Living with consequences of stroke and risk factors for unhealthy diet- experiences among stroke survivors and caregivers in Nairobi, Kenya.

BACKGROUND: Stroke prevalence is increasing in sub-Saharan Africa and has been partly attributed to the rapid economic and population growth that have contributed to changes in lifestyle and increased the prevalence of modifiable risk factors for stroke. Healthy diet is important in stroke management and secondary stroke prevention. The aim was to explore the clinical characteristics and functioning after stroke and the experiences of nutritional aspects among stroke survivors and caregivers in Nairobi, Kenya. METHODS: A cross-sectional study with qualitative and quantitative methods involving two rounds of data collection was utilised. In the first round, data on demographics and clinical characteristics were collected for 30 people poststroke during a seminar organized by the Kenya Stroke Association. In the second round, nine participants then agreed to be interviewed together with their caregivers and asked to describe their own experiences and their household eating patterns after suffering a stroke. The food frequency questionnaire and anthropometric measurements of weight, height and waist measurements were used. The self-reported data were analyzed using descriptive statistics and the transcribed interview texts used a constructivist-based theory. RESULTS: The results give an insight in the life situation for people living with consequences after stroke and their caregivers in Nairobi. The participants were aware that they were overweight and that this indicated an increased risk for the development of cardiovascular diseases. A core category emerged: The caregiver as the main definer of health and enabler of healthy diet among persons who have had a stroke. Healthy diets and provided information on eating healthy were lacking from the healthcare professionals, whereupon the responsibility for managing a healthy diet had shifted to the caregivers. CONCLUSIONS: Support needs to be given to people with stroke and their caregivers to achieve a healthy diet. The importance of healthy eating as a way of reducing the risk of suffering a stroke needs to be communicated by health care. The Kenyan food-based dietary guidelines need to be more implemented and accessible as well as an overall secondary stroke prevention program.

Psychometric properties of the Fatigue Severity Scale: Rasch analyses of responses in a Norwegian and a Swedish MS cohort.

BACKGROUND: Rigorous testing of the original Fatigue Severity Scale (FSS-9) with modern psychometric methods is warranted. OBJECTIVE: To determine the psychometric properties of the FSS-9 in multiple sclerosis (MS): internal scale validity; person response validity; unidimensionality; uniform differential item functioning; temporal stability of response patterns; and ability to separate people into distinct groups of fatigue. METHODS: Rasch analyses were conducted on data from a Norwegian and a Swedish MS cohort followed for two years. RESULTS: Item estimations in the FSS-9 did not differ between sex or levels of education but between the cohorts with regard to disability, disease course and time for evaluation, however, items 1 and 2 demonstrated unacceptable high outfit mean-square values in both cohorts. In an FSS-7 item version, items 3 and 4 in the Norwegian and 4 in the Swedish cohort demonstrated unacceptable goodness of fit but high separation indexes. In the FSS-7, the first unidimensional factor explained 87.5% (Norwegian cohort) and 86.4% (Swedish cohort) of the total variation. CONCLUSIONS: In MS, the FSS-7 demonstrates better psychometric properties than the FSS-9; items 1 and 2 neither empirically nor conceptually fit with the other seven items.

Non-adherence to interferon-beta therapy in Swedish patients with multiple sclerosis.

OBJECTIVES: To explore the occurrence and reasons for stopping, switching or continuing first prescribed interferon-beta therapy in patients with multiple sclerosis in Sweden, with respect to demographic, clinical and/or therapy-related factors. MATERIALS AND METHODS: A retrospective study reviewing the medical charts of 259 patients with multiple sclerosis, comparing patients continuing therapy for at least 3 years with those switching or stopping therapy. RESULTS: Sixty 9% stopped (15%), or switched (54%), interferon-beta therapy within 3 years. Stoppers had longer disease duration before starting therapy (P = 0.002), less frequently relapsing-remitting multiple sclerosis (P = 0.046), and more often Expanded Disability Status Scale scores 6-9.5 (P = 0.045) compared to Switchers. The most common reasons for switching/stopping therapy were perceived lack of effect and side-effects. CONCLUSIONS: Adherence to initial immune-modulating therapy is low; identification of patients at higher risk of stopping therapy and provision of adequate support are essential.

Palliative day care--a study of well-being and health-related quality of life.

AIM: The aim of the study was to study the outcomes of palliative day care, in terms of health-related quality of life and the emotional well-being of cancer patients participating in a palliative day care programme for a period of five weeks, compared with a group of palliative cancer patients not participating in day-care. METHODS: The day care sample comprised of patients in a palliative day care programme delivered in two different day care facilities. Participants in the comparison group were recruited from a palliative home care service facility. All patients had a cancer diagnosis. The participants were invited to respond to two questionnaires once a week for a period of five weeks; the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-30) and the Mood Adjective List (MACL). RESULTS: The participants in the day care group and the comparison group reported similar levels of perceived functioning and symptoms, as measured by the EORTC QLQ-30, with no significant differences between the groups. However, the day care group reported higher levels of emotional well-being as measured by the MACL than the comparison group reported, although these differences were not statistically significant.

A longitudinal study of variations in and predictors of fatigue in multiple sclerosis.

OBJECTIVES: To describe variations in fatigue over the course of 2 years in a sample of persons with multiple sclerosis (MS), and to investigate the predictive value of the following variables on variations in fatigue: sex, age, sense of coherence, living with a partner, living with children, work status, immunomodulatory treatment, mood, disease severity, disease course, time since diagnosis and time. METHODS: Every 6 months, 219 outpatients at an MS specialist clinic were assessed using the Fatigue Severity Scale (FSS). Predictive values were explored with Generalised Estimating Equation employing proportional odds models; FSS scores were categorised as non-fatigue, borderline fatigue or fatigue. RESULTS: FSS scores varied significantly (p = 0.02); 54% changed FSS category one or several times, 27% were persistently fatigued and 19% persistently non-fatigued. Independent predictors of increased fatigue were depressive symptoms, weak/moderate sense of coherence, living with a partner and not working. Furthermore, moderate disease severity predicted increase when combined with >10 years since diagnosis or a progressive course. Independent predictors of decreased fatigue were no depressive symptoms, strong sense of coherence, living alone and working. Moreover, mild and severe disease predicted a decrease when combined with >10 years since diagnosis, and mild severity combined with a progressive course. CONCLUSION: Mood, sense of coherence and living with a partner were independent predictors of fatigue in persons with MS. In addition to monitoring disease related variables, health related services should apply a broad range of approaches and repeatedly assess fatigue in persons with MS, to provide preventive care and appropriate interventions.

A population-based study of depressive symptoms in multiple sclerosis in Stockholm county: association with functioning and sense of coherence.

OBJECTIVES: To explore and analyse the prevalence of depressive symptoms in people with multiple sclerosis (PwMS), taking into account disease-related and sociodemographic factors, and also to analyse the association between depressive symptoms and functioning (tested and self-reported) and sense of coherence (SOC), respectively. METHODS: Home visits were made to a population-based sample of 166 PwMS. Data were obtained from structured, face-to-face interviews using the Beck Depression Inventory (BDI), the Sickness Impact Profile (SIP) and the SOC scale. A range of tests were also carried out for analyses of different aspects of functioning such as cognitive function, walking capacity and manual dexterity, and structured interviews examined activities of daily living and frequency of social/lifestyle activities. RESULTS: 19% (28/149) of the people were depressed (BDI > or = 13). Depressive symptoms were associated with worse self-reported functioning on the SIP and with poor memory function, but not with any of the other tests of functioning. Depressive symptoms were associated with weak SOC, but not with any of the disease-related or sociodemographic factors studied. CONCLUSION: The prevalence of depressive symptoms in a population-based sample of PwMS is high. Given the serious nature of depression and its association with worse self-reported functioning and weak SOC, attention to, and treatment of, mental-health problems and depression are strongly indicated in the clinical management of multiple sclerosis.

Aneurysm of the sinus of Valsalva producing obstruction of the left main coronary artery.

An aneurysm of the left sinus of Valsalva compressed the left main coronary artery and the patient experienced anginal pain. Surgical correction consisted of obliteration of the orifice of the aneurysm, aortic valve replacement, and a saphenous vein bypass from the ascending aorta to the distal left anterior descending coronary artery. Postoperative studies revealed excellent function of the prosthetic valve, no recurrence of the aneurysm and retrograde filling of the left anterior descending and circumflex coronary arteries. Three years after the operation, the patient is asymptomatic.

A practical method of autotransfusion in the emergency center.

A new mobile autotransfusion device, modified for use in the Emergency Center, is described. Preliminary usage in thirty trauma patients who underwent autotransfusion of 60 units of blood indicated the device was simple to utilize, efficacious, inexpensive, cost-effective, and safe.

Possible femoral "steal" syndrome following femoral-femoral bypass.

1. The results of a clinical study of two patients who exhibited transitory donor limb ischemia without angiographic evidence of donor limb occlusive arterial disease following femoral-femoral bypass has been reported. 2. Although the circulation seemed to have been diminished in the donor limb following creation of a femoral-femoral bypass, the acute development of ischemia, there may have been other causes for the donor limb ischemia.

Rehabilitation in the home versus the hospital: the importance of context.

PURPOSE: Stroke rehabilitation has received increased attention in the past decade. Recent trials with new alternatives such as home-based rehabilitation services are being conducted. The purpose of the study was to explore differences between a therapy session with a stroke patient in two different contexts, i.e. in the patient's home and in the hospital. METHODS: The research design was a qualitative case study. Three data collection methods were used; participant observations of therapy sessions in two different contexts, semi-structured interviews and documents. RESULTS: The data were examined and coded for common categories. Analysis of the data looking for similarities and differences in behaviour of two therapists and their patients during therapy sessions in the hospital and in the home was performed. The observations revealed that there was clearly a difference in behaviour; a different role-set used by the two therapists when working in the patient's home versus in the hospital. The major difference in patient behaviour was that the patient, observed in his home, took the initiative and expressed his goals, which was not the case with the patients observed in the hospital. The findings were confirmed in the interviews and the documents. CONCLUSION: It is suggested that the context is a key component to be considered in the rehabilitation process of stroke patients.

Use of health services in people with multiple sclerosis with and without fatigue.

OBJECTIVE: To explore and compare the use of health services in people with multiple sclerosis (MS) with and without fatigue. METHODS: Over a period of 30 months, the use of health services in 48 MS outpatients with persistent fatigue and 36 without fatigue was studied. Data were collected from a computerized register and by interviews, and analyzed with regard to disease severity categorized as mild or moderate/severe MS. RESULTS: Fatigued people with mild MS used more hospital outpatient care and primary care including rehabilitation, and a higher proportion had transportation service, compared with non-fatigued people with mild MS. In moderate/severe MS, the differences were that non-fatigued people used more occupational therapy in primary care and a higher proportion had salaried service. Regardless of MS severity, informal care was more common among fatigued people. CONCLUSIONS: Overall, fatigued people with mild MS have more contacts with outpatient health care compared with non-fatigued people. There are few such differences in people with moderate/severe MS. The reasons for the differences in use between fatigued and non-fatigued people are not understood and need further exploration. Fatigued people more often receive informal care, thus support to caregivers are of particular importance if fatigue is present.

Use of health care services and satisfaction with care in people with multiple sclerosis in Stockholm County: a population-based study.

OBJECTIVES: To explore and to describe the use of health, social, and informal care services and satisfaction with care in a population-based sample of people with multiple sclerosis (PwMS) in Stockholm County. METHODS: The sample consisted of 166 PwMS who participated in the Stockholm MS study. Data on the use of health care services and satisfaction with care and services in PwMS were collected through a computerized register and through home visits to PwMS using structured, face-to-face interviews. RESULTS: During the study period of 3 years, 92% had been in contact with out-patient departments of Neurology, and 76% had been in contact with other hospital out-patient departments. Some 83% were in contact with primary care, and primary care contacts constituted 54% of all out-patient care. One third of the PwMS (32%) used home help service (17%) or personal assistants (19%), and higher proportions used informal help from partners (37%). PwMS were in general satisfied with the care received, with the exception of access to coordinated rehabilitation and psychosocial counseling. The proportion of PwMS using inpatient, outpatient, and social/informal (excluding neurological) care increased with the degree of disease severity. CONCLUSIONS: The great majority of PwMS use hospital specialist care and primary care in parallel, with many departments and services involved. Better accessibility of certain services, for example, psychosocial counseling and rehabilitation, and other improvements, for example efforts to provide coordinated and comprehensive care for PwMS may increase satisfaction with care and should be the focus of scientific evaluation.

Combination therapy with interferon-beta and glatiramer acetate in multiple sclerosis.

OBJECTIVES: To compare the effects of mono-therapy with interferon-beta (IFN-beta) or glatiramer acetate (GA) with IFN-beta + GA combination therapy for persons with multiple sclerosis (MS). MATERIALS & METHODS: In the context of a longitudinal observational study at the MS Centre, Karolinska University Hospital, Huddinge, 83 persons with MS receiving mono-therapy at baseline were studied. Because of MS worsening 21 switched to IFN-beta + GA combination therapy for 16-24 months, and 62 remained on the same mono-therapy for 24 months. Multiple Sclerosis Functional Composite, cognitive function, depressed mood, relapse occurrence and perceived physical and psychological impact were assessed. Linear mixed-effects models and generalized estimating equations were employed to evaluate changes in each outcome over time. RESULTS: Patients on IFN-beta + GA therapy showed greater change in odds for high perceived psychological impact. No other significant differences between treatments were found. CONCLUSIONS: The results underline the need for a randomized trial of IFN-beta + GA in MS.

Rapid cognitive screening in multiple sclerosis accomplished by the Free Recall and Recognition Test.

This study sought to investigate the feasibility of the Free Recall and Recognition Test (FRRT) as a practical screening tool for cognitive impairment in multiple sclerosis (MS). Persons with MS (n = 227) were consecutively recruited and assessed with four cognitive tests; FRRT, Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and the Mini-Mental State Examination (MMSE). Disease severity was assessed by the Expanded Disability Status Scale (EDSS). The FRRT, which was completed by 99% of the cohort in approximately 5 minutes per assessment, correlated significantly with the other cognitive tests, as well as with the disease severity rating. A cut-off of 4 for the FRRT recall rendered 90% sensitivity and 25% specificity, and a cut-off of 4.2 for the FRRT recognition resulted in 70% sensitivity and 51% specificity. We conclude that the FRRT proved feasible as a practical screening tool for cognitive impairment in MS within a clinical setting.

Activities of daily living and social activities in people with multiple sclerosis in Stockholm County.

OBJECTIVE: To describe independence in personal and instrumental activities of daily living (ADL), and frequency of social/lifestyle activities in a population-based sample of people with multiple sclerosis in Stockholm. DESIGN: Population-based survey. SETTING: Data collection in home environment. SUBJECTS: One hundred and sixty-six people with multiple sclerosis. INTERVENTIONS: Data were collected using measurements and structured interviews. MAIN MEASURES: Independence in ADL was assessed by the Barthel Index; independence in personal and instrumental ADL by the Katz Extended ADL Index; and frequency of social/lifestyle activities by the Frenchay Activities Index. RESULTS: The mean age was 51 +/- 12 years in the included 166 people with multiple sclerosis, of whom 71% (n = 118) were women. Fifty-two per cent (n = 85) were independent in personal ADL, 30% (n = 50) in instrumental ADL, and 35% (n = 57) had normal frequency of social/lifestyle activities. Most frequently affected ADL items were cleaning indoors and outdoors transportation (62%, n = 102) and the social/lifestyle items of household maintenance (59%, n = 97), walking outside (59%, n = 97), heavy housework (61%, n = 100), and gardening (68%, n = 112). CONCLUSIONS: ADL and social/lifestyle activities were affected in two-thirds of people with multiple sclerosis in Stockholm. The most affected items were items that could be classified as mobility-related and physically demanding, underlining the importance of developing and using evidence-based exercise treatments and rehabilitation to increase independence in people with multiple sclerosis in Stockholm.

Cognitive and motor function in people with multiple sclerosis in Stockholm County.

The aim of this study was to analyse cognitive and motor function in a population-based sample of people with multiple sclerosis (PwMS), taking into account both disease-related data and sociodemographic factors. Data were collected from 166 PwMS during home visits. Cognitive function was assessed by the Mini-Mental State Examination (MMSE), the Free Recall and Recognition of 12 Random Words Test (FRR12RWT), and the Symbol Digit Modalities Test (SDMT); manual dexterity by the Nine-Hole Peg Test (NHPT); global motor capacity by the Lindmark Motor Capacity Assessment; and walking capacity by a timed 10-metre walk. On cognitive tests, 55% (MMSE), 84% (FRR12RWT), and 45% (SDMT) of PwMS scored within the normal range; 27% of PwMS displayed normal manual dexterity, 9% had a maximal motorcapacity score, and 8% walked at normal speed. Factors associated with normal cognitive function were lower disability and higher education; lower disability and current employment were predictive of capacity to perform the NHPT and to walk 10 metres. In conclusion, cognitive function was normal in approximately half of the PwMS investigated, while a minority displayed normal manual dexterity and normal walking capacity. Thus, both disease severity and sociodemographic factors appear to influence cognitive and motor function in MS.