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BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has led to significant strain on front-line healthcare workers. AIMS: In this multicentre study, we compared the psychological outcomes during the COVID-19 pandemic in various countries in the Asia-Pacific region and identified factors associated with adverse psychological outcomes. METHOD: From 29 April to 4 June 2020, the study recruited healthcare workers from major healthcare institutions in five countries in the Asia-Pacific region. A self-administrated survey that collected information on prior medical conditions, presence of symptoms, and scores on the Depression Anxiety Stress Scales and the Impact of Events Scale-Revised were used. The prevalence of depression, anxiety, stress and post-traumatic stress disorder (PTSD) relating to COVID-19 was compared, and multivariable logistic regression identified independent factors associated with adverse psychological outcomes within each country. RESULTS: A total of 1146 participants from India, Indonesia, Singapore, Malaysia and Vietnam were studied. Despite having the lowest volume of cases, Vietnam displayed the highest prevalence of PTSD. In contrast, Singapore reported the highest case volume, but had a lower prevalence of depression and anxiety. In the multivariable analysis, we found that non-medically trained personnel, the presence of physical symptoms and presence of prior medical conditions were independent predictors across the participating countries. CONCLUSIONS: This study highlights that the varied prevalence of psychological adversity among healthcare workers is independent of the burden of COVID-19 cases within each country. Early psychological interventions may be beneficial for the vulnerable groups of healthcare workers with presence of physical symptoms, prior medical conditions and those who are not medically trained.
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BACKGROUND: We sought to study the association between carotid stenosis and white-matter hyperintensity (WMH) among patients without intracranial large-vessel stenosis. METHODS: This was a prospective study of patients with acute lacunar infarcts without concomitant intracranial large-vessel stenosis having undergone carotid ultrasonography. WMH was quantified using the modified Fazekas scale. Patients were grouped into quartiles based on the degree of carotid stenosis. The association among carotid stenosis, vascular risk factors, and WMH were modeled using logistic regression analysis. RESULTS: In all, 100 patients with a mean age of 56.2 ± 11.7 years were studied. The quartile with the greatest carotid stenosis had a mean internal/common carotid artery peak systolic velocity ratio of 2.36. Total WMH was 4.64 in the highest quartile and 2.52 in the lowest quartile of carotid stenosis. Periventricular (pv)-WMH was significantly greater between the highest and lowest quartiles (2.80 versus 1.28, P = .025). No significant difference was observed for deep subcortical WMH (1.84 versus 1.24, P = .281). With increasing carotid stenosis, increase in both ipsilateral and contralateral pv-WMH was observed. When patients with significant carotid stenosis were compared to those without significant carotid stenosis, pv-WMH was significantly higher in the group with significant stenosis even after correcting for age and comorbid vascular risk factors (odds ratio 1.24; confidence interval 1.0-1.54). CONCLUSIONS: Carotid stenosis is an important risk factor for WMH. Volumes of pv-WMH significantly increase with higher grades of carotid stenosis.
Asunto(s)
Encefalopatías/etiología , Estenosis Carotídea/complicaciones , Adulto , Factores de Edad , Anciano , Velocidad del Flujo Sanguíneo , Encefalopatías/epidemiología , Arterias Carótidas/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Estenosis Carotídea/epidemiología , Intervalos de Confianza , Femenino , Lateralidad Funcional/fisiología , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Estudios Prospectivos , Factores de Riesgo , Accidente Vascular Cerebral Lacunar/epidemiología , Accidente Vascular Cerebral Lacunar/etiología , UltrasonografíaRESUMEN
BACKGROUND: The incidence of post stroke cognitive impairment (PSCI) and predictive factors for PSCI among patients with acute lacunar infarcts is unclear. OBJECTIVE: To study the impact of acute lacunar infarcts and chronic white matter disease in the development of PSCI. METHODS: Prospective cohort study of stroke patients attending a tertiary neurology center. Patients with MRI confirmed acute lacunar infarcts without pre-existing dementia were recruited. Logistic regression was used to determine risk factors for developing PSCI. RESULTS: 145 patients with a mean age of 55.8 years were studied of which 48 patients (33.1%) were identified to have PSCI. Patients with PSCI performed worse on the MMSE, MOCA and FAB and had significantly greater white matter hyperintensity (WMH) in the frontal subcortical (FSC) region (p = 0.006) and higher frontal subcortical acute infarct load (p = 0.002). Logistic regression demonstrated that deep subcortical WMH (odds ratio, OR = 1.45) and acute FSC infarcts (OR = 1.51) were associated with PSCI. High WMH load without acute FSC infarcts was associated with increased risk of PSCI (OR = 4.1). When patients developed acute FSC infarcts on pre-existing severe WMH, the risk of PSCI increased substantially (OR = 11.0). CONCLUSIONS: Patients with acute lacunar infarcts in the FSC region have 1.5 times risk of PSCI. This risk increases substantially to 11 times when there is pre-existing severe white matter disease.