Investigation of Stroke Needs (INVISION) Study: Stroke Awareness and Education

The objective of this study was to assess the overall understanding and effectiveness of current inpatient stroke education practice by using the data from the Investigation of Stroke Needs (INVISION) Study, a qualitative study assessing various challenges and barriers of the hemorrhagic stroke survivors and their caregivers. Semi-structured interviews were conducted on patients who were recently hospitalized with intracerebral hemorrhage (ICH) and their caregivers during the follow-up visits. The electronic medical record for each patient was reviewed to assess whether they received standard stroke education material during their hospitalization. A phenomenological approach was utilized to identify gaps of education and knowledge in the targeted sample. A total of 21 participants were interviewed. Despite receiving formal stroke education material during their hospitalization, there were three major gaps in stroke knowledge that participants noted, including (1) lack of stroke knowledge/awareness, (2) need for stroke education, and (3) fear of recurrent stroke and comorbid diseases. The majority of ICH survivors had no memory of their hospitalization. This study suggests a need for increased continuity and communication with health-care providers to address the evolving educational and practical needs of stroke patients and their caregivers after hospital discharge.     

Living with the aftermaths of a stroke in the era of the COVID-19 pandemic; the significance of home and close surroundings

Stay-at-home recommendations to reduce the spread of the COVID-19 virus have had a major impact on people's everyday lives. However, while the evidence indicates that such recommendations have caused distress, anxiety, and fear among the public, little is known about how persons living with complex health conditions, e.g., disability after stroke, have experienced and handled the situation. We interviewed fourteen participants (7 women, 7 men) aged 61–91 years living in ordinary housing during summer 2020 to explore how people who recovered after a stroke experienced their everyday lives in their homes and close surroundings during the COVID-19 pandemic recommendations. Three intertwined themes were constructed from the narrative data and the iterative thematic analysis: (1) Places within and out of reach, (2) Upholding activities–strategies and structures, and (3) Adapting to new circumstances. The findings suggest that places within reach were important to maintain activities and provide structure in daily life. The participants seemed to make use of their previous experiences of adjusting to new circumstances after stroke when adapting to living under the stay-at-home recommendations. In addition, feeling that they now shared the restrictions with all other people in society seemed to ease their situations. Access to nature and spaces in the close surroundings was essential for staying socially connected and receiving support in daily life. The significance of the home and the neighbourhood for health experiences among people who recently have had a stroke should inform rehabilitation interventions both during and after pandemics and environmental planning.     

The experiences and needs of Chinese‐Canadian stroke survivors and family caregivers as they re‐integrate into the community

Stroke is a leading cause of adult disability and community re‐integration is a priority for stroke rehabilitation. In North America, we have a growing population of individuals whose first language is not English. Little is known about the experiences of visible minorities living in North America as they re‐integrate into the community post stroke or how these experiences change over time. Specifically, this research aimed to explore the experiences and needs of Chinese stroke survivors and family caregivers as they return to community living using the Timing it Right Framework as a conceptual guide. We recruited Cantonese‐speaking stroke survivors and family caregivers from outpatient rehabilitation programmes. Using qualitative interviews conducted in Cantonese or English, we examined their experiences and needs as they return to community living and explored the influence of culture and time on their experiences. The interviews were transcribed and translated, and then analysed using framework analysis. Using framework analysis, we coded the data corresponding to the phases of the Timing it Right framework to determine the influence of time on the themes. We interviewed five Cantonese‐speaking stroke survivors and 13 caregivers in 2009. We identified two main themes: (i) Participants' education and support needs change over time and (ii) Chinese resources are needed across care environments. These resources include access to care in their preferred language, traditional Chinese medicine, and Chinese food during their recovery and rehabilitation. To optimise Chinese stroke survivors' and caregivers' community re‐integration, healthcare professionals should provide timely and accessible education and be aware of the role of Chinese diet and traditional medicine in stroke survivors' rehabilitation.     

Sexuality in Stroke Care: A Neglected Quality of Life Issue in Stroke Rehabilitation? A Pilot Study

Although there is a substantial body of literature on the physical and psychosexual consequences of stroke, there is a paucity of empirical studies on the experiences of rehabilitation professionals in addressing sexuality issues with patients during the rehabilitation process. This is the first small-scale pilot study in Northern Ireland, informed by a comprehensive literature review, which explores the experiences of health and social care professionals in addressing sexuality issues with patients and their perceptions of the training they require in this area of stroke rehabilitation. Questionnaire survey data were collected from community and hospital based stroke professionals in a Health and Social Services Trust in Northern Ireland. The study groups comprised nurses, doctors, physiotherapists, occupational therapists, speech and language therapists and social workers. The findings revealed that although the majority of staff had been asked for advice on sexuality issues during rehabilitation, most of them had received no training in this aspect of stroke rehabilitation since joining stroke services. The findings suggest that all rehabilitation professionals need to become more knowledgeable about sexuality issues in stroke care and could benefit from further education and training in comprehensive sexual health care.     

儿童与青少年身高生长曲线的比较研究

为探讨我国儿童与青少年的生长发育特征及发展趋势，用ＪＰＡ２模型对我国８０年代和９０年代的身高资料（不含台湾省和香港）作生长曲线拟合，并与发达国家和地区的生长标准进行比较。结果显示，生长曲线拟合使不同来源的资料具有可比性。比较结果，８０年代我国城市儿童身高的生长差距以青春发育期最为明显。９０年代，北京市７岁以上至成熟期之前男女儿童各年龄组的身高已高于香港和日本，基本达到美国健康统计中心（ＮＣＨＳ）标准，但成年高度仍比ＮＣＨＳ低３～４ｃｍ。与８０年代相比，北京市青少年成年高度趋于稳定。     

‘After the stroke’: patients’ and carers’ experiences of healthcare after stroke in Scotland

We report findings on patients with stroke and carers experiences of the healthcare system in Scotland after stroke. These findings emerged from data collected in a primary qualitative study exploring patients with stroke and carers perception of a Functional Electrical Stimulation (FES) Clinic. Rich data emerged in relation to healthcare after stroke as experienced by both patients and carers, highlighting important clinically relevant messages and constituting an important area for dissemination. Thirteen patients with stroke and nine carers consented to participate. Data were collected using face‐to‐face semi‐structured interviews, undertaken in April and May 2007, and analysed using the framework of Interpretative Phenomenological Analysis (IPA). IPA aims to explore in depth the participants lived experiences of a specific phenomenon. An overarching theme of ‘After the stroke’ was identified. Within this, six sub‐themes emerged entitled, (1) ‘What is wrong?’; (2) ‘Help came quickly’; (3) ‘Something is still wrong’; (4) ‘In the hospital’; (5) ‘I’m taking them home’ and (6) ‘Back at home’. Interestingly, patients with stroke and carers recalled similar parts of the pathway through the healthcare system after stroke, resulting in the six chronological sub‐themes. The data highlighted issues surrounding recognition of stroke symptoms by both participants and professionals; expeditious admission to hospital and stroke unit; consultation during the discharge planning process and access to support and community follow up. Despite the availability of clinical guidelines to direct the management of stroke, this study suggests that the experiences of patients with stroke and carers do not always concur with guideline recommendations. These results highlight that such recommendations do not always transfer into clinical practice. Both clinicians and service managers should consider these issues when delivering care to patients after stroke.     

Time use of stroke patients in three rehabilitation hospitals

The active role of the patient in the rehabilitation hospital requires the efficient use of patient time. Previous work has found that such patients spend a relatively small portion of their day in treatment. In this study 63 stroke patients in three hospitals were observed for two work days each. Fifty observations were made during each day of the patient's location, activity and whom the patient was with. Treatment occupied an average of 31% of the day. Passive behavior took up 42% of patients' time. Discriminant analysis showed that patients in the hospital with a separate stroke unit spent more time in treatment. In spite of quantitative differences, the three hospitals had similar patterns of treatment activity and deployment of staff. Clinical norms for the treatment of stoke across the three hospitals resulted in similar treatment experiences for patients. A system of prospective payment which did not require specific billed treatment hours might allow more flexibility and efficiency in this type of specialty hospital.     

The unfortunate generation: stroke survivors in Riga,Latvia

The poor health status of citizens in post-Soviet states has been reported but few studies have investigated the illness experiences of people in those countries. This paper reports findings from an interview study conducted with stroke patients in Riga, Latvia, who were part of a cohort recruited over 1 year for a European study comparing the provision of care, outcomes and resource use. The interview study aimed to elicit stroke patients' own perceptions of the impact of stroke 1 year after the event. Adopting a phenomenological perspective we illustrate how the particular social setting shapes stroke as an illness, its influences on access to health care and on consideration of the impact of stroke. We argue that for stroke survivors and their relatives in post-Soviet Latvia this disorder acquires a meaning that transcends the individual biography and signifies an upheaval of social life in general. The meanings attributed to stroke by interviewees are developed in the context of the momentous recent historical events which participants lived through. In this sense, stroke has become an idiom of a disruption in social biography rather than individual biography alone. Most participants were pensioners and their main concern was their own poverty. Some complained of their inability to meet their basic needs, much less pay for on-going medication and therapy. Only one person was 'severely disabled', using a standard neurological definition, but about half of those interviewed regarded the stroke as a sign foretelling their own death. Although this generation had expected to be cared for in their older age under the Soviet regime, the much longed for Latvian independence was seen to have brought unexpected hardships for those who were old and sick.     

Changes in Sexual Experiences and Relationship Quality During Pregnancy

The present research examined changes in sexuality and relationship quality during pregnancy. In three studies, participants completed self-report scales of sex-related emotions, thoughts, motives, and experiences, as well as relationship quality. Study 1 (N = 361) examined the differences between pregnant and non-pregnant women in sexual and relational experiences. Study 2 (N = 25) monitored women’s sexuality and relationship quality throughout the three trimesters of pregnancy. Study 3 examined gender differences in changes in sexual and relational experiences during the second and third trimesters of pregnancy among 31 cohabiting couples. The findings revealed that pregnant women were more sexually motivated by relational concerns than both their partners and non-pregnant women. Additionally, the results pointed to the involvement of two corresponding processes: Sexual enjoyment declined as pregnancy progressed, whereas relational satisfaction was relatively unchanged during pregnancy. These findings suggest that the progress of pregnancy may independently affect sexuality and relational quality.     

FIGHTING BACK—STRUGGLING TO CONTINUE LIFE AND PRESERVE THE SELF FOLLOWING A STROKE

The aim of this longitudinal phenomenological study was to explore how female stroke survivors experienced their life following a stroke and how they managed their altered situation. Twenty-five women suffering first-time stroke were interviewed in depth three times during the first one and a half years after the stroke. Applying the method of Giorgi, we found that there was a lengthy struggle to continue life and preserve the self following the stroke. The struggle was closely related to their deeply rooted identity as mothers, wives, grandmothers, and housewives. The situation of women following a stroke needs particular attention because their needs may conflict with their female caring roles. On the other hand, supporting them in transforming these roles may secure their sense of self and a continued meaningful life.     

Fighting back--struggling to continue life and preserve the self following a stroke

The aim of this longitudinal phenomenological study was to explore how female stroke survivors experienced their life following a stroke and how they managed their altered situation. Twenty-five women suffering first-time stroke were interviewed in depth three times during the first one and a half years after the stroke. Applying the method of Giorgi, we found that there was a lengthy struggle to continue life and preserve the self following the stroke. The struggle was closely related to their deeply rooted identity as mothers, wives, grandmothers, and housewives. The situation of women following a stroke needs particular attention because their needs may conflict with their female caring roles. On the other hand, supporting them in transforming these roles may secure their sense of self and a continued meaningful life.     

Balancing satisfaction and stress: carer burden among White and British Asian Indian carers of stroke survivors

Objectives: This paper presents the findings of a qualitative study exploring White and British Indian informal stroke carers’ experiences of caring, factors contributing to their stress, and strategies used to overcome stress.

Design: A qualitative approach involving in-depth interviews was used to explore informal carers’ experiences of caring for stroke survivors and the stress of caring at one and three to six months from the onset of stroke. Interviewers bilingual in English and Gujarati or Punjabi conducted interviews with carers. Socio-demographic data of carers and stroke survivors were collected at one, and three to six months by dedicated stroke research nurses.

Results: A total of 37 interviews with carers caring for stroke survivors with a wide range of physical and mental impairments were completed. A majority of carers had assumed the task of caring within a few weeks of the stroke. Irrespective of ethnicity, carers’ emotional and physical well-being was undermined by the uncertainty and unpredictability of caring for stroke survivors, and meeting their expectations and needs. The strain of managing social obligations to care was common to all carers irrespective of gender and ethnicity, but the higher levels of anxiety and depression reported by Indian British female carers appeared to stem from the carers’ pre-existing physical ailments, their cultural and religious beliefs, and household arrangements. Carers’ strain in extended households was exacerbated by the additional responsibility of caring for other dependent relatives.

Conclusion: Since the role of carers is clearly indispensable in the successful rehabilitation of survivors, it is vital to ensure that their well-being is not undermined by a lack of information and training, and that their need for professional support is prioritised.     

中国人群中父母脑卒中史与脑卒中发病关系的前瞻性研究

目的探讨中国人群中父母脑卒中史与子代脑卒中发病的关系。方法1992—1994年在全国12组人群中分别整群随机抽取1000～2000人进行心血管病危险因素调查，并对心血管事件的发生情况进行随访观察，随访至2005年6月，平均随访10．8年。结果15131例随访对象共发生脑卒中事件370例。在控制了年龄、性别后，父母双方均无脑卒中史者、仅父母一方有脑卒中史者、父母双方均有脑卒中史者发生脑卒中的相对危险分别为1．00、1．74（1．33～2．29）和3．61（1．86～7．01）。在进一步控制了基线时的吸烟、饮酒、总胆固醇、高密度脂蛋白胆固醇、空腹血糖、体重指数和收缩压后，上述各组发生脑卒中的相对危险分别为1．00、1．34（1．02～1．77）和2．50（1．29～4．87）。结论父母有脑卒中史者具有较高的发生脑卒中危险性，父母双方均有脑卒中者脑卒中发病危险的增加尤为显著。     

大学生不同时期不良经历与抑郁症的关系

探讨大学生不同时期不良经历与抑郁症的关系,为预防大学生抑郁症提供参考.方法 采用分层整群抽样方法抽取湖北省6所高校5 913名在校本科生,采用网络调查问卷,问卷内容包括大学生基本信息、家庭有关信息、不同时期不良经历以及是否患有抑郁症.率之间的比较用x2/Fisher检验,多元Logistic回归分析相关影响因素.结果 5 913名大学生中,自我报告被医生诊断患有/患过抑郁症的有82名,患病率为1.4%.2 198名(37.2%)有童年期不良经历,l 757名(29.7%)有青少年期不良经历,5 158名(87.2%)有上大学后的挫折经历.1 329名(22.5%)同时有童年期和青少年期不良经历,1 160名(19.6%)同时有童年期和青少年期不良经历以及上大学后挫折经历.童年期不良经历与抑郁症有关,童年期有不良经历者患抑郁症的可能性是童年期无不良经历者的2.351倍(95%CI=1.475~ 3.747),而青少年期不良经历、上大学后的挫折经历以及各时期不良经历的叠加均与抑郁症无关(P值均>0.05).结论 需积极关注有童年期不良经历的大学生,给予一定的心理辅导和社会支持,预防或减少抑郁情绪的产生.     

An exploration of participation in leisure activities post‐stroke

Aim: The purpose of this study was to illuminate the experiences of older adults’ return to leisure activities, following rehabilitation, post‐stroke. Method: A phenomenological approach was used to explore the experiences of re‐engaging in leisure occupations post‐stroke. In‐depth interviews were conducted with five community‐dwelling individuals (three men, two women) aged 68–74 years who had experienced a stroke in the past year. Data were analysed using thematic analysis. Findings: Four themes emerged: (i) Re‐engaging in leisure activities, (ii) acceptance of physical limitations post‐stroke, (iii) gratitude for help and support and (iv) looking forward to the future. Conclusion: Implications revealed that post‐stroke interventions need a more occupation‐focussed approach, including return to leisure at an earlier stage of stroke rehabilitation.     

Energy metabolism, body composition, and milk production in healthy Swedish women during lactation

Variables of relevance to energy requirements during reproduction were studied in 23 healthy lactating Swedish women. Body composition and resting metabolic rate (RMR) were studied before pregnancy and three times postpartum. Energy intake was studied before pregnancy and, together with breast-milk production, 2 mo postpartum. The women gained 5.8 +/- 4.2 kg fat during pregnancy and their average fat content was unchanged during the first 2 mo of lactation whereas a slight loss (1.7 +/- 4.2 kg) occurred during the following 4 mo. RMR increased slightly during lactation in spite of a decrease in fat-free body weight 2 and 6 mo postpartum. Energy intake increased during lactation (280 +/- 440 kcal/d). The women produced 740 +/- 150 g breast milk/d containing 0.64 +/- 0.08 kcal/g. The results indicate that current estimates of energy needs during lactation may be too high.     

Age and follow-up time affect the prognostic value of the ECG and conventional cardiovascular risk factors for stroke in adult men

OBJECTIVES: To explore whether the predictive power of mid-life ECG abnormalities and conventional cardiovascular risk factors for future stroke change over a 30-year follow-up period, and whether a repeated examination improves their predictive power. DESIGN AND SETTING: Longitudinal population-based study. PARTICIPANTS: 2,322 men aged 50 years, with a follow-up period of 30 years. 1,221 subjects were re-examined at age 70 years MAIN OUTCOME MEASURE: Risk for fatal and non-fatal stroke during three decades of follow-up. Investigations included resting ECG and traditional cardiovascular risk factors. RESULTS: When measured at age 50 years, ST segment depression and T wave abnormalities, together with ECG-left ventricular hypertrophy, were of importance only during the first 20 years, but regained importance when re-measured at age 70 years. Blood pressure was a significant predictor for stroke over all three decades of follow-up. In elderly people only, there is evidence that apolipoprotein A1 may protect from future stroke. CONCLUSION: Mid-life values for blood pressure and ECG abnormalities retain their predictive value over long follow-up periods even though they improved in predictive power when re-measured in elderly people. Despite lower prevalence, ECG abnormalities had greater impact at age 50 years than at age 70 years. By contrast, apolipoprotein A1 was protective for future stroke only at age 70 years.