| 1. |
- Nguyen, Thanh N, et al.
(författare)
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Global Impact of the COVID-19 Pandemic on Stroke Volumes and Cerebrovascular Events: A 1-Year Follow-up.
- 2023
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Ingår i: Neurology. - 1526-632X. ; 100:4, s. e408-e421
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Tidskriftsartikel (refereegranskat)abstract
- Declines in stroke admission, IV thrombolysis (IVT), and mechanical thrombectomy volumes were reported during the first wave of the COVID-19 pandemic. There is a paucity of data on the longer-term effect of the pandemic on stroke volumes over the course of a year and through the second wave of the pandemic. We sought to measure the effect of the COVID-19 pandemic on the volumes of stroke admissions, intracranial hemorrhage (ICH), IVT, and mechanical thrombectomy over a 1-year period at the onset of the pandemic (March 1, 2020, to February 28, 2021) compared with the immediately preceding year (March 1, 2019, to February 29, 2020).We conducted a longitudinal retrospective study across 6 continents, 56 countries, and 275 stroke centers. We collected volume data for COVID-19 admissions and 4 stroke metrics: ischemic stroke admissions, ICH admissions, IVT treatments, and mechanical thrombectomy procedures. Diagnoses were identified by their ICD-10 codes or classifications in stroke databases.There were 148,895 stroke admissions in the 1 year immediately before compared with 138,453 admissions during the 1-year pandemic, representing a 7% decline (95% CI [95% CI 7.1-6.9]; p < 0.0001). ICH volumes declined from 29,585 to 28,156 (4.8% [5.1-4.6]; p < 0.0001) and IVT volume from 24,584 to 23,077 (6.1% [6.4-5.8]; p < 0.0001). Larger declines were observed at high-volume compared with low-volume centers (all p < 0.0001). There was no significant change in mechanical thrombectomy volumes (0.7% [0.6-0.9]; p = 0.49). Stroke was diagnosed in 1.3% [1.31-1.38] of 406,792 COVID-19 hospitalizations. SARS-CoV-2 infection was present in 2.9% ([2.82-2.97], 5,656/195,539) of all stroke hospitalizations.There was a global decline and shift to lower-volume centers of stroke admission volumes, ICH volumes, and IVT volumes during the 1st year of the COVID-19 pandemic compared with the prior year. Mechanical thrombectomy volumes were preserved. These results suggest preservation in the stroke care of higher severity of disease through the first pandemic year.This study is registered under NCT04934020.
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| 2. |
- Marto, João Pedro, et al.
(författare)
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Safety and Outcome of Revascularization Treatment in Patients With Acute Ischemic Stroke and COVID-19: The Global COVID-19 Stroke Registry.
- 2023
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Ingår i: Neurology. - 1526-632X. ; 100:7, s. e739-e750
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Tidskriftsartikel (refereegranskat)abstract
- COVID-19-related inflammation, endothelial dysfunction, and coagulopathy may increase the bleeding risk and lower the efficacy of revascularization treatments in patients with acute ischemic stroke (AIS). We aimed to evaluate the safety and outcomes of revascularization treatments in patients with AIS and COVID-19.This was a retrospective multicenter cohort study of consecutive patients with AIS receiving intravenous thrombolysis (IVT) and/or endovascular treatment (EVT) between March 2020 and June 2021 tested for severe acute respiratory syndrome coronavirus 2 infection. With a doubly robust model combining propensity score weighting and multivariate regression, we studied the association of COVID-19 with intracranial bleeding complications and clinical outcomes. Subgroup analyses were performed according to treatment groups (IVT-only and EVT).Of a total of 15,128 included patients from 105 centers, 853 (5.6%) were diagnosed with COVID-19; of those, 5,848 (38.7%) patients received IVT-only and 9,280 (61.3%) EVT (with or without IVT). Patients with COVID-19 had a higher rate of symptomatic intracerebral hemorrhage (SICH) (adjusted OR 1.53; 95% CI 1.16-2.01), symptomatic subarachnoid hemorrhage (SSAH) (OR 1.80; 95% CI 1.20-2.69), SICH and/or SSAH combined (OR 1.56; 95% CI 1.23-1.99), 24-hour mortality (OR 2.47; 95% CI 1.58-3.86), and 3-month mortality (OR 1.88; 95% CI 1.52-2.33). Patients with COVID-19 also had an unfavorable shift in the distribution of the modified Rankin score at 3 months (OR 1.42; 95% CI 1.26-1.60).Patients with AIS and COVID-19 showed higher rates of intracranial bleeding complications and worse clinical outcomes after revascularization treatments than contemporaneous non-COVID-19 patients receiving treatment. Current available data do not allow direct conclusions to be drawn on the effectiveness of revascularization treatments in patients with COVID-19 or to establish different treatment recommendations in this subgroup of patients with ischemic stroke. Our findings can be taken into consideration for treatment decisions, patient monitoring, and establishing prognosis.The study was registered under ClinicalTrials.gov identifier NCT04895462.
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| 3. |
- Rodríguez, Teresa, 1966-, et al.
(författare)
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Biological Monitoring of Pesticide Exposures among Applicators and Their Children in Nicaragua
- 2006
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Ingår i: International journal of occupational and environmental health. - : Maney Publishing. - 1077-3525 .- 2049-3967. ; 12, s. 312-320
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Tidskriftsartikel (refereegranskat)abstract
- Exposures were assessed for seven small-scale farmers using chlorpyrifos on corn and ten banana plantation employees applying diazinon, and for one child of each worker. Metabolites (TCPYand IMPY) were measured in urine before and after applications. TCPY concentrations peaked at 27 and 8.5 hours post-application for applicators and children, respectively (geometric means, 26 and 3.0 microg/L). Proximity to spraying and spray mixture preparation in homes were important exposure factors. IMPY concentrations differed substantially across workers at two plantations (geometric means, 1.3 and 168 mirog/L); however, their children had little or no diazinon exposure. These workers and children were also exposed to chlorpyrifos, most likely through contact with chlorpyrifos-impregnated bags used in banana production. Several recommendations are offered: (1) monitor children's activities during applications; (2) do not store or prepare pesticides in homes; (3) institute sound occupational hygiene practices at banana plantations; (4) dispose of plastic insecticide bags properly at the worksite.
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| 4. |
- Rodriguez, Teresa, 1966-, et al.
(författare)
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Cognitive deficits in organophosphate exposed children of Nicaraguan subsistence farmers
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: This study examined cognitive and behavioral performance among school-age children in Nicaragua in relation with long-term and recent organophosphate exposures.Methods: Long-term organophosphate was assessed in 110 children aged 7-9 through a parental use index of kg of organophosphate during de pregnancy, first year of life and from 1 year old to the present. Recent exposure was determined in a subset of 74 children by urinary 3,5,6-trichloro-2-pyridinol (TCPY) levels. Cognitive function was evaluated with Wechsler Intelligence Scale for Children (WISC IV), total IQ and subtests grouped into indices for perceptual reasoning, verbal comprehension, working memory, and processing speed. Behavior at school was measured with the Conners’ Teacher Rating Scale-Revised:Short (CTRS-R:S). Multivariate linear regression models assessed adjusted associations.Results: For each 10-fold increase in prenatal indices for total OP use, children’s performance on working memory significantly decreased with 3.5 points, and similarly for chlorpyrifos and methamidophos. Prenatal methamidophos use was, in addition, significantly associated with poorer verbal comprehension and decrease in total IQ, a 10-fold use increase decreasing scores with 3.8 and 3.3 points respectively. Urinary TCPY (mg/g of creatinine) also affected, not significantly, working memory with a 3.2 point decrease for each 10-fold increase. This study did not find associations between postnatal organophosphate use indices and cognitive performance, or pre or postnatal use indices with behavior. Conclusion: Prenatal exposure to organophosphates decreased the cognitive abilities in Nicaraguan children, particularly in working memory. Methamidophos was also associated with poor verbal comprehension and total IQ.
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| 5. |
- Rodríguez, Teresa, 1966-
(författare)
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Environmental Pesticide Exposure and Neurobehavioral Effects among Children of Nicaraguan Agricultural Workers
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Children exposed to pesticides are susceptible for neurodevelopmental disruption. Data from developing countries are scarce.Aim: Assessing long-term and recent pesticide exposure in Nicaraguan children in relation to parental pesticide use and examining potential associated neurobehavioral effects.Methods: In the first study, pre- and post-spraying urinary residues of the chlorpyrifos metabolite TCPY and diazinon metabolite IMPY were measured among 7 subsistence farmers and 10 plantation workers, and in one child per worker. In the second study, for 110 children in an agricultural village and 22 in a non-agricultural village, aged 7-9, parental pesticide use was assessed by hours of spraying and kilograms of active ingredients during pre-and-postnatal time windows, as proxies for children’s long term pesticide exposures. Urinary TCPY, 3-PBA (pyrethroid metabolite), and 2,4-D were determined in 211 samples of 74 children of the agricultural village. IQ components and total IQ (WISC-IV) were evaluated in all agricultural village children. Behavior was evaluated with the Conners’ Teacher Rating Scale-Revised: Short. Multivariate linear regression models assessed associations between long-term and recent exposure to organophosphates and pyrethroids and cognitive and behavioral scales.Results: In study 1, post-spraying urinary levels of pesticide metabolites of subsistence farmers and their children were highly correlated (r=0.85), but not those of plantation workers and their children. In study 2, a wide range of exposures was reported by parents for all pesticides and time windows. The median urinary TCPY (3.7 μg/g creatinine), 3-PBA (2.8), and 2,4-D (0.9) were comparable to other studies for TCPY and 3-PBA but high for 2,4-D. Maximum levels were the highest reported for all compounds. Prenatal use of organophosphates affected working memory, and methamidophos also verbal comprehension and total IQ. Urinary TCPY was associated with poorer working memory. Organophosphate exposures were not associated with children’s behavior. Pyrethroid exposure during the first year of life associated with poorer perceptual reasoning and behavior, and urinary 3-PBA with a number of cognitive functions and ADHD in girls but not in boys.Conclusion: Nicaraguan children in poor agricultural areas are highly exposed to pesticides, which is influenced by parental pesticide use in subsistence farms. Organophosphate and pyrethroid exposures adversely affect their neurobehavioral development.
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| 6. |
- Rodriguez, Teresa, 1966-, et al.
(författare)
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Pyrethroids exposure and neurobehavioral performance in school age children in rural Nicaragua
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Objective: This cross-sectional study explored whether pre or postnatal pyrethroid exposure impaired cognitive performance and behavior in school-aged children from a rural area in Nicaragua.Methods: Pyrethroid exposure was assessed in 110 children age 7-9, attending grade 1-3, with cumulative parental pyrethroid use indices of hours of spraying, during pregnancy, the first year of life, and older than age one. Cypermethrin accounted for most of the pyrethroid use. Cognitive performance of the children was evaluated with 12 sub-tests and total IQ of Wechsler Intelligence Scale for Children (WISC IV), grouped into indices for perceptual reasoning, verbal comprehension, working memory, and processing speed. Behavior at school was measured with the oppositional, cognitive problem/inattention, hyperactivity and ADHD index subscales of the Conners’ Teacher Rating Scale-Revised:Short form (CTRS-R:S). One year later, the pyrethroid metabolite 3-PBA was measured in 211 urine samples from 74 children (median 3.3 µg/g creatinine, max. 547) and the effect of recent exposure on cognitive and behavior was assessed with a shortened battery. Results:Pyrethroid exposure indices during the first year of life significantly decreased performance of perceptual reasoning in children aged 7-9. For each 10-fold increasein hours of pyrethroid application , children’s performance on the Perceptual Reasoning Index decreased on average with 1.1 point. Postnatal exposures, during the first year and after age 1, associated with hyperactivity and attention problem. Urinary 3-PBA levels were negatively associated with a number of cognitive functions and, noteworthy, with increased scores for ADHD in girls but not in boys.Conclusion:Pyrethroid exposure in the first year of life was associated with decreased perceptual reasoning in rural children and with hyperactivity and ADHD predominantly in girls.
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| 7. |
- Rodriguez, Teresa, 1966-, et al.
(författare)
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Pyrethroids exposure and neurobehavioral performance in school age children in rural Nicaragua
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Annan publikation (populärvet., debatt m.m.)abstract
- Objective: This cross-sectional study explored whether pre or postnatal pyrethroid exposure impaired cognitive performance and behavior in school-aged children from a rural area in Nicaragua.Methods: Pyrethroid exposure was assessed in 110 children age 7-9, attending grade 1-3, with cumulative parental pyrethroid use indices of hours of spraying, during pregnancy, the first year of life, and older than age one. Cypermethrin accounted for most of the pyrethroid use. Cognitive performance of the children was evaluated with 12 sub-tests and total IQ of Wechsler Intelligence Scale for Children (WISC IV), grouped into indices for perceptual reasoning, verbal comprehension, working memory, and processing speed. Behavior at school was measured with the oppositional, cognitive problem/inattention, hyperactivity and ADHD index subscales of the Conners’ Teacher Rating Scale-Revised:Short form (CTRS-R:S). One year later, the pyrethroid metabolite 3-PBA was measured in 211 urine samples from 74 children (median 3.3 µg/g creatinine, max. 547) and the effect of recent exposure on cognitive and behavior was assessed with a shortened battery. Results:Pyrethroid exposure indices during the first year of life significantly decreased performance of perceptual reasoning in children aged 7-9. For each 10-fold increasein hours of pyrethroid application , children’s performance on the Perceptual Reasoning Index decreased on average with 1.1 point. Postnatal exposures, during the first year and after age 1, associated with hyperactivity and attention problem. Urinary 3-PBA levels were negatively associated with a number of cognitive functions and, noteworthy, with increased scores for ADHD in girls but not in boys.Conclusion:Pyrethroid exposure in the first year of life was associated with decreased perceptual reasoning in rural children and with hyperactivity and ADHD predominantly in girls.
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