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Jones SP, Injety RJ, Pandian JD, Ratra S, Sylaja PN, Babu V, Srivastava MP, Sharma S, Sharma S, Webster J, Koirala A, Kaushal P, Kulkarni GB, Dixit A, Sharma A, Prajapati J, Weldon JC, Kuroski JA, Watkins CL, Lightbody CE. Healthcare professionals' perspectives of the provision of, and challenges for, eating, drinking and psychological support post stroke: findings from semistructured interviews across India. BMJ Open 2023; 13:e069150. [PMID: 37880173 PMCID: PMC10603406 DOI: 10.1136/bmjopen-2022-069150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 09/21/2023] [Indexed: 10/27/2023] Open
Abstract
AIM This qualitative study explores with health professionals the provision of, and challenges for, postdischarge stroke care, focussing on eating, drinking and psychological support across India. DESIGN Qualitative semistructured interviews. SETTING Seven geographically diverse hospitals taking part in a Global Health Research Programme on Improving Stroke Care in India. PARTICIPANTS A purposive sample of healthcare professionals with current experience of working with patients who had a stroke. RESULTS Interviews with 66 healthcare professionals (23 nurses (14 staff nurses; 7 senior nurse officers; 1 intensive care unit nurse; 1 palliative care nurse)); 16 doctors (10 neurologists; 6 physicians); 10 physiotherapists; 5 speech and language therapists; 4 occupational therapists; 4 dieticians; 2 psychiatrists; and 2 social workers resulted in three main themes: integrated inpatient discharge care planning processes; postdischarge patient and caregiver role and challenges; patient and caregiver engagement post discharge. CONCLUSIONS Discharge planning was integrated and customised, although resources were limited in some sites. Task shifting compensated for a lack of specialists but was limited by staff education and training. Caregivers faced challenges in accessing and providing postdischarge care. Postdischarge care was mainly hospital based, supported by teleservices, especially for rural populations. Further research is needed to understand postdischarge care provision and the needs of stroke survivors and their caregivers.
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Affiliation(s)
- Stephanie P Jones
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Ranjit J Injety
- Department of Neurology, Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India
| | - Jeyaraj D Pandian
- Department of Neurology, Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India
| | - Sanjali Ratra
- Department of Neurology, Christian Medical College and Hospital Ludhiana, Ludhiana, Punjab, India
| | - P N Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Veena Babu
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Mv Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sakshi Sharma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Sudhir Sharma
- Department of Neurology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Jemin Webster
- Department of Medicine, Baptist Christian Hospital Tezpur, Tezpur, Assam, India
| | - Amrit Koirala
- Department of Medicine, Baptist Christian Hospital Tezpur, Tezpur, Assam, India
| | - Pawna Kaushal
- Department of Neurology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
| | - Girish Baburao Kulkarni
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Anand Dixit
- Department of Neurology, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
| | - Arvind Sharma
- Department of Neurology, Zydus Research Center, Ahmedabad, Gujarat, India
| | - Jagruti Prajapati
- Department of Neurology, Zydus Research Center, Ahmedabad, Gujarat, India
| | - Jo Catherine Weldon
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
| | - Jennifer A Kuroski
- School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
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Dinesh M, Thenmozhi P, KalaBarathi S. Proprioceptive Neuromuscular Facilitation Neck Pattern and Trunk Specific Exercise on Trunk Control and Balance—an Experimental Study. Int J Ther Massage Bodywork 2022; 15:9-17. [PMCID: PMC9683997 DOI: 10.3822/ijtmb.v15i4.727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Most stroke survivors continue to live with disabilities and may require physical rehabilitation to control the trunk and balance during the post-stroke period. The cause of lack of trunk control and balance among stroke patients is the weakened trunk muscle strength. Purpose To study the effect of proprioceptive neuromuscular facilitation (PNF) neck pattern and trunk-specific exercise on trunk control and balance among stroke patients. Setting The study was conducted at the medical wards of Saveetha Medical College and Hospital, Chennai, India. Participants Sixty patients with stroke who met the inclusion criteria participated in the study. Research Design This is a quasi-experimental study. Intervention PNF trunk-specific exercise was administered to the experimental group for 45 min of 28 sessions, which contained 15 min of stretching exercise and 30 min trunk-specific exercise. The control group received routine hospital care services. Main Outcome Measures The study’s primary outcome was balance and trunk control, measured by the Berg Balance Scale (BBS) and Trunk Impairment Scale (TIS) before the intervention and at the end of the intervention of 28 days. Results Within-group analysis, paired t test showed a significant improvement comparing the trunk control and balance score before (13.40±1.04 & 25.40±1.81) and after (15.03±0.96 & 27.07± 1.48) the intervention in the experimental group (p < .001). Between-group analysis, both the experimental and control group post-test mean score of TIS (15.03±0.96 &13.70±1.15) and BBS (27.07±1.48 & 25.30±1.73) showed significant difference (p < .001). Conclusion PNF neck pattern and trunk-specific exercise used in this study effectively improved balance and trunk control among patients with stroke.
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Affiliation(s)
- Marimuthu Dinesh
- Nursing (NPCC II Year), Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Chennai
| | - Paluchamy Thenmozhi
- Medical Surgical Nursing Department, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Chennai,Corresponding author: Paluchamy Thenmozhi, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Chennai – 602105, Tamilnadu, India,
| | - Selvaraj KalaBarathi
- Obstetrics and Gynecological Nursing Department, Saveetha College of Nursing, Saveetha Institute of Medical and Technical Sciences, Chennai, India
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Owolabi MO, Thrift AG, Martins S, Johnson W, Pandian J, Abd-Allah F, Varghese C, Mahal A, Yaria J, Phan HT, Roth G, Gall SL, Beare R, Phan TG, Mikulik R, Norrving B, Feigin VL, on behalf of the Stroke Experts Collaboration Group. The state of stroke services across the globe: Report of World Stroke Organization-World Health Organization surveys. Int J Stroke 2021; 16:889-901. [PMID: 33988062 PMCID: PMC8800855 DOI: 10.1177/17474930211019568] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Improving stroke services is critical for reducing the global stroke burden. The World Stroke Organization-World Health Organization-Lancet Neurology Commission on Stroke conducted a survey of the status of stroke services in low and middle-income countries (LMICs) compared to high-income countries. METHODS Using a validated World Stroke Organization comprehensive questionnaire, we collected and compared data on stroke services along four pillars of the stroke quadrangle (surveillance, prevention, acute stroke, and rehabilitation) in 84 countries across World Health Organization regions and economic strata. The World Health Organization also conducted a survey of non-communicable diseases in 194 countries in 2019. RESULTS Fewer surveillance activities (including presence of registries, presence of recent risk factors surveys, and participation in research) were reported in low-income countries than high-income countries. The overall global score for prevention was 40.2%. Stroke units were present in 91% of high-income countries in contrast to 18% of low-income countries (p < 0.001). Acute stroke treatments were offered in ∼ 60% of high-income countries compared to 26% of low-income countries (p = 0.009). Compared to high-income countries, LMICs provided less rehabilitation services including in-patient rehabilitation, home assessment, community rehabilitation, education, early hospital discharge program, and presence of rehabilitation protocol. CONCLUSIONS There is an urgent need to improve access to stroke units and services globally especially in LMICs. Countries with less stroke services can adapt strategies from those with better services. This could include establishment of a framework for regular monitoring of stroke burden and services, implementation of integrated prevention activities and essential acute stroke care services, and provision of interdisciplinary care for stroke rehabilitation.
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Affiliation(s)
- Mayowa O Owolabi
- Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Nigeria
| | - Amanda G Thrift
- Epidemiology and Prevention Division, Stroke and Ageing Research (STAR), School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Sheila Martins
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Hospital Moinhos de Vento & Brazilian Stroke Network
| | | | | | - Foad Abd-Allah
- Department of Neurology, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
| | - Cherian Varghese
- Non-communicable Disease Department, World Health Organization, Geneva, Switzerland
| | - Ajay Mahal
- Nossal Institute of Global Health, University of Melbourne, Australia
| | - Joseph Yaria
- Department of Neurology, University College Hospital, Ibadan, Nigeria
| | - Hoang T Phan
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Gregory Roth
- NUI Galway Health Research Board, Clinical Research Coordination, Galway, Ireland
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Richard Beare
- Peninsula Clinical School, Monash University, and Developmental Imaging Group, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Thanh G Phan
- Department of Neurology, Monash Health and School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Robert Mikulik
- International Clinical Research Center and Neurology Department of St. Anne’s, University Hospital and Masaryk University, Brno, Czech Republic
| | - Bo Norrving
- Department of Clinical Sciences, Lund University, Sweden
| | - Valery L Feigin
- National Institute for Stroke and Applied Neurosciences (NISAN), School of Clinical Sciences, Auckland University of Technology, New Zealand
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Determinants of Selected Cardiovascular Diseases among Adult Patients at Cardiac Clinic of Debre Berhan Referral Hospital, Ethiopia: Unmatched Case-Control Study. Cardiovasc Ther 2020; 2020:7036151. [PMID: 32547636 PMCID: PMC7273416 DOI: 10.1155/2020/7036151] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/22/2020] [Accepted: 05/04/2020] [Indexed: 11/17/2022] Open
Abstract
Background Africans are experiencing a rapid epidemiological transition characterized by urbanization and lifestyle changes, which are thought to contribute to increased incidence and prevalence of cardiovascular diseases (CVDs) in many African countries, including Ethiopia. Despite this, however, there is scarcity of evidence on cardiovascular disease risk factors among adults in the current research setting. This study thus aimed at assessing determinants of selected cardiovascular diseases among adult patients at Debre Berhan Referral Hospital (DBRH). Methodology. An unmatched case-control study was conducted on 143 newly diagnosed patients with CVDs and 286 controls at the cardiac clinic of DBRH from June to September 2017. Primary data were collected using the WHO-STEPS wise structured questionnaires. Multiple logistic regression analysis was used to identify potential risk factors for cardiovascular diseases at p values < 0.05. Result The mean age of study participants is estimated as 45.5 ± 13.8 and ranges from 25 to 64 years. Sixty-one (42.7%) of cases and 147 (51.4%) of controls are males. Half of the cases (49.9%) had ischemic heart diseases (IHD), and 44.1% of cases had hypertensive heart disease (HHD), whereas the rest had chronic valvular heart disease (CRVHD) (4.2%) and peripheral and vascular disease (2.1%). This study identified older age as a risk factor for CVD: age group 35–44 years (adjusted odds ratio (AOR) = 2.20; 95% CI: 1.05–4.62), 45-54 years (AOR = 4.23; 95% CI: 2.19–8.16), and 55-64 years (AOR = 5.98; 95% CI: 3.26–10.98). Other risk factors were smoking history (AOR = 9.52; 95% CI: 2.12–42.8), low level of physical activity (AOR = 2.19; 95% CI: 1.10–5.02), and higher waist circumference (AOR = 2.75; 95% CI: 1.16–6.56). Conclusion This study has demonstrated that the most frequent risk factors for CVD were older age, cigarette smoking, physical inactivity, and abdominal obesity. Therefore, behavior change communication focusing on lifestyle modification including regular physical activities, smoking cessation, and a balanced diet should be strengthened.
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Gagliardi VDB, Simis M, Cabeça HLS, Gagliardi RJ. Medical perception of stroke care conditions in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2018; 76:13-21. [PMID: 29364389 DOI: 10.1590/0004-282x20170178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/19/2017] [Indexed: 11/22/2022]
Abstract
Stroke is currently the second leading cause of death in Brazil. Neurologists' reports on the absence of adequate resources for stroke care are frequent; however, there are no objective data on this perception.To assess the perception of neurologists of stroke care conditions in Brazil. Neurologists from all over Brazil were surveyed by means of an anonymous questionnaire about the main shortcomings in stroke care, focusing particularly on physical structure and infrastructure (diagnostic methods, patient transport, availability of beds, multi-professional team). The main shortcomings are indicated: the worst conditions, among all items surveyed, were found in the public sector. In the private sector, conditions were better. Care conditions are worse in the public sector with regard to both infrastructure and human resources. Future public health policies for the prevention and treatment of stroke should be formulated, taking into consideration neurologists' perceptions.
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Affiliation(s)
- Vivian Dias Baptista Gagliardi
- Irmandade da Santa Casa de São Paulo, Disciplina de Neurologia, São Paulo SP, Brasil.,Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brasil
| | - Marcel Simis
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto de Medicina Física e Reabilitação, São Paulo SP, Brasil
| | | | - Rubens José Gagliardi
- Irmandade da Santa Casa de São Paulo, Disciplina de Neurologia, São Paulo SP, Brasil.,Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo SP, Brasil
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Grenier-Genest A, Gérard M, Courtois F. Stroke and sexual functioning: A literature review. NeuroRehabilitation 2017; 41:293-315. [DOI: 10.3233/nre-001481] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Marina Gérard
- Department of Psychology, Université du Québec à Montréal, Montreal, QC, Canada
| | - Frédérique Courtois
- Department of Sexology, Université du Québec à Montréal, Montreal, QC, Canada
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Smithard DG. Stroke in Frail Older People. Geriatrics (Basel) 2017; 2:E24. [PMID: 31011034 PMCID: PMC6371123 DOI: 10.3390/geriatrics2030024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 02/01/2023] Open
Abstract
The population is ageing, with the greatest proportional increase in those >80 years of age. Many of these people will be frail and at risk of stroke. Research has shown that the very old have much to benefit from hyperacute stroke intervention, but at the same time they suffer increased mortality. Their outcome following stroke and intervention is more often predicted by the presence of frailty rather than age alone. Intervention both in primary prevention and hyperacute stroke management needs to allow for preexisting morbidity and frailty in deciding what is and what is not appropriate, rather than an arbitrary decision on age. Frail older people are more likely to develop delirium and dysphagia combined with poor mouthcare and die, yet all of these issues are managed badly. An increased awareness of these complications of stroke in the frail older person is necessary.
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Affiliation(s)
- David G Smithard
- Department of Electronic and Digital Arts, University of Kent, Canterbury CT2 7NZ, UK.
- Clinical Gerontology, King's College Hospital, London SE5 9RS, UK.
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Farmani F, Mohseni Bandpei MA, Bahramizadeh M, Aminian G, Nikoo MR, Sadeghi-Goghari M. The effect of different shoes on functional mobility and energy expenditure in post-stroke hemiplegic patients using ankle-foot orthosis. Prosthet Orthot Int 2016; 40:591-597. [PMID: 26184035 DOI: 10.1177/0309364615592704] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 05/27/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Ankle-foot orthoses could be utilized both with and without shoes. While several studies have shown that ankle-foot orthoses improve gait abilities in hemiplegic patients, it remains unclear whether they should be used with shoes or without. OBJECTIVES The study purpose was to compare the effect of standard shoes and rocker shoes on functional mobility in post-stroke hemiplegic patients utilizing ankle-foot orthosis. STUDY DESIGN Randomized clinical study. METHODS Thirty post-stroke hemiplegic patients participated in this study randomly assigned to two groups. Group I received standard shoes + ankle-foot orthosis and group II were provided with rocker shoes + ankle-foot orthosis. Their functional mobility and energy expenditure parameters including timed up and go, timed up stairs, timed down stairs, preferred walking speed, and oxygen (O2) cost (mL/kg/m) were measured. RESULTS In group I, no significant changes were seen in outcome measures after wearing standard shoes. While in group II, O2 cost and timed up and go time significantly decreased, and preferred walking speed increased when patients wore rocker shoes. Also, there was a significant difference between rocker shoes and standard shoes in improvement of timed up and go, preferred walking speed, and O2 cost. CONCLUSION When patients using ankle-foot orthosis wore rocker shoes, their functional mobility improved and oxygen cost diminished. Also, rocker shoes was significantly more effective than standard shoes in improving functional mobility parameters. CLINICAL RELEVANCE This study suggests that in post-stroke hemiplegic patients using ankle-foot orthosis, wearing rocker shoes can lead to much more improved functional mobility and decreased energy expenditure compared to ankle-foot orthosis only. Thus, in stroke patients, the combination of ankle-foot orthosis-rocker shoes is recommended for both rehabilitation programs and ankle-foot orthosis efficacy investigations.
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Affiliation(s)
- Farzad Farmani
- Department of Occupational Therapy, School of Rehabilitation Sciences, Hamedan University of Medical Sciences, Hamedan, Islamic Republic of Iran Department of Orthotics & Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Ali Mohseni Bandpei
- Iranian Research Center on Aging, Department of Physiotherapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran Faculty of Allied Health, University Institute of Physical Therapy, University of Lahore, Lahore, Pakistan
| | - Mahmood Bahramizadeh
- Department of Orthotics & Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Gholamreza Aminian
- Department of Orthotics & Prosthetics, University of Social Welfare and Rehabilitation Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Reza Nikoo
- Department of Occupational Therapy, School of Rehabilitation Sciences, Hamedan University of Medical Sciences, Hamedan, Islamic Republic of Iran
| | - Mohammad Sadeghi-Goghari
- Department of Physiotherapy, School of Paramedical Sciences, Kerman University of Medical Sciences, Kerman, Islamic Republic of Iran
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Ganjiwale D, Ganjiwale J, Parikh S. Association of quality of life of carers with quality of life and functional independence of stroke survivors. J Family Med Prim Care 2016; 5:129-33. [PMID: 27453857 PMCID: PMC4943119 DOI: 10.4103/2249-4863.184637] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Stroke has a great impact not only on patients’ but also on their caregivers’ lives. Carers may experience high levels of burden that can result in deterioration of their health status, social life, and well-being. Association between quality of life (QOL) of carers and that of stroke survivors in Indian setting is not much researched. Aims and Settings: To find out QOL and mental health of caregivers of individuals with stroke visiting Physiotherapy Department of Tertiary Care Center in Western India. Design and Methodology: A cross-sectional survey to find QOL and mental health of caregiver of stroke survivors, self-administered screening instrument WHO-QOL BREF, functional independence measurement (FIM) scale, and BRIEF COPE were used for data collection on adult populations. Statistical Analysis Used: The statistical analysis was performed by descriptive analysis and correlation. Result: Fifty-four stroke patients and their caregivers (all adults) were included in the study. Average FIM score was 83.75 (18.46) while median was 90 (25). FIM score of patients did not much affect QOL of caregivers. Discussion: Analysis of QOL data showed that QOL of caregivers was good in all domains, but patient's QOL was good only in social relations. There was no correlation found in QOL of carers and stroke survivors. Nine percent of change in caregivers social relationship scores can be attributed to patients’ sphincter scores. Conclusion: QOL of carers and stroke survivors may be independent. Stroke patients in the study required a moderate assistance for their functional independence which does not seem to affect the caregivers QOL significantly.
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Affiliation(s)
- Deepak Ganjiwale
- Department of Occupational Therapy, K.M. Patel Institute of Physiotherapy, H.M. Patel Center for Medical Care and Education, Karamsad, Gujarat, India
| | - Jaishree Ganjiwale
- Department of Community Medicine, PSMC and Central Research Services, H.M. Patel Center for Medical Care and Education, Karamsad, Gujarat, India
| | - Shweta Parikh
- Department of Physiotherapy, K.M. Patel Institute of Physiotherapy, H.M. Patel Center for Medical Care and Education, Karamsad, Gujarat, India
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Cortez BV, da Silva Coêlho CK, Silva DRC, Oliveira MDCB, de Oliveira GBVP, de Sousa e Silva FM, Frederico ÉHFF, de Sá-Caputo DDC, Bernardo-Filho M, de Moraes Silva J. Effects of Mirror Therapy on the Lower Limb Functionality Hemiparesis after Stroke. Health (London) 2016. [DOI: 10.4236/health.2016.814144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sureshkumar K, Murthy GVS, Munuswamy S, Goenka S, Kuper H. 'Care for Stroke', a web-based, smartphone-enabled educational intervention for management of physical disabilities following stroke: feasibility in the Indian context. ACTA ACUST UNITED AC 2015; 1:127-136. [PMID: 26246902 PMCID: PMC4516008 DOI: 10.1136/bmjinnov-2015-000056] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 05/16/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Stroke rehabilitation is a process targeted towards restoration or maintenance of the physical, mental, intellectual and social abilities of an individual affected by stroke. Unlike high-income countries, the resources for stroke rehabilitation are very limited in many low-income and middle-income countries (LMICs). Provision of cost-effective, post-stroke multidisciplinary rehabilitation services for the stroke survivors therefore becomes crucial to address the unmet needs and growing magnitude of disability experienced by the stroke survivors in LMICs. In order to meet the growing need for post-stroke rehabilitation services in India, we developed a web-based Smartphone-enabled educational intervention for management of physical disabilities following a stroke. METHODS On the basis of the findings from the rehabilitation needs assessment study, guidance from the expert group and available evidence from systematic reviews, the framework of the intervention content was designed. Web-based application designing and development by Professional application developers were subsequently undertaken. RESULTS The application is called 'Care for Stroke'. It is a web-based educational intervention for management of physical disabilities following a stroke. This intervention is developed for use by the Stroke survivors who have any kind of rehabilitation needs to independently participate in his/her family and social roles. DISCUSSION 'Care for stroke' is an innovative intervention which could be tested not just for its feasibility and acceptability but also for its clinical and cost-effectiveness through rigorously designed, randomised clinical trials. It is very important to test this intervention in LMICs where the rehabilitation and information needs of the stroke survivors seem to be substantial and largely unmet.
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Affiliation(s)
- K Sureshkumar
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine , London , UK
| | - G V S Murthy
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine , London , UK
| | - Suresh Munuswamy
- Institute of Public Health-Hyderabad , Hyderabad, Telangana , India
| | | | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine , London , UK
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Aiyagari V, Pandey DK, Testai FD, Grysiewicz RA, Tsiskaridze A, Sacks C, Ogun Y, Ogunrin OA, Uthman BM, Lindsay P, Gorelick PB. A Prototype Worldwide Survey of Diagnostic and Treatment Modalities for Stroke. J Stroke Cerebrovasc Dis 2015; 24:290-6. [DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Revised: 07/11/2014] [Accepted: 08/10/2014] [Indexed: 10/24/2022] Open
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Kim KJ, Heo M, Chun IA, Jun HJ, Lee JS, Jegal H, Yang YS. The relationship between stroke and quality of life in Korean adults: based on the 2010 Korean community health survey. J Phys Ther Sci 2015; 27:309-12. [PMID: 25642097 PMCID: PMC4305588 DOI: 10.1589/jpts.27.309] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 08/04/2014] [Indexed: 11/24/2022] Open
Abstract
[Purpose] The purpose of this study was to investigate the status of stroke in the
Republic of Korea and its relationship with QOL based on standardized data. [Subjects and
Methods] This study utilized raw data from the 2010 KCHS. In total, 229,229 individuals
participated in the 2010 survey. The final analysis identified 4,604 individuals who had
been diagnosed by a doctor with stroke. To identify the correlation between the
aftereffect-related characteristics of stroke patients and QOL, a multiple linear
regression analysis was performed. [Results] Participants experiencing aftereffects had a
statistically significantly lower QOL than participants who had not experienced
aftereffects. Regarding the types of aftereffects, participants experiencing palsy in the
arms and legs, facial palsy, communication disabilities, swallowing or eating
disabilities, and visual disabilities had a statistically significantly lower QOL than
participants without aftereffects. The QOL of participants with one, two, three, four, or
five aftereffects was statistically significantly less than that of participants without
aftereffects [Conclusion] Stroke directly influences QOL and the number of types of
aftereffects experienced by patients. Therefore, it is highly important that physical
therapists seek to end the occurrence of one or more types of aftereffects in stroke
patients.
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Affiliation(s)
- Ki-Jong Kim
- Department of Physical Therapy, Cheongam College, Republic of Korea
| | - Myoung Heo
- Department of Occupational Therapy, Gwangju University, Republic of Korea
| | - In-Ae Chun
- Department of Preventive Medicine, College of Medicine, Chosun University, Republic of Korea
| | - Hyun-Ju Jun
- Department of Physical Therapy, Cheongam College, Republic of Korea
| | | | - Jin-Su Lee
- Department of Physical Therapy, Graduate School of Dongshin University, Republic of Korea
| | - Hyuk Jegal
- Department of Physical Therapy, Dongin Geriatric Hospital, Republic of Korea
| | - Young-Sik Yang
- Department of Physical Therapy, Teun Teun Hospital, Republic of Korea
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Ahmad MA, Najmi AK, Mujeeb M, Akhtar M. Neuroprotective effect of guggulipid alone and in combination with aspirin on middle cerebral artery occlusion (MCAO) model of focal cerebral ischemia in rats. Toxicol Mech Methods 2014; 24:438-47. [DOI: 10.3109/15376516.2014.939320] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Souza RCS, Arcuri EAM. Communication Strategies Of The Nursing Team In The Aphasia After Cerebrovascular Accident. Rev Esc Enferm USP 2014; 48:292-8. [DOI: 10.1590/s0080-6234201400002000014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Accepted: 01/22/2014] [Indexed: 11/22/2022] Open
Abstract
This is an exploratory, cross-sectional study of quantitative design that aimed to identify the communication strategies used and reported by the nursing staff in the care of aphasic patients after a stroke. The techniques used were the participant observation and interviews with 27 subjects of the nursing staff of neurological units in a general hospital. The most frequently mentioned strategies were gestures (100%), verbal communication (33.3%), written communication (29.6%) and the touch (18.5 %). Among the observed strategies, the gestures reached 40.7% and the touch was present in all situations, given its instrumental character essential to care. The findings show lack of knowledge of nonverbal, proxemics , kinesics and tacesics communication. No significant differences were observed among the professional categories depending on the length of experience with respect to the strategies reported by members of the nursing staff in the care for aphasic patients.
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Feigin VL, Krishnamurthi R, Barber PA, Arroll B. Stroke prevention in New Zealand: can we do better? Int J Stroke 2013; 9:61-3. [PMID: 24165320 DOI: 10.1111/ijs.12117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There are approximately 45,000 stroke survivors in New Zealand and this number is projected to increase to 50,000 survivors, with annual costs to the health system exceeding $700 million by 2015 if no effective primary stroke prevention strategies are introduced. However, development of evidence-based stroke prevention strategies requires answering several research questions. In this article, we summarize some key research questions that are particularly pertinent to stroke prevention in New Zealand.
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Affiliation(s)
- Valery L Feigin
- Faculty of Health and Environmental Studies, National Institute for Stroke and Applied Neurosciences, AUT University, Auckland, New Zealand
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Toward a Modern Delivery of Stroke Care in Emerging Economies. J Stroke Cerebrovasc Dis 2013; 22:e1-3. [DOI: 10.1016/j.jstrokecerebrovasdis.2012.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 02/29/2012] [Accepted: 03/03/2012] [Indexed: 01/22/2023] Open
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Pandian JD, Sudhan P. Stroke epidemiology and stroke care services in India. J Stroke 2013; 15:128-34. [PMID: 24396806 PMCID: PMC3859004 DOI: 10.5853/jos.2013.15.3.128] [Citation(s) in RCA: 175] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 09/04/2013] [Accepted: 09/05/2013] [Indexed: 12/16/2022] Open
Abstract
Developing countries like India are facing a double burden of communicable and non-communicable diseases. Stroke is one of the leading causes of death and disability in India. The estimated adjusted prevalence rate of stroke range, 84-262/100,000 in rural and 334-424/100,000 in urban areas. The incidence rate is 119-145/100,000 based on the recent population based studies. There is also a wide variation in case fatality rates with the highest being 42% in Kolkata. Stroke units are predominantly available in urban areas that too in private hospitals. Intravenous (IV) and intra-arterial thrombolysis (IA) are commonly used in India. In the on-going Indo USA National stroke registry the rate of IV thrombolysis is 11%. Stroke rehabilitation is not well developed in India due to lack of personnel. Organised rehabilitation services are available in the country but they are mainly in private hospitals of the cities. Even though India is a leading generic drugs producer still many people can't afford the commonly used secondary prevention drugs. As a first step the Government of India has started the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases & Stroke (NPCDCS). The government is focusing on early diagnosis, management, infrastructure, public awareness and capacity building at different levels of health care for all the non-communicable diseases including stroke. An organised effort from both the government and the private sector is needed to tackle the stroke epidemic in India.
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Affiliation(s)
- Jeyaraj Durai Pandian
- Professor and Head, Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
| | - Paulin Sudhan
- Research Co-ordinator, Department of Neurology, Christian Medical College, Ludhiana, Punjab, India
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Mason-Whitehead E, Ridgway V, Barton J. Passed without a stroke: a UK mixed method study exploring student nurses' knowledge of stroke. NURSE EDUCATION TODAY 2013; 33:998-1002. [PMID: 22981516 DOI: 10.1016/j.nedt.2012.07.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Revised: 07/27/2012] [Accepted: 07/30/2012] [Indexed: 06/01/2023]
Abstract
AIMS AND OBJECTIVES To evaluate third year student nurses' knowledge and experiences of stroke education. To identify how student nurses can develop their understanding of stroke and its application to clinical nursing practice. BACKGROUND Stroke is an international health issue and a major cause of morbidity and mortality in many countries throughout the world. Nurses have a significant role to play in reducing death and disability in people who have suffered a stroke and it has been suggested that some nurses may not be educationally prepared to meet the challenges of this complex condition. DESIGN This evaluative study was based on a mixed method evaluative design. These quantitative and qualitative approaches involved the implementation of focus groups and questionnaires. METHOD The following outcomes were measured during students' final year of their nursing studies: students' profiles and an assessment of students' knowledge of stroke. RESULTS There was a mixed picture of student nurses' knowledge of stroke; a lack of awareness of some fundamental aspects of stroke including common symptoms, complications, risk factors and the long term treatment. Reassuringly, students expressed decisively the importance for nurses to be equipped with a sound foundation of stroke knowledge for clinical practice. CONCLUSIONS All nursing students should have experience of being in contact with people who have had a stroke - and at present this does not always happen. A national intervention study is now suggested with a view to providing stroke education which is proportionate to its significance as a major health issue. RELEVANCE TO CLINICAL PRACTICE Nurses draw upon their fundamental clinical skills to care and treat patients who have survived a stroke. Additionally, stroke survivors also require enhanced knowledge and this is recognised in the growth of specialist stroke nurses. Improving stroke mortality and morbidity is the responsibility of all of us involved in nurse education - introducing creative evaluative interventions could hold the most promising way forward.
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Affiliation(s)
- Elizabeth Mason-Whitehead
- University of Chester, Faculty of Health and Social Care, Riverside Campus, Castle Drive, Chester CH1 1SL, United Kingdom.
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Farooq MU, Bhatt A, Safdar A, Kassab MY, Majid A. Stroke symptoms and risk factor awareness in high school children in Pakistan. Int J Stroke 2013; 7:E15. [PMID: 23134547 DOI: 10.1111/j.1747-4949.2012.00899.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Adeboye B, Bermano G, Rolland C. Obesity and its health impact in Africa: a systematic review. Cardiovasc J Afr 2013; 23:512-21. [PMID: 23108519 PMCID: PMC3721807 DOI: 10.5830/cvja-2012-040] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 05/03/2012] [Indexed: 01/17/2023] Open
Abstract
Abstract Obesity and its association with co-morbidities in Africa are on the rise. This systematic review examines evidence of obesity and its association with co-morbidities within the African continent. Comparative studies conducted in Africa on adults 17 years and older with mean body mass index (BMI) ≥ 28 kg/m2 were included. Five electronic databases were searched. Surveys, case–control and cohort studies from January 2000 to July 2010 were evaluated. Of 720 potentially relevant articles, 10 met the inclusion criteria. Prevalence of obesity was higher in urban than rural subjects with significant increases in obesity rates among women. Inflammatory marker levels were significantly elevated among Africans compared with Caucasians. The co-relationship between obesity and chronic diseases was also highlighted. This systematic review demonstrates that while obesity remains an area of significant public health importance to Africans, particularly in urban areas, there is little evidence of proper diagnosis, treatment and/or prevention.
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Affiliation(s)
- Bridget Adeboye
- Centre for Obesity Research and Epidemiology, Faculty of Health and Social Care, Robert Gordon University, Aberdeen, Scotland, UK
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Abstract
Until 4 decades ago, the rates of stroke in low- and middle-income countries were considerably lower than those in more economically robust countries. In the intervening years, however, the rates of stroke in places such as southern India and rural South Africa have approximately doubled, whereas stroke rates in more economically developed nations have decreased. What is far more striking is that rates of disability and mortality arising from stroke are at least 10 times greater in medically underserved regions of the world compared with the most developed nations. The causes of these disparities are clear: above all, there is a lack of primary care treatment to screen patients for stroke risk and to mitigate risk factors. In addition, the lack of access to common drugs and basic medical equipment, as well as the lack of poststroke follow-up programs, rehabilitation, and secondary stroke prevention, means that individuals who would, in countries with better medical care, likely recover from stroke, instead have high rates of death and disability. Several global organizations, most notably the World Health Organization, have formulated and begun to implement public health programs to address these underserved regions. Their success depends on the support and expansion of these efforts so that short-term response to stroke, long-term stroke prevention and care, and screening and treatment of poststroke disabilities can be improved in underserved regions and the human and economic burden on these populations can be minimized.
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Affiliation(s)
- Bo Norrving
- Department of Clinical Neuroscience, Section of Neurology, Lund University, Lund, Sweden.
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Fülesdi B, Réka Kovács K, Bereczki D, Bágyi P, Fekete I, Csiba L. Computed tomography and transcranial Doppler findings in acute and subacute phases of intracerebral hemorrhagic stroke. J Neuroimaging 2013; 24:124-30. [PMID: 23317088 DOI: 10.1111/j.1552-6569.2012.00776.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 08/06/2012] [Accepted: 08/26/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND PURPOSE The hematoma volume is an important determinant of outcome and a predictor of clinical deterioration in patients with intracerebral hemorrhage (ICH). Our goal was to evaluate alterations in the cerebral circulation, in respect to hemorrhage and edema volume changes, using transcranial Doppler (TCD). METHODS Twenty patients with acute supratentorial ICH were examined. Brain, hematoma, and edema volumes were calculated from CT scans performed at admission and 2 weeks later. Data were compared with those obtained from bilateral TCD recordings of the middle cerebral arteries. RESULTS During TCD examination, blood flow velocities did not change, cerebral perfusion pressure (CPP) and resistance area product (RAP) decreased (P = .006, P = .002) while cerebral blood flow index (CBFI) remained constant on the affected side. Although hemorrhage volume did not correlate with RAP in the acute phase, correlation was found in the subacute phase (r = -.44, P = .04). CONCLUSIONS TCD monitoring sensitively demonstrates the hemodynamic change caused by ICH but the severity of the changes does not correlate with the volume of the ICH in acute stage. The CPP, RAP, and CBFI values are more sensitive parameters than the absolute velocity values, therefore they contribute more to the understanding of hemodynamic changes developed after spontaneous ICH.
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Affiliation(s)
- Béla Fülesdi
- Department of Anesthesiology and Intensive Care, University of Debrecen Medical and Health Science Center, Debrecen, Hungary
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Thom S, Field J, Poulter N, Patel A, Prabhakaran D, Stanton A, Grobbee DE, Bots ML, Reddy KS, Cidambi R, Rodgers A. Use of a Multidrug Pill In Reducing cardiovascular Events (UMPIRE): rationale and design of a randomised controlled trial of a cardiovascular preventive polypill-based strategy in India and Europe. Eur J Prev Cardiol 2012; 21:252-61. [PMID: 23038750 DOI: 10.1177/2047487312463278] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The use of preventive medications in people at high risk of cardiovascular disease is conceptually straightforward, yet in practice the adoption of such measures is disappointingly low, plus there is wide international variation in preventive therapies. Several barriers might explain this shortfall and variation, but the simplicity and economy of a polypill-based strategy might overcome some barriers. The 'Use of a Multidrug Pill In Reducing cardiovascular Events' (UMPIRE) trial assesses whether a polypill strategy (by combining aspirin, a statin and two blood pressure lowering agents) would improve adherence to guideline-indicated therapies and would lower both blood pressure and cholesterol, in people with established cardiovascular disease. UMPIRE, running in India and three European countries (England, Ireland and the Netherlands), is an open, randomised, controlled trial designed to include 1000 participants in India and 1000 in Europe, with a followup of 12-24 months. Participants were randomised to one of two versions of the polypill or relegated to usual care. The primary study outcomes were the self-reported use of aspirin, a statin and at least two blood pressure lowering agents; as well as changes in blood pressure and cholesterol. Secondary outcomes included: any cardiovascular events, reasons for stopping medications, serious adverse events and perceived changes in quality of life. Interpretation of the study data will be enhanced by health, economic and process-related evaluations. UMPIRE is registered with the European Clinical Trials database, as EudraCT: 2009-016278-34 and the Clinical Trials Registry, India as CTRI/2010/091/000250. The trial was part of the 'Single Pill Against Cardiovascular Events (SPACE)' collaboration, which encompasses the 'IMProving Adherence using Combination Therapy (IMPACT)' and 'Kanyini Guidelines Adherence with the Polypill (Kanyini-GAP)' trials.
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Affiliation(s)
- Simon Thom
- International Centre for Circulatory Health, Imperial College London, UK
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25
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Dalal PM, Bhattacharjee MA, Vairale JY. WHO-Global Stroke Initiative-Mumbai Stroke Registry: A Report on Incidence of First-Ever-Stroke during Re-Survey 2009. Int J Stroke 2012; 7:E3. [DOI: 10.1111/j.1747-4949.2012.00873.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Jaee Y. Vairale
- LKMM Trust Research Centre, Lilavati Hospital, Mumbai, India
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Hashmi M, Khan M, Wasay M. Growing burden of stroke in Pakistan: a review of progress and limitations. Int J Stroke 2012; 8:575-81. [PMID: 22759392 DOI: 10.1111/j.1747-4949.2012.00827.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Stroke rates in middle-aged people are five to ten times higher in Pakistan, India, Russia, China, and Brazil, compared with the United Kingdom or United States. South Asia is home to 20% of the world's population and has one of the highest burdens of cardiovascular disease in the world. With an aging population, there is an expected increase in the number of stroke cases and a corresponding increase in the burden of stroke in developing countries including South Asian countries like Pakistan. Limited data from prior studies in developing countries indicate that stroke epidemiology differs between these and Western countries. These differences include a higher incidence of stroke at younger ages, a higher prevalence of hemorrhagic stroke, and higher age-specific prevalence rates of stroke in women. The reasons for these differences in stroke epidemiology in developing countries are not clear. This may be explained by higher prevalence of established stroke risk factors, or potential nontraditional risk factors such as water pipe smoking, use of daldaghee or naswaar, and paan chewing; hepatitis and rheumatic heart disease may also contribute to these differences. Acute and long-term stroke treatment has shown limited progress in Pakistan like other developing countries because of poor awareness of patients and general physician on stroke symptomatology, management of stroke risk factors, lack of specialized stroke units in the country, very low utilization of thrombolytic therapy because of financial constraints and, above all, poor knowledge of physicians on the role of rehabilitation and its different aspects in the management of post stroke disability.
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Maharaj JC, Reddy M. Young stroke mortality in fiji islands: an economic analysis of national human capital resource loss. ISRN NEUROLOGY 2012; 2012:802785. [PMID: 22778993 PMCID: PMC3388426 DOI: 10.5402/2012/802785] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 03/02/2012] [Indexed: 11/23/2022]
Abstract
Introduction. The objective of this study was to perform an economic analysis in terms of annual national human capital resource loss from young stroke mortality in Fiji. The official retirement age is 55 years in Fiji. Method. Stroke mortality data, for working-age group 15-55 years, obtained from the Ministry of Health and per capita national income figure for the same year was utilised to calculate the total output loss for the economy. The formula of output loss from the economy was used. Results. There were 273 stroke deaths of which 53.8% were of working-age group. The annual national human capital loss from stroke mortality for Fiji for the year was calculated to be F$8.85 million (US$5.31 million). The highest percentage loss from stroke mortality was from persons in their forties; that is, they still had more then 10 years to retirement. Discussion. This loss equates to one percent of national government revenue and 9.7% of Ministry of Health budget for the same year. The annual national human capital loss from stroke mortality is an important dimension in the overall economic equation of total economic burden of stroke. Conclusion. This study demonstrates a high economic burden for Fiji from stroke mortality of young adults in terms of annual national human capital loss.
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Affiliation(s)
- Jagdish C Maharaj
- Lourdes Hospital and Community Health Service, P.O. Box 974, Dubbo, NSW 2830, Australia
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Martins SCO, Friedrich MAG, Brondani R, de Almeida AG, de Araújo MD, Chaves MLF, Berger JR, Massaro AR. Thrombolytic Therapy for Acute Stroke in the Elderly: An Emergent Condition in Developing Countries. J Stroke Cerebrovasc Dis 2011; 20:459-64. [DOI: 10.1016/j.jstrokecerebrovasdis.2010.02.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 01/11/2010] [Accepted: 02/05/2010] [Indexed: 11/25/2022] Open
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Alleyne G, Basu S, Stuckler D. Who's afraid of noncommunicable diseases? Raising awareness of the effects of noncommunicable diseases on global health. JOURNAL OF HEALTH COMMUNICATION 2011; 16 Suppl 2:82-93. [PMID: 21916716 DOI: 10.1080/10810730.2011.602178] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Public-health priorities are in part driven by fear, yet fear has long been recognized as posing a threat to effective public health interventions. In this article, the authors review the role of fear in global health by focusing on the leading global cause of death and disability: noncommunicable diseases. Taking an historical perspective, first the authors review Samuel Adams' 1911 analysis of the role of fear in generating public health priority and his recommendations about mass educating the public. Next, they show that Adams' analysis still applies today, drawing on contemporary responses to H1N1 and HIV, while illustrating the ongoing neglect of long-term threats such as noncommunicable diseases. Then, they pose the question, "Is it possible, necessary, or useful to create a fear factor for noncommunicable diseases?" After reviewing mixed evidence about the effects of fear on social change (on individual behaviors and on building a mass movement to achieve collective action), the authors conclude by setting out an evidence-based, marketing strategy to generate a sustained, rational response to the noncommunicable disease epidemic.
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Affiliation(s)
- George Alleyne
- Pan American Health Organization, Washington, District of Columbia, USA
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Abstract
BACKGROUND Although stroke and ischemic heart disease (IHD) have several well-established risk factors in common, the extent of global variation in the relative burdens of these forms of vascular disease and reasons for any observed variation are poorly understood. METHODS AND RESULTS We analyzed mortality and disability-adjusted life-year loss rates from stroke and IHD, as well as national estimates of vascular risk factors that have been developed by the World Health Organization Burden of Disease Program. National income data were derived from World Bank estimates. We used linear regression for univariable analysis and the Cuzick test for trends. Among 192 World Health Organization member countries, stroke mortality rates exceeded IHD rates in 74 countries (39%), and stroke disability-adjusted life-year loss rates exceeded IHD rates in 62 countries (32%). Stroke mortality ranged from 12.7% higher to 27.2% lower than IHD, and stroke disability-adjusted life-year loss rates ranged from 6.2% higher to 10.2% lower than IHD. Stroke burden was disproportionately higher in China, Africa, and South America, whereas IHD burden was higher in the Middle East, North America, Australia, and much of Europe. Lower national income was associated with higher relative mortality (P<0.001) and burden of disease (P=0.001) from stroke. Diabetes mellitus prevalence and mean serum cholesterol were each associated with greater relative burdens from IHD even after adjustment for national income. CONCLUSIONS There is substantial global variation in the relative burden of stroke compared with IHD. The disproportionate burden from stroke for many lower-income countries suggests that distinct interventions may be required.
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Affiliation(s)
- Anthony S Kim
- Department of Neurology, University of California, San Francisco, CA 94143-0114, USA.
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Kolapo KO, Vento S. Stroke: a realistic approach to a growing problem in sub-Saharan Africa is urgently needed. Trop Med Int Health 2011; 16:707-710. [PMID: 21557793 DOI: 10.1111/j.1365-3156.2011.02759.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Stroke is an increasing problem in sub-Saharan Africa, even in children. High rates of hypertension, diabetes, alcohol abuse, smoking, insufficient fruit and vegetable consumption, sickle cell disease, HIV infection, antiretroviral use and race are likely contributing factors. Although often considered as related to increasing wealth, stroke is more strongly related to poverty, and in turn increases it. Case-fatality rates are high and premature death and years of life lost are a major problem. We propose an approach to stroke prevention and treatment that takes into account the real situation on the ground and can be applied in sub-Saharan Africa, an area where stroke units are largely not feasible and many patients do not reach hospitals. Involvement of community and faith-based organisations, use of simple diagnostic tests, emphasis on clinical examination to differentiate between haemorrhagic and ischaemic stroke, prompt initiation of aspirin therapy and training of community nurses on essential management of stroke should be urgently implemented.
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Affiliation(s)
- Kehinde O Kolapo
- Department of Internal Medicine, Faculty of Medicine and Health Sciences, University of Botswana, Gaborone, Botswana
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Farooq MU, Majid A, Reeves MJ, Birbeck GL. The epidemiology of stroke in Pakistan: past, present, and future. Int J Stroke 2009; 4:381-9. [PMID: 19765127 DOI: 10.1111/j.1747-4949.2009.00327.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Stroke is a major public health problem in developing countries of South Asia. In this paper, we review the epidemiology of stroke in Pakistan. Most of the available data are based on hospital-centred case series addressing established stroke risk factors, stroke-related mortality and disability, functional status, and case fatality rates. There are limited population-based data regarding the prevalence of established stroke risk factors in the general population, and no epidemiologic studies have been conducted to specifically identify potential stroke risk factors unique to the region. The limited data that are available from Pakistan indicate that stroke epidemiology differs between Pakistan and Western populations - in Pakistan first stroke occurs at a younger age, particularly among women, and there is a higher proportion of haemorrhagic strokes. Besides the established stroke risk factors (e.g. hypertension, smoking, and diabetes) some potentially unique stroke risk factors related to life style and dietary habits such as huqqa smoking, use of dalda and desi ghee, and orally consumed forms of tobacco, may exist in Pakistan, and warrant further investigation. The shortage of trained stroke epidemiologists is a major limiting factor to the conduct of epidemiological stroke studies in Pakistan. Epidemiologic data are essential to guide health policy development aimed at decreasing the mortality and morbidity from stroke in Pakistan. To facilitate this process, medical professionals in Pakistan could participate in the World Health Organization's STEPwise approach to stroke surveillance, which provides a framework for data collection and comparison between and within populations.
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Affiliation(s)
- M U Farooq
- Department of Neurology and Ophthalmology, Division of Cerebrovascular Disorders, Michigan State University, East Lansing, MI 48824, USA
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BeLue R, Okoror TA, Iwelunmor J, Taylor KD, Degboe AN, Agyemang C, Ogedegbe G. An overview of cardiovascular risk factor burden in sub-Saharan African countries: a socio-cultural perspective. Global Health 2009; 5:10. [PMID: 19772644 PMCID: PMC2759909 DOI: 10.1186/1744-8603-5-10] [Citation(s) in RCA: 207] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2009] [Accepted: 09/22/2009] [Indexed: 02/07/2023] Open
Abstract
Background Sub-Saharan African (SSA) countries are currently experiencing one of the most rapid epidemiological transitions characterized by increasing urbanization and changing lifestyle factors. This has resulted in an increase in the incidence of non-communicable diseases, especially cardiovascular disease (CVD). This double burden of communicable and chronic non-communicable diseases has long-term public health impact as it undermines healthcare systems. Purpose The purpose of this paper is to explore the socio-cultural context of CVD risk prevention and treatment in sub-Saharan Africa. We discuss risk factors specific to the SSA context, including poverty, urbanization, developing healthcare systems, traditional healing, lifestyle and socio-cultural factors. Methodology We conducted a search on African Journals On-Line, Medline, PubMed, and PsycINFO databases using combinations of the key country/geographic terms, disease and risk factor specific terms such as "diabetes and Congo" and "hypertension and Nigeria". Research articles on clinical trials were excluded from this overview. Contrarily, articles that reported prevalence and incidence data on CVD risk and/or articles that report on CVD risk-related beliefs and behaviors were included. Both qualitative and quantitative articles were included. Results The epidemic of CVD in SSA is driven by multiple factors working collectively. Lifestyle factors such as diet, exercise and smoking contribute to the increasing rates of CVD in SSA. Some lifestyle factors are considered gendered in that some are salient for women and others for men. For instance, obesity is a predominant risk factor for women compared to men, but smoking still remains mostly a risk factor for men. Additionally, structural and system level issues such as lack of infrastructure for healthcare, urbanization, poverty and lack of government programs also drive this epidemic and hampers proper prevention, surveillance and treatment efforts. Conclusion Using an African-centered cultural framework, the PEN3 model, we explore future directions and efforts to address the epidemic of CVD risk in SSA.
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Affiliation(s)
- Rhonda BeLue
- Department of Health Policy and Administration, 604 Ford Building, The Pennsylvania State University, University Park, PA, USA
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Pereira ABCNDG, Alvarenga H, Pereira Júnior RS, Barbosa MTS. Prevalência de acidente vascular cerebral em idosos no Município de Vassouras, Rio de Janeiro, Brasil, através do rastreamento de dados do Programa Saúde da Família. CAD SAUDE PUBLICA 2009; 25:1929-36. [DOI: 10.1590/s0102-311x2009000900007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Accepted: 05/15/2009] [Indexed: 11/22/2022] Open
Abstract
O estudo estimou a prevalência de acidente vascular cerebral (AVC) em idosos em Vassouras, Rio de Janeiro, Brasil, pelo rastreamento de dados do Programa Saúde da Família (PSF). A população idosa foi escolhida por seu aumento no Brasil e pelo risco do AVC aumentar com a idade. Foram rastreados todos os idosos de Vassouras cadastrados no PSF, identificando os acometidos por AVC e analisando o seu perfil sócio-demográfico. Foram utilizados os dados do Sistema de Informação e Atenção Básica, do censo populacional do Instituto Brasileiro de Geografia e Estatística e a ficha de atendimento padronizada pelo PSF, do Ministério da Saúde. Avaliou-se a qualidade dos diagnósticos de AVC do PSF. No rastreamento, foram encontrados 122 idosos com diagnóstico de AVC, com prevalência de 2,9%, e aumento progressivo com o avançar da idade, sendo a prevalência nos homens (3,2%) maior do que nas mulheres (2,7%). A taxa de prevalência foi igual tanto na zona rural quanto na zona urbana (2,9%). O conhecimento da magnitude da prevalência do AVC na população idosa é fundamental para melhor planejamento de saúde.
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Johnston SC, Mendis S, Mathers CD. Global variation in stroke burden and mortality: estimates from monitoring, surveillance, and modelling. Lancet Neurol 2009; 8:345-54. [DOI: 10.1016/s1474-4422(09)70023-7] [Citation(s) in RCA: 655] [Impact Index Per Article: 40.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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