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Female stroke patients may experience poorer functional outcomes than males following inpatient rehabilitation.
Data from Alberta inpatient stroke rehabilitation units were examined to determine: (1) the impact of sex on time to inpatient rehabilitation, functional gains (using the Functional Independence Measure (FIM)), length of stay (LOS), and discharge destination; (2) if sex was related to age at the time of stroke, stroke severity, and living arrangement at discharge from rehabilitation; and (3) whether patients’ age and preadmission living arrangement had an influence on LOS in rehabilitation or discharge destination.
Two thousand two hundred sixty-six adult stroke patients (1283 males and 983 females) were subcategorized as mild (FIM >80; n = 1155), moderate (FIM 40–80; n = 994), or severe (FIM <40; n = 117). Fifty-five percent of males (45.7% females) had mild stroke; 39.5% of males (49.5% females) had moderate stroke; and 5.5% of males (4.8% females) had severe stroke. Females were significantly older than males (p = 2.4 × 10−4). No sex difference existed in time from acute care to rehabilitation admission (p = 0.73) or in mean FIM change (p = 0.294). Mean LOS was longer for females than males (p=0.018). Males were more likely than females to be discharged home (p = 1.8 × 10−13). Further, male patients (p = 6.4 × 10−7) and those < 65 years (p = 1.4 × 10−23) were more likely to be discharged home without homecare.
There are significant sex and age differences in LOS in rehabilitation and discharge destination of stroke patients. These differences may suggest that sex and age of the patient need to be considered in care planning.
We examined the impact of stroke severity and timing to inpatient rehabilitation admission on length of stay (LOS), functional gains, and discharge destination.
Alberta inpatient stroke rehabilitation data between April 2013 and March 2017 were analyzed. We evaluated the impact of stroke severity, as measured by the Functional Independence Measure (FIM), on timing to inpatient rehabilitation, functional gains, LOS, and discharge destination. Further, we examined whether timing to inpatient rehabilitation impacted the latter three factors.
The 2404 adults were subcategorized as mild (1237), moderate (1031), or severe (136) based on FIM at inpatient rehabilitation admission. Length of time to rehabilitation admission was not significantly (p = 0.232) different between stroke severities. Mean length of time (days) to rehabilitation admission was 19.79 (20.3 SD) for mild, 27.7 (35.7 SD) for moderate, and 37.70 (56.8 SD) for severe stroke. Mean FIM change for mild (M = 16.3, 9.9 SD) differed significantly (p = 5.1 × 10–9) from moderate (M = 30.4, 16.4 SD) and severe (M = 31.0, 25.7 SD) stroke. The mean LOS for mild stroke (M = 41.3, 31.9 SD) was significantly (p = 5.1 × 10–9) different from moderate stroke (M = 86.8, 76.4 SD) and severe stroke (M = 126.1, 104.2 SD). Time to inpatient rehabilitation admission showed a small, significant impact on FIM change (p = 1.4 × 10–9, partial η2 0.022) and LOS (p = 1.1 × 10–19, partial η2 0.042). Shorter times to rehabilitation admission and mild stroke were associated with discharging home without needing homecare.
Stroke severity has a significant impact on the conduct of inpatient rehabilitation. Yet, despite suggestions shortening timing to rehabilitation should improve outcomes, the impact on functional gains and rehabilitation LOS was small.
The first case of evolved protoporphyrinogen oxidase (PPO)-inhibitor resistance was observed in 2001 in common waterhemp [Amaranthus tuberculatus (Moq.) Sauer var. rudis (Sauer) Costea and Tardif]. This resistance in A. tuberculatus is most commonly conferred by deletion of the amino acid glycine at the 210th position (ΔGly-210) of the PPO enzyme (PPO2) encoded by PPX2. In a field in Kentucky in 2015, inadequate control of Amaranthus plants was observed following application of a PPO inhibitor. Morphological observations indicated that survivors included both A. tuberculatus and Palmer amaranth (Amaranthus palmeri S. Watson). Research was conducted to confirm species identities and resistance and then to determine whether resistance evolved independently in the two species or via hybridization. Results from a quantitative PCR assay based on the ribosomal internal transcribed spacer confirmed that both A. tuberculatus and A. palmeri coexisted in the field. The mutation conferring ΔGly-210 in PPO2 was identified in both species; phylogenetic analysis of a region of PPX2, however, indicated that the mutation evolved independently in the two species. Genotyping of greenhouse-grown plants that survived lactofen indicated that all A. tuberculatus survivors, but only a third of A. palmeri survivors, contained the ΔGly-210 mutation. Consequently, A. palmeri plants were evaluated for the presence of an arginine to glycine or methionine substitution at position 128 of PPO2 (Arg-128-Gly and Arg-128-Met). The Arg-128-Gly substitution was found to account for resistance that was not accounted for by the ΔGly-210 mutation in plants from the A. palmeri population. Results from this study provide a modern-day example of both parallel and convergent evolution occurring within a single field.
Close relationships are a vital part of people's daily lives; thus family members, friends, and romantic partners play an integral role in people's health and well-being. Understanding the ways in which close relationships both shape and reflect people's health and wellness is an important area of inquiry. Showcasing studies from various disciplines that are on the cutting-edge of research exploring the interdependence between health and relationships, this collection highlights several relationship processes that are instrumental in the maintenance of health and the management of illness, including interpersonal influence, information management, uncertainty, social support, and communication. Although the existing health literature is rich with knowledge about individual and ecological factors that are influential in promoting certain health behaviors, the relationship scholars featured in this volume have much to contribute in terms of documenting the interpersonal dynamics that are involved in experiences of health and illness.