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  1. Article ; Online: Hypertension and mild cognitive impairment: state-of-the-art review.

    Shajahan, Sultana / Peters, Ruth / Carcel, Cheryl / Woodward, Mark / Harris, Katie / Anderson, Craig S

    American journal of hypertension

    2024  

    Abstract: Background: Mid-life hypertension is associated with cognitive decline and dementia in later life. Reducing high blood pressure (BP) with antihypertensive agents is a well-researched strategy to prevent dementia and mild cognitive impairment (MCI). ... ...

    Abstract Background: Mid-life hypertension is associated with cognitive decline and dementia in later life. Reducing high blood pressure (BP) with antihypertensive agents is a well-researched strategy to prevent dementia and mild cognitive impairment (MCI). However, there is still limited direct evidence to support the approach, and particularly for the treatment of the very old and those with existing MCI.
    Methods: This review presents an overview of the current evidence for the relationship between MCI and hypertension, and of the potential pathophysiological mechanisms related to cognitive decline and incidence dementia in relation to aging.
    Results: Although observational data are near consistent in showing an association between mid-life hypertension and MCI and/or dementia, the evidence in relation to hypertension in younger adults and the very old (age >80 years) is much more limited. Most of the commonly available antihypertensive agents appear to provide beneficial effects in reducing the risk dementia, but there is limited evidence to support such treatment in those with existing MCI.
    Conclusions: Further studies are needed to determine the optimal levels of BP control across different age groups, especially in adults with MCI, and which class(es) of antihypertensive agents and duration of treatment best preserve cognitive function in those at risk of, or with established, MCI.
    Language English
    Publishing date 2024-01-12
    Publishing country United States
    Document type Journal Article
    ZDB-ID 639383-4
    ISSN 1941-7225 ; 1879-1905 ; 0895-7061
    ISSN (online) 1941-7225 ; 1879-1905
    ISSN 0895-7061
    DOI 10.1093/ajh/hpae007
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Relationship between sex and cardiovascular mortality in chronic kidney disease: A systematic review and meta-analysis.

    Shajahan, Sultana / Amin, Janaki / Phillips, Jacqueline K / Hildreth, Cara M

    PloS one

    2021  Volume 16, Issue 7, Page(s) e0254554

    Abstract: Chronic kidney disease (CKD) is a significant health challenge associated with high cardiovascular mortality risk. Historically, cardiovascular mortality risk has been found to higher in men than women in the general population. However, recent research ... ...

    Abstract Chronic kidney disease (CKD) is a significant health challenge associated with high cardiovascular mortality risk. Historically, cardiovascular mortality risk has been found to higher in men than women in the general population. However, recent research has highlighted that this risk may be similar or even higher in women than men in the CKD population. To address the inconclusive and inconsistent evidence regarding this relationship between sex and cardiovascular mortality within CKD patients, a systematic review and meta-analysis of articles published between January 2004 and October 2020 using PubMed/Medline, EMBASE, Scopus and Cochrane databases was performed. Forty-eight studies were included that reported cardiovascular mortality among adult men relative to women with 95% confidence intervals (CI) or provided sufficient data to calculate risk estimates (RE). Random effects meta-analysis of reported and calculated estimates revealed that male sex was associated with elevated cardiovascular mortality in CKD patients (RE 1.13, CI 1.03-1.25). Subsequent subgroup analyses indicated higher risk in men in studies based in the USA and in men receiving haemodialysis or with non-dialysis-dependent CKD. Though men showed overall higher cardiovascular mortality risk than women, the increased risk was marginal, and appropriate risk awareness is necessary for both sexes with CKD. Further research is needed to understand the impact of treatment modality and geographical distribution on sex differences in cardiovascular mortality in CKD.
    MeSH term(s) Cardiovascular Diseases/mortality ; Female ; Humans ; Male ; Renal Dialysis ; Renal Insufficiency, Chronic/mortality ; Sex Factors
    Language English
    Publishing date 2021-07-12
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Research Support, Non-U.S. Gov't ; Systematic Review
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0254554
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  3. Article ; Online: Sex differences in the utilization and outcomes of endovascular treatment after acute ischemic stroke: A systematic review and meta-analysis.

    Ouyang, Menglu / Shajahan, Sultana / Liu, Xiaoying / Sun, Lingli / Carcel, Cheryl / Harris, Katie / Anderson, Craig S / Woodward, Mark / Wang, Xia

    Frontiers in global women's health

    2023  Volume 3, Page(s) 1032592

    Abstract: Background: Studies of sex differences in the use and outcomes of endovascular treatment (EVT) for acute ischemic stroke report inconsistent results.: Methods: We systematically searched PubMed and Embase databases for studies examining sex-specific ... ...

    Abstract Background: Studies of sex differences in the use and outcomes of endovascular treatment (EVT) for acute ischemic stroke report inconsistent results.
    Methods: We systematically searched PubMed and Embase databases for studies examining sex-specific utilization of EVT for acute ischemic stroke published before 31 December 2021. Estimates were compared by study type: randomized clinical trials (RCTs) and non-RCTs (hospital-based, registry-based or administrative data). Random effects odds ratios (ORs) were generated to quantify sex differences in EVT use. To estimate sex differences in functional outcome on the modified Rankin scale after EVT, the female:male ratio of ORs and 95% confidence intervals (CIs) were obtained from ordinal or binary analysis.
    Results: 6,396 studies were identified through database searching, of which 594 qualified for a full review. A total of 51 studies (36 non-RCT and 15 RCTs) reporting on sex-specific utilization of EVT were included, and of those 10 estimated the sex differences of EVT on functional outcomes. EVT use was similar in women and men both in non-RCTs (OR: 1.03, 95% CI: 0.96-1.11) and RCTs (1.02, 95% CI: 0.89-1.16), with consistent results across years of publication and regions of study, except that in Europe EVT treatment was higher in women than men (1.15, 95% CI: 1.13-1.16). No sex differences were found in the functional outcome by either ordinal and binary analyses (ORs 0.95, 95% CI: 0.68-1.32] and 0.90, 95% CI: 0.65-1.25, respectively).
    Conclusions: No sex differences in EVT utilization or on functional outcomes were evident after acute ischemic stroke from large-vessel occlusion. Further research may be required to examine sex differences in long-term outcomes, social domains, and quality of life.
    Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=226100, identifier: CRD42021226100.
    Language English
    Publishing date 2023-01-18
    Publishing country Switzerland
    Document type Journal Article ; Review
    ISSN 2673-5059
    ISSN (online) 2673-5059
    DOI 10.3389/fgwh.2022.1032592
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  4. Article ; Online: Sex differences in the symptom presentation of stroke: A systematic review and meta-analysis.

    Shajahan, Sultana / Sun, Lingli / Harris, Katie / Wang, Xia / Sandset, Else Charlotte / Yu, Amy Yx / Woodward, Mark / Peters, Sanne Ae / Carcel, Cheryl

    International journal of stroke : official journal of the International Stroke Society

    2022  Volume 18, Issue 2, Page(s) 144–153

    Abstract: Background: Early diagnosis through symptom recognition is vital in the management of acute stroke. However, women who experience stroke are more likely than men to be initially given a nonstroke diagnosis and it is unclear if potential sex differences ... ...

    Abstract Background: Early diagnosis through symptom recognition is vital in the management of acute stroke. However, women who experience stroke are more likely than men to be initially given a nonstroke diagnosis and it is unclear if potential sex differences in presenting symptoms increase the risk of delayed or missed stroke diagnosis.
    Aims: To quantify sex differences in the symptom presentation of stroke and assess whether these differences are associated with a delayed or missed diagnosis.
    Methods: PubMed, EMBASE, and the Cochrane Library were systematically searched up to January 2021. Studies were included if they reported presenting symptoms of adult women and men with diagnosed stroke (ischemic or hemorrhagic) or transient ischemic attack (TIA) and were published in English. Mean percentages with 95% confidence intervals (CIs) of each symptom were calculated for women and men. The crude relative risks (RRs) with 95% CI of symptoms being present in women, relative to men, were also calculated and pooled. Any data on the delayed or missed diagnosis of stroke for women compared to men based on symptom presentation were also extracted.
    Results: Pooled results from 21 eligible articles showed that women and men presented with a similar mean percentage of motor deficit (56% in women vs 56% in men) and speech deficit (41% in women vs 40% in men). Despite this, women more commonly presented with nonfocal symptoms than men: generalized nonspecific weakness (49% vs 36%), mental status change (31% vs 21%), and confusion (37% vs 28%), whereas men more commonly presented with ataxia (44% vs 30%) and dysarthria (32% vs 27%). Women also had a higher risk of presenting with some nonfocal symptoms: generalized weakness (RR 1.49, 95% CI 1.09-2.03), mental status change (RR 1.44, 95% CI 1.22-1.71), fatigue (RR 1.42, 95% CI 1.05-1.92), and loss of consciousness (RR 1.30, 95% CI 1.12-1.51). In contrast, women had a lower risk of presenting with dysarthria (RR 0.89, 95% CI 0.82-0.95), dizziness (RR 0.87, 95% CI 0.80-0.95), gait disturbance (RR 0.79, 95% CI 0.65-0.97), and imbalance (RR 0.68, 95% CI 0.57-0.81). Only one study linking symptoms to definite stroke/TIA diagnosis found that pain and unilateral sensory loss are associated with lower odds of a definite diagnosis in women compared to men.
    Conclusion: Although women showed a higher prevalence of some nonfocal symptoms, the prevalence of focal neurological symptoms, such as motor weakness and speech deficit, was similar for both sexes. Awareness of sex differences in symptoms in acute stroke evaluation, careful consideration of the full constellation of presenting symptoms, and further studies linking symptoms to diagnostic outcomes can be helpful in improving early diagnosis and management in both sexes.
    MeSH term(s) Adult ; Humans ; Female ; Male ; Stroke/diagnosis ; Stroke/epidemiology ; Stroke/complications ; Ischemic Attack, Transient/complications ; Ischemic Attack, Transient/diagnosis ; Ischemic Attack, Transient/epidemiology ; Sex Characteristics ; Dysarthria/complications ; Dizziness
    Language English
    Publishing date 2022-04-12
    Publishing country United States
    Document type Meta-Analysis ; Systematic Review ; Journal Article ; Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2303728-3
    ISSN 1747-4949 ; 1747-4930
    ISSN (online) 1747-4949
    ISSN 1747-4930
    DOI 10.1177/17474930221090133
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    Zs.A 6582: Show issues Location:
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  5. Article ; Online: Sex and Gender in COVID-19 Vaccine Research: Substantial Evidence Gaps Remain.

    Vassallo, Amy / Shajahan, Sultana / Harris, Katie / Hallam, Laura / Hockham, Carinna / Womersley, Kate / Woodward, Mark / Sheel, Meru

    Frontiers in global women's health

    2021  Volume 2, Page(s) 761511

    Abstract: Since the start of the COVID-19 pandemic there has been a global call for sex/gender-disaggregated data to be made available, which has uncovered important findings about COVID-19 testing, incidence, severity, hospitalisations, and deaths. This mini ... ...

    Abstract Since the start of the COVID-19 pandemic there has been a global call for sex/gender-disaggregated data to be made available, which has uncovered important findings about COVID-19 testing, incidence, severity, hospitalisations, and deaths. This mini review scopes the evidence base for efficacy, effectiveness, and safety of COVID-19 vaccines from both experimental and observational research, and asks whether (1) women and men were equally recruited and represented in vaccine research, (2) the outcomes of studies were presented or analysed by sex and/or gender, and (3) there is evidence of sex and/or gender differences in outcomes. Following a PubMed search, 41 articles were eligible for inclusion, including seven randomised controlled trials (RCTs), 11 cohort studies, eight cross-sectional surveys, eight routine surveillance studies, and seven case series. Overall, the RCTs contained equal representation of women and men; however, the observational studies contained a higher percentage of women. Of 10 studies with efficacy data, only three (30%) presented sex/gender-disaggregated results. Safety data was included in 35 studies and only 12 (34%) of these presented data by sex/gender. For those that did present disaggregated data, overall, the majority of participants reporting adverse events were women. There is a paucity of reporting and analysis of COVID-19 vaccine data by sex/gender. Research should be designed in a gender-sensitive way to present and, where possible analyse, data by sex/gender to ensure that there is a robust and specific evidence base of efficacy and safety data to assist in building public confidence and promote high vaccine coverage.
    Language English
    Publishing date 2021-11-01
    Publishing country Switzerland
    Document type Journal Article ; Review
    ISSN 2673-5059
    ISSN (online) 2673-5059
    DOI 10.3389/fgwh.2021.761511
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Antithrombotics prescription and adherence among stroke survivors: A systematic review and meta-analysis.

    Yang, Min / Cheng, Hang / Wang, Xia / Ouyang, Menglu / Shajahan, Sultana / Carcel, Cheryl / Anderson, Craig / Kristoffersen, Espen Saxhaug / Lin, Yapeng / Sandset, Else Charlotte / Wang, Xiaoyun / Yang, Jie

    Brain and behavior

    2022  Volume 12, Issue 10, Page(s) e2752

    Abstract: Objectives: We aimed to investigate the prescription of antithrombotic drugs (including anticoagulants and antiplatelets) and medication adherence after stroke.: Methods: We performed a systematic literature search across MEDLINE and Embase, from ... ...

    Abstract Objectives: We aimed to investigate the prescription of antithrombotic drugs (including anticoagulants and antiplatelets) and medication adherence after stroke.
    Methods: We performed a systematic literature search across MEDLINE and Embase, from January 1, 2015, to February 17, 2022, to identify studies reporting antithrombotic medications (anticoagulants and antiplatelets) post stroke. Two people independently identified reports to include, extracted data, and assessed the quality of included studies according to the Newcastle-Ottawa scale. Where possible, data were pooled using random-effects meta-analysis.
    Results: We included 453,625 stroke patients from 46 studies. The pooled proportion of prescribed antiplatelets and anticoagulants among patients with atrial fibrillation (AF) was 62% (95% CI: 57%-68%), and 68% (95% CI: 58%-79%), respectively. The pooled proportion of patients who were treated according to the recommendation of guidelines of antithrombotic medications from four studies was 67% (95% CI: 41%-93%). It was reported that 11% (95% CI: 2%-19%) of patients did not receive antithrombotic medications. Good adherence to antiplatelet, anticoagulant, and antithrombotic medications was 78% (95% CI: 67%-89%), 71% (95% CI: 57%-84%), and 73% (95% CI: 59%-86%), respectively.
    Conclusion: In conclusion, we found that less than 70% of patients were prescribed and treated according to the recommended guidelines of antithrombotic medications, and good adherence to antithrombotic medications is only 73%. Prescription rate and good adherence to antithrombotic medications still need to be improved among stroke survivors.
    MeSH term(s) Anticoagulants/therapeutic use ; Fibrinolytic Agents/therapeutic use ; Humans ; Platelet Aggregation Inhibitors/therapeutic use ; Prescriptions ; Stroke/drug therapy ; Survivors
    Chemical Substances Anticoagulants ; Fibrinolytic Agents ; Platelet Aggregation Inhibitors
    Language English
    Publishing date 2022-09-06
    Publishing country United States
    Document type Journal Article ; Meta-Analysis ; Review ; Systematic Review ; Research Support, Non-U.S. Gov't
    ZDB-ID 2623587-0
    ISSN 2162-3279 ; 2162-3279
    ISSN (online) 2162-3279
    ISSN 2162-3279
    DOI 10.1002/brb3.2752
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  7. Article ; Online: Differences in the pre-hospital management of women and men with stroke by emergency medical services in New South Wales.

    Wang, Xia / Carcel, Cheryl / Hsu, Benjumin / Shajahan, Sultana / Miller, Matthew / Peters, Sanne / Randall, Deborah A / Havard, Alys / Redfern, Julie / Anderson, Craig S / Jorm, Louisa / Woodward, Mark

    The Medical journal of Australia

    2022  Volume 217, Issue 3, Page(s) 143–148

    Abstract: Objectives: To examine whether pre-hospital emergency medical service care differs for women and men subsequently admitted to hospital with stroke.: Design, setting, participants: Population-based cohort study; analysis of linked Admitted Patient ... ...

    Abstract Objectives: To examine whether pre-hospital emergency medical service care differs for women and men subsequently admitted to hospital with stroke.
    Design, setting, participants: Population-based cohort study; analysis of linked Admitted Patient Data Collection and NSW Ambulance data for people admitted to New South Wales hospitals with a principal diagnosis of stroke at separation, 1 July 2005 - 31 December 2018.
    Main outcome measures: Emergency medical service assessments, protocols, and management for patients subsequently diagnosed with stroke, by sex.
    Results: Of 202 231 people hospitalised with stroke (mean age, 73 [SD, 14] years; 98 599 women [51.0%]), 101 357 were conveyed to hospital by ambulance (50.1%). A larger proportion of women than men travelled by ambulance (52.4% v 47.9%; odds ratio [OR], 1.09; 95% CI, 1.07-1.11), but time between the emergency call and emergency department admission was similar for both sexes. The likelihood of being assessed as having a stroke (adjusted OR [aOR], 0.97; 95% CI, 0.93-1.01) or subarachnoid haemorrhage (aOR, 1.22; 95% CI, 0.73-2.03) was similar for women and men, but women under 70 years of age were less likely than men to be assessed as having a stroke (aOR, 0.89; 95% CI, 0.82-0.97). Women were more likely than men to be assessed by paramedics as having migraine, other headache, anxiety, unconsciousness, hypertension, or nausea. Women were less likely than men to be managed according to the NSW Ambulance pre-hospital stroke care protocol (aOR, 0.95; 95% CI, 0.92-0.97), but the likelihood of basic pre-hospital care was similar for both sexes (aOR, 1.01; 95% CI, 0.99-1.04).
    Conclusion: Our large population-based study identified sex differences in pre-hospital management by emergency medical services of women and men admitted to hospital with stroke. Paramedics should receive training that improves the recognition of stroke symptoms in women.
    MeSH term(s) Aged ; Cohort Studies ; Emergency Medical Services ; Emergency Service, Hospital ; Female ; Hospitals ; Humans ; Male ; New South Wales ; Stroke/diagnosis ; Stroke/epidemiology ; Stroke/therapy
    Language English
    Publishing date 2022-07-13
    Publishing country Australia
    Document type Journal Article
    ZDB-ID 186082-3
    ISSN 1326-5377 ; 0025-729X
    ISSN (online) 1326-5377
    ISSN 0025-729X
    DOI 10.5694/mja2.51652
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