Browsing by Subject "Stroke"
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- ItemOpen AccessComparative assessment of absolute cardiovascular disease risk characterization from non-laboratory-based risk assessment in South African populations(BioMed Central, 2013-07-24) Gaziano, Thomas A; Pandya, Ankur; Steyn, Krisela; Levitt, Naomi; Mollentze, Willie; Joubert, Gina; Walsh, Corinna M; Motala, Ayesha A; Kruger, Annamarie; Schutte, Aletta E; Naidoo, Datshana P; Prakaschandra, Dorcas R; Laubscher, RiaBackground: All rigorous primary cardiovascular disease (CVD) prevention guidelines recommend absolute CVD risk scores to identify high- and low-risk patients, but laboratory testing can be impractical in low- and middle-income countries. The purpose of this study was to compare the ranking performance of a simple, non-laboratory-based risk score to laboratory-based scores in various South African populations. Methods: We calculated and compared 10-year CVD (or coronary heart disease (CHD)) risk for 14,772 adults from thirteen cross-sectional South African populations (data collected from 1987 to 2009). Risk characterization performance for the non-laboratory-based score was assessed by comparing rankings of risk with six laboratory-based scores (three versions of Framingham risk, SCORE for high- and low-risk countries, and CUORE) using Spearman rank correlation and percent of population equivalently characterized as ‘high’ or ‘low’ risk. Total 10-year non-laboratory-based risk of CVD death was also calculated for a representative cross-section from the 1998 South African Demographic Health Survey (DHS, n = 9,379) to estimate the national burden of CVD mortality risk. Results: Spearman correlation coefficients for the non-laboratory-based score with the laboratory-based scores ranged from 0.88 to 0.986. Using conventional thresholds for CVD risk (10% to 20% 10-year CVD risk), 90% to 92% of men and 94% to 97% of women were equivalently characterized as ‘high’ or ‘low’ risk using the non-laboratory-based and Framingham (2008) CVD risk score. These results were robust across the six risk scores evaluated and the thirteen cross-sectional datasets, with few exceptions (lower agreement between the non-laboratory-based and Framingham (1991) CHD risk scores). Approximately 18% of adults in the DHS population were characterized as ‘high CVD risk’ (10-year CVD death risk >20%) using the non-laboratory-based score. Conclusions: We found a high level of correlation between a simple, non-laboratory-based CVD risk score and commonly-used laboratory-based risk scores. The burden of CVD mortality risk was high for men and women in South Africa. The policy and clinical implications are that fast, low-cost screening tools can lead to similar risk assessment results compared to time- and resource-intensive approaches. Until setting-specific cohort studies can derive and validate country-specific risk scores, non-laboratory-based CVD risk assessment could be an effective and efficient primary CVD screening approach in South Africa.
- ItemOpen AccessCorrelates of social support on report of probable common mental disorders in Zimbabwean informal caregivers of patients with stroke: a cross-sectional survey(2019-08-16) Marima, Phillipa; Gunduza, Ropafadzo; Machando, Debra; Dambi, Jermaine MAbstract Objective Stroke is a major global public health burden. Unfortunately, stroke invariably leads to functional limitations, consequently, most stroke survivors are hugely dependent on family members/informal caregivers in carrying out essential daily activities. The increased demands of caregiving negatively impact caregivers’ mental health. Nevertheless, caregivers who receive an adequate amount of social support are likely to adjust better to the caregiving role. We sought to determine the impact of social support on the mental wellbeing of 71 caregivers of patients with stroke in Zimbabwe, a low-resourced country. Results The mean caregiver age was 41.5 (SD 13.8) years. Patients had a mean age of 65.2 (SD 15.3) years with most being functionally dependent (93.2%). 45.1% of the caregivers showed excessive psychiatric morbidity. The mean Multidimensional Scale of Perceived Social Support (MSPSS) score was 44 (SD 9.4), denoting high levels of social support. Caregivers who received an adequate amount of social support were likely to report of lower psychiatric morbidity (Rho = − 0.285, p = 0.016). Furthermore, caregiver who were; poorer, were caring for more functionally-dependent patients, and did not receive additional assistance were likely to report of poor mental health functioning. There is therefore a strong need to implement context-specific caregivers wellness programs.
- ItemOpen AccessMetabolic syndrome and fatal outcomes in the post-stroke event: a 5-year cohort study in Cameroon(Public Library of Science, 2013) Balti, Eric Vounsia; Kengne, André Pascal; Fokouo, Jean Valentin Fogha; Nouthé, Brice Enid; Sobngwi, EugeneBackground and Purpose: Determinants of post-acute stroke outcomes in Africa have been less investigated. We assessed the association of metabolic syndrome (MetS) and insulin resistance with post-stroke mortality in patients with first-ever-in-lifetime stroke in the capital city of Cameroon (sub-Saharan Africa). METHODS: Patients with an acute first-stroke event (n = 57) were recruited between May and October 2006, and followed for 5 years for mortality outcome. MetS definition was based on the Joint Interim Statement 2009, insulin sensitivity/resistance assessed via glucose-to-insulin ratio, quantitative insulin sensitivity check index and homeostatic model assessment. RESULTS: Overall, 24 (42%) patients deceased during follow-up. The prevalence of MetS was higher in patients who died after 28 days, 1 year and 5 years from any cause or cardiovascular-related causes (all p≤ 0.040). MetS was associated with an increased overall mortality both after 1 year (39% vs. 9%) and 5 years of follow-up (55% vs. 26%, p = 0.022). Similarly, fatal events due to cardiovascular-related conditions were more frequent in the presence of MetS both 1 year (37% vs. 9%) and 5 years after the first-ever-in-lifetime stroke (43% vs. 13%, p = 0.017). Unlike biochemical measures of insulin sensitivity and resistance (non-significant), in age- and sex-adjusted Cox models, MetS was associated with hazard ratio (95% CI) of 2.63 (1.03-6.73) and 3.54 (1.00-12.56) respectively for all-cause and cardiovascular mortality 5 years after stroke onset. CONCLUSION: The Joint Interim Statement 2009 definition of MetS may aid the identification of a subgroup of black African stroke patients who may benefit from intensification of risk factor management.
- ItemOpen AccessOther manifestations of HIV vasculopathy(Health and Medical Publishing Group, 2009) Naidoo, N G; Beningfield, S JDescriptions of the numerous manifestations of human immunodeficiency virus (HIV) infection affecting almost every organ system have abounded in recent publications. Multiple radiological, clinical and postmortem reports have recorded the cerebral, pulmonary, cardiac, renal, rheumatological and gastrointestinal pathologies in HIV-infected individuals, ranging from the bizarre to the mundane. Large-vessel HIV-related vascular manifestations have previously been reported in the surgical literature. We describe and review the manifestations of HIV-associated vasculopathy as it pertains to the cerebral, cardiovascular, mesenteric and renal circulations.
- ItemOpen AccessPattern of recovery and outcome after stroke in patients accessing a Western Cape rehabilitation facility(2007) Rouillard, Susan; Jelsma, Jennifer; De Weerdt, WillyBackground: Stroke is a growing healthcare problem in South Africa, and contributes significantly to theburden of disease. Rehabilitation is thought to improve recovery and outcome, but little is known about current rehabilitation practices and outcomes in the South African setting. Aims and Objectives: The primary aim was to describe pattern of recovery and outcome after stroke in first ever stroke patients at a Western Cape Rehabilitation Facility. The secondary aim was to explore factors that may influence outcome after stroke. Objectives included describing characteristics of stroke patients the rehabii itation process, and certain aspects of the environment. Study Design: The study was a prospective, longitudinal, descriptive study of first ever stroke patients admitted to the Western Cape Rehabilitation Centre between 22 June 2005 and 28 March 2006. Instrumentation: The ational Institute of Health Stroke Scale IHSS) was used to describe severity on admission. The Barthel Index (BI) and Rivermead Motor Assessment (RMA) were used to describe functional and motor recovery respectively. The main outcome measure at six months was the Modified Rankin Scale (MRS), with secondary outcomes including the ottingham Extended Activities of Daily Living Scale, the Caregiver Strain Jndex and the EQ-5D, a measure of health related quality of life. Questionnaires drawn up for use in the study collected further information on patient characteristics, residential and work status at six months, as well as environmental features. Procedure: Patients who met the eligibility criteria were assessed at admission discharge and six months post stroke. Data Analysis: Summary statistics were used to present descriptive data. Friedmans analysis of variance and Wilcoxons matched pairs test were used to assess the significance of change across the selected measurement points. A repeated measures A OYA was used to investigate differences in pattern of recovery between sub-groups. Bivariate analysis and logistic regression were used to analyse the influence of certain factors on MRS scores at six months. Results: Participants were noted to be younger (average age of 51.3 ± I 4.4 SD) than those in overseas rehabilitation studies with a high proportion of haemorrhagic strokes and infective aetiologies. Participants were mostly from low income homes although the majority lived in formal housing (86.3%) with access to services. The rehabilitation process was characterised by early admission after stroke (74.5% within 30 days), and an average length of rehabilitation stay of approximately 60 days. Four participants were readmitted for further rehabilitation stays within the six month follow up period. Of the remaining patients, fewer than I 0% had received any substantial rehabilitation input after discharge, although most had been seen at least once by a health professional (89.4%). The overall pattern of recovery showed change between all three time points with most change occurring between admission and discharge (median Bl change of 25, p<0.017). However, clinically significant change (defined by> 15% of total scores) was seen between discharge and six months in terms of Bl scores in 55.3% and RMA Gross Sub-scale scores in 45.5% of participants. Mobility items reflected the most change with 81.8% of participants independently mobile at six months compared to 54.5% at discharge. The pattern of recovery over time did not appear to be influenced by severity of stroke (F=2.29, p>0.05) or early/late admission to rehabilitation (F=0.51, p>0.05). Only one participant was living in an institution at six months, despite the fact that more than 20% of participants required constant care. The majority of participants (59.6%) were independent in self-care but many required assistance for extended activities of daily living such as housework, meal preparation, using public transport and shopping. Of interest were difficulties experienced with community mobility, a high prevalence of depression or anxiety (50%) as well as problems with relationships or feelings of isolation (82.6%). High levels of caregiver strain were reported in 55.8% of caregivers. Only 10% of those working prior to their stroke had returned to work at six months. Severity of stroke (fHSS) emerged as the clearest predictor of outcome (OR 0.70, CJ 0.53-0.94), but environmental factors were also seen to be significant. Income group affected outcome (adj z=-2.08, p<0.05), and the presence of at least one reported environmental barrier reduced the odds of favourable recovery according to the MRS (OR 0.18 Cl 0.03-0.98). Lack of transport and financial problems were highlighted by participants as major barriers affecting participation. Discussion and Conclusions: Pattern of recovery followed a more or less expected course over time with greater change between admission and discharge, than between discharge and six months. The high percentage of participants improving between admission and discharge suggests appropriate selection of rehabilitation candidates and effectiveness of the rehabilitation programme. Clinically significant change occurring between discharge and six months particularly with regard to higher mobility, implies that patients may benefit from follow up after discharge in order to optimize outcomes, especially as many participants were discharged fairly early after their strokes while recovery may still be ongoing. In terms of outcomes, BJ scores at six months were comparable to other studies, with most patients functionally independent or requiring only minimal assistance with activities of daily living (ADL). However, a higher prevalence of difficulties was seen in more complex extended ADL and at the level participation restrictions than in studies in developed countries. In particular, there were higher levels of depression, social isolation and caregiver strain, and only a small percentage of those previously working had returned to work at six months. Lack of community mobility and difficulties with transport may have contributed to restrictions in participating in activities outside of the home. These difficulties are most likely to arise after discharge from rehabilitation, as the patient tries to resume pre-stroke roles in the community. Further research is recommended to determine whether provision of follow up after discharge from rehabilitation will improve outcomes. Research is also recommended to explore how caregivers can be best supported to reduce levels of caregiver strain. Although the severity of stroke at admission was found to be the clearest predictor of outcome, the influence of adverse environmental factors on outcome was also apparent. Other characteristics of the study sample such as the young age distribution and medical profile may also have contributed to differences in recovery and outcome.
- ItemOpen AccessPopulation awareness of cardiovascular disease and its risk factors in Buea, Cameroon(2017) Aminde, Leopold Ndemnge; Takah, Noah; Ngwasiri, Calypse; Noubiap, Jean Jacques; Tindong, Maxime; Dzudie, Anastase; Veerman, J LennertAbstract Background Adequate awareness of cardiovascular diseases (CVD) and their risk factors may help reduce the population’s exposure to modifiable risk factors and thereby contribute to prevention and control strategies. There is limited data on knowledge among the general population in sub-Saharan Africa regarding CVD and risk factors. We aimed to assess the population awareness (and associated factors) of CVD types and risk factors in Buea, Cameroon. Methods This was a community-based cross-sectional study conducted in 2016 among randomly selected adults (>18 years). Data on socio-demographic characteristics, knowledge about CVD types, their risk factors and warning signs for CVD events (stroke and heart attack) were acquired using a self-administered questionnaire. Logistic regression analysis was used to investigate factors associated with moderate-to-good knowledge. Results Of the 1162 participants (61.7% women, mean age 32 years), 52.5% had overall poor knowledge (mean score 12.1 on total of 25) on CVD with only about a quarter correctly identifying types of CVD. Overall, 36, 63 and 45% were unaware of CVD risk factors, warning signs of heart attack and stroke respectively. In multivariable analysis; high level of education (aOR = 2.26 (1.69–3.02), p < 0.0001), high monthly income (aOR = 1.64 (1.07–2.51), p = 0.023), having a family history of CVD (aOR = 1.59 (1.21–2.09), p = 0.001) and being a former smoker (aOR = 1.11 (1.02–1.95), p = 0.043) were associated with moderate-to-good knowledge. Conclusions There exists a significant gap in population awareness about CVDs in Cameroon and this is similar to previous reports. Cost-effective community health education interventions taking into account socioeconomic status may be beneficial in this setting.
- ItemOpen AccessPrehospital triage tools across the world: a scoping review of the published literature(2022-04-27) Bhaumik, Smitha; Hannun, Merhej; Dymond, Chelsea; DeSanto, Kristen; Barrett, Whitney; Wallis, Lee A; Mould-Millman, Nee-KofiBackground: Accurate triage of the undifferentiated patient is a critical task in prehospital emergency care. However, there is a paucity of literature synthesizing currently available prehospital triage tools. This scoping review aims to identify published tools used for prehospital triage globally and describe their performance characteristics. Methods: A comprehensive search was performed of primary literature in English-language journals from 2009 to 2019. Papers included focused on emergency medical services (EMS) triage of single patients. Two blinded reviewers and a third adjudicator performed independent title and abstract screening and subsequent full-text reviews. Results: Of 1521 unique articles, 55 (3.6%) were included in the final synthesis. The majority of prehospital triage tools focused on stroke (n = 19; 35%), trauma (19; 35%), and general undifferentiated patients (15; 27%). All studies were performed in high income countries, with the majority in North America (23, 42%) and Europe (22, 40%). 4 (7%) articles focused on the pediatric population. General triage tools aggregate prehospital vital signs, mental status assessments, history, exam, and anticipated resource need, to categorize patients by level of acuity. Studies assessed the tools’ ability to accurately predict emergency department triage assignment, hospitalization and short-term mortality. Stroke triage tools promote rapid identification of patients with acute large vessel occlusion ischemic stroke to trigger timely transport to diagnostically- and therapeutically-capable hospitals. Studies evaluated tools’ diagnostic performance, impact on tissue plasminogen activator administration rates, and correlation with in-hospital stroke scales. Trauma triage tools identify patients that require immediate transport to trauma centers with emergency surgery capability. Studies evaluated tools’ prediction of trauma center need, under-triage and over-triage rates for major trauma, and survival to discharge. Conclusions: The published literature on prehospital triage tools predominantly derive from high-income health systems and mostly focus on adult stroke and trauma populations. Most studies sought to further simplify existing triage tools without sacrificing triage accuracy, or assessed the predictive capability of the triage tool. There was no clear ‘gold-standard’ singular prehospital triage tool for acute undifferentiated patients. Trial registration Not applicable.
- ItemOpen AccessSouth African tobacco smoking cessation clinical practice guideline(2013) van Zyl-Smit, Richard N; Allwood, Brian; Stickells, David; Symons, Gregory; Abdool-Gaffar, Sabs; Murphy, Kathy; Lalloo, Umesh; Vanker, Aneesa; Sabur, Natasha F; Richards, GuyTobacco smoking (i.e. cigarettes, rolled tobacco, pipes, etc.) is associated with significant health risks, reduced life expectancy and negative personal and societal economic impact. Smokers have an increased risk of cancer (i.e. lung, throat, bladder), chronic obstructive pulmonary disease (COPD), tuberculosis and cardiovascular disease (i.e. stroke, heart attack). Smoking affects unborn babies, children and others exposed to second hand smoke. Stopping or 'quitting' is not easy. Nicotine is highly addictive and smoking is frequently associated with social activities (e.g. drinking, eating) or psychological factors (e.g. work pressure, concerns about body weight, anxiety or depressed mood). The benefits of quitting, however, are almost immediate, with a rapid lowering of blood pressure and heart rate, improved taste and smell, and a longer-term reduction in risk of cancer, heart attack and COPD. Successful quitting requires attention to both the factors surrounding why an individual smokes (e.g. stress, depression, habit, etc.) and the symptoms associated with nicotine withdrawal. Many smokers are not ready or willing to quit and require frequent motivational input outlining the benefits that would accrue. In addition to an evaluation of nicotine dependence, co-existent medical or psychiatric conditions and barriers to quitting should be identified. A tailored approach encompassing psychological and social support, in addition to appropriate medication to reduce nicotine withdrawal, is likely to provide the best chance of success. Relapse is not uncommon and reasons for failure should be addressed in a positive manner and further attempts initiated when the individual is ready. Key steps in smoking cessation include: (i) identifying all smokers, alerting them to the harms of smoking and benefits of quitting; (ii) assessing readiness to initiate an attempt to quit; (iii) assessing the physical and psychological dependence to nicotine and smoking; (iv) determining the best combination of counselling/support and pharmacological therapy; (v) setting a quit date and provide suitable resources and support; (vi) frequent follow-up as often as possible via text/telephone or in person; (vii) monitoring for side-effects, relapse and on-going cessation; and (viii) if relapse occurs, providing the necessary support and encourage a further attempt when appropriate.
- ItemOpen AccessWarfarin in non-valvular atrial fibrillation(2013) Dalby, Anthony J; Wessels, Pieter; Opie, Lionel HThe development of novel oral anticoagulants that are effective alternatives to warfarin in non-valvular atrial fibrillation (AF) is a welcome advance. However, a variety of unresolved problems with their use, and not least with their cost, make it important to re-evaluate the use of warfarin as it will likely remain the anticoagulant of choice in South African patients with non-valvular AF for the foreseeable future. In this article, we review the correct clinical use of warfarin. Guidance is provided on commencing warfarin treatment, maintenance dosing, the recommended steps when temporary withdrawal of treatment is necessary, the management of bleeding, and the use of warfarin in chronic kidney disease. Techniques for changing from warfarin to one of the new oral anticoagulants and vice versa are included.