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Gomez-Figueroa E, Ruiz-Sandoval JL, De Alba-Sánchez AM, Cárdenas-Sáenz O, Zúñiga-Ramírez C, Amavisca-Espinosa R, Macías-Ortiz F, Jímenez-Ruiz A. Contribution of Stroke to Long-Term All-Cause and Cause-Specific Mortality in Mexico City. Neurology 2024; 103:e209778. [PMID: 39151103 DOI: 10.1212/wnl.0000000000209778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Stroke mortality is more common in low-income and middle-income nations such as Mexico. Prognosis data typically rely on short-term hospital follow-ups, revealing high mortality rates due to systemic complications and early recurrence. We aim to explore stroke's long-term impact by examining all-cause and cause-specific mortality. METHODS We analyzed data from the Mexico City Prospective Study (1998-2004) with known mortality outcomes until December 2022. Baseline variables were compared between participants who had stroke and nonstroke participants. Cox proportional hazard regression assessed each variable's contribution to overall mortality. Subsequent analysis within the stroke subgroup aimed to identify unique risk factors of mortality, using Cox regression models adjusted for age, sex, and time since stroke. RESULTS Among 145,537 eligible participants, 1,492 (1.0%) had a history of stroke. Participants who had stroke were older (57.58 vs 50.16, p < 0.001); had lower mean weekly income ($108.24 vs $176.14, p < 0.001); had higher alcohol intake and smoking frequency; and had more frequent comorbidities such as hypertension (48.9 vs 19.3%, p < 0.001), diabetes (23.4 vs 12.9%, p < 0.001), and ischemic heart disease (5.4 vs 1.0%, p < 0.001). They had a significantly increased risk of death from any cause (hazard ratio [HR] 2.59, 95% CI 2.37-2.83, p < 0.001). Deceased participants with stroke were more likely to be male, with a higher prevalence of diabetes, hypertension, and abnormal waist-hip index. Stroke increased the risk of death from cardiac (HR 3.56, 95% CI 3.02-4.19, p < 0.001), renal (HR 2.05, 95% CI 1.58-2.66, p < 0.001), and pulmonary (HR 2.29, 95% CI 1.79-2.92, p < 0.001) causes. DISCUSSION This study confirms stroke's association with higher mortality rates, especially from cardiac, renal, and pulmonary causes in Mexico. It underscores the elevated prevalence of cardiovascular comorbidities and adverse socioeconomic profiles among participants who had stroke and those who died with a history of stroke.
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Affiliation(s)
- Enrique Gomez-Figueroa
- From the Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Jalisco, México
| | - José Luis Ruiz-Sandoval
- From the Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Jalisco, México
| | | | - Omar Cárdenas-Sáenz
- From the Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Jalisco, México
| | - Carlos Zúñiga-Ramírez
- From the Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Jalisco, México
| | - Raúl Amavisca-Espinosa
- From the Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Jalisco, México
| | - Fátima Macías-Ortiz
- From the Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Jalisco, México
| | - Amado Jímenez-Ruiz
- From the Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde," Jalisco, México
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Panicker P, Iype T, Appireddy R, Ajithan A, Lijimol AS, Sasikumar A, Dileep R, Vijaya N, Booth C, Rajagopal MR. Palliative care needs of stroke patients at a tertiary care center in South India. J Neurosci Rural Pract 2024; 15:349-356. [PMID: 38746512 PMCID: PMC11090594 DOI: 10.25259/jnrp_7_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 03/03/2024] [Indexed: 05/16/2024] Open
Abstract
Objectives Stroke survivors have palliative care needs in multiple domains, which are overlooked. Accurate estimation of these is pivotal in ensuring proper rehabilitation and planning interventions to improve quality of life (QoL). We aimed to assess the palliative care needs of stroke patients in various domains in a structured manner at the neurology service of a tertiary care center in South India. Materials and Methods Seventy-five consecutive stroke patients presenting to the neurology service were recruited over six months with assessment across various domains including symptom burden, physical domain, activities of daily living (ADL), psychiatric/psychological domain, and QoL at baseline and with follow-up at one month and three months. Results Despite improvement in the conventional stroke impairment measures among stroke survivors, there were significant unmet needs across various domains; 98% were severely or entirely dependent on ADL at three-month follow-up; and pain and insomnia were the most frequent (33% incidence) troubling symptoms encountered. There were substantial mental health related issues. The QoL measurement tools employed were the stroke impact assessment questionnaire (SIAQ), a novel tool and the World Health Organization Quality Of Life Brief Version (WHO-QOL-BREF). SIAQ scores at one month showed that 19 patients (42.22%) had their QoL severely affected, and 36 patients (80%) showed the same trend at the three-month follow-up. WHO-BREF scores showed that 27 (62%) did not report good QoL, and 32 (73%) were found not to be satisfied with their health at a one-month follow-up. Conclusion There is a significant burden of unmet palliative care needs among stroke survivors in India across various domains.
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Affiliation(s)
- Praveen Panicker
- Department of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Thomas Iype
- Department of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Ramana Appireddy
- Department of Neurology, Queens University, Queens University School of Medicine, Kingston, Ontario, Canada
| | - Ayana Ajithan
- Department of Palliative Care, Pallium India, Thiruvananthapuram, Kerala, India
| | - A. S. Lijimol
- Department of Palliative Care, Pallium India, Thiruvananthapuram, Kerala, India
| | - Asha Sasikumar
- Department of Nursing, Government Medical College Thiruvananthapuram, Medical College, Thiruvananthapuram, Kerala, India
| | - R. Dileep
- Department of Neurology, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Nirmala Vijaya
- Department of Palliative Care, Pallium India, Thiruvananthapuram, Kerala, India
| | - Chris Booth
- Department of Oncology, Queens University, Queens University School of Medicine, Kingston, Ontario, Canada
| | - M. R. Rajagopal
- Department of Palliative Care, Pallium India, Thiruvananthapuram, Kerala, India
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Marshall K, Beaden P, Durrani H, Tang K, Mogilevskii R, Bhutta Z. The role of the private sector in noncommunicable disease prevention and management in low- and middle-income countries: a series of systematic reviews and thematic syntheses. Int J Qual Stud Health Well-being 2023; 18:2156099. [PMID: 36591948 PMCID: PMC9815432 DOI: 10.1080/17482631.2022.2156099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE Conduct six systematic reviews investigating for-profit private sector roles in NCD prevention and management in low- and middle-income countries (LMICs) through our a priori framework's pillars. METHODS Six systematic reviews and thematic syntheses were performed between March-August 2021, Six databases, websites of relevant organizations, and references lists of included studies were comprehensively searched. Studies published in English from 2000 onwards involving the pillar of interest, for-profit private sector, NCD prevention/management, and LMIC context were included. Results were synthesized using an inductive thematic synthesis approach. RESULTS Ultimately, 25 articles were included in the PPP review, 33 in Governance and Policy, 22 in Healthcare Provision, 15 in Innovation, 14 in Knowledge Educator, and 42 in Investment and Finance. The following themes emerged: PPPs (coordination; financial resources; provision; health promotion; capacity building; innovation; policy); Governance/Policy (lobbying; industry perception; regulation); Healthcare Provision (diagnosis/treatment; infrastructure; availability/accessibility/affordability); Innovation (product innovation; process innovation; marketing innovation; research; innovation dissemination); Knowledge Educator (training; health promotion; industry framework/guideline formation); Investment and Finance (treatment cost; regulation; private insurance; subsidization; direct investment; collaborative financing; innovative financing; research). CONCLUSION These findings will be instrumental for LMICs considering private sector engagement. Potential conflicts of interest must be considered when implementing private sector involvement.
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Affiliation(s)
- Keiko Marshall
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,CONTACT Keiko Marshall University of Toronto
| | - Philippa Beaden
- Department of Medicine, University of Toronto, Toronto, Canada
| | - Hammad Durrani
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Kun Tang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Roman Mogilevskii
- Institute of Public Policy and Administration, University of Central Asia, Bishkek, Kyrgyzstan
| | - Zulfiqar Bhutta
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada,Centre for Excellence in Women and Child Health and Institute of Global Health and Development, The Aga Khan University, Karachi, Pakistan,Zulfiqar Bhutta Zulfiqar BhuttaCentre for Global Child Health Hospital, Sick Children 686 Bay Street, 11th Floor, Suite 11.9805 Toronto, ON M5G 0A4 Canada ext. 328532 Aga Khan University
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Renjith V, Soman B, Shanmughasundaram S, Arun K, Jeemon P, Antony R, Gopal B, Sylaja PN. Stroke awareness among community health workers from rural health blocks of Thiruvananthapuram, India. J Neurosci Rural Pract 2023; 14:735-740. [PMID: 38059223 PMCID: PMC10696348 DOI: 10.25259/jnrp_222_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 09/01/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives Secondary prevention of stroke largely depends on risk factor control and lifestyle modification. Optimal secondary prevention strategies are limited in rural settings due to the shortage of primary care physicians and neurologists. Awareness of community health workers (CHWs) regarding stroke and its management remains largely unexplored. The current cross-sectional study aimed at assessing the knowledge, attitude, and practice (KAP) of CHWs regarding stroke care. Materials and Methods A structured KAP questionnaire was administered among 510 CHWs from randomly selected rural health blocks of Thiruvananthapuram, Kerala, India. Results Knowledge assessment showed that the CHWs possessed an average knowledge of stroke care. The mean attitude and practice scores were higher, indicating a favorable attitude and good practice. The overall mean (standard deviation) KAP scores of CHWs were 13.54 (4.43) against a total score of 23. The KAP scores were highest among palliative care nurses. The stroke awareness of the accredited social health activists was comparatively lower than other CHWs. Factors such as age and years of work experience were not correlated to the KAP scores. Conclusion Recurrent strokes remain a major challenge in primary care. Overall, the health workers demonstrated average knowledge, favorable attitudes, and positive practices. The study highlights the importance of training accredited social health activists (ASHAs) and other CHWs in stroke to improve secondary prevention strategies.
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Affiliation(s)
- Vishnu Renjith
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Biju Soman
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Sivasambath Shanmughasundaram
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - K. Arun
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Panniyammakal Jeemon
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Roni Antony
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Bipin Gopal
- Directorate of Health Services, Kerala Health Services, Thiruvananthapuram, Kerala, India
| | - P. N. Sylaja
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
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Xavier D, Murphy R, Pais P, Pandian J, Gosala S, Mathur N, Khurana D, Sundararajan R, Gupta R, Joshi R, Vanchilingam S, Venkatarathanamma PN, Desai S, Reddin C, O'Donnell M, Yusuf S. Characteristics, clinical practice patterns, and outcomes of strokes in India: INSPIRE-A multicentre prospective study. Int J Stroke 2023; 18:965-975. [PMID: 37114983 DOI: 10.1177/17474930231175584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
BACKGROUND India has a high burden of stroke, but there are limited data available on the characteristics of patients presenting with stroke in India. AIMS We aimed to document the clinical characteristics, practice patterns, and outcomes of patients presenting with acute stroke to Indian hospitals. METHODS A prospective registry study of patients admitted with acute clinical stroke was conducted in 62 centers across different regions in India between 2009 and 2013. RESULTS Of the 10,329 patients included in the prescribed registry, 71.4% had ischemic stroke, 25.2% had intracerebral hemorrhage (ICH), and 3.4% had an undetermined stroke subtype. Mean age was 60 years (SD = 14) with 19.9% younger than 50 years; 65% were male. A severe stroke at admission (modified-Rankin score 4-5) was seen in 62%, with 38.4% of patients having severe disability at discharge or dying during hospitalization. Cumulative mortality was 25% at 6 months. Neuroimaging was completed in 98%, 76% received physiotherapy, 17% speech and language therapy (SLT), 7.6% occupational therapy (OT), with variability among sites; 3.7% of ischemic stroke patients received thrombolysis. Receipt of physiotherapy (odds ratio (OR) = 0.41, 95% confidence interval (CI): 0.33-0.52) and SLT (OR = 0.45, 95% CI: 0.32-0.65) was associated with lower mortality, while a history of atrial fibrillation (OR = 2.22, 95% CI: 1.37-3.58) and ICH (OR = 2.00, 95% CI: 1.66-2.40) were associated with higher mortality. CONCLUSION In the INSPIRE (In Hospital Prospective Stroke Registry) study, one-in-five patients with acute stroke was under 50 years of age, and one-quarter of stroke was ICH. There was a low provision of thrombolysis and poor access to multidisciplinary rehabilitation highlighting how improvements are needed to reduce morbidity and mortality from stroke in India.
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Affiliation(s)
| | - Robert Murphy
- HRB Clinical Research Facility, University of Galway, Galway, Ireland
| | - Prem Pais
- St. John's Research Institute, Bangalore, India
| | | | | | | | - Dheeraj Khurana
- Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Rajeev Gupta
- Eternal Heart Care Centre & Research Institute, Jaipur, India
| | | | | | | | | | - Catriona Reddin
- HRB Clinical Research Facility, University of Galway, Galway, Ireland
| | - Martin O'Donnell
- HRB Clinical Research Facility, University of Galway, Galway, Ireland
- PHRI, McMasters University, Hamilton, ON, Canada
| | - Salim Yusuf
- PHRI, McMasters University, Hamilton, ON, Canada
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Shah A, Diwan A. Stumbling Blocks to Stroke Thrombolysis: An Indian Perspective. Indian J Crit Care Med 2023; 27:616-619. [PMID: 37719355 PMCID: PMC10504641 DOI: 10.5005/jp-journals-10071-24517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 07/26/2023] [Indexed: 09/19/2023] Open
Abstract
Background and purpose Stroke is a leading cause of morbidity and mortality worldwide. Developing countries, however, still lag behind in providing timely thrombolytic therapy (TLT) to many eligible patients owing to various reasons. This study aims to identify such factors. Materials and methods This was a descriptive observational study undertaken over a period of 18 months at a tertiary care teaching hospital and included 252 acute ischemic stroke patients of which 200 were not thrombolyzed. The reasons for nonthrombolysis were recorded and analyzed. Results The study included 252 acute ischemic stroke patients of which only 20% were thrombolyzed. Of the 200 nonthrombolyzed patients, 55% arrived out of the window period while patient-related factors were the second biggest factor preventing thrombolysis. Hospital factors at 14% and financial constraints at 4.5% contributed significantly. Delayed consent emerged as an important factor making 6% of the delays. Conclusion Stroke thrombolysis still faces various pre- and intrahospital barriers in India. There is an urgent need to improve infrastructure and organizational streamlining to enable eligible patients to receive prompt treatment. How to cite this article Shah A, Diwan A. Stumbling Blocks to Stroke Thrombolysis: An Indian Perspective. Indian J Crit Care Med 2023;27(9):616-619.
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Affiliation(s)
- Aviral Shah
- Department of Medicine, Atal Bihari Vajpayee Institute of Medical Sciences and Dr Ram Manohar Lohia Hospital, New Delhi, India
| | - Arundhati Diwan
- Department of Medicine, Bharati Vidyapeeth (Deemed to be University) Medical College, Pune, Maharashtra, India
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7
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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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Yadav N, Kumar A, Hedaoo K, Jain A, Singh K, Vikram A. Establishing a New Neurointerventional Facility in a Remote Area of a Low–Middle Income Country (LMIC): Initial Experience. Asian J Neurosurg 2022; 17:50-57. [PMID: 35873835 PMCID: PMC9298586 DOI: 10.1055/s-0042-1749150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background
Timely performed Neurointervention procedures in patients with neurovascular disorders save them from mortality and lifelong morbidity, in addition to relieving the immense economic and social burden associated with these diseases.
Materials and Methods
We retrospectively reviewed data of neurointerventions performed in our hospital from November 2019 till March 2021. Patient age, sex, diagnosis, preoperative, and postoperative imaging findings were collected and analyzed. Types of procedures, success/failure, procedure-related and procedure-unrelated complications were noted and described.
Results
Total 161 procedures were done (diagnostic n = 89, therapeutic n = 72). Among the 72 cases of therapeutic procedures, angiographic success was noted in 60 cases, partial success was noted in 5 cases (RR grade 3 occlusion) and failure was noted in 7 cases [mechanical thrombectomy (n = 2), coiling (n = 1), flow diverter (n = 1), Caroticocavernous fistula (n = 1), cerebral Arteriovenous malformation (n = 2)]. Among therapeutic cases (n = 72), patient outcome was categorized as improved (with mRS 0-2 at discharge) in 64 cases (60 neurointerventions, 4 converted to surgery), morbidity in form of weakness was noted in 2 cases, mortality was noted in 8 cases. There were no hemorrhagic complications due to rupture or dissection. Ischemic complications were noted in form of thromboembolic complications in three cases and vessel occlusion (delayed MCA occlusion) in one case.
Conclusion
With recent efforts by medical associations and governments to provide access to these lifesaving, disability averting neuro-interventions, it’s important to recognize and define challenges in implementation of neuro-intervention services. In this article, we share our early experience in establishing a neurointervention facility in a backward region of a low–middle income country.
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Affiliation(s)
- Nishtha Yadav
- Department of Neuroradiology, School of Excellence in Neurosurgery Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Ambuj Kumar
- Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Ketan Hedaoo
- Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Anivesh Jain
- Department of Anaesthesia, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Kamalraj Singh
- Department of Anaesthesia, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
| | - Aditya Vikram
- Department of Neurosurgery, Super Speciality Hospital, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India
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Mahmood A, Deshmukh A, Natarajan M, Marsden D, Vyslysel G, Padickaparambil S, Ts S, Direito A, Kumaran S, N G, Sachdev H, Kumar Veluswamy S, Karthikbabu S, Unnikrishnan B, English C, Solomon JM. Development of strategies to support home-based exercise adherence after stroke: a Delphi consensus. BMJ Open 2022; 12:e055946. [PMID: 34992120 PMCID: PMC8739434 DOI: 10.1136/bmjopen-2021-055946] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE To develop a set of strategies to enhance adherence to home-based exercises after stroke, and an overarching framework to classify these strategies. METHOD We conducted a four-round Delphi consensus (two online surveys, followed by a focus group then a consensus round). The Delphi panel consisted of 13 experts from physiotherapy, occupational therapy, clinical psychology, behaviour science and community medicine. The experts were from India, Australia and UK. RESULTS In round 1, a 10-item survey using open-ended questions was emailed to panel members and 75 strategies were generated. Of these, 25 strategies were included in round 2 for further consideration. A total of 64 strategies were finally included in the subsequent rounds. In round 3, the strategies were categorised into nine domains-(1) patient education on stroke and recovery, (2) method of exercise prescription, (3) feedback and supervision, (4) cognitive remediation, (5) involvement of family members, (6) involvement of society, (7) promoting self-efficacy, (8) motivational strategies and (9) reminder strategies. The consensus from 12 experts (93%) led to the development of the framework in round 4. CONCLUSION We developed a framework of comprehensive strategies to assist clinicians in supporting exercise adherence among stroke survivors. It provides practical methods that can be deployed in both research and clinical practices. Future studies should explore stakeholders' experiences and the cost-effectiveness of implementing these strategies.
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Affiliation(s)
- Amreen Mahmood
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
- Center for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| | - Anagha Deshmukh
- Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Manikandan Natarajan
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Center for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| | - Dianne Marsden
- Hunter Stroke Service, Hunter New England Local Health District, New Lambton, New South Wales, Australia
- Priority Research Centre Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia
- Brain and Mental Health Program, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia
| | - Glade Vyslysel
- Westlakes Community Rehabilitation Team, Hunter New England Local Health District, Toronto, NSW, Australia
| | - Sebastian Padickaparambil
- Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Shwetha Ts
- Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Artur Direito
- Centre for Behaviour Change, University College London, London, UK
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Senthil Kumaran
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Center for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| | - Girish N
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Harpreet Sachdev
- Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Suruliraj Karthikbabu
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Bangalore, Karnataka, India
| | - B Unnikrishnan
- Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Coralie English
- Priority Research Centre Stroke and Brain Injury, University of Newcastle, Callaghan, NSW, Australia
- School of Health Sciences, University of Newcastle, Newcastle, New South Wales, Australia
| | - John M Solomon
- Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
- Center for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
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Pedapati R, Bhatia R, Shakywar M, Gupta A, Vishnubhatla S, Srivastava MVP, Tripathi M, Singh MB, Singh RK, Y VV, Rajan R, Gupta A, Aggarwal R, Prasad K. Educating Caregivers to Reduce Complications and Improve Outcomes of Stroke Patients (ECCOS) - A Cluster-Randomized Trial. J Stroke Cerebrovasc Dis 2021; 30:105966. [PMID: 34271274 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/20/2021] [Accepted: 06/22/2021] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES Stroke constitutes a significant public health problem in developing countries. Caregivers provide an important support system for patient care but usually lack knowledge and skill to attend their stroke patients. We assessed whether a caregiver-directed educational intervention would reduce hospital-acquired complications and improve stroke patients' outcomes. MATERIALS AND METHODS We randomly assigned two Neurology inpatient wards to receive either standard care or an educational intervention. The coprimary outcomes included incidence of hospital-acquired complications and in-hospital mortality. Secondary outcomes included the modified Rankin Scale and mortality at three months. RESULTS Among 164 patients recruited, 82 received intervention, and standard care each. The mean (Standard deviation) Glasgow coma scale of patients was 11.01 (3.4), and National Institute of Health Stroke Scale was 19.17 (8.54). The incidence of complications (72 in the intervention versus 81 in the control group; p=0.56) was not different. Ten patients (12.2%) in the intervention group and 16 (19.5%) in the control group (p=0.20) died in-hospital. Twenty patients (27.8%) in the intervention and twelve (18.2%) in the control group attained modified Rankin Scale 0-2 at three months (p=0.12). The mortality at three months (20 [24.4%] in the intervention versus 25 [30.5%] in the control group) was not different (p=0.38). The intervention group had fewer complications (42 versus 68 in the control group; p=0.01) during the initial ten days of hospital stay, but adjusted analysis revealed no difference. CONCLUSION A structured educational intervention did not reduce the incidence of hospital-acquired complications, mortality, or morbidity. However, there was a trend towards fewer complications in the initial days of hospital stay. Extended hospital stay, caregiver fatigue, and dilution of the intervention over time might be reasons for the apparent lack of effect. CLINICAL TRIAL REGISTRATION-URL: http://www.ctri.nic.in. Unique identifier: CTRI/2018/11/016312.
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Affiliation(s)
- Radhakrishna Pedapati
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Maneesh Shakywar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Akash Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Sreenivas Vishnubhatla
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Mamta Bhushan Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Rajesh Kumar Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Vishnu V Y
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Anu Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Rajeev Aggarwal
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
| | - Kameshwar Prasad
- Department of Neurology, All India Institute of Medical Sciences, New Delhi. 110029, India.
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11
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Jayawardana KS, Crowfoot G, Janssen H, Nayak P, Solomon JM, English CK. Comparing the physical activity of stroke survivors in high-income countries and low to middle-income countries. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1918. [PMID: 34228383 DOI: 10.1002/pri.1918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 04/19/2021] [Accepted: 06/22/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Low physical activity levels in people with stroke may contribute to higher risk of cardiovascular disease morbidity and mortality. Differences in economic status, culture and the built environment may influence the applicability of interventions developed in high income countries (HIC) for stroke survivors in low to middle-income countries (LMIC). PURPOSE To compare physical activity levels of stroke survivors in HIC and LMIC and to explore the influence of lower limb impairment on physical activity levels. METHODS AND MATERIALS An exploratory secondary analysis of observational data on physical activity levels of stroke survivors from Australia (HIC) and India (LMIC). Physical activity variables (step count, light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA)) were measured by accelerometery. Comparisons of physical activity levels between (a) Australian and Indian stroke survivors and (b) participants with and without lower limb impairments were performed using independent t-tests or Mann-Whitney U tests. RESULTS There were no significant differences in physical activity levels between (i) Australian and Indian stroke survivors (step count mean difference 201 steps [-1375 to 974], LPA mean difference -24 min [-22 to 69], MVPA mean difference 2 min [-8 to 3]), and (ii) stroke survivors with and without lower limb impairments in either country. CONCLUSION Stroke survivors were highly inactive in both countries. Despite differences in economic status, cultural influences and the built environment, the physical activity of stroke survivors in Australia and India did not differ. People with and without lower limb impairment also had similar physical activity levels.
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Affiliation(s)
- Krishni S Jayawardana
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Gary Crowfoot
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Heidi Janssen
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
| | - Pradeepa Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Udupi, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Udupi, India
| | - Coralie K English
- School of Health Sciences, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Newcastle, New South Wales, Australia
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12
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Mahmood A, Nayak P, English C, Deshmukh A, U S, N M, Solomon JM. Adherence to home exercises and rehabilitation (ADHERE) after stroke in low-to-middle-income countries: A randomized controlled trial. Top Stroke Rehabil 2021; 29:438-448. [PMID: 34180370 DOI: 10.1080/10749357.2021.1940800] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Adherence to prescribed exercises is essential for home-based programs to be effective, but evidence for strategies to enhance exercise adherence in people with stroke is lacking.Objectives: To determine the effect of adherence strategies on the proportion of people with stroke who adhere to prescribed home-based exercises and their level of adherence at 6 and 12 weeks of intervention. Our secondary objective was to determine the effect of the combined intervention on mobility and quality of life post-stroke.Methods: We conducted an RCT among people with stroke (Exp = 27, Con = 25) living in semi-urban India. Both groups received standard hospital care and a home exercise program. The experimental group also received adherence strategies delivered over five sessions. Adherence was measured using the Stroke-Specific Measure of Adherence to Home-based Exercises (SS-MAHE) , mobility using Mobility Disability Scale, and quality of life using the Stroke Impact Scale.Results: The experimental group had better exercise adherence compared to the control group both at six (mean difference [MD] 45, 95% CI 40, 64, p < .001) and 12 weeks (MD 51, 95% CI 39, 63, p < .001). The experimental group also had better mobility at 12 weeks (median (IQR), experimental 42 (57), median (IQR), control 95 (50), p = .002). There was no difference in the quality of life scores between groups at six or 12 weeks.Conclusion: The adherence strategies were effective in improving exercise adherence and mobility post-stroke but did not improve quality of life.Trial registration: CTRI/2018/08/015212.
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Affiliation(s)
- Amreen Mahmood
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Pradeepa Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Coralie English
- School of Health Sciences and Priority Research, Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Anagha Deshmukh
- Department of Clinical Psychology, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Shashikiran U
- Department of Medicine, Dr. TMA Pai Hospital, Udupi, MMMC, Manipal Academy of Higher Education, India
| | - Manikandan N
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Centre for Comprehensive Stroke Rehabilitation and Research, Manipal Academy of Higher Education, Manipal, India
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13
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Rajasulochana SR, Kar SS. Economic burden associated with stroke in India: insights from national sample survey 2017-18. Expert Rev Pharmacoecon Outcomes Res 2021; 22:455-463. [PMID: 34110261 DOI: 10.1080/14737167.2021.1941883] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective: To estimate the out-of-pocket (OOP) expenditure and catastrophic expenditure due to stroke-related hospitalization and determine associated predictors.Methods: Secondary analysis of household-based survey conducted by National Sample Survey Organization from June 2017 to 2018.Results: A total of 1152 and 407 individuals reported stroke-related hospitalization and outpatient care, respectively, in the survey. Stroke-related hospitalization rate in India is 46 per 100,000 persons. The mean and median expenditure per episode of stroke-related hospitalization was INR 40,360 (US$ 539.75) and INR 17,140 (US$ 229.22), respectively, with significant OOP hospitalization expenditure across wealth quintiles (p < 0.001). About 29% (25-34%) of households seeking stroke treatment in public medical institutions experienced catastrophic expenditure. 37% (34-40%) of households resorted to distress health financing due to stroke-related hospitalization. Medicines accounted on an average 38% and 73% of public sector hospitalization and outpatient care, respectively. Patients treated in a private facility, hospitalized for over 7 days, within the poorest wealth quintiles had higher odds of incurring catastrophic expenditure.Conclusion: Economic burden associated with stroke-related hospitalization is substantial in India. The publicly funded health insurance scheme should cover expenses on stroke-related medicines to reduce OOP expenditure of patients seeking treatment in public sector facilities.
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Affiliation(s)
- Subramania Raju Rajasulochana
- Health Technology Assessment Resource Centre, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sitanshu Sekhar Kar
- Health Technology Assessment Resource Centre, Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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14
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Watkins KE, Levack WMM, Rathore FA, Hay-Smith EJC. What would 'upscaling' involve? A qualitative study of international variation in stroke rehabilitation. BMC Health Serv Res 2021; 21:399. [PMID: 33926440 PMCID: PMC8082958 DOI: 10.1186/s12913-021-06293-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 03/18/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Demand for stroke rehabilitation is expected to grow dramatically; with the estimated prevalence of stroke survivors rising to 70 million worldwide by 2030. The World Health Organization's (WHO) report - Rehabilitation 2030: A call for action - has introduced the objective of 'upscaling' rehabilitation globally to meet demand. This research explored what upscaling stroke rehabilitation might mean for health professionals from countries at different stages of economic development. METHODS Qualitative descriptive study design using semi-structured interviews was employed. Purposively sampled, clinical leaders in stroke rehabilitation were recruited for interviews from low through to high-income countries. RESULTS Twelve rehabilitation professionals (medicine, physical therapy, occupational therapy, and speech and language therapy) from high (United States of America, Germany, United Kingdom, United Arab Emirates, New Zealand), upper-middle (Colombia and Turkey), lower-middle (Vietnam, Pakistan, Ghana), and low-income countries (Nepal and Sierra Leone) were interviewed. Upscaling was seen as a necessity. Successful scaling up will require initiatives addressing: political governance and managerial leadership, increasing knowledge and awareness of the value of rehabilitation, financial support, workforce developments, physical space and infrastructure, and the development of community services and reintegration. CONCLUSION Although there have been many gains within the development of stroke rehabilitation internationally, further investment is required to ensure that this patient population group continues to receive the best quality services. For the WHO to be successful in implementing their objective to upscale rehabilitation, specific attention will need to be paid to political, professional, economic, and sociocultural issues at global and local levels.
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Affiliation(s)
- Kimberley Elizabeth Watkins
- Department of Medicine, Rehabilitation Teaching and Research Unit, University of Otago, Mein St, Newtown, PO Box 7343, Wellington, 6242, New Zealand.
| | - William Mark Magnus Levack
- Department of Medicine, Rehabilitation Teaching and Research Unit, University of Otago, Mein St, Newtown, PO Box 7343, Wellington, 6242, New Zealand
| | - Farooq Azam Rathore
- Department of Rehabilitation Medicine PNS Shifa Hospital DHA-II, Karachi, Pakistan
| | - Elizabeth Jean Carleton Hay-Smith
- Department of Medicine, Rehabilitation Teaching and Research Unit, University of Otago, Mein St, Newtown, PO Box 7343, Wellington, 6242, New Zealand
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15
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Nayak P, Kumaran D S, Mahmood A, Manikandan N, Unnikrishnan B, Solomon JM. Feasibility of context-specific activities for improving physical activity levels among Indian adults with stroke. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2021. [DOI: 10.1080/21679169.2020.1866663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Pradeepa Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Senthil Kumaran D
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Amreen Mahmood
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - Natarajan Manikandan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Bhaskaran Unnikrishnan
- Department of Community Medicine, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, India
| | - John M Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education (MAHE), Manipal, India
- Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education (MAHE), Manipal, India
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16
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Mathur P, Rangamani S, Kulothungan V, Huliyappa D, Bhalla BB, Urs V. National Stroke Registry Programme in India for Surveillance and Research: Design and Methodology. Neuroepidemiology 2020; 54:454-461. [DOI: 10.1159/000510482] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 07/22/2020] [Indexed: 11/19/2022] Open
Abstract
The burden of stroke is increasing, and India lacks comparable long-term data on stroke incidence and mortality. Disease surveillance using a registry model can provide long-term data on stroke for linking with public health interventions in stroke prevention, treatment, and rehabilitation. The objectives of the National Stroke Registry Programme (NSRP), India, are to generate reliable data on the incidence of first-ever stroke events in defined populations through a population-based stroke registry (PBSR) and to describe the patterns of care and outcomes of patients with stroke in different treatment settings through a hospital-based stroke registry (HBSR). Continuous systematic collection on a standardized format of diagnostic, treatment, and outcome information on stroke events in persons of defined population (PBSR) and those who attend hospitals (HBSR) is conducted through active data abstraction from review of records from all health facilities and imaging centres that cater to stroke patients. Data are ICD coded, verified, and completed by obtaining survival status of registered patients. IT tools are used for data collection,management and analysis. The NSRP shall establish a standardized stroke surveillance system that would reliably measure stroke incidence, subtypes, treatment patterns, complications, disability, case fatality, and survival. This evidence shall inform health planning of stroke interventions and control activities. It would facilitate improvement in stroke services to improve quality of care and outcomes of stroke. A thrust for research on stroke would be encouraged based on evidence-based hypothesis generation.
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17
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Kate MP, Arora D, Verma SJ, Sylaja PN, Renjith V, Sharma M, Pandian JD. Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA) study protocol. Int J Stroke 2020; 15:109-115. [PMID: 31852411 DOI: 10.1177/1747493019895653] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
RATIONALE Recurrent stroke, cardiovascular morbidity, and mortality are important causes of poor outcome in patients with index stroke. Despite the availability of best medical management recurrent stroke occur in up to 15-20% of patients with stroke in India. Education for stroke prevention could be a strategy to prevent recurrent strokes. HYPOTHESIS We hypothesize that a structured semi-interactive stroke prevention package can reduce the risk of recurrent strokes, acute coronary artery syndrome, and death in patients with sub-acute stroke at the end of one year. DESIGN Secondary Prevention by Structured Semi-Interactive Stroke Prevention Package in INDIA (SPRINT INDIA) is a multi-center stroke trial involving 25 centers under the Indian Stroke Clinical Trial Network. Patients with first ever sub-acute stroke within two days to three months of onset, age 18-85 years, mRS <5, showing recent stroke in imaging are included. Participants or caregivers able to read and complete tasks suggested in a stroke prevention workbook and have a cellular device for receiving short message service and watching videos. A total of 5830 stroke patients speaking 11 different languages are being randomized to intervention or control arm. Patients in the intervention arm are receiving a stroke prevention workbook, regular educational short messages, and videos. All patients in the control arm are receiving standard of care management. SUMMARY Structured semi-interactive stroke prevention package may reduce the risk of recurrent strokes, acute coronary artery syndrome, and death in patients with sub-acute stroke. TRIAL REGISTRATION This trial is registered with clinicaltrials.gov (NCT03228979) and CTRI (Clinical Trial Registry India; CTRI/2017/09/009600).
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Affiliation(s)
| | - Deepti Arora
- Department of Neurology, Christian Medical College, Ludhiana, India
| | | | - P N Sylaja
- Department of Neurology, Sri Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, India
| | - Vishnu Renjith
- Department of Neurology, Sri Chitra Tirunal Institute of Medical Sciences and Technology, Thiruvananthapuram, India
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18
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Mahmood A, Solomon JM, English C, Bhaskaran U, Menon G, Manikandan N. Measurement of adherence to home-based exercises among community-dwelling stroke survivors in India. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2019; 25:e1827. [PMID: 31880059 DOI: 10.1002/pri.1827] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/16/2019] [Accepted: 11/24/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVES To develop an adherence questionnaire specific to stroke and measure the level of adherence to home-based exercises among community-dwelling stroke survivors. METHODS We developed and validated the "Stroke-Specific Measure of Adherence to Home-based Exercises" (SS-MAHE). We measured the exercise adherence among 92 community-dwelling stroke survivors in a cross-sectional study. RESULTS The SS-MAHE has two sections covering (a) the dosage of prescribed exercises and (b) dosage of actual exercises done by the participants. It was found to be reliable with ICC score of 0.81 (95% CI, 0.44, 0.94, p = .001.) Adherence was measured by comparing prescribed exercises to the actual exercises performed at home. We rated participants as "adherent" if they were following more than 70% of the prescribed exercise dosage. In our sample of 92 stroke survivors, only 28% of participants were adherent to prescribed home-based exercises. CONCLUSION SS-MAHE is a practical and reliable tool to measure adherence to home-based exercises after a stroke. Exercise adherence among stroke survivors is less than ideal. There is a need for strategies to specifically target exercise adherence in stroke survivors.
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Affiliation(s)
- Amreen Mahmood
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - John Michael Solomon
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, India
| | - Coralie English
- School of Health Sciences and Priority Research Centre for Stroke and Brain Injury, University of Newcastle, Newcastle, Australia
| | - Unnikrishnan Bhaskaran
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Mangalore, India
| | - Girish Menon
- Department of Neurosurgery, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Natarajan Manikandan
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India.,Centre for Comprehensive Stroke Rehabilitation and Research (CCSRR), Manipal Academy of Higher Education, Manipal, India
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19
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Chhabra M, Gudi SK, Rashid M, Sharma P, Sharma S, Khan H. Assessment of Knowledge on Risk Factors, Warning Signs, and Early Treatment Approaches of Stroke among Community Adults in North India: A Telephone Interview Survey. J Neurosci Rural Pract 2019; 10:417-422. [PMID: 31595113 PMCID: PMC6779547 DOI: 10.1055/s-0039-1697561] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background
As stroke is a catastrophic illness, knowing its risk factors, early signs and symptoms, and management strategies could potentially prevent morbidity and mortality among the people.
Objectives
The aim of this study is to determine the public cognizance of risk factors, signs and symptoms, and early treatment options available for stroke with particular emphases on thrombolysis, and its window period.
Materials and Methods
A cross-sectional telephonic interview-based survey was conducted in the states of Punjab, Haryana, and Himachal Pradesh of North India from August 2017 to December 2017.
Results
Of 350 respondents those participated in the survey with a mean age ± standard deviation of 39.93 ± 13.41 years, hypertension was found to be the most common risk factor among the study participants (
n
= 205, 58.57%) and 28.85% of the study participants were not aware of the risk factors, whereas 46% of the participants were not aware of warning signs of stroke. The window period of thrombolysis was compared with gender, and it was found that the higher number of male participants (
n
= 49) adduced the right window of thrombolysis (0–4.5 hours) as compared with the female participants (
n
= 26).
Conclusions
Survey results suggested that there exists scant information about risk factors, alarming signs, and early treatment approaches among community adults toward stroke. In this regard, there is an immense need to conduct awareness camps related to stroke to educate the vulnerable public.
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Affiliation(s)
- Manik Chhabra
- Department of Pharmacy Practice, Indo-Soviet Friendship College of Pharmacy, Moga, Punjab, India
| | - Sai Krishna Gudi
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Manitoba, Canada
| | - Muhammed Rashid
- Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, Mandya, Karnataka, India
| | | | - Puneet Sharma
- Department of Pharmacy Practice, Indo-Soviet Friendship College of Pharmacy, Moga, Punjab, India
| | - Shubham Sharma
- Department of Pharmacy Practice, Indo-Soviet Friendship College of Pharmacy, Moga, Punjab, India
| | - Hashim Khan
- Department of Pharmacy Practice, College of Pharmacy, Teerthanker Mahaveer University (TMU), Moradabad, Uttar Pradesh, India
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20
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Chhabra M, Sharma A, Ajay KR, Rathore MS. Assessment of risk factors, cost of treatment, and therapy outcome in stroke patients: evidence from cross-sectional study. Expert Rev Pharmacoecon Outcomes Res 2019; 19:575-580. [DOI: 10.1080/14737167.2019.1580574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Manik Chhabra
- Department of Pharmacy Practice, ISF College of Pharmacy, Moga, India
| | - Amit Sharma
- Department of Pharmacy Practice, ISF College of Pharmacy, Moga, India
| | | | - Mahendra Singh Rathore
- Department of Pharmacy Practice, MM College of Pharmacy, Maharishi Markandeshwar (Deemed to be University), Ambala, India
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21
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Pandian JD, Gall SL, Kate MP, Silva GS, Akinyemi RO, Ovbiagele BI, Lavados PM, Gandhi DBC, Thrift AG. Prevention of stroke: a global perspective. Lancet 2018; 392:1269-1278. [PMID: 30319114 DOI: 10.1016/s0140-6736(18)31269-8] [Citation(s) in RCA: 209] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/04/2018] [Accepted: 05/29/2018] [Indexed: 12/16/2022]
Abstract
Along with the rising global burden of disability attributed to stroke, costs of stroke care are rising, providing the impetus to direct our research focus towards effective measures of stroke prevention. In this Series paper, we discuss strategies for reducing the risk of the emergence of disease (primordial prevention), preventing the onset of disease (primary prevention), and preventing the recurrence of disease (secondary prevention). Our focus includes global strategies and campaigns, and measurements of the effectiveness of worldwide preventive interventions, with an emphasis on low-income and middle-income countries. Our findings reveal that effective tobacco control, adequate nutrition, and development of healthy cities are important strategies for primordial prevention, whereas polypill strategies, use of mobile technology (mHealth), along with salt reduction and other dietary interventions, are effective in the primary prevention of stroke. An effective collaboration between various health-care sectors, government policies, and campaigns can successfully implement secondary prevention strategies, through surveillance and registries, such as the WHO's non-communicable diseases programmes, across high-income and low-income countries.
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Affiliation(s)
- Jeyaraj D Pandian
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India.
| | - Seana L Gall
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Mahesh P Kate
- Department of Neurology, Christian Medical College and Hospital, Ludhiana, India
| | - Gisele S Silva
- Programa Integrado de Neurologia, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rufus O Akinyemi
- Neuroscience and Ageing Research Unit, Institute for Advanced Medical Research and Training, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Bruce I Ovbiagele
- Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Pablo M Lavados
- Vascular Neurology Unit, Neurology Service, Department of Neurology and Psychiatry, Clínica Alemana de Santiago, Santiago, Chile; Facultad de Medicina, Clínica Alemana Universidad del Desarrollo, Santiago, Chile; Department of Neurological Sciences, Facultad de Medicina, Universidad de Chile, Santiago, Chile
| | - Dorcas B C Gandhi
- College of Physiotherapy, Christian Medical College and Hospital Ludhiana, Ludhiana, India
| | - Amanda G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia
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22
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Mairami FF, Warren N, Allotey PA, Mak JS, Reidpath DD. Documenting the impact of stroke in a middle-income country: a Malaysian case study. Disabil Rehabil 2018; 42:102-113. [PMID: 30183424 DOI: 10.1080/09638288.2018.1493544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose: Stroke is an abrupt event that often leaves survivors with long term disabilities, causing role changes, and financial strains on households. The profound impact of stroke on survivors may lead to a decline in quality of life due to the physical, psychological, and social difficulties they experience. Taking Malaysia as an example, this study aimed to explore the impact of stroke on survivors and how health services influence their recovery in low and middle-income countries (LMIC).Method: An ethnographic approach with data obtained primarily through in-depth interviews was used. Twenty-seven participants identified as having suffered a stroke were drawn from a health and demographic surveillance system in Malaysia.Results: The physical and social disruption of the lives of stroke survivors was intensified by the resultant financial constraints placed upon individuals, families and households, compounded by inadequate support from the health, and welfare systems. Despite the disruption to their lives, most participants were, at least in part, able to reestablish their lives through various factors that include a strong family support and active coping strategies.Conclusion: In LMIC, recovery can be shaped by the family unit and through active coping strategies especially those in relation to spirituality.Implications for rehabilitationThe impact of stroke on survivors and lack of specialized stroke care compromise the recovery process and quality of life for stroke survivors in low and middle-income countries.Support from the family and reinforcement of religious coping were judged to successfully aid recovery.Physical and emotional impairments as well as psychosocial wellbeing of survivors in the context of environmental factors need to be addressed.
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Affiliation(s)
- Fatima Fanna Mairami
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Narelle Warren
- School of Social Sciences, Clayton Campus, Monash University, Melbourne, Australia
| | - Pascale A Allotey
- UN University International Institute for Global Health (UNU-IIGH), Kuala Lumpur, Malaysia
| | - Jun Shin Mak
- School of Social Sciences, Clayton Campus, Monash University, Melbourne, Australia
| | - Daniel D Reidpath
- Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Malaysia.,South East Asia Community Observatory (SEACO), Monash University, Segamat, Johor, Malaysia
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23
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Liu H, Lindley R, Alim M, Felix C, Gandhi DB, Verma SJ, Tugnawat DK, Syrigapu A, Ramamurthy RK, Pandian JD, Walker M, Forster A, Hackett ML, Anderson CS, Langhorne P, Murthy GV, Maulik PK, Harvey LA, Jan S. Family-led rehabilitation in India (ATTEND)-Findings from the process evaluation of a randomized controlled trial. Int J Stroke 2018; 14:53-60. [PMID: 30044209 DOI: 10.1177/1747493018790076] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Training family carers to provide evidence-based rehabilitation to stroke patients could address the recognized deficiency of access to stroke rehabilitation in low-resource settings. However, our randomized controlled trial in India (ATTEND) found that this model of care was not superior to usual care alone. AIMS This process evaluation aimed to better understand trial outcomes through assessing trial implementation and exploring patients', carers', and providers' perspectives. METHODS Our mixed methods study included process, healthcare use data and patient demographics from all sites; observations and semi-structured interviews with participants (22 patients, 22 carers, and 28 health providers) from six sampled sites. RESULTS Intervention fidelity and adherence to the trial protocol was high across the 14 sites; however, early supported discharge (an intervention component) was not implemented. Within both randomized groups, some form of rehabilitation was widely accessed. ATTEND stroke coordinators provided counseling and perceived that sustaining patients' motivation to continue with rehabilitation in the face of significant emotional and financial stress as a key challenge. The intervention was perceived as an acceptable community-based package with education as an important component in raising the poor awareness of stroke. Many participants viewed family-led rehabilitation as a necessary model of care for poor and rural populations who could not access rehabilitation. CONCLUSION Difficulty in sustaining patient and carer motivation for rehabilitation without ongoing support, and greater than anticipated access to routine rehabilitation may explain the lack of benefit in the trial. Nonetheless, family-led rehabilitation was seen as a concept worthy of further development.
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Affiliation(s)
- Hueiming Liu
- 1 The George Institute for Global Health, Sydney, Australia.,2 University of Sydney, Sydney, Australia.,3 University of New South Wales, Sydney, Australia
| | - Richard Lindley
- 1 The George Institute for Global Health, Sydney, Australia.,2 University of Sydney, Sydney, Australia
| | - Mohammed Alim
- 4 George Institute for Global Health, Hyderabad, India
| | - Cynthia Felix
- 4 George Institute for Global Health, Hyderabad, India
| | | | | | | | | | | | | | | | | | - Maree L Hackett
- 1 The George Institute for Global Health, Sydney, Australia.,2 University of Sydney, Sydney, Australia.,3 University of New South Wales, Sydney, Australia.,10 University of Central Lancashire, Preston, UK
| | - Craig S Anderson
- 1 The George Institute for Global Health, Sydney, Australia.,2 University of Sydney, Sydney, Australia.,3 University of New South Wales, Sydney, Australia.,11 The George Institute China at Peking University Health Science Centre, China
| | | | | | - Pallab K Maulik
- 3 University of New South Wales, Sydney, Australia.,4 George Institute for Global Health, Hyderabad, India.,13 The George Institute for Global Health, Oxford University, Oxford, UK
| | | | - Stephen Jan
- 1 The George Institute for Global Health, Sydney, Australia.,2 University of Sydney, Sydney, Australia.,3 University of New South Wales, Sydney, Australia
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24
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Public and Private Hospital Care Disparities of Ischemic Stroke in Mexico: Results from the Primer Registro Mexicano de Isquemia Cerebral (PREMIER) Study. J Stroke Cerebrovasc Dis 2017; 27:445-453. [PMID: 29103861 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 08/28/2017] [Accepted: 09/18/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND AIMS Mortality and bad outcome by stroke are higher in developing countries than in industrialized countries. Health-care system efficiency could explain these disparities. Our objective was to identify the impact on short- and middle-term outcomes of patients with acute ischemic stroke (AIS) among public and private Mexican medical care. METHODS We analyzed data from patients with AIS included in the Primer Registro Mexicano de Isquemia Cerebral (PREMIER) study. Transient ischemic attacks (TIAs) and ambulatory patients were excluded. Mortality and good outcome were assessed by the modified Rankin Scale (mRS) and analyzed at 1, 3, and 12 months of follow-up. RESULTS From 1246 patients with AIS included in the registry, 1123 were hospitalized, either in public (n = 881) or in private (n = 242) hospitals. There were no significant differences regarding age and gender. In private settings, patients had a higher educational level, a major frequency of dyslipidemia, a previous stroke and TIA, less overweight and obesity, a sedentary lifestyle, and diabetes; stroke severity, the rate of systemic complications, the length of stay, and in-hospital mortality were also lower; a major frequency of thrombolysis was observed when compared with public hospitals. Our study showed a better outcome (mRS score ≤2) in private scenarios and a higher mortality in patients treated in public hospitals at short- and middle-term follow-ups. CONCLUSIONS A polarized medical practice was observed in the AIS care in this large multicenter cohort of Mexico. There is evidence of an advantage for private scenarios, possibly related with an optimal infrastructure or with a strong patient's economic status.
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25
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Padma VM, Bhatia R, Kuruttukulam G, Alurkar A, Talwar KK, Khurana D, Kaul S, Suri V, Singh G, Huded V. A call for neurologists to take up stroke intervention. Ann Indian Acad Neurol 2016; 19:429-432. [PMID: 27994348 PMCID: PMC5144460 DOI: 10.4103/0972-2327.194408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Recent data have provided overwhelming evidence in favor of benefits of emergent endovascular intervention in large vessel acute ischemic stroke (AIS). India with its large population has a huge burden of AIS. Hence, neurologists need to gear up to the new challenge of providing interventional care to huge populations of AIS in the country. The best way to cover this unprecedented unmet need is to encourage neurologists to take up interventional subspecialty interests through new but sound training pathways.
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Affiliation(s)
- Vasantha M Padma
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Anand Alurkar
- Department of Neurology, KEM Hospital, Pune, Maharashtra, India
| | | | - Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Subhash Kaul
- Department of Neurology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Vinit Suri
- Department of Neurology, Apollo Hospital, New Delhi, India
| | - Gagandeep Singh
- Department of Neurology, Dayanand Medical College, Ludhiana, Punjab, India
| | - Vikram Huded
- NH institute of Neurosciences, Bangalore, Karnataka, India
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26
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Liu H, Lindley R, Alim M, Felix C, Gandhi DBC, Verma SJ, Tugnawat DK, Syrigapu A, Ramamurthy RK, Pandian JD, Walker M, Forster A, Anderson CS, Langhorne P, Murthy GVS, Shamanna BR, Hackett ML, Maulik PK, Harvey LA, Jan S. Protocol for process evaluation of a randomised controlled trial of family-led rehabilitation post stroke (ATTEND) in India. BMJ Open 2016; 6:e012027. [PMID: 27633636 PMCID: PMC5030603 DOI: 10.1136/bmjopen-2016-012027] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION We are undertaking a randomised controlled trial (fAmily led rehabiliTaTion aftEr stroke in INDia, ATTEND) evaluating training a family carer to enable maximal rehabilitation of patients with stroke-related disability; as a potentially affordable, culturally acceptable and effective intervention for use in India. A process evaluation is needed to understand how and why this complex intervention may be effective, and to capture important barriers and facilitators to its implementation. We describe the protocol for our process evaluation to encourage the development of in-process evaluation methodology and transparency in reporting. METHODS AND ANALYSIS The realist and RE-AIM (Reach, Effectiveness, Adoption, Implementation and Maintenance) frameworks informed the design. Mixed methods include semistructured interviews with health providers, patients and their carers, analysis of quantitative process data describing fidelity and dose of intervention, observations of trial set up and implementation, and the analysis of the cost data from the patients and their families perspective and programme budgets. These qualitative and quantitative data will be analysed iteratively prior to knowing the quantitative outcomes of the trial, and then triangulated with the results from the primary outcome evaluation. ETHICS AND DISSEMINATION The process evaluation has received ethical approval for all sites in India. In low-income and middle-income countries, the available human capital can form an approach to reducing the evidence practice gap, compared with the high cost alternatives available in established market economies. This process evaluation will provide insights into how such a programme can be implemented in practice and brought to scale. Through local stakeholder engagement and dissemination of findings globally we hope to build on patient-centred, cost-effective and sustainable models of stroke rehabilitation. TRIAL REGISTRATION NUMBER CTRI/2013/04/003557.
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Affiliation(s)
- Hueiming Liu
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Richard Lindley
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Mohammed Alim
- George Institute for Global Health, Hyderabad, Telangana, India
| | | | | | | | | | | | | | | | | | | | - Craig S Anderson
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | | | | | | | - Maree L Hackett
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Pallab K Maulik
- George Institute for Global Health, Hyderabad, Telangana, India
- The George Institute for Global Health, Oxford University, Oxford, UK
| | - Lisa A Harvey
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
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27
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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: 1.0] [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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Abstract
Transient ischemic attack (TIA) is a transient episode of neurologic dysfunction caused due to loss of blood flow to the brain or spinal cord without acute infarction. Depending on the area of the brain involved, symptoms of TIA vary widely from patient to patient. Since the blockage period in TIA is very short-lived, there is no permanent damage. Risk factors for TIA include family history of stroke or TIA, age above 55 years or older, higher risk of TIA in males than females, high blood pressure, diabetes mellitus, and tobacco smoking. Genetics, race, and imbalance in lipid profile are other risk factors of TIA. TIA is usually diagnosed after taking a thorough history and a physical examination. Several radiological tests such as computed tomography and magnetic resonance imaging are useful in the evaluation of patients who have had a TIA. Ultrasound of the neck and an echocardiogram of the heart are other tests useful in the diagnosis and evaluation of the attack. The treatment following acute recovery from a TIA depends on the underlying cause. Patients who have more than 70% stenosis of the carotid artery, removal of atherosclerotic plaque is usually done by carotid endarterectomy surgery. One-third of the people with TIA can later have recurrent TIAs and one-third can have a stroke because of permanent nerve cell loss. Having a TIA is a risk factor for eventually having a stroke. Educating the patients and inculcating lifestyle modifications in them are initial steps to minimize the prevalence of transient ischemic attack.
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Affiliation(s)
- Supreet Khare
- Armed Forces Medical College, Pune, Maharashtra, India
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29
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Mirelman AJ, Rose S, Khan JA, Ahmed S, Peters DH, Niessen LW, Trujillo AJ. The relationship between non-communicable disease occurrence and poverty-evidence from demographic surveillance in Matlab, Bangladesh. Health Policy Plan 2016; 31:785-92. [PMID: 26843515 DOI: 10.1093/heapol/czv134] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2015] [Indexed: 11/13/2022] Open
Abstract
In low-income countries, a growing proportion of the disease burden is attributable to non-communicable diseases (NCDs). There is little knowledge, however, of their impact on wealth, human capital, economic growth or household poverty. This article estimates the risk of being poor after an NCD death in the rural, low-income area of Matlab, Bangladesh. In a matched cohort study, we estimated the 2-year relative risk (RR) of being poor in Matlab households with an NCD death in 2010. Three separate measures of household economic status were used as outcomes: an asset-based index, self-rated household economic condition and total household landholding. Several estimation methods were used including contingency tables, log-binomial regression and regression standardization and machine learning. Households with an NCD death had a large and significant risk of being poor. The unadjusted RR of being poor after death was 1.19, 1.14 and 1.10 for the asset quintile, self-rated condition and landholding outcomes. Adjusting for household and individual level independent variables with log-binomial regression gave RRs of 1.19 [standard error (SE) 0.09], 1.16 (SE 0.07) and 1.14 (SE 0.06), which were found to be exactly the same using regression standardization (SE: 0.09, 0.05, 0.03). Machine learning-based standardization produced slightly smaller RRs though still in the same order of magnitude. The findings show that efforts to address the burden of NCD may also combat household poverty and provide a return beyond improved health. Future work should attempt to disentangle the mechanisms through which economic impacts from an NCD death occur.
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Affiliation(s)
- Andrew J Mirelman
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK,
| | - Sherri Rose
- Harvard Medical School, 25 Shattuck Street, Boston, MA, 02115, USA
| | - Jahangir Am Khan
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden and International Center for Diarrheal Disease Research (Icddr,B), Mohakhali, Dhaka, Bangladesh
| | - Sayem Ahmed
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden and International Center for Diarrheal Disease Research (Icddr,B), Mohakhali, Dhaka, Bangladesh
| | - David H Peters
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA and
| | - Louis W Niessen
- Liverpool School of Tropical Medicine, University of Liverpool, Pembroke Place, Liverpool, L3 5QA, UK
| | - Antonio J Trujillo
- Centre for Health Economics, University of York, Heslington, York, YO10 5DD, UK
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30
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Alim M, Lindley R, Felix C, Gandhi DBC, Verma SJ, Tugnawat DK, Syrigapu A, Anderson CS, Ramamurthy RK, Langhorne P, Murthy GVS, Shamanna BR, Hackett ML, Maulik PK, Harvey LA, Jan S, Liu H, Walker M, Forster A, Pandian JD. Family-led rehabilitation after stroke in India: the ATTEND trial, study protocol for a randomized controlled trial. Trials 2016; 17:13. [PMID: 26739268 PMCID: PMC4704425 DOI: 10.1186/s13063-015-1129-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/17/2015] [Indexed: 11/26/2022] Open
Abstract
Background Globally, most strokes occur in low- and middle-income countries, such as India, with many affected people having no or limited access to rehabilitation services. Western models of stroke rehabilitation are often unaffordable in many populations but evidence from systematic reviews of stroke unit care and early supported discharge rehabilitation trials suggest that some components might form the basis of affordable interventions in low-resource settings. We describe the background, history and design of the ATTEND trial, a complex intervention centred on family-led stroke rehabilitation in India. Methods/design The ATTEND trial aims to test the hypothesis that a family-led caregiver-delivered home-based rehabilitation intervention, designed for the Indian context, will reduce the composite poor outcome of death or dependency at 6 months after stroke, in a multicentre, individually randomized controlled trial with blinded outcome assessment, involving 1200 patients across 14 hospital sites in India. Discussion The ATTEND trial is testing the effectiveness of a low-cost rehabilitation intervention that could be widely generalizable to other low- and middle-income countries. Trial registration Clinical Trials Registry-India CTRI/2013/04/003557. Australian New Zealand Clinical Trials Registry ACTRN12613000078752. Universal Trial Number U1111-1138-6707. Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-1129-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mohammed Alim
- Research and Development, George Institute for Global Health India, Unit 301, Second Floor ANR Centre, Road No 1, Banjara Hills, Hyderabad, Telangana, India.
| | - Richard Lindley
- The George Institute for Global Health, Sydney, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia.
| | | | | | | | | | | | - Craig Stuart Anderson
- The George Institute for Global Health, Sydney, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia. .,Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia.
| | | | | | | | | | - Maree Lisa Hackett
- The George Institute for Global Health, Sydney, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia. .,University of Central Lancashire, Preston, Lancashire, UK.
| | - Pallab Kumar Maulik
- Research and Development, George Institute for Global Health India, Unit 301, Second Floor ANR Centre, Road No 1, Banjara Hills, Hyderabad, Telangana, India. .,The George Institute for Global Health, Oxford University, Oxford, UK.
| | | | - Stephen Jan
- The George Institute for Global Health, Sydney, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia.
| | - Hueiming Liu
- The George Institute for Global Health, Sydney, Australia. .,Sydney Medical School, University of Sydney, Sydney, Australia.
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31
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Samal S, Panigrahi P, Dutta A. Social epidemiology of excess weight and central adiposity in older Indians: analysis of Study on global AGEing and adult health (SAGE). BMJ Open 2015; 5:e008608. [PMID: 26610757 PMCID: PMC4679837 DOI: 10.1136/bmjopen-2015-008608] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES We aimed to estimate the prevalence of overweight and obesity, represented by extra body weight and abdominal circumference, among older Indians; and to characterise the social pattern of obesity and measure the magnitude of hypertension attributable to it. SETTING A nationally representative sample of older Indians was selected from 6 Indian states, including Rajasthan, Uttar Pradesh, West Bengal, Assam, Maharashtra and Karnataka, as a part of the multicountry Study on global AGEing and adult health (SAGE). PARTICIPANTS Indians aged 50 years or more (n=7273) were included in the first wave of the SAGE (2010), which we used in our study. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measures included excess weight (EW), defined by body mass index (BMI) >25 kg/m(2), and central adiposity (CA), defined by waist circumference >90 cm for men and >80 cm for women. The secondary outcome included hypertension, defined by systolic blood pressure >139 or diastolic blood pressure >79 mm Hg, or by those receiving antihypertensive medications. RESULTS 14% of older Indians possessed EW, whereas 35% possessed CA; 50.9% of the wealthier third and 27.7% of the poorer two-thirds have CA; the proportions being 69.1% and 46.2%, respectively, in older women. Mostly wealth (adjusted OR for CA: 4.36 (3.23 to 5.95) and EW: 4.39 (3.49 to 5.53)), but also urban residence, privileged caste, higher education, white-collared occupation and female gender, were important determinants. One of 17 older Indians overall and 1 of 18 in the poorer 70% suffered from CA-driven hypertension, independent of BMI. CONCLUSIONS The problem of CA and its allied diseases is already substantial and expected to rise across all socioeconomic strata of older Indians, though currently, CA affects the privileged more than the underprivileged, in later life. Population-based promotion of appropriate lifestyles, with special emphasis on women, is required to counteract prosperity-driven obesity before it becomes too entrenched and expensive to uproot.
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Affiliation(s)
- Sudipta Samal
- Centre for Disease Epidemiology and Surveillance, Asian Institute of Public Health, Bhubaneswar, Odisha, India
| | - Pinaki Panigrahi
- Center for Global Health and Development, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Ambarish Dutta
- Centre for Disease Epidemiology and Surveillance, Asian Institute of Public Health, Bhubaneswar, Odisha, India
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32
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Anderson CS, Woodward M, Arima H, Chen X, Lindley RI, Wang X, Chalmers J. Statistical analysis plan for evaluating low- vs. standard-dose alteplase in the ENhanced Control of Hypertension and Thrombolysis strokE stuDy (ENCHANTED). Int J Stroke 2015; 10:1313-5. [PMID: 26283139 PMCID: PMC5324659 DOI: 10.1111/ijs.12602] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 06/22/2015] [Indexed: 12/01/2022]
Abstract
Background The ENhanced Control of Hypertension And Thrombolysis strokE stuDy trial is a 2 × 2 quasi‐factorial active‐comparison, prospective, randomized, open, blinded endpoint clinical trial that is evaluating in thrombolysis‐eligible acute ischemic stroke patients whether: (1) low‐dose (0·6 mg/kg body weight) intravenous alteplase has noninferior efficacy and lower risk of symptomatic intracerebral hemorrhage compared with standard‐dose (0·9 mg/kg body weight) intravenous alteplase; and (2) early intensive blood pressure lowering (systolic target 130–140 mmHg) has superior efficacy and lower risk of any intracerebral hemorrhage compared with guideline‐recommended blood pressure control (systolic target <180 mmHg). Objective To outline in detail the predetermined statistical analysis plan for the ‘alteplase dose arm’ of the study. Methods All data collected by participating researchers will be reviewed and formally assessed. Information pertaining to the baseline characteristics of patients, their process of care, and the delivery of treatments will be classified, and for each item, appropriate descriptive statistical analyses are planned with appropriate comparisons made between randomized groups. For the trial outcomes, the most appropriate statistical comparisons to be made between groups are planned and described. Results A statistical analysis plan was developed for the results of the alteplase dose arm of the study that is transparent, available to the public, verifiable, and predetermined before completion of data collection. Conclusions We have developed a predetermined statistical analysis plan for the ENhanced Control of Hypertension And Thrombolysis strokE stuDy alteplase dose arm which is to be followed to avoid analysis bias arising from prior knowledge of the study findings.
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Affiliation(s)
- Craig S Anderson
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - Mark Woodward
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - Hisatomi Arima
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia.,Centre for Epidemiologic Research in Asia, Shiga University of Medical Sciences, Shiga University, Shiga, Japan
| | - Xiaoying Chen
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - Richard I Lindley
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - Xia Wang
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
| | - John Chalmers
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, NSW, Australia
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Saefudin T, Apriantoro NH, Hidayat ES, Purnamawati S. The Correlation Between Age and Bleeding Volume in Haemorrhagic Stroke Using Multi Slice CT at District Hospitals in Jakarta. Glob J Health Sci 2015; 8:152-7. [PMID: 26573030 PMCID: PMC4873570 DOI: 10.5539/gjhs.v8n4p152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 07/06/2015] [Indexed: 11/30/2022] Open
Abstract
Haemorrhagic Stroke is a common disease in Indonesia. The best imaging modality for this disease is Multi Slice Computed Tomography Scanning (MSCT), as it may help strengthening the diagnosis as well as determining the brain bleeding volume. This study aimed to show correlation between bleeding volume of the brain and patient’s age using cross-sectional approach. The 68 samples in this study were taken from secondary data from Head CT Scan of Haemorrhagic Stroke cases. Brain bleeding volume is the dependent variable, obtained through slice thickness of 5 mm and ABC/2 method with software measurement in MSCT Scan device. The independent variable of this study is the patient’s age. The result of the study was the average brain’s bleeding volume of 21.76 ml ± 2.48 ml (range of 1.04 ml to 94.73 ml). The slice thickness using ABC/2 method, has a significant correlation with brain’s bleeding volume in MSCT Scan examination, with correlation coefficient value r of 0.79. Brain bleeding volume in patients who have ages lower than 50 years and more or equal to 50 years were (18.93 ± 3.26) ml and (23.53 ± 3.47) ml respectively. There is no correlation between age and brain’s bleeding volume in haemorrhagic stroke cases, with p value of 0.18, r = 0.19.
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Sureshkumar K, Murthy GVS, Kinra S, Goenka S, Kuper H. Development and evaluation of a Smartphone-enabled, caregiver-supported educational intervention for management of physical disabilities following stroke in India: protocol for a formative research study. ACTA ACUST UNITED AC 2015; 1:117-126. [PMID: 26751379 PMCID: PMC4687506 DOI: 10.1136/bmjinnov-2015-000042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The incidence and prevalence of stroke in India has reached epidemic proportions. The growing magnitude of disability in patients with stroke in India poses a major public health challenge. Given the nature of the condition, affected individuals often become disabled with profound effects on their quality of life. The availability of rehabilitation services for people with disabilities is inadequate in India. Rehabilitation services are usually offered by private hospitals located in urban areas and many stroke survivors, especially those who are poor or live in rural areas, cannot afford to pay for, or do not have access to, such services. Thus, identification of cost-effective ways to rehabilitate people with stroke-related disability is an important challenge. Educational interventions in stroke rehabilitation can assist stroke survivors to make informed decisions regarding their on-going treatment and to self-manage their condition with support from their caregivers. Although educational interventions have been shown to improve patient knowledge for self-management of stroke, an optimal format for the intervention has not as yet been established, particularly in low- and middle-income countries. This formative research study aims to systematically develop an educational intervention for management of post-stroke disability for stroke survivors in India, and evaluate the feasibility and acceptability of delivering the intervention using Smartphones and with caregiver support. The research study will be conducted in Chennai, India, and will be organised in three different phases. Phase 1: Development of the intervention. Phase 2: Field testing and finalising the intervention. Phase 3: Piloting of the intervention and assessment of feasibility and acceptability. A mixed-methods approach will be used to develop and evaluate the intervention. If successful, it will help realise the potential of using Smartphone-enabled, carer-supported educational intervention to bridge the gaps in service access for rehabilitation of individuals with stroke-related disability in India. The proposed research will also provide valuable information for clinicians and policymakers.
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Affiliation(s)
- K Sureshkumar
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene and Tropical Medicine , London , UK
| | - G V S Murthy
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene and Tropical Medicine , London , UK
| | - Sanjay Kinra
- Department of Non-Communicable Disease, Epidemiology, London School of Hygiene and Tropical Medicine , London , UK
| | | | - Hannah Kuper
- International Centre for Evidence in Disability, Department of Clinical Research, London School of Hygiene and Tropical Medicine , London , UK
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Menon J, Vijayakumar N, Joseph JK, David PC, Menon MN, Mukundan S, Dorphy PD, Banerjee A. Below the poverty line and non-communicable diseases in Kerala: The Epidemiology of Non-communicable Diseases in Rural Areas (ENDIRA) study. Int J Cardiol 2015; 187:519-24. [PMID: 25846664 DOI: 10.1016/j.ijcard.2015.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/01/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION India carries the greatest burden of global non-communicable diseases (NCDs). Poverty is strongly associated with NCDs but there are few prevalence studies which have measured poverty in India, particularly in rural settings. METHODS In Kerala, India, a population of 113,462 individuals was identified. The "Epidemiology of Non-communicable Diseases in Rural Areas" (ENDIRA) study was conducted via ASHAs (Accredited Social Health Activists). Standardised questionnaires were used in household interviews of individuals ≥18years during 2012 to gather sociodemographic, lifestyle and medical data for this population. The Government of Kerala definition of "the poverty line" was used. The association between below poverty line (BPL) status, NCDs and risk factors was analysed in multivariable regression models. RESULTS 84,456 adults were included in the analyses (25.4% below the poverty line). The prevalence of NCDs was relatively common: myocardial infarction (MI) 1.4%, stroke 0.3%, respiratory diseases 5.0%, and cancer 1.1%. BPL status was not associated with age (p=0.96) or gender (p=0.26). Compared with those above the poverty line (APL), the BPL group was less likely to have diabetes, hypertension or dyslipidaemia (p<0.0001), and more likely to smoke (p<0.0001). Compared with APL, BPL was associated with stroke (OR 1.33, 1.04-1.69; p=0.02) and respiratory disease (OR 1.23, 1.15-1.32; p<0.0001) in multivariable analyses, but not MI or cancer. CONCLUSIONS In rural Kerala, BPL status was associated with stroke and respiratory diseases, but not with MI and cancer although it was associated with smoking status, compared with above poverty line status.
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Affiliation(s)
- Jaideep Menon
- Amrita Institute of Medical Sciences, Ponekkara, Kochi, Kerala, India.
| | - N Vijayakumar
- Blood Bank & Dialysis Unit, Aluva Taluk Hospital, Kochi, Kerala, India.
| | | | - P C David
- MAGJ Hospital, Mookkannoor, Kerala, India.
| | - M N Menon
- Aiswarya Clinic, Sree Moolanagaram, Kerala, India.
| | | | - P D Dorphy
- Deva Matha Hospital, Koratty, Kerala, India.
| | - Amitava Banerjee
- University of Birmingham Centre for Cardiovascular Sciences, Birmingham, UK.
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Huang Y, Sharma VK, Robinson T, Lindley RI, Chen X, Kim JS, Lavados P, Olavarría V, Arima H, Fuentes S, Nguyen HT, Lee TH, Parsons MW, Levi C, Demchuk AM, Bath PMW, Broderick JP, Donnan GA, Martins S, Pontes-Neto OM, Silva F, Pandian J, Ricci S, Stapf C, Woodward M, Wang J, Chalmers J, Anderson CS. Rationale, Design, and Progress of the ENhanced Control of Hypertension ANd Thrombolysis Stroke Study (ENCHANTED) Trial: An International Multicenter 2 × 2 Quasi-Factorial Randomized Controlled Trial of Low- vs. Standard-Dose rt-PA and Early Intensive vs. Guideline-Recommended Blood Pressure Lowering in Patients with Acute Ischaemic Stroke Eligible for Thrombolysis Treatment. Int J Stroke 2015; 10:778-88. [DOI: 10.1111/ijs.12486] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 03/08/2015] [Indexed: 11/27/2022]
Abstract
Rationale Controversy exists over the optimal dose of intravenous (iv) recombinant tissue plasminogen activator (rt-PA) and degree of blood pressure (BP) control in acute ischaemic stroke (AIS). Asian studies suggest low-dose (0·6 mg/kg) is more efficacious than standard-dose (0·9 mg/kg) iv rt-PA, and guidelines recommend reducing systolic BP to <185 mmHg before and <180 mmHg after use of iv rt-PA, despite observational studies indicating better outcomes at much lower (<140 mmHg) systolic BP levels in this patient group. Aims The study aims to assess in thrombolysis-eligible AIS patients whether: (i) low-dose (0·6 mg/kg body weight; maximum 60 mg) iv rt-PA has non-inferior efficacy and lower risk of symptomatic intracerebral haemorrhage (sICH) compared to standard-dose (0·9 mg/kg body weight; maximum 90 mg) iv rt-PA; and (ii) early intensive BP lowering (systolic target 130–140 mmHg) has superior efficacy and lower risk of any ICH compared to guideline-recommended BP control (systolic target < 180 mmHg). Design The ENhanced Control of Hypertension And Thrombolysis strokE stuDy (ENCHANTED) trial is an independent, 2 × 2 quasi-factorial, active-comparison, prospective, randomized, open blinded endpoint (PROBE), clinical trial that is evaluating Arm [A] ‘rt-PA dose’ and/or Arm [B] ‘BP control’, using central Internet randomization and data collection in patients fulfilling local criteria for thrombolysis and clinician uncertainty over the study treatments. The treatment arms will be analyzed separately. Study outcomes The primary study outcome in both trial Arms is death or disability according to the modified Rankin scale (mRS, scores 2–6) assessed at 90 days. Secondary outcomes include sICH, any ICH, a shift (‘improvement’) in function across mRS scores, separately on death and disability, early neurological deterioration, recurrent major vascular events, health-related quality of life, length of hospital stay, need for permanent residential care, and health care costs. Results Following launch of the trial in February 2012, the study has recruited more than 2500 patients across a global network of approximately 100 sites in 15 countries. The required sample sizes are 3300 for Arm [A] and 2300 for Arm [B], which will provide >90% power to detect non-inferiority of low-dose iv rt-PA and superiority of intensive BP lowering on the primary clinical outcome, respectively. Conclusions Low-dose iv rt-PA and early intensive BP lowering could provide more affordable and safer use of thrombolysis treatment for patients with AIS worldwide.
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Affiliation(s)
- Yining Huang
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Vijay K. Sharma
- Division of Neurology, Department of Medicine, National University Hospital and YLL School of Medicine, National University of Singapore, Singapore
| | - Thompson Robinson
- Department of Cardiovascular Sciences and NIHR Biomedical Research Unit, University of Leicester University, Leicester, UK
| | - Richard I. Lindley
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Xiaoying Chen
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Jong Sung Kim
- Asan Medical Center, University of Ulsan, Seoul, South Korea
| | - Pablo Lavados
- Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
- Universidad de Chile, Santiago, Chile
| | - Verónica Olavarría
- Clinica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile
| | - Hisatomi Arima
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Sully Fuentes
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | | | - Tsong-Hai Lee
- Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Mark W. Parsons
- John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Christopher Levi
- John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Andrew M. Demchuk
- Calgary Stroke Program, Department of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Philip M. W. Bath
- Stroke trials Unit, Division of Clinical Neuroscience, University of Nottingham, Nottingham, UK
| | - Joseph P. Broderick
- Departments of Neurology and Rehabilitation Medicine and Radiology, University of Cincinnati Neuroscience Institute, University of Cincinnati Academic Health Center, Cincinnati, OH, USA
| | - Geoffrey A. Donnan
- The Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia
| | - Sheila Martins
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio grande do Sul, Rio Grande do Sul, Brazil
| | - Octavio M. Pontes-Neto
- Stroke Service — Neurology Division, Department of Neuroscience and Behavior, Ribeirão Preto School of Medicine, University of Sao Paulo, Ribeirão Preto, SP, Brazil
| | | | - Jeyaraj Pandian
- Department of Neurology, Christian Medical College, Ludhiana, India
| | - Stefano Ricci
- Direttore, UO Neurologia, USL Umbria 1, Sedi di Città di Castello e Branca, Italy
| | - Christian Stapf
- Department of Neurology, APHP — Hôpital Lariboisière and DHU NeuroVasc Paris — Sorbonne, Univ Paris Diderot — Sorbonne Paris Cité, Paris, France
| | - Mark Woodward
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Jiguang Wang
- The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao-tong University School of Medicine, Shanghai, China
| | - John Chalmers
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
| | - Craig S. Anderson
- The George Institute for Global Health, Royal Prince Alfred Hospital and University of Sydney, Sydney, Australia
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Sharma VK, Kawnayn G, Sarkar N. Acute ischemic stroke: comparison of low-dose and standard-dose regimes of tissue plasminogen activator. Expert Rev Neurother 2014; 13:895-902. [PMID: 23965163 DOI: 10.1586/14737175.2013.827412] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Intravenous tissue plasminogen activator (IV-TPA), administered within 4.5 h of symptom onset, is the only therapeutic agent approved for achieving arterial recanalization in acute ischemic stroke. Current major guidelines recommend the use of a standard dose (0.9 mg/kg bodyweight; maximum 90 mg) of IV-TPA. However, comparable efficacy of IV-TPA was demonstrated in the observational studies from Japan when a lower dose (0.6 mg/kg bodyweight; maximum 60 mg) was used and later approved by the regulatory authorities. Although limited in numbers, considerable variations in the dose of IV-TPA are noted in recent publications from Asia, with variable results and optimal dose of TPA in Asia remains controversial. The authors present a systemic review of the existing literature and compare the efficacy and safety of standard-versus the low-dose IV-TPA therapy in acute ischemic stroke.
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Affiliation(s)
- Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Hospital, 5 Lower Kent Ridge Road, 119074 Singapore
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Engels T, Baglione Q, Audibert M, Viallefont A, Mourji F, El Alaoui Faris M. Socioeconomic status and stroke prevalence in Morocco: results from the Rabat-Casablanca study. PLoS One 2014; 9:e89271. [PMID: 24586649 PMCID: PMC3938460 DOI: 10.1371/journal.pone.0089271] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 01/18/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Stroke is a growing public health concern in low- and middle- income countries. Improved knowledge about the association between socioeconomic status and stroke in these countries would enable the development of effective stroke prevention and management strategies. This study presents the association between socioeconomic status and the prevalence of stroke in Morocco, a lower middle-income country. METHODS Data on the prevalence of stroke and stroke-related risk factors were collected during a large population-based survey. The diagnosis of stroke in surviving patients was confirmed by neurologists while health, demographic, and socioeconomic characteristics of households were collected using structured questionnaires. We used Multiple Correspondence Analysis to develop a wealth index based on characteristics of the household dwelling as well as ownership of selected assets. We used logistic regressions controlling for multiple variables to assess the statistical association between socioeconomic status and stroke. FINDINGS Our results showed a significant association between household socioeconomic status and the prevalence of stroke. This relationship was non-linear, with individuals from both the poorest (mainly rural) and richest (mainly urban) households having a lower prevalence of stroke as compared to individuals with medium wealth level. The latter belonged mainly to urban households with a lower socioeconomic status. When taking into account the urban population only, we observed that a third of poorest households experienced a significantly higher prevalence of stroke compared to the richest third (OR = 2.06; CI 95%: 1.09; 3.89). CONCLUSION We conclude that individuals from the most deprived urban households bear a higher risk of stroke than the rest of the population in Morocco. This result can be explained to a certain extent by the higher presence of behavioral risk factors in this specific category of the population, which leads in turn to metabolic and physiological risk factors of stroke, such as obesity, diabetes, and hypertension.
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Affiliation(s)
- Thomas Engels
- CERDI-CNRS, University of Auvergne, Clermont-Ferrand, France
| | | | | | - Anne Viallefont
- CERDI-CNRS, University of Auvergne, Clermont-Ferrand, France
| | - Fouzi Mourji
- Hassan II Aïn Chock University and LASAARE, Casablanca, Morocco
| | - Mustapha El Alaoui Faris
- Department of Neurology and Neuropsychology, Hôpital des Spécialités and Mohamed V-Souissi University, Rabat, Morocco
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Shrivastav M, Padte S, Arora V, Biffi M. Pilot evaluation of an integrated monitor-adhesive patch for long-term cardiac arrhythmia detection in India. Expert Rev Cardiovasc Ther 2013; 12:25-35. [PMID: 24325206 DOI: 10.1586/14779072.2013.867807] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Electrocardiographic monitoring represents one of the most reliable and time-tested methods for reducing ambiguity in cardiac arrhythmia diagnosis. In India, the resting ECG is generally the first tool of choice for in-clinic diagnosis. The external loop recorder (ELR) is another useful tool that compounds the advantages of traditional tools by coupling ambulatory monitoring with a long-term window. Thus, the objective was to test the use of a 7-day ELR for arrhythmia diagnosis in India for a broad range of presenting symptoms. In this study set in the Indian healthcare environment, an auto-triggered, wireless patch-type ELR was used with 125 patients (62.5 ± 16.7 years, 76 males) presenting a broad range of symptoms. Eighty percent of the symptoms were related to syncope, presyncope or palpitations. Patients were administered an ELR for 7-28 days depending on the physician's prescription. Prespecified significant arrhythmias included sinus pause >2 s, symptomatic bradycardia <40 b.p.m., second-degree (and higher) AV block, complete heart block, ventricular fibrillation, sustained/nonsustained ventricular tachycardia (>3 beats), atrial fibrillation (chronic or paroxysmal), atrial flutter and supraventricular tachycardia (SVT) >130 b.p.m. Diagnostic yield was 38% when a stringent tabulation methodology considering only clinically significant arrhythmia was used. When first-degree AV block, premature atrial and ventricular beats, couplets (both atrial and ventricular in origin), bigeminy or trigeminy, or sudden changes in rate (noted as sinus arrhythmia) were included in the calculation, diagnostic yield was 80%. Patient compliance was 98%; patients wore the patch for the entire prescribed monitoring period without disruption. Seventy percent of the reported symptoms corresponded with an arrhythmia. Use of the ELR led to therapy change in 24% of patients: 15 patients went on to receive an implantable cardioverter defibrillator or pacemaker, 4 received ablation therapy and 11 altered their medication after diagnosis. This study demonstrates that a high diagnostic yield for clinically significant arrhythmias and high patient compliance can be achieved with a wearable patch monitor in Indian patients suffering from a variety of symptoms.
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Affiliation(s)
- Maneesh Shrivastav
- India Medtronic Private Limited, 1241 Solitaire Corporate Park, Andheri-Ghatkopar Link Road, Andheri East, Mumbai 400 093, India
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Berkowitz AL, Mittal MK, McLane HC, Shen GC, Muralidharan R, Lyons JL, Shinohara RT, Shuaib A, Mateen FJ. Worldwide Reported Use of IV Tissue Plasminogen Activator for Acute Ischemic Stroke. Int J Stroke 2013; 9:349-55. [DOI: 10.1111/ijs.12205] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 08/30/2013] [Indexed: 11/27/2022]
Abstract
Background and Purpose Intravenous tissue plasminogen activator is the most effective treatment for acute ischemic stroke, and its use may therefore serve as an indicator of the available level of acute stroke care. The greatest burden of stroke is in low- and middle-income countries, but the extent to which intravenous tissue plasminogen activator is used in these countries is unreported. Summary of Review A systematic review was performed searching each country name AND ‘stroke’ OR ‘tissue plasminogen activator’ OR ‘thrombolysis’ using PubMed, Embase, Global Health, African Index Medicus, and abstracts published in the International Journal of Stroke (Jan. 1, 1996–Oct. 1, 2012). The reported use of intravenous tissue plasminogen activator was then analyzed according to country-level income status, total expenditure on health per capita, and mortality and disability-adjusted life years due to stroke. There were 118 780 citations reviewed. Of 214 countries and independent territories, 64 (30%) reported use of intravenous tissue plasminogen activator for acute ischemic stroke in the medical literature: 3% (1/36) low-income, 19% (10/54) lower-middle-income, 33% (18/54) upper-middle-income, and 50% (35/70) high-income-countries (test for trend, P < 0·001). When considering country-level determinants of reported intravenous tissue plasminogen activator use for acute ischemic stroke, total healthcare expenditure per capita (odds ratio 3·3 per 1000 international dollar increase, 95% confidence interval 1·4–9·9, P = 0·02) and reported mortality rate from cerebrovascular disease (odds ratio 1·02, 95% confidence interval 0·99–1·06, P = 0·02) were significant, but reported disability-adjusted life years from cerebrovascular diseases and gross national income per capita were not ( P > 0·05). Of the 10 countries with the highest disability-adjusted life years due to stroke, only one reported intravenous tissue plasminogen activator use. Conclusions By reported use, intravenous tissue plasminogen activator for acute ischemic stroke is available to some patients in approximately one-third of countries. Access to advanced acute stroke care is most limited where the greatest burden of cerebrovascular disease is reported.
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Affiliation(s)
- Aaron L. Berkowitz
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Manoj K. Mittal
- Department of Neurology, The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Gordon C. Shen
- Health Policy and Management Division, School of Public Health, University of California, Berkeley, CA, USA
| | - RajaNandini Muralidharan
- Division of Neurocritical Care, Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
| | - Jennifer L. Lyons
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Russell T. Shinohara
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashfaq Shuaib
- Division of Neurology, Department of Internal Medicine, University of Alberta, Edmonton, AB, Canada
| | - Farrah J. Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
- Department of International Health, Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, MD, USA
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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: 163] [Impact Index Per Article: 14.8] [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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Mangat A, Grewal D, Kaur P, Jyotsna R, Singh R, Pandian JD. Dietary patterns in stroke patients in Northwest India. Nutr Neurosci 2013; 16:288-92. [PMID: 23433119 DOI: 10.1179/1476830513y.0000000058] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Little is known about the dietary patterns among stroke patients in India. We explored the dietary patterns in stroke patients and attempted to correlate the dietary patterns with stroke characteristics. METHODS This hospital-based study was carried out in a tertiary referral centre in Northwest India from March 2008 to September 2009. All first ever stroke (ischaemic and hemorrhagic) patients were interviewed by the dietician using an oral diet questionnaire. The demographic information and risk factors were noted and outcome was assessed after 30 days using modified Rankin scale (≤2 = good outcome). RESULTS A total of 210 stroke patients were enrolled. The mean age was 60 ± 14 years and 126 (60%) patients were men. Hypertension (167 (79.5%)) was the major risk factor. All patients consumed cereals and beverages. Consumption of other food items in the diet were as follows: milk and milk products (203 (96.7%)), saturated fats (butter, butter oil, cream) (133 (63.3%)), bakery items (139 (66.2%)), fried snacks (116 (55.2%)), fruits (96 (45.7%)), and juices (20 (9.5%)). Large proportion of the patients (112 (53.6%)) consumed more food calories than recommended. Use of fried snacks was significant in patients who consumed alcohol (P = 0.03) and patients who had diabetes mellitus were more likely to use saturated fats (P = 0.01). DISCUSSION Majority of the patients consumed milk and milk products. Fruits and juices were consumed by a small proportion of patients. Our results provide opportunities for stroke prevention by diet modification.
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Affiliation(s)
- Arshi Mangat
- Christian Medical College, Ludhiana, Punjab, India
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Finlayson K, Downe S. Why do women not use antenatal services in low- and middle-income countries? A meta-synthesis of qualitative studies. PLoS Med 2013; 10:e1001373. [PMID: 23349622 PMCID: PMC3551970 DOI: 10.1371/journal.pmed.1001373] [Citation(s) in RCA: 281] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 12/05/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Almost 50% of women in low- and middle-income countries (LMICs) don't receive adequate antenatal care. Women's views can offer important insights into this problem. Qualitative studies exploring inadequate use of antenatal services have been undertaken in a range of countries, but the findings are not easily transferable. We aimed to inform the development of future antenatal care programmes through a synthesis of findings in all relevant qualitative studies. METHODS AND FINDINGS Using a predetermined search strategy, we identified robust qualitative studies reporting on the views and experiences of women in LMICs who received inadequate antenatal care. We used meta-ethnographic techniques to generate themes and a line-of-argument synthesis. We derived policy-relevant hypotheses from the findings. We included 21 papers representing the views of more than 1,230 women from 15 countries. Three key themes were identified: "pregnancy as socially risky and physiologically healthy", "resource use and survival in conditions of extreme poverty", and "not getting it right the first time". The line-of-argument synthesis describes a dissonance between programme design and cultural contexts that may restrict access and discourage return visits. We hypothesize that centralised, risk-focused antenatal care programmes may be at odds with the resources, beliefs, and experiences of pregnant women who underuse antenatal services. CONCLUSIONS Our findings suggest that there may be a misalignment between current antenatal care provision and the social and cultural context of some women in LMICs. Antenatal care provision that is theoretically and contextually at odds with local contextual beliefs and experiences is likely to be underused, especially when attendance generates increased personal risks of lost family resources or physical danger during travel, when the promised care is not delivered because of resource constraints, and when women experience covert or overt abuse in care settings.
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Affiliation(s)
- Kenneth Finlayson
- Research into Childbirth and Health Unit, School of Health, University of Central Lancashire, Preston, United Kingdom
| | - Soo Downe
- Research into Childbirth and Health Unit, School of Health, University of Central Lancashire, Preston, United Kingdom
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Shrivastav M, Shrivastav R, Makkar J, Biffi M. Patient selection for ambulatory cardiac monitoring in the Indian healthcare environment. HEART ASIA 2013; 5:112-9. [PMID: 27326100 DOI: 10.1136/heartasia-2012-010228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 05/23/2013] [Accepted: 05/26/2013] [Indexed: 11/03/2022]
Abstract
Cardiovascular disease (CVD) in India comprises the bulk of non-communicable diseases, resulting in 2 million deaths per year. The incidence of CVD in India is estimated to be up to four times higher than in other countries. Though the quantification of the prevalence of rhythm disorders in India is not available, it can be inferred to be proportionately high. Identification and treatment of arrhythmia is limited by several socioeconomic factors including low health insurance penetration, limited reimbursement and high out-of-pocket expenditures. Thus, there exists a need in India to (1) select an appropriate tool that is both high yielding and cost effective and (2) employ a suitable patient selection method. This paper focuses on these two aspects for cardiac arrhythmia diagnosis using ambulatory monitoring technology, while keeping in mind the dynamics of the Indian healthcare setting.
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Affiliation(s)
| | | | - Jitendra Makkar
- Department of Cardiology , Fortis Escorts Hospital , Jaipur , India
| | - Mauro Biffi
- Institute of Cardiology, University of Bologna , Bologna , Italy
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Toivanen S. Social Determinants of Stroke as Related to Stress at Work among Working Women: A Literature Review. Stroke Res Treat 2012; 2012:873678. [PMID: 23251832 PMCID: PMC3518054 DOI: 10.1155/2012/873678] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2012] [Accepted: 10/25/2012] [Indexed: 12/03/2022] Open
Abstract
In adult life, many of the social determinants of health are connected to working life. Yet, our knowledge of the role of work-related factors for the risk of stroke is fairly limited. In contemporary occupational health research, the Demand-Control Model (DCM) is frequently used to measure work stress. Previous literature reviews of the association of work stress and cardiovascular disease (CVD) do not include stroke as a specific outcome. Results regarding work stress and the risk of CVD are less evident in working women. With the focus on working women, the purpose of the present paper was to review the current research into the DCM in relation to stroke and to scrutinize potential gender differences. A literature search was performed and eight studies from three countries were identified. Based on the reviewed studies, there is some evidence that high psychological demands, low job control, and job strain are associated with increased stroke risk in women as well as in men. Any major reduction in deaths and disability from stroke is likely to come from decreasing social inequalities in health, and reducing work stress has a potential to contribute to a reduced risk of stroke in working populations.
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Affiliation(s)
- Susanna Toivanen
- Centre for Health Equity Studies (CHESS), Stockholm University and Karolinska Institutet, 106 91 Stockholm, Sweden
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Pandian JD, Kaur A, Jyotsna R, Sylaja PN, Vijaya P, Padma MV, Venkateswaralu K, Sukumaran S, Mathew R, Kaur P, Singh YP, Radhakrishnan K. Complications in Acute Stroke in India (CAST-I): A Multicenter Study. J Stroke Cerebrovasc Dis 2012; 21:695-703. [DOI: 10.1016/j.jstrokecerebrovasdis.2011.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2011] [Revised: 03/04/2011] [Accepted: 03/09/2011] [Indexed: 10/18/2022] Open
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Cotlarciuc I, Khan MS, Maheshwari A, Yadav S, Khan FY, Al-Hail H, de Silva R, Gorthi SP, Gupta S, Sharma SR, Sylaja PN, Prasad K, Sharma P. Bio-repository of DNA in stroke: a study protocol of three ancestral populations. JRSM Cardiovasc Dis 2012; 1:10.1258_cvd.2012.012019. [PMID: 24175068 PMCID: PMC3738328 DOI: 10.1258/cvd.2012.012019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Stroke is a leading cause of death and disability in the world. Identifying the genes underlying stroke risk may help us to improve our understanding of the mechanisms that cause stroke and also identify novel therapeutic targets. To have sufficient power to disentangle the genetic component of stroke, large-scale highly phenotyped DNA repositories are necessary. The BRAINS (Bio-repository of DNA in stroke) study aims to recruit subjects with all subtypes of stroke as well as controls from UK, India, Sri Lanka and Qatar. BRAINS-UK will include 1500 stroke patients of European ancestry as well as British South Asians. BRAINS-South Asia aims to recruit 3000 stroke subjects and 3000 controls from across India and Sri Lanka. BRAINS-Middle East aims to enrol 1500 stroke patients from Qatar. The controls for BRAINS-Middle East will be recruited from a population-based Qatari Biobank. With the addition of new recruitment centres in India and Qatar, we present an updated version of the BRAINS study protocol. This is the first international DNA biobank for stroke patients and controls from the Middle East. By investigating the influence of genetic factors on stroke risk in European, South Asian and Middle Eastern populations, BRAINS has the potential to improve our understanding of genetic differences between these groups and may lead to new population-specific therapeutic targets.
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Affiliation(s)
- Ioana Cotlarciuc
- Imperial College Cerebrovascular Research Unit (ICCRU) , Imperial College London , London , UK
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Pandian JD, Bhullar RS, Kaur P, Dhillon S, Toor G, Singh Y. Trends in the use of intravenous recombinant tissue plasminogen activator from northwest India. Int J Stroke 2012; 7:363-4. [PMID: 22583526 DOI: 10.1111/j.1747-4949.2012.00793.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fitzgerald SM, Srikanth VK, Evans RG, Thrift AG. Benefits and Challenges in Stroke Research in Developing Countries. BRAIN IMPAIR 2012. [DOI: 10.1375/brim.9.2.198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractStroke is one of the leading causes of death worldwide. Currently more than two thirds of the burden of stroke occurs in developing countries. Development of strategies for prevention and management of stroke in these countries requires data on incidence, risk factors and management practices that are relevant to the specific socioeconomic and cultural factors present in these populations. Yet currently available data come almost exclusively from developed countries. Herein, we aim to discuss some of the issues, impediments and opportunities faced by researchers undertaking population-based studies on the burden of stroke in developing countries. Important criteria to be addressed include the establishment of productive working relationships with both local collaborators and the community; the identification of an appropriate population group; and development of a working protocol which takes into account potential language barriers and the need for cultural sensitivity. When possible the protocol should include similar methods to studies conducted elsewhere so that comparisons can be made between regions. Furthermore, the results of such studies should be disseminated in an appropriate and timely manner to the local community and appropriate government and nongovernment organisations. This will enable the development and implementation of prevention and intervention programs to reduce the impact of stroke in these nations.
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Sharma VK, Ng KWP, Venketasubramanian N, Teoh HL, Chan BP. Intravenous thrombolysis for acute ischemic stroke in Asia. Expert Rev Neurother 2012; 12:209-17. [PMID: 22288676 DOI: 10.1586/ern.11.148] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Data regarding thrombolysis for acute ischemic stroke in Asia are scarce and only a small percentage of patients are thrombolysed. Clinical trials that led to the recommended dose of intravenously administered tissue plasminogen activator (IV-tPA) included predominantly Caucasian patients. However, the single-arm case-controlled observational studies in Japanese patients suggested the clinical efficacy and safety of low-dose IV-tPA (0.6 mg/kg bodyweight; maximum 60 mg) comparable with standard dose (0.9 mg/kg bodyweight; maximum 90 mg). There has been no randomized clinical trial for determining the dose, efficacy or safety of IV-tPA in Asia. Accordingly, the dose of IV-tPA in Asia remains controversial. Reduced treatment cost, lower symptomatic intracerebral hemorrhage risk and comparable efficacy encouraged many Asian centers to adopt low-dose or even variable-dose IV-tPA regimens. We present the current status of thrombolysis for acute ischemic stroke in Asia.
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Affiliation(s)
- Vijay K Sharma
- Division of Neurology, National University Hospital, 1E Kent Ridge Road, Singapore, 119228.
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