Stroke and Infectious Diseases

Journal Club March 2020: Blackburn et al (2018) Laboratory-confirmed respiratory infections as predictors of hospital admission for myocardial infarction and stroke: Time-series analysis of English data for 2004-2015. Clinical Infectious Diseases, 67(1), 8-17,

Comment: I’ve never asked myself this before, but, as concern about, and infections from, COVID-19 start to spread globally, I wondered: Is there an association between respiratory infections and stroke? I’m certainly not meaning to be alarmist, or cause any offence by even giving this some consideration, but yes, is there any association? Obviously, it’s far, far too early to know if “respiratory infections” includes COVID-19.

Before I tell you about what I found, can I quickly extol the incredible contribution of clinical epidemiologists and biostatisticians at times like these. Together, their expertise maps patterns across populations, with particular focus on cause and effect. When a totally new disease “arrives”, like COVID-19, the role of these experts come to the fore. Without them, we’re unable to map, explore, understand, respond to, and/or learn from, the impact of diseases on our communities, societies and world-wide. Many of my colleagues are clinical epidemiologists and biostatisticians. Their work is mainly viewed within the context of journal publications and conference presentations, but at times like these, we do well to appreciate their significant contribution to our ability to overcome global diseases like COVID-19.

So, back to my question. Blackburn et al (2018) found an association between increases in hospital admissions for respiratory diseases and increases in hospital admissions for stroke, but that association was limited to certain diagnoses and it was only present in the elderly. It will, of course, be some years before we know if this association includes COVID-19 or not.  As always, this is just my humble opinion. Please read this article for yourself before you make up your own mind. To find the abstract, go to Journal Club 2020 and select Stroke and Infections Diseases.

Falls and Acute Stroke

March 2019: Westerlind et al (In Press) Drug treatment, postural control and falls: An observational cohort study of 504 patients with acute stroke, the fall study of Gothenburg. Archives of Physical Medicine and Rehabilitation.

As some of you might know, I have fairly strong opinions about our approaches to reducing the risk of falls, generally, and more specifically, reducing risk in those recovering from stroke. I challenge the applying of a zero tolerance to falls, because it assumes that risk-reduction is a unilateral approach; however, in those recovering from stroke, there is the competing demand of the benefits of getting up and about! Rarely are the two issues discussed in tandem. In those recovering from stroke, we already have a cohort known to have a higher-than-average risk of falls. So, does this mean we go all out to reduce the risk of falls? Yes, but only if consideration is given to the physical, cognitive and emotional benefits of getting up-and-out and about! So, to assist us in this, let’s better understand who is most at risk and why.

In this month’s Journal Club, Westerlind et al (In press) report on their investigation of the risk of falls in acute stroke, with a particular focus on its association with postural control, and in turn, the impact of drug treatment. In my humble opinion, their findings make for very interesting reading.

This article is not publicly available; but you can always contact the corresponding author for a copy if your library doesn’t have access to the APHR journal. To find the abstract, go to Journal Club 2019 tab and select Falls and Acute Stroke from the drop-down menu. “Humble Opinion” is added as comment to this post.

Global Burden of Stroke

February 2018: Feigin et al (2016) Global burden of stroke and risk factors in 188 countries, during 1990-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet Neurology, 15(9), 913–24 S1474-4422(16)30073-4

I thought I should start off this year talking about stroke prevention. As the old adage says: “Prevention is better than cure”, and this is certainly the case for stroke. Sure, I have digressed from stroke recovery in its purest sense, but actually, all those who have experienced stroke and/or transient ischemic attack or TIA, are at high risk of experiencing another stroke. Therefore, although risk and prevention are not ordinarily a component of the stroke recovery programs discourse, perhaps it should be, because, as Feigin et al found, “90.5% (95% UI 88.5-92.5) of the stroke burden was attributable to the modifiable risk factors analysed, including 74.2% (95% UI 70.7-76.7) due to behavioural factors (smoking, diet and low physical activity)”. If you think the blame lies mainly at the feet of those who appear to have unhealthy lifestyles, you may be surprised to read that these researchers found nearly 30% of all strokes are attributable to air pollution!

It’s important that all health professionals have an understanding of the factors that place some people at higher risk of stroke than others. The articles published by this research collaboration are, in my humble opinion, the most significant publications that those of us working in stroke, could be reading.  As with all Journal Club reviews, you’ll find the abstract and my Humble Opinion, under Journal Club 2018 and under the Global Burden of Disease option in the drop-down menu. This article is freely available from

I’m excited about starting the year on such a significant article. I’m also looking forward to our journeying together in 2018, Isobel