Stroke Prevalence in a Coastal Town on the Black Sea Coast in Turkey: Community Based Study

Impact of stroke on people that receive rehabilitation and are living in Ankara, Turkey

Background

Clinical guidelines for stroke rehabilitation and practices vary between high and low/middle-income countries (LMICs). Knowledge of the perceived impact of stroke in Turkey is limited. Understanding these perceptions can serve as a basis for developing rehabilitation.

Design and methods

The aim was to investigate and compare the perceived impact of stroke in two groups of people living in Ankara. A cross-sectional study with 150 participants divided by stroke onset (Group I: stroke onset <12 months; Group II: >12 months) was conducted. The Barthel Index was used to describe the level of independence in daily living activities and stroke severity. The Stroke Impact Scale (SIS 3.0) was used to investigate the perceived impact of stroke.

Results

The proportion of mild strokes was 78 and 82%, respectively, and 46% of participants in the total sample were moderately dependent. The impact of stroke was high; mean domain scores were below 50 in six of the eight SIS domains.

Conclusions

Turkish stroke survivors perceived a higher impact of stroke regardless of the time passed since stroke onset, compared to survivors from other countries, including other LMICs. The high impact among survivors with mostly mild stroke indicates that Turkish survivors might not receive adequate rehabilitation. The content of rehabilitation services needs to be developed, and an evaluation of individually tailored interventions, preferably with a multidisciplinary approach, is warranted to find ways to decrease the perceived impact of stroke among Turkish stroke survivors.

Relationships between stroke prevalence, health literacy, and oral health-related quality of life in middle-aged and older adults: a national survey study

BACKGROUND

Stroke may cause debilitating neurological deficiencies that result in motor, sensory, and cognitive deficits and poorer psychosocial functioning. Prior studies have provided some initial evidence for the significant roles of health literacy and poor oral health for old people. However, few studies have focused on the health literacy of individuals who had a stroke; therefore, the relationships between the health literacy and oral health-related quality of life (OHRQoL) among middle-aged and older adults who had a stroke are unknown. We aimed to assess the relationships between stroke prevalence, health literacy status, and OHRQoL in middle-aged and older adults.

METHODS

We retrieved the data from The Taiwan Longitudinal Study on Aging, a population-based survey. For each eligible subject, we gathered data in 2015 on age, sex, level of education, marital status, health literacy, the activity daily living (ADL), stroke history and OHRQoL. We evaluated the respondents' health literacy by using a nine-item health literacy scale and categorized their health literacy level as low, medium, or high. OHRQoL was identified based on the Taiwan version of the Oral Health Impact Profile (OHIP-7T).

RESULTS

The final study contained 7702 community-based dwelling elderly people (3630 male and 4072 female) were analysis in our study. Stroke history was reported in 4.3% of participants, 25.3% reported low health literacy, and 41.9% had at least one ADL disability. Furthermore, 11.3% of participants had depression, 8.3% had cognitive impairment, and 3.4% had poor OHRQoL. Age, health literacy, ADL disability, stroke history, and depression status were significantly associated with poor OHRQoL after sex and marital status was adjusted. Medium (odds ratio [OR] = 1.784, 95% confidence interval [CI] = 1.177, 2.702) to low health literacy (OR = 2.496, 95% CI = 1.628, 3.828) was significantly associated with poor OHRQoL.

CONCLUSIONS

Base our study results, people with stroke history had poor OHRQoL. Lower health literacy and ADL disability were associated with worse QHRQoL. Further studies are necessary to define practical strategies for reducing the risk of stroke and oral health with constantly lower health literacy, thereby improving the quality of life and providing health care of older people.

Adaptation of the Aphasia Impact Questionnaire-21 into Greek: A Reliability and Validity Study

The impact of aphasia on the everyday life of Greek-speaking people with aphasia (PWA) is often underestimated by rehabilitation clinicians. This study explores the adaptation and psychometric properties of the Greek (GR) version of The Aphasia Impact Questionnaire-21 (AIQ-21-GR) to address this issue. The aim of this study is to determine the reliability and validity of the Greek version of the AIQ-21. The AIQ-21-GR was administered to 69 stroke survivors, 47 with aphasia and 22 without aphasia. The data were analyzed to determine reliability and validity. Content validity was based on the Consensus-based Standards for the selection of health Measurement Instruments guidelines. The AIQ-21-GR shows high levels of reliability and validity. The results confirmed high scores of internal consistency (Cronbach’s α = 0.91) and indicated good known—groups validity (Mann–Whitney U = 202, p < 001). Content validity achieved high scores with an overall median score of 4 [Q25 = 4, Q75 = 5]. The psychometric properties of the AIQ-21-GR support the reliability and validity of the tool for investigating the impact of aphasia on the quality of life of Greek-speaking PWA. The AIQ-21-GR can be used for setting functional goals in collaboration with PWA and as a patient reported outcome measure for functional communication training.

Prevalence of stroke, associated risk factors and stroke related physical, mental, and economic burden in the Republic of Georgia

Introduction

We investigated the prevalence, risk factors and physical, mental, and economic consequences of ischemic Janelidze and hemorrhagic stroke in the population of the Republic of Georgia.

Materials and Methods

A population-based, cross-sectional study was conducted among 3036 adults residing in the Imereti Region of Georgia, selected using a multistage, probability proportionate-to-size, cluster sampling technique. Data were collected by medical students, using an interviewer-administered questionnaire. Diagnosis of stroke was confirmed by neurologists based on clinical examination and corroborated by documental evidence.

Results

Of the targeted 3036 subjects, 2811 (92.6%) participated, of whom 1223 (43.5%) were women. Mean age of the sample was 49.7 (SD 15.2) years. The overall prevalence of stroke was 8.9%, the prevalence of ischemic stroke - 7.8% (95% CI 6.9-8.9) and of hemorrhagic stroke - 0.7% (95% CI 0.4-1.0). Ischemic stroke was more prevalent in males, while hemorrhagic stroke was more prevalent in females. Age, smoking, hypertension, and diabetes were associated with stroke. Stroke victims were young, many of them in the fifth decade of life. Sixty-five percent of them had a modified Rankin scale of three or greater, 25% were depressed, and 85% suffered cognitive impairment.

Discussion

Stroke affected people and their families, experiencing a significant economic burden due to loss of the income and increase in out-of-pocket payment for post-stroke medical care.

Conclusion

The stroke prevalence in the Republic of Georgia is higher than in Europe and is associated with a significant physical, mental, and economic burden.

Stroke prevalence among the Turkish population in a rural area of Istanbul: A community-based study

Background

The population-based information on the prevalence of stroke from rural areas of Middle East countries including Turkey is unknown. Our aim is to evaluate the prevalence of stroke in those ⩾18 years in the Turkish population in a rural area of Istanbul.

Methods

A cross-sectional door-to-door study was conducted in a rural area of Istanbul between 1 March and 30 March 2013. A research protocol recommended by World Health Organization for developing countries was used. Each screening teams consisted of one neurologist, one local nurse, and five surveyors. Teams were trained about the survey and questionnaire. The patients, who claimed to have suffered a stroke, were examined, and the diagnosis was confirmed by a neurologist on site. The findings and medical records were documented.

Results

In total, 2906 people ⩾18 years were screened. 50 stroke cases were detected. 80% of those were found to have had an ischemic stroke, 14% of those were hemorrhagic cases, and 6% of those had an unclassified stroke type. The overall prevalence rate in those ⩾ 18 years was 1.7%. The male/female ratio was 0.92. Young (<45) stroke prevalence was found to be 0.6%.

Conclusion

This study was the first of its kind to show the stroke prevalence among Turkish population ⩾ 18 years in a rural area of Istanbul. When compared to other studies which investigate people ⩾45 years from Turkey, the result (in the same age group) was moderate high. The male/female ratio was low compared to many other studies.