Dysphagia may predispose stroke patients toward undernutrition and hydration. These comorbidities increase patient risks for reduced functional outcome and short-term mortality. Despite this impact, available information on relationships among dysphagia, nutrition, and hydration status in acute stroke is limited and conflicted. This study evaluated nutrition and hydration status in ischemic stroke patients with versus without clinically significant dysphagia at admission and at discharge from acute care. Sixty-seven patients admitted to the stroke unit in a tertiary-care hospital provided data for this study. On the day of hospital admission and upon discharge or at 7 days post admission, serum biochemical measures were obtained for nutrition (prealbumin) and hydration status (BUN/Cr). Clinical evaluation for dysphagia, nutrition status, and stroke severity were completed an average of 1.4 days following hospital admission. Dysphagia was identified in 37 % of the cohort. At admission 32 % of patients demonstrated malnutrition based on prealbumin levels and 53 % demonstrated evidence of dehydration based on BUN/Cr levels. No differences in nutrition status were attributed to dysphagia. Patients with dysphagia demonstrated significantly higher BUN/Cr levels (greater dehydration) than patients without dysphagia at admission and at discharge. Dehydration at both admission and discharge was associated with dysphagia, clinical nutrition status, and stroke severity. Results of this study support prior results indicating that dysphagia is not associated with poor nutrition status during the first week post stroke. Dehydration status is associated with dysphagia during this period. The results have implications for future confirmatory research and for clinical management of dysphagia in the acute stroke period.
Indoor and outdoor number concentrations of fine particulate matter (PM2.5), black carbon (BC), carbon monoxide (CO), and nitrogen dioxide (NO2) were monitored continuously for two to seven days in 28 low-income homes in Denver, Colorado, during the 2016 and 2017 wildfire seasons. In the absence of indoor sources, all outdoor pollutant concentrations were higher than indoors except for CO. Results showed that long-range wildfire plumes elevated median indoor PM2.5 concentrations by up to 4.6 times higher than outdoors. BC, CO, and NO2 mass concentrations were higher indoors in homes closer to roadways compared to those further away. Four of the homes with mechanical ventilation systems had 18% higher indoor/outdoor (I/O) ratios of PM2.5 and 4% higher I/O ratios of BC compared to other homes. Homes with exhaust stove hoods had PM2.5 I/O ratios 49% less than the homes with recirculating hoods and 55% less than the homes with no stove hoods installed. Homes with windows open for more than 12 hours a day during sampling had indoor BC 2.4 times higher than homes with windows closed. This study provides evidence that long-range wildfire plumes, road proximity, and occupant behavior have a combined effect on indoor air quality in low-income homes.
This study examined the correlation of peer victimization to psychosocial adjustment in a sample of children diagnosed with attention-deficit hyperactivity disorder (ADHD). A total of 303 files of youth who received a psycho-educational assessment were reviewed; of these, 116 had an ADHD diagnosis. The data collected included the Child Behavior Checklist (which includes items assessing peer victimization), Conner's Parent Rating Scale, Revised Children's Manifest Anxiety Scale and Children's Depression Inventory. Peer victimization was positively correlated with parent reports of anxiety, depression, social problems, delinquent behavior and aggressive behavior. Children with a comorbid psychiatric diagnosis with ADHD reported higher rates of peer victimization than those without a comorbid diagnosis. Children diagnosed with ADHD along with a comorbid externalizing psychiatric diagnosis experienced higher rates of peer victimization than those with a comorbid internalizing psychiatric diagnosis. The implications of this study concerning peer victimization and psychosocial adjustment in children with ADHD are discussed.
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