Archive for August, 2011

New Study Reveals Significant Increase in Pregnancy-Related Strokes

Monday, August 8th, 2011

A new study published in the Journal of the American Heart Association this month reveals that pregnant women have a significantly high risk of developing a stroke. According to the lead author of the study,  Dr. Elena V. Kuklina (senior service fellow and epidemiologist at the Center for Disease Control and Prevention (CDC)), “the overall rate of women having strokes while they are expecting a baby and in the three months after birth went up 54% in the 12 years leading up to 2006-07.”

This is a significant finding! To put it in context, consider the following facts about stroke:

  • Stroke is the third leading cause of death in the United States. Over 143,579 people die each year from stroke in the United States.
  • Stroke is the leading cause of serious, long-term disability in the United States.
  • Each year, about 795,000 people suffer a stroke. About 600,000 of these are first attacks, and 185,000 are recurrent attacks.
  • Nearly three-quarters of all strokes occur in people over the age of 65. The risk of having a stroke more than doubles each decade after the age of 55.
  • Strokes can – and do – occur at ANY age. Nearly one quarter of strokes occur in people under the age of 65.
  • Stroke death rates are higher for African Americans than for whites, even at younger ages.
  • Among adults age 20 and older, the prevalence of stroke in 2005 was 6,500,000 (about 2,600,000 males and 3,900,000 females).
  • On average, every 40 seconds someone in the United States has a stroke.
  • Each year, about 55,000 more women than men have a stroke.

“A stroke is an interruption of the blood supply to any part of the brain. A stroke is sometimes called a ‘brain attack.’” The following are well-recognized stroke risk factors: high blood pressures (hypertension), atrial fibrillation, diabetes, heart disease, high cholesterol, increasing age, and a family history of strokes.  Being pregnant is a risk factor in and of itself.

As part of the study, Dr. Kuklina and colleagues used information from 5 to 8 million discharge records from about 1000 hospitals. According to Dr. Kuklina, the increase in the stroke rate during pregnancy and in the 3 months after birth was mainly attributable to high blood pressure and obesity. The study enumerates these specific findings:

  • Pregnancy-related stroke hospitalizations went up by 54%, from 4,085 to 6,293 over the 12 years leading up to 2006- 07.
  • Strokes in pregnancy went up by 47% (from 0.15 to 0.22 per 1,000 deliveries).
  • Strokes recently after giving birth went up by 83% (from 0.12 to 0.22 per 1,000 deliveries).
  • Strokes during delivery did not change (they stayed at 0.27 per 1,000 deliveries).
  • In 2006-07, about 32% and 53% of women who were hospitalized after having strokes in pregnancy and shortly after giving birth respectively had either high blood pressure or heart disease.
  • Increased prevalence of these two conditions over the 12 years up to 2006-07 accounted for almost all the increase in stroke hospitalization after giving birth that occurred in the same period.

It appears that an increasingly larger number of women enter pregnancy with one or more stroke risk factors. This is particularly true with respect to hypertension and obesity. According to Dr. Kuklina, “[s]ince pregnancy by itself is a risk factor, if you have one of these other stroke risk factors, it doubles the risk.” For this reason, it is particularly important to enter pregnancy in relatively good cardiovascular health and to reduce other risk factors, if possible. If you are pregnant or plan on becoming pregnant, talk to your OB/GYN about your stroke risk factors. In collaboration with your physician, implement a plan to manage and reduce your stroke risks before, during, and after pregnancy.

Read these related blogs:

Stroke Warnings: Most People Who Experience Minor Strokes Do Not Recognize Its Symptoms

Strokes – Family History a Significant Risk Factor

Spinal Stroke: An atypical cause of back pain

Brother, will you help me? If you don’t this stroke might kill me.

Landmark NIH Clinical Trial Comparing Two Stroke Prevention Procedures Shows Surgery and Stenting Equally Safe and Effective

Parents – be aware and read this article: Children Don’t Have Strokes? Just Ask Jared About His, at Age 7 – NYTimes.com

To view our collection of educational videos about stroke, visit us at:

http://www.youtube.com/user/nashlawatty#g/c/BDCB5099E7C9F6C4

Autism and Wandering – a constant struggle

Wednesday, August 3rd, 2011

I have written before in this space about special needs children, including children with autism. This week I want to turn my attention to one aspect of autism – wandering – and some of the ways parents and schools are trying to keep kids safe. Wandering is something I really had not heard of before, but I’ve since learned that it is a serious danger to children with autism or other cognitive deficits. It is also a major source of stress to parents who are constantly worried about their child wandering off.

All children have a tendency to wander away from their parents at times. When my daughter was two, I lost her at Sports Authority. I thought she was standing right next to me while I was looking at something, then I looked down and she was gone. After a few frantic minutes – and with the quick help of the store employees – we found her all the way on the opposite side of the store looking at balls. She was perfectly fine, but it was terrifying for me.

For reasons that are not well understood, children with Autism Spectrum Disorder (ASD) tend to wander more than non-autistic children. As reported by the Child Mind Institute and others, a recent study by the Interactive Autism Network has finally tried to quantify what has traditionally been more anecdotal evidence about wandering.

According to the responses from more than 800 parents, roughly 50 percent of children between the ages of 4 and 10 with an ASD wander at some point, four times more than their unaffected siblings. The behavior peaks at 4, almost four times higher than their unaffected siblings, but almost 30 percent of kids with an ASD between the ages of 7 and 10 are still eloping, eight times more than their unaffected brothers and sisters.

Autistic children seem to wander for two basic reasons. One is to find something they like, such as their favorite pond or playground; and one is to get away from something they don’t like such as a stressful school environment. It’s not really running away, at least as that term is usually used to describe a child who decides to leave home because of some real or perceived injustice at home. A majority of parents in the study described their child as happy and focused when they wandered off. It is usually a matter of the child being drawn to something that he or she likes. One child referenced in the Child Mind story had a fascination with exit signs. One day at school, the boy wandered off through the woods toward the highway to find his favorite exit sign. Thankfully, a good Samaritan picked-up the boy and returned him to where he belonged.

The danger for children is very real. While concrete statistics are difficult to come by, drowning seems to be the biggest danger (there are some who believe that autistic children are drawn to water). Children can also wander into traffic. Of course, when any small child wanders alone there is the risk of getting lost or being abducted. To further complicate matters, thirty-five percent of families in the study reported that their child is never or rarely able to communicate basic identifying information such as name, address and phone number. This obviously makes it harder for a wandering child to get back home. Even older or more high-functioning children may – due to their social anxiety – be reluctant to seek out help or cooperate with someone who is trying to intervene.

Wandering represents a challenge to schools because it can be very difficult to monitor a child all day long, especially during class changes and recess. The problem, however, also occurs at home. Wandering occurs not just during the day; night-time wandering is an especially big fear for parents of autistic children. Some children have been known to get up in the middle of the night, undo the deadbolt on the front door, and walk-off into the night. The terror of finding your child gone in the middle of the night is unimaginable. Some parents have installed deadbolts higher up on the doors, some have installed alarms that go off if the door is opened. Some parents have gone so far as to have their children wear tracking devices that send out a signal that can be pin-pointed. While all of these techniques can help, there are no sure-fire methods of preventing wandering. It is a constant worry for parents.

The autism community has taken action by getting the Center for Disease Control’s safety subcommittee to assign a specific medical code for wandering, which will be in conjunction with the diagnosis of ASD. By doing this, it is hoped that doctors will more readily recognize wandering as a legitimate diagnosis that they can address with the parents or other caregivers (the new code applies to adults with ASD as well). The American Academy of Pediatrics is also preparing a fact sheet to educate doctors on the topic so that they can better work with parents to try to reduce the incidence of wandering. The new code may also make it easier for parents to seek reimbursement from their insurance companies for alarms and tracking devices, and it may make it easier for parents to argue to their schools that a one-on-one monitor is needed as part of the child’s Individualized Education Plan (IEP). The new code takes effect in October 2011.

Lori McIlwain, Chairwoman of the National Autism Association, recently discussed how to deal with wandering:

The best overall strategy is a multi-tiered approach, which includes educating the child about safety and dangers using whatever means of communication works, including social stories, language and/or visual prompts. It’s also important that caregivers—and schools—work to understand what is causing, or contributing to, the wandering or bolting behaviors so that any triggers may be addressed or eliminated.

Have any of our readers had any experience with wandering? I’d like to hear your stories as to how you deal with it and how it affects your life.

Related Nash and Associates Links:

Dogs a Huge Help to Special Needs Kids

The Daily Struggle of Raising a Disabled Child

Many Parents Still Believe Vaccines Cause Autism

 

 

Photo courtesy of: Issueswithautism.com