Self-perceived and Actual Risk of Further Stroke in Patients with Recurrent Stroke or Recurrent Transient Ischemic Attack in Thailand.

BACKGROUND: The correct perception in patients of their future risk of recurrent stroke may lead to changes in behavior and to successful secondary prevention of stroke. The primary aim was to compare patients' perceived risk with the actual risk of further stroke. METHODS: This cross-sectional study was carried out in 2 tertiary hospitals in northeast Thailand. Self-perceived risk of further stroke was assessed by validated questionnaire and categorized as low, medium, or high. Actual risk was calculated using Stroke Prognosis Instrument II which classified patients into 3 risk groups: low, medium, and high. The level of agreement between perceived and actual risk was analyzed using the kappa statistic. RESULTS: One hundred forty patients with recurrent stroke or recurrent transient ischemic attack were enrolled (age 65.6 ± 11.3 years, mean ± standard deviation). Most patients wrongly estimated their risk of further stroke: 43.6% of patients underestimated and nearly one fifth (17.1%) overestimated their risk; the kappa coefficient was .08. Patients with hypertension and diabetes were more likely to underestimate their risk of recurrent stroke. The only characteristic found to be significantly associated with perceived high risk was the level of independence in activities of daily living: patients with Barthel index less than or equal to 60 were more likely to perceive themselves as having high risk for recurrent stroke. CONCLUSIONS: Most patients underestimated their risk for further stroke. Implementation of a comprehensive care program to communicate to patients their future risk of stroke and to modify their risk factors is warranted in Thailand.

Efficacy and safety of Curcuma domestica extracts compared with ibuprofen in patients with knee osteoarthritis: a multicenter study.

OBJECTIVE: To determine the efficacy and safety of Curcuma domestica extracts in pain reduction and functional improvement. METHODS: 367 primary knee osteoarthritis patients with a pain score of 5 or higher were randomized to receive ibuprofen 1,200 mg/day or C. domestica extracts 1,500 mg/day for 4 weeks. The main outcomes were Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total, WOMAC pain, WOMAC stiffness, and WOMAC function scores. Adverse events (AEs) were also recorded. RESULTS: 185 and 182 patients were randomly assigned into C. domestica extracts and ibuprofen groups, respectively. The baseline characteristics were no different between groups. The mean of all WOMAC scores at weeks 0, 2, and 4 showed significant improvement when compared with the baseline in both groups. After using the noninferiority test, the mean difference (95% confidence interval) of WOMAC total, WOMAC pain, and WOMAC function scores at week 4 adjusted by values at week 0 of C. domestica extracts were noninferior to those for the ibuprofen group (P=0.010, P=0.018, and P=0.010, respectively), except for the WOMAC stiffness subscale, which showed a trend toward significance (P=0.060). The number of patients who developed AEs was no different between groups. However, the number of events of abdominal pain/discomfort was significantly higher in the ibuprofen group than that in the C. domestica extracts group (P=0.046). Most subjects (96%-97%) were satisfied with the treatment, and two-thirds rated themselves as improved in a global assessment. CONCLUSION: C. domestica extracts are as effective as ibuprofen for the treatment of knee osteoarthritis. The side effect profile was similar but with fewer gastrointestinal AE reports in the C. domestica extracts group.