Diseases of the nervous system: patients' aetiological beliefs

Examining the relationship between fatigue and cognition after stroke: A systematic review

Many stroke survivors experience fatigue, which is associated with a variety of factors including cognitive impairment. A few studies have examined the relationship between fatigue and cognition and have obtained conflicting results. The aim of the current study was to review the literature on the relationship between fatigue and cognition post-stroke. The following databases were searched: EMBASE (1980-February, 2014), PsycInfo (1806-February, 2014), CINAHL (1937-February, 2014), MEDLINE (1946-February, 2014), Ethos (1600-February, 2014) and DART (1999-February, 2014). Reference lists of relevant papers were screened and the citation indices of the included papers were searched using Web of Science. Studies were considered if they were on adult stroke patients and assessed the following: fatigue with quantitative measurements (≥ 3 response categories), cognition using objective measurements, and the relationship between fatigue and cognition. Overall, 413 papers were identified, of which 11 were included. Four studies found significant correlations between fatigue and memory, attention, speed of information processing and reading speed (r = -.36 to .46) whereas seven studies did not. Most studies had limitations; quality scores ranged from 9 to 14 on the Critical Appraisal Skills Programme Checklists. There was insufficient evidence to support or refute a relationship between fatigue and cognition post-stroke. More robust studies are needed.

Etiological beliefs of patients with neurological disorders attending a tertiary care center: A cross-sectional study

BACKGROUND

The understanding and management of neurological disorders is undergoing revolutionary changes over the last three decades in the background of ever increasing advances in medical technologies, diagnostic techniques, therapeutic processes and, molecular and genetic medicine. The fruits of these advances can reach patients only if the psychosocial hurdles in their delivery are identified, acknowledged and addressed.

AIM

To explore the beliefs and practices of patients with neurological disorders in a tertiary care center in the eastern Nepal.

MATERIALS AND METHODS

One hundred patients attending neurology/medicine outpatient for neurological disorders were interviewed about their beliefs regarding the triggering factors, causation and treatment-seeking behavior particularly from traditional healers.

RESULT

Of the 100 patients (49 males, 51 females) recruited in the study, 51% expressed having 'no idea' about their illness. Only 20% patients gave medically congruent explanation for their illness. Psychological factors were attributed as triggering factors by 16% of patients, of which two-thirds were females. Chance, destiny and 'jadu tona' topped the list of triggering factors. Forty-four percent patients had sought help of traditional faith healers ('Dhami Jhakri') before seeking medical help. Traditional faith healers were approached by patients irrespective of their educational background. Fifty-nine percent of patients who first sought traditional faith healers, believed in 'jadu-tona'. Of those interviewed, 16% were planning to go to a faith healer in near future.

CONCLUSION

The beliefs of patients with neurological disorders frequently do not conform to current medical opinion. There is need for greater communication and education of patients by their treating physicians.

Factors Related to Continuation of Health Behaviours among Stroke Survivors

PURPOSE

This study investigated stroke survivors' perspectives of health behaviours after stroke. We aimed to explore the actual process by which stroke survivors changed their health behaviours.

METHOD

Semi-structured interviews were conducted with 40 people in a 1-year prospective study in the regional city of Chiba, Japan. Interviews covered views of health behaviours in order to explore why patients change their risk factors. Data were analysed using the principles of modified grounded theory.

RESULTS

Six categories related to practising health behaviours were identified: cause of stroke, antithetic thinking, awareness of the body, fear of disease progression, view of health, and psychological meaning of practise. Stroke survivors constructed a meaning of practise for each health behaviour. The recognition of previous lifestyle as cause of stroke, hope for recovery, and fear of future progression influenced health behaviours.

CONCLUSIONS

The key finding of this study is that when cognitive behavioural therapy principles are enforced, an important aspect is that stroke survivors recognize the possibility that previous lifestyle was a cause of stroke and appreciate the necessity of preventing a new stroke.

Risk awareness and knowledge of patients with stroke: results of a questionnaire survey 3 months after stroke

BACKGROUND

Secondary prevention of stroke has been shown to dramatically reduce recurrence and has been described as suboptimal.

OBJECTIVE

To analyse patients' awareness and knowledge about cerebrovascular risk factors (CVRF) and their influence on CVRF control.

METHODS

Patients (n = 164) who were attending a stroke outpatient clinic for the first time after hospital discharge (3 months) for a first stroke were asked to answer a short questionnaire including questions on awareness and knowledge of CVRF, visits to a CVRF specialist, number of visits to a general practitioner, adherence to drug treatments, cigarette smoking and cessation.

RESULTS

CVRF were spontaneously mentioned as relevant for their stroke by only 13% of patients. A specialist was visited by only one-third of the patients and a general practitioner was not visited at all by 27% of the patients since their stroke. Awareness was inversely correlated with older age and good recovery. More than half of the patients had high blood pressure (> or = 140 mmHg for systolic and > or = 90 mmHg for diastolic values) at the time of follow-up. These high values were correlated with poor awareness. Appropriate secondary stroke prevention measures were not received by one-fourth of the patients; this was also correlated with poor awareness.

CONCLUSIONS

CVRF control is not optimal and is at least partially related to patients' awareness and knowledge and suboptimal medical follow-up. Older patients and patients with excellent recovery are at particular risk for poor awareness and CVRF control.