From the literature

BACKGROUND AND OBJECTIVES: Despite an overall decline in incidence rate, the burden of stroke may be rising in young adults. We aimed to characterize the incidence rates, 30-day case fatality rates (CFRs), and the burden of stroke risk factors over time in young adults in a representative population-based study of stroke. METHODS: Using validated methods, hospitalized stroke cases in a 5-county region were ascertained and adjudicated by stroke-trained physicians in 6 study periods: July 1993-June 1994 and calendar years 1999, 2005, 2010, 2015, and 2020. Stroke in the young was defined as those occurring among individuals who were aged 20-54 years. Incidence rates were generated using US Census data standardized to the 2010 population, and trends were tested with linear regression. Temporal trends in 30-day CFR were evaluated with logistic regression after adjusting for age, race, and sex. RESULTS: Across all study periods, there were 2,076 first-ever strokes in young adults. Hypertension, diabetes, atrial fibrillation, and substance use were more common over time ( < 0.001). The stroke incidence rate increased in young adults over time (33.90 cases/100,000 person-years in 1993/4 to 62.18 cases/100,000 person-years in 2020, trend = 0.04), while declining in older adults (618.78 cases/100,000 person-years in 1993/4 to 453.04 cases/100,000 person-years in 2020, trend = 0.02). The rise in stroke incidence appeared driven by ischemic stroke, with an almost doubled incidence rate of 23.8 cases/100,000 person-years in 1993/4 to 47.3 cases/100,000 person-years in 2020 (trend = 0.02). There was a modest decline in the 30-day CFR in young adults (11.7% in 1993/4 to 9.4% in 2020, trend = 0.002), driven by intracerebral hemorrhage (27.5% in 1993/4 to 21.2% in 2020, trend = 0.03) and subarachnoid hemorrhage (27.9% in 1993/4 to 18.6% in 2020, trend = 0.09). DISCUSSION: The incidence of stroke in young adults is rising over time, while the CFR simultaneously declines. This coincides with a rise in both traditional vascular risk factors and substance use.

ObjectivesThis study aimed to identify multidimensional factors associated with hypertension self-management and examine candidate self-care support domains to inform the development of a person-centered nursing-based self-care bundle.MethodsA cross-sectional study was conducted among 152 patients with hypertension aged 40-59 years in primary healthcare centers in Bali, Indonesia, using multistage random sampling. Data were collected using researcher-developed questionnaires informed by established instruments, theories, and previous studies, and preliminarily tested for validity and reliability, measuring patient, family, socio-cultural, healthcare service, candidate self-care support domains, and self-management ability. Partial least squares structural equation modeling was used to examine associations among constructs.ResultsPatient factors were associated with candidate self-care support domains (β=0.593, p<0.001) and self-management ability (β=0.379, p<0.001). Family, sociocultural, and healthcare-service factors were associated with candidate self-care support domains but not directly with self-management ability. Candidate self-care support domains were also associated with self-management ability (β=0.481, p<0.001).ConclusionsThe findings provide a cross-sectional needs-assessment foundation for developing a person-centered nursing-based integrated self-care bundle for hypertension self-management. Future studies should refine the bundle through expert validation and test its feasibility and effectiveness using intervention designs.

Pulmonary arterial hypertension (PAH) with features of venous and/or capillary involvement, formerly pulmonary veno-occlusive disease (PVOD), represents a rare and severe subset of pulmonary hypertension. While PVOD is typically idiopathic, heritable or drug/toxin-induced, "PVOD-like" features have long been recognised in PAH associated with connective tissue diseases (CTDs), especially systemic sclerosis (SSc). This review synthesises the available evidence on this phenotype, integrating published data with an unreported cohort of 25 patients. Venular remodelling is a frequent histological finding in SSc-PAH lung explants, but high-resolution computed tomography (HRCT) signs of PVOD are inconsistently observed at PAH presentation, reflecting a progression of the lung vasculopathy and/or an unmasking effect of pulmonary vasodilators. Patients often exhibit major functional limitation, profound impairment in gas transfer and severe haemodynamic compromise. Assessing venular involvement in SSc-PAH poses unique challenges, due to possible lung fibrosis on HRCT and differential diagnosis with an occult post-capillary component. Despite the lack of robust evidence, PAH-approved therapies are commonly used, although with caution due to a high risk of pulmonary oedema with pulmonary vasodilators. As these patients also display significant arteriolar involvement, which can benefit from these drugs, dedicated treatment strategies warrant further investigation. Prognosis remains dismal, with a 5-year survival around 45-50%. Similar PVOD-like patterns have also anecdotally been reported in systemic lupus erythematosus, rheumatoid arthritis, mixed connective tissue disease, Sjögren syndrome and inflammatory myopathies, with comparable features. Overall, PVOD-like disease in CTD-PAH constitutes a high-risk phenotype with unresolved pathogenic and management challenges, requiring refined patient stratification and improved therapeutic strategies.