완주(Cho, Wan-Ju) 한국체육과학회 2015 한국체육과학회지 Vol.24 No.2

This study conducted closed kinetic chain and sling exercise with 16 patients with hemiplegia after stroke for 12 weeks to examine the effects of closed kinetic chain and sling exercise on balance, walking, and isokinetic muscle function. The subjects were male patients who were diagnosed as hemiplegia caused by stroke in J University Hospital of G Metropolitan City and had chronic hemiplegia over 12 months after a stroke attack. They should participate in exercise based on physiatrist’s opinion, walk independently using walking assistance devices, and not have subcutaneous atrophy and orthopedic-diseases of lower extremity. Their consents to the whole process of experiment were obtained and they were willing to participate in the study. The subjects were randomly assigned to the exercise group(n=10) and the control group(n=8). 2 participants of the exercise group dropped out. The purpose of this study was to examine how closed kinetic chain and sling exercise for 12 weeks made a difference to balance, walking, and isokinetic muscle function in patients with hemiplegia after stroke. The results of analysis and comparison were as follows. First, for the change of balance ability, patients with hemiplegia after stroke who participated in closed kinetic chain and sling exercise showed improved balance. It suggests that closed kinetic chain and sling exercise had a positive effect in patients with hemiplegia after stroke. Second, for the change of walking ability, patients with hemiplegia after stroke who participated in closed kinetic chain and sling exercise showed improved walking in both TUG and 10MWT. It suggests that closed kinetic chain and sling exercise had a positive effect in patients with hemiplegia after stroke. Third, for the change of isokinetic muscle function, patients with hemiplegia after stroke who participated in closed kinetic chain and sling exercise showed the improvement of affected extension, unaffected extension, affected flexion, and unaffected flexion. It suggests that closed kinetic chain and sling exercise had a positive effect in patients with hemiplegia after stroke. Based on the findings, closed kinetic chain and sling exercise had a positive effect on the improvement of balance, walking, and isokinetic muscle function in patients with hemiplegia after stroke. However, it is difficult to generalize the findings for all patients with hemiplegia after stroke because the number of the subjects of this study was small. It is considered that more various exercise programs should be applied to patients with hemiplegia after stroke who are usually limited in exercise.

Stroke Update 2009: 뇌졸중의 이차 예방

이용석 대한뇌졸중학회 2009 Journal of stroke Vol.11 No.2

In The Prevention Regimen for Effectively Avoiding Second Strokes (PRoFESS) trial, recurrent stroke occurred in 9.0% receiving aspirin and extended-release dipyridamole (ASA-ERDP) and in 8.8% receiving clopidogrel [hazard ratio (HR) 1.01; 95% confidence interval (CI) 0.92 to 1.11]. There were more major hemorrhagic events among ASA-ERDP group (4.1% vs. 3.6%, P<0.05). Therapy with telmisartan did not significantly lower the rate of recurrent stroke, major cardiovascular events, or diabetes in spite of blood pressure (BP) lowering. In The Cilostazol versus Aspirin for Secondary Ischaemic Stroke Prevention (CASISP) trial comparing cilostazol with aspirin in patients with ischemic stroke, cilostazol showed non-significant trend to prevent recurrent stroke (HR 0.62; 95% CI 0.30-1.26). Symptomatic and aymptomatic hemorrhage was less frequent in cilostazol group. Three-year follow-up of The Stenting and Angioplasty with Protection in Patients at High Risk for Endarterectomy (SAPPHIRE) trial showed that there was no difference between carotid artery stenting group and endarterectomy group. Two to four-year follow-up study of The Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) and Endarterectomy Versus Angioplasty in Patients with Symptomatic Severe Carotid Stenosis (EVA-3S) trial, in which patients with symptomatic carotid stenosis were included, also showed no difference of cardiovascular events including stroke. These results suggested that mid or long-term outcome is comparable between stenting and endarterectomy. Meta-analysis from 8,832 patients with statin therapy showed decreased incidence of recurrent ischemic stroke [relative risk (RR) 0.80; 95% CI 0.70-0.92], while increased risk of hemorrhagic stroke (RR 1.73; 95% CI 1.19-2.50) in statin group. Post-hoc analysis of Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) study revealed that hemorrhagic stroke as an entry event, age, hypertension, ator-vastatin per se, and small vessel disease subtype increase the risk of intracerebral hemorrhage. (Korean J Stroke 2009;11:67-72)

Diabetes and Stroke: What Are the Connections?

Ofri Mosenzon,Alice Y.Y. Cheng,Alejandro A. Rabinstein,Simona Sacco 대한뇌졸중학회 2023 Journal of stroke Vol.25 No.1

Stroke is a major cause of death and long-term disability worldwide. Diabetes is associated with an increased risk of cardiovascular complications, including stroke. People with diabetes have a 1.5–2 times higher risk of stroke compared with people without diabetes, with risk increasing with diabetes duration. These risks may also differ according to sex, with a greater risk observed among women versus men. Several mechanisms associated with diabetes lead to stroke, including large artery atherosclerosis, cerebral small vessel disease, and cardiac embolism. Hyperglycemia confers increased risk for worse outcomes in people presenting with acute ischemic stroke, compared with people with normal glycemia. Moreover, people with diabetes may have poorer post-stroke outcomes and higher risk of stroke recurrence than those without diabetes. Appropriate management of diabetes and other vascular risk factors may improve stroke outcomes and reduce the risk for recurrent stroke. Secondary stroke prevention guidelines recommend screening for diabetes following a stroke. The diabetes medications pioglitazone and glucagon-like peptide-1 receptor agonists have demonstrated protection against stroke in randomized controlled trials; this protective effect is believed to be independent of glycemic control. Neurologists are often involved in the management of modifiable risk factors for stroke (including hypertension, hyperlipidemia, and atrial fibrillation), but less often in the direct management of diabetes. This review provides an overview of the relationships between diabetes and stroke, including epidemiology, pathophysiology, post-stroke outcomes, and treatments for people with stroke and diabetes. This should aid neurologists in diabetes-related decision-making when treating people with acute or recurrent stroke.

Family History and Functional Outcome in Korean Stroke Patients: A Preliminary Study

박희정,김태욱,현정근,김정윤 대한재활의학회 2015 Annals of Rehabilitation Medicine Vol.39 No.6

Objective To investigate the association of family history of stroke with functional outcomes in stroke patients in Korea. Methods A case-control study was conducted. A total of 170 patients who were admitted to a rehabilitation unit were included. Risk factors for stroke such as age, sex, diabetes mellitus, hypertension, atrial fibrillation, smoking, high blood cholesterol and homocysteine level, obesity, and family history of stroke were taken into account. Stroke subtypes were the following: large vessel infarct, small vessel infarct, embolic infarct, subarachnoid hemorrhage, and intracranial hemorrhage. Stroke severity as assessed with the National Institutes of Health Stroke Scale (NIHSS), functional outcomes using the Korean version of the Modified Barthel index (K-MBI), Functional Independence Measurement (FIM), and cognitive function using the Korean version of Mini-Mental State Examination (K-MMSE) were assessed at admission and discharge. Results Subjects with a family history of stroke were more likely to have an ischemic stroke (90.7%) than were those without a family history (70.9%). The K-MBI, FIM, NIHSS, and K-MMSE scores did not show significant differences between patients with or without family history. Conclusion Family history of stroke was significantly associated with ischemic stroke, but not with functional outcomes. Other prognostic factors of stroke were not distributed differently between patients included in this study with or without a family history of stroke.

뇌졸중 환자의 이차예방 이행 순응도 : 서울 ·경기지역 주민을 대상으로

고임석,김형철,권석범,황성희,권기한,김성민,송홍기,이병철 대한신경과학회 1999 대한신경과학회지 Vol.17 No.4

선진국의 뇌졸중집중치료서비스 모형과 실제

이원영,배희준 대한신경과학회 2009 대한신경과학회지 Vol.27 No.3

Background: It has been reported that organized inpatient (stroke unit) care reduces the mortality rate, and the need for institutional care or dependent living after stroke. Based on this evidence, stroke units have becomes popular among large-scale hospitals in developed countries. The aim of this study was to provide perspective regarding the efficacy of stroke units and their current status in developed countries. Methods and Results: An electronic search was conducted using the Cochrane Database, PubMed, and other online databases, in addition to a manual search. The efficacy of stroke-unit care compared to general-ward care was summarized and is presented with respect to death, death or institutional care, and death or dependency by the end of the scheduled follow-up. Current concepts and the status of stroke-unit services among developed countries were reviewed and compared with each other. The desirable models of stroke-unit services are discussed in terms of the stroke center. Conclusions: Stroke is the second leading cause of death in Korea and there that stroke-unit care is effective at improving the outcome of stroke patients. The expeditious development and realization of organized inpatient care for stroke victims should be a Government priority. Background: It has been reported that organized inpatient (stroke unit) care reduces the mortality rate, and the need for institutional care or dependent living after stroke. Based on this evidence, stroke units have becomes popular among large-scale hospitals in developed countries. The aim of this study was to provide perspective regarding the efficacy of stroke units and their current status in developed countries. Methods and Results: An electronic search was conducted using the Cochrane Database, PubMed, and other online databases, in addition to a manual search. The efficacy of stroke-unit care compared to general-ward care was summarized and is presented with respect to death, death or institutional care, and death or dependency by the end of the scheduled follow-up. Current concepts and the status of stroke-unit services among developed countries were reviewed and compared with each other. The desirable models of stroke-unit services are discussed in terms of the stroke center. Conclusions: Stroke is the second leading cause of death in Korea and there that stroke-unit care is effective at improving the outcome of stroke patients. The expeditious development and realization of organized inpatient care for stroke victims should be a Government priority.

뇌졸중경고증상과 위험인자 인식도: 2010년 광주 지역주민 설문결과

이영훈,신민호,권순석,최진수,박만석,조기현,임영실 대한신경과학회 2012 대한신경과학회지 Vol.30 No.1

Background: A high level of public awareness of stroke may reduce the stroke risk. The aim of this study was to assess the public’s awareness of stroke warning signs and risk factors, and to determine the associated factors. Methods: The study population was 2492 community-dwelling adults aged 50 years and older who participated in the 2010baseline Dong-gu Study. Information regarding knowledge of stroke warning signs, stroke risk factors, and demographics was collected using standardized open- and closed-form questionnaires. Results: The stroke warning signs that were most frequently identified by respondents were “sudden numbness or weakness” (73.7%) and “sudden difficulty in speaking or in understanding speech” (73.6%). In multivariate analysis,incomplete awareness of stroke warning signs was significantly associated with a lower education level, no history of past stroke, and incorrect knowledge of the definition of stroke. Hypertension and stress were most commonly recognized as risk factors when open-ended questions were used (by 22.3% and 14.1% of the respondents, respectively) and also with close-ended questions (77.7% and 82.4%, respectively). In multivariate analysis, older age, current smoking, lower education level, and incorrect knowledge of the definition of stroke were associated with a worse awareness of stroke risk factors. Conclusions: A community-based program is needed to improve public awareness of the warning signs and risk factors for stroke. In order to reduce the risk of stroke, public health education and media efforts should focus on people who are older and have a lower level of education.