Prevention of stroke: a global perspective Pandian, Jeyaraj D; Gall, Seana L; Kate, Mahesh P ...
The Lancet (British edition),
10/2018, Volume:
392, Issue:
10154
Journal Article
Peer reviewed
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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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Abstract Background Youth leisure-time physical activity participation benefits physical activity habits and health outcomes later in life. However, it is unknown if certain types of leisure-time ...physical activity contribute to these benefits in different ways; this knowledge could enhance public health efforts. This systematic review aimed to synthesise evidence of the longitudinal associations between childhood and adolescent leisure-time physical activity on adulthood physical activity behaviours and health outcomes. Methods A systematic search of the literature was conducted across five databases from inception to July 2022. English, peer-reviewed observational studies with a minimum of two timepoints of data collection were eligible for inclusion. We included studies that investigated the association between participation in leisure-time physical activity types in children and adolescents (i.e., 5–18 years), and physical activity, mental health, or cardiovascular outcomes in adulthood (i.e., ≥ 18 years). Results Fourteen studies were included in the review, totalling 34,388 observations across five countries. Running in adolescence was associated with increased adulthood physical activity in both sexes, while sports involvement was associated with an increase in physical activity in males only. Adolescent team sports participation was associated with reduced odds of early adulthood depression, with varying findings for anxiety disorders. There was preliminary evidence of minimum threshold requirements for participation in certain activities before associations with future physical activity or health outcome benefits were observed. Conclusions Preliminary findings suggest that the lifelong behavioural and health benefits of adolescent participation in leisure-time physical activity appear to be related to the type of activity undertaken, with potential differences between sexes. With the rarity of longitudinal studies spanning from childhood into adulthood, these findings provide important insights for public health strategies to optimise lifelong health and physical activity participation. Prospero registration CRD42022347792.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The long-term effects of skipping breakfast on cardiometabolic health are not well understood.
The objective was to examine longitudinal associations of breakfast skipping in childhood and adulthood ...with cardiometabolic risk factors in adulthood.
In 1985, a national sample of 9-15-y-old Australian children reported whether they usually ate breakfast before school. During follow-up in 2004-2006, 2184 participants (26-36 y of age) completed a meal-frequency chart for the previous day. Skipping breakfast was defined as not eating between 0600 and 0900. Participants were classified into 4 groups: skipped breakfast in neither childhood nor adulthood (n = 1359), skipped breakfast only in childhood (n = 224), skipped breakfast only in adulthood (n = 515), and skipped breakfast in both childhood and adulthood (n = 86). Diet quality was assessed, waist circumference was measured, and blood samples were taken after a 12-h fast (n = 1730). Differences in mean waist circumference and blood glucose, insulin, and lipid concentrations were calculated by linear regression.
After adjustment for age, sex, and sociodemographic and lifestyle factors, participants who skipped breakfast in both childhood and adulthood had a larger waist circumference (mean difference: 4.63 cm; 95% CI: 1.72, 7.53 cm) and higher fasting insulin (mean difference: 2.02 mU/L; 95% CI: 0.75, 3.29 mU/L), total cholesterol (mean difference: 0.40 mmol/L; 95% CI: 0.13, 0.68 mmol/L), and LDL cholesterol (mean difference: 0.40 mmol/L; 95% CI: 0.16, 0.64 mmol/L) concentrations than did those who ate breakfast at both time points. Additional adjustments for diet quality and waist circumference attenuated the associations with cardiometabolic variables, but the differences remained significant.
Skipping breakfast over a long period may have detrimental effects on cardiometabolic health. Promoting the benefits of eating breakfast could be a simple and important public health message.
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CMK, GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Public transport users tend to accumulate more physical activity than non-users; however, whether physical activity is increased by financially incentivising public transport use is unknown. The ...trips4health study aimed to determine the impact of an incentive-based public transport intervention on physical activity. A single-blinded randomised control trial of a 16-week incentive-based intervention involved Australian adults who were infrequent bus users (greater than or equal to 18 years; used bus less than or equal to 2 times/week) split equally into intervention and control groups. The intervention group were sent weekly motivational text messages and awarded smartcard bus credit when targets were met. The intervention group and control group received physical activity guidelines. Accelerometer-measured steps/day (primary outcome), self-reported transport-related physical activity (walking and cycling for transport) and total physical activity (min/week and MET-min/week) outcomes were assessed at baseline and follow-up. Due to the COVID pandemic, the trial was abandoned prior to target sample size achievement and completion of all assessments (N = 110). Steps/day declined in both groups, but by less in the intervention group -557.9 steps (-7.9%) vs.-1018.3 steps/week (-13.8%). In the intervention group, transport-related physical activity increased 80.0 min/week (133.3%); 264.0 MET-min/week (133.3%) while total physical activity levels saw little change 35.0 min/week (5.5%); 25.5 MET-min/week (1.0%). Control group transport-related physical activity decreased -20.0 min/week (-27.6%); -41.3 MET-min/week (-17.3%), but total physical activity increased 260.0 min/week (54.5%); 734.3 MET-min/week (37.4%). This study found evidence that financial incentive-based intervention to increase public transport use is effective in increasing transport-related physical activity These results warrant future examination of physical activity incentives programs in a fully powered study with longer-term follow-up.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Skipping breakfast has been linked with poor diet quality, higher BMI and adverse cardiometabolic outcomes. This study aimed to determine the prevalence and correlates of skipping breakfast among ...Australian children and adolescents.
A total of 1,592 2–17‐year‐olds completed two 24‐hour recalls, collected via face‐to‐face and telephone interview, in the 2011–12 National Nutrition and Physical Activity Survey. Breakfast was an eating occasion of ≥210kJ named as ‘breakfast’ by the participant. Child, household and adult correlates of skipping breakfast were reported. Odds ratios were calculated using ordinal regression. Linear regression was used to examine differences in dietary intake. Survey weights were applied to give nationally representative estimates.
Most (86.8% of boys, 81.4% of girls) ate breakfast on both days, 11.8% of boys and 14.8% girls skipped on one day and 1.4% boys and 3.8% girls skipped on both days. Characteristics associated with skipping breakfast were being female, being older, being underweight or overweight/obese, poorer diet, lower physical activity, inadequate sleep, lower household income, greater socioeconomic disadvantage, and being from a single‐parent home.
Skipping breakfast was common among Australian adolescents but few consistently skipped.
Interventions to increase breakfast should target adolescents, particularly girls, and low SEP households.
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BFBNIB, CEKLJ, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Real-world evidence is limited on whether antihypertensive medications help avert major adverse cardiovascular events (MACE) after stroke without increasing the risk of falls. We investigated the ...association of adherence to antihypertensive medications on the incidence of MACE and falls requiring hospitalization after stroke.
A retrospective cohort study of adults who were newly dispensed antihypertensive medications after an acute stroke (Australian Stroke Clinical Registry 2012-2016; Queensland and Victoria). Pharmaceutical dispensing records were used to determine medication adherence according to the proportion of days covered in the first 6 months poststroke. Outcomes between 6 and 18 months postdischarge included: (i) MACE, a composite outcome of all-cause death, recurrent stroke or acute coronary syndrome; and (ii) falls requiring hospitalization. Estimates were derived using Cox models, adjusted for >30 confounders using inverse probability treatment weights.
Among 4076 eligible participants (median age 68 years; 37% women), 55% had a proportion of days covered ≥80% within 6 months postdischarge. In the subsequent 12 months, 360 (9%) participants experienced a MACE and 337 (8%) experienced a fall requiring hospitalization. After achieving balance between groups, participants with a proportion of days covered ≥80% had a reduced risk of MACE (hazard ratio: 0.68; 95% CI: 0.54-0.84) and falls requiring hospitalization (subdistribution hazard ratio: 0.78; 95% CI: 0.62-0.98) than those with a proportion of days covered <80%.
High adherence to antihypertensive medications within 6 months poststroke was associated with reduced risks of both MACE and falls requiring hospitalization. Patients should be encouraged to adhere to their antihypertensive medications to maximize poststroke outcomes.
To examine whether change in rehabilitation environment (hospital or home) and other factors influence time spent sitting upright and walking after stroke.
Observational study.
Two inpatient ...rehabilitation units and community residences following discharge.
Participants (N=34) with stroke were recruited.
An activity monitor was worn continuously for 7 days during the final week in the hospital and the first week at home. Other covariates included mood, fatigue, physical function, pain, and cognition. Linear mixed models were performed to examine the associations between the environment (exposure) and physical activity levels (outcome) in the hospital and at home. Interaction terms between the exposure and other covariates were added to the model to determine whether they modified activity with change in environment.
The mean age of participants was 68±13 years and 53% were male. At home, participants spent 45 fewer minutes sitting (95% CI -84.8, -6.1; P=.02), 45 more minutes upright (95% CI 6.1, 84.8; P=.02), and 12 more minutes walking (95% CI 5, 19; P=.001), and completed 724 additional steps (95% CI 199, 1250; P=.01) each day compared to in the hospital. Depression at discharge predicted greater sitting time and less upright time (P=.03 respectively) at home.
Environmental change from hospital to home was associated with reduced sitting time and increased the time spent physically active, though depression modified this change. The rehabilitation environment may be a target to reduce sitting and promote physical activity.
Socioeconomic status (SES) is associated with stroke occurrence and survival following stroke but its association with health-related quality of life (HRQoL) following stroke remains uncertain. We ...performed a systematic review and meta-analysis to examine the association between SES and HRQoL after stroke. PubMed, SCOPUS, EMBASE, and Web of Science were searched to identify relevant cohort and case-control studies between January 2000 and May 2022. Two authors screened titles, abstracts and full text articles. One author extracted data from all included studies. Meta-analyses were performed for studies with comparable measurements of SES and HRQoL. Random effects models were used to estimate pooled summary standardised mean differences in HRQoL by SES. Out of 1,876 citations, 39 studies incorporated measurement of overall HRQoL following stroke and were included in the systematic review, with 17 studies included in the meta-analyses. Overall, reports including education, income, occupation and work status effects on HRQoL after stroke were inconsistent among all included 39 studies. In the global meta-analysis of 17 studies, HRQoL among survivors of stroke was lower in the low SES group than in the high SES group (standardised mean difference (SMD) -0.36, 95% CI -0.52, -0.20, p < 0.0001). When using education and income indicators separately, summary effects were similar to those of the global analysis (low versus high education SMD -0.38, 95% CI -0.57, -0.18, p < 0.0001; low versus high income SMD -0.39, 95% CI -0.59, -0.19, p < 0.0001). Across all SES indicators, people with stroke who have lower SES have poorer overall HRQoL than those with higher SES. Accessibility and affordability of poststroke support services should be taken into consideration when planning and delivering services to people with low SES.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Background Partnering and parenting are important life-stage transitions that often occur during young adulthood. Little is known about how these transitions affect two dietary behaviors ...linked to increased cardiometabolic disease risk: skipping breakfast and takeaway-food consumption. Objective Our aim was to examine whether partnering and parenting transitions during a 5-year period were associated with change in diet quality, skipping breakfast, and takeaway-food consumption. Design We conducted a cohort study. Questionnaires were completed at baseline (2004 to 2006) and follow-up (2009 to 2011). Marital status and number of children were self-reported. Participants/setting Australian participants (n=1,402 39% men) aged 26 to 36 years were included. Main outcomes measures Diet quality was assessed using a Dietary Guideline Index. Breakfast skipping (not eating before 9 am the previous day) and frequent takeaway-food consumption (≥2 times/week) were reported. Statistical analysis Linear regression (mean differences in Dietary Guideline Index) and log binomial regression (relative risks for skipping breakfast and frequent takeaway-food consumption) were adjusted for age, education, follow-up duration, day of the week (skipping breakfast only), the other transition, and baseline behavior. Results During the 5-year follow-up, 101 men and 93 women became married/living as married, and 149 men and 155 women had their first child. Diet quality improved among all groups and was similar at follow-up between those who experienced the transitions and those who did not. Compared to having no children, having a first child was associated with a lower risk of skipping breakfast for men (relative risk 0.65; 95% CI 0.42 to 1.01) and women (relative risk 0.47; 95% CI 0.31 to 0.72). Men who became partnered also had a lower risk of skipping breakfast than those who remained single (relative risk 0.64; 95% CI 0.42 to 0.98). The transitions were not significantly associated with takeaway-food consumption. Conclusions Life-stage transitions were not associated with better diet quality. Participants who became partnered or parents were more likely to eat breakfast at follow-up than those who remained single or had no children.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
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