Body mass index, waist circumference, and waist/hip ratio have been shown to be associated with type 2 diabetes. From the clinical perspective, central obesity (approximated by waist circumference or waist/hip ratio) is known to generate diabetogenic substances and should therefore be more informative than general obesity (body mass index). Because of their high correlation, from the statistical perspective, body mass index and waist circumference are unlikely to yield different answers. To compare associations of diabetes incidence with general and central obesity indicators, the authors conducted a meta-analysis based on published studies from 1966 to 2004 retrieved from a PubMed search. The analysis was performed with 32 studies out of 432 publications initially identified. Measures of association were transformed to log relative risks per standard deviation (pooled across all studies) increase in the obesity indicator and pooled using random effects models. The pooled relative risks for incident diabetes were 1.87 (95% confidence interval (CI): 1.67, 2.10), 1.87 (95% CI: 1.58, 2.20), and 1.88 (95% CI: 1.61, 2.19) per standard deviation of body mass index, waist circumference, and waist/hip ratio, respectively, demonstrating that these three obesity indicators have similar associations with incident diabetes. Although the clinical perspective focusing on central obesity is appealing, further research is needed to determine the usefulness of waist circumference or waist/hip ratio over body mass index. body fat distribution; body mass index; diabetes mellitus, type 2; meta-analysis; obesity; waist-hip ratio Abbreviations: BMI, body mass index; CI, confidence interval; RR, relative risk; SD, standard deviation; WC, waist circumference; WHR, waist/hip ratio.

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BACKGROUND AND PURPOSE:Although recanalization is the goal of thrombolysis, it is well recognized that it fails to improve outcome of acute stroke in a subset of patients. Our aim was to assess the rate of and factors associated with "futile recanalization," defined by absence of clinical benefit from recanalization, following endovascular treatment of acute ischemic stroke.

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In this cross-sectional analysis of obese children and adolescents, musculoskeletal pain was common and, in the knee and hip joints, was positively associated with extra bodyweight. Clinicians may want to ask about musculoskeletal pain when recommending physical activity for weight management counselling.

Background and Purpose-Dysphagia screening before oral intake (DS) is a stroke care quality indicator. The value of DS is unproven. Quality adherence and outcome data from the Paul Coverdell National Acute Stroke Registry were examined to establish value of DS. Methods-Adherence to the DS quality indicator was examined in patients with stroke discharged from Paul Coverdell National Acute Stroke Registry hospitals between March 1 and December 31, 2009. Patients were classified as unscreened (US), screened and passed (S/P), and screened and failed. Associations between screening status and pneumonia rate were assessed by logistic regression models after adjustment for selected variables. Results-A total of 18 017 patients with stroke discharged from 222 hospitals in 6 states were included. A total of 4509 (25%) were US; 8406 (47%) were S/P, and 5099 (28%) were screened and failed. Compared with US patients, screened patients were significantly more impaired. Pneumonia rates were: US 4.2%, S/P 2.0%, and screened and failed 6.8%. After adjustment for demographic and clinical features, US patients were at a higher risk of pneumonia (OR, 2.2; 95% CI, 1.7 to 2.7) compared with S/P patients. Conclusions-Data suggest that patients are selectively screened based on stroke severity. Pneumonia rate was higher in US patients compared with S/P patients. Clinical judgment regarding who should be screened is imperfect. S/P patients have a lower pneumonia rate indicating that DS adds accuracy in predicting pneumonia risk. The Joint Commission recently retired DS as a performance indicator for Primary Stroke Center certification. These results suggest the need to implement a DS performance measure for patients with acute stroke. (Stroke. 2010;41:2849-2854.)

The results of the ISAT have been associated with a prominent change in practice patterns related to the treatment of ruptured aneurysms. The cost of hospitalization has increased and the mortality has decreased, presumably due to a larger proportion of patients receiving any treatment and endovascular treatment.

Background To track mortality and rehospitalizations over 5 years post-stroke in a stroke cohort (SC) and compare long-term risks of complications to a matched non-stroke cohort (NSC). Methods A cohort design with a matched NSC comparison was used. The SC constituted a validated database of acute ischemic stroke patients, 65 years or older, hospitalized across 19 Minnesota hospitals in the year 2000. The NSC was constructed from the year 2000 General Medicare Population by matching SC members on age, race and sex. Both cohorts were tracked across 5 years of Medicare claims data to identify dates and causes of rehospitalization and death dates. Kaplan-Meier survival curves estimated cumulative incidence rates. Cox models calculated adjusted hazard ratios (HR). Results Event rates and adjusted HR were: Mortality: 1 year SC=24%, NSC=4%; 5 years SC=49%, NSC= 24%; HR: 4.4 (95% confidence intervals (CI) 3.6-5.5). Overall rehospitalization rates: 1 year SC=49%, NSC=20%; 5 years SC=83%; NSC=63%; HR: 2.6 (95% CI 2.2-3.0). Cause specific 5-year rehospitalization rates were significantly higher in SC versus NSC for recurrent ischemic stroke, heart failure, cardiac events, any vascular events, pneumonia, and hip fractures. The excess risk of mortality and rehospitalizations in the SC persisted beyond the initial aftermath of the acute stroke (i.e. beyond 30 days post-stroke) and persisted even after 1 year post-stroke. Average acute care Medicare charges in SC more than doubled those in NSC. Conclusions The high rates of acute care post-stroke readmissions indicate a need for trials to prevent long-term complications in stroke survivors.