Objectives Cognitive impairment poststroke is progressive. We aimed to synthesise the existing evidence evaluating risk factors and the effects of treatments to prevent/improve cognitive function in patients who had a stroke with cognitive impairment. Design Umbrella review. Data source Medline, PsycINFO, EMBASE, Cochrane and PROSPERO were searched from inception until 11 June 2019. Eligibility criteria Published systematic review (SR) that incorporated randomised controlled trials to investigate an intervention to improve poststroke cognitive impairment, or SR of longitudinal observational studies that evaluated the risk factors of this condition. No restrictions were applied. Data extraction and synthesis From each eligible study, details were recorded by one reviewer in a validated form. Grading of Recommendations, Assessment, Development and Evaluations criteria were used to assess our certainty level of each outcome, and A Measurement Tool to Assess Systematic Reviews 2 to assess quality. Results Altogether, 3464 abstracts were retrieved, 135 full texts were evaluated and 22 SRs were included in the final analysis. From four SRs of observational studies, we found 19 significant associations with postulated risk factors, and those which we determined to be confident about were: atrial fibrillation (3 SRs, 25 original studies); relative risk 3.01 (1.96–4.61), ORs 2.4 (1.7–3.5) and 2.0 (1.4–2.8), leukoaraiosis, multiple and recurrent strokes, ORs 2.5 (1.9–3.4), 2.5 (1.9–3.1) and 2.3 (1.5–3.5), respectively. From 18 SRs of interventional trials, we found that interventions including physical activity or cognitive rehabilitation were enhancing cognitive function, while the certainty of the other interventions was rated low, due to limited methodological quality. Conclusions This review represents common risk factors related to poststroke cognitive impairment, in particular atrial fibrillation, and points to different interventions that warrant attention in the development of treatment strategies. Physical activity and cognitive rehabilitation interventions showed evidence of enhancing cognitive function; however, we could not recommend a change in practice yet, due to lack of strong evidence. PROSPERO registration number CRD42018096667.

The potential migration of chemical compounds from plastic food packaging poses significant health risks, necessitating continuous monitoring and enhanced safety protocols. This study aimed to investigate the migration of nine chemical groups, including alanine, acetic acid, cyano derivatives, urea, amines, amides, benzene derivatives, nitrites, and non-specified compounds, across different food categories. A total of 195 packaged food samples from eleven food categories were analyzed using Headspace Gas Chromatography-Mass Spectrometry (GC-MS) to identify and quantify chemical migrants. Statistical analysis revealed significant differences in migration levels among food categories (p < 0.05). Cheese, candies, and chips exhibited the highest concentrations of alanine (65.95 ± 0.6384 mg/kg), acetic acid (57.80 ± 0.6383 mg/kg), and benzene derivatives (59.96 ± 1.844 mg/kg), respectively, while frozen raw meat and seafood showed the lowest levels for most compounds. High benzene and nitrite concentrations in certain samples raised particular concern due to their carcinogenic and toxicological effects. Regression analysis confirmed that food matrix type is a strong predictor of migration levels for several compounds. The findings emphasize the urgent need for stricter regulation, improved analytical techniques, and the development of safer packaging materials to reduce chemical migration risks and protect public health.

Background: The Hajj pilgrimage poses significant public health challenges due to the risk of infectious disease transmission. Despite mandatory vaccination policies, barriers such as hesitancy, logistical issues, and vaccine availability persist. Objective: This study assesses vaccine uptake, reasons for compliance or non-compliance, and barriers among Hajj pilgrims. Methods: A cross-sectional study was conducted during the 2024 Hajj season, with data collected via structured interviews from 5,355 participants. Descriptive statistics and logistic regression analyzed vaccination status and influencing factors. Results: Of the participants, 4298 (80.3%) reported receiving mandatory or recommended vaccines, including influenza, COVID-19, and meningococcal. Primary motivators for vaccination were compliance to mandatory requirements 2240 (52.1%) and healthcare provider recommendations 2018 (46.9%). Among non-vaccinated respondents, the main reasons included belief in vaccine ineffectiveness 250(23.7%), reliance on natural immunity 243(23%), and lack of awareness 174(16.5%). Common barriers included long wait times 721(13.5%) and limited access to vaccination centers 543(10.1%). Women and individuals with higher education demonstrated greater vaccine uptake, while logistical barriers were more prevalent among self-employed and less-educated participants. Conclusion: Despite high vaccine uptake, barriers remain. Addressing hesitancy, improving access, and aligning vaccine availability with Hajj timing are essential to enhance coverage and reduce disease transmission risks. Clinical Trial Number: Not applicable.

Hajj, one of the largest annual religious gatherings, attracts millions of Muslim pilgrims globally, with a significant proportion being older adults. Cogn

Limited data exist on the impact of secondary stroke prevention and on cognitive function after stroke. This study aims to investigate whether post-stroke care strategies protect cognitive function up to ten-year. Data were collected between 1995 and 2018 from the population-based South London Stroke Register (SLSR, n = 6504). Multivariable Poisson regression models with robust standard errors and confounders were constructed to evaluate adjusted relative risks (aRRs) between cognitive impairment and different treatment strategies; before, at acute care or after stroke. Use multiple imputation to manage the missing data. The prevalence of cognitive impairment was 29% (confidence interval (CI) 26-32). 5-years after stroke, in ischemic stroke patients with a history of atrial fibrillation (AF), there was a reduced risk of cognitive impairment of 50% associated with antihypertensive (aRR:0.5, 0.27-0.91), 77% with statin (aRR:0.23, 0.06-0.91) and 82% with anticoagulant (aRR:0.18, CI 0.05-0.64). In ischemic stroke patients with no history of AF, the reduced risk was 26% (aRR:0.74, 0.57-0.95) with antihypertensive and 19% (aRR:0.81, 0.64-1.03) with statin. All these protective associations tend to diminish over time up to ten years after stroke. When clinically indicated, a combined treatment of these were strongly associated with a reduced risk of cognitive impairment. Small risk reduction was observed between cognitive impairment and acute stroke unit admission (aRR:0.96, 0.93-0.98). Consistent use of combined treatments is associated with better cognitive function up to 10 years post-stroke. These findings suggest that optimizing medication management could help reduce the risk of long-term cognitive decline.