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101 Seiten, Note: 5.0
List of Tables iii
List of Figures v
Chapter One: Introduction
1.2 Statement of the Problem
1.3 Justification of the Assay
1.4 Statement of Objectives
1.4.1 General Objective
1.4.2 Specific Objectives
1.5 Research Questions
1.6 Research Hypotheses
Chapter Two: Literature Review
2.1 Conceptual Framework
2.2.1 Socio-economic State and Stroke
2.2.2 Quality of life and Stroke
2.2.3 Lifestyle Changes and Stroke
2.2.4 Pathophysiology of Stroke
2.2.5 Occurrence and Epidemiology of Stroke
2.2.6 Risk Factors in Stroke
2.3 Osteoarthritis (OA)
2.3.1 SES and Osteoarthritis
2.3.2 Quality of life and Osteoarthritis
2.3.3 Lifestyle Changes and Osteoarthritis
2.3.4 Causes and Risk Factors of Osteoarthritis
2.3.5 Epidemiology and Occurrence of Osteoarthritis
2.4 Empirical Reviews of Related Studies
Chapter Three: Research Methodology
3.1 Assay Area
3.2 Assay Design
3.3 Assay Population
3.3.1 Inclusion Criteria
3.3.2 Exclusion Criteria
3.4 Sample Size Determination
3.5 Sampling Method
3.6 Assay Instrument
3.7 Administration of the Instrument
3.8 Data Management
3.8.1 Measurement of variables
3.8.2 Data Analysis
3.8.3 Independent and Dependent Variables
3.9 Validity and reliability of the Instrument
3.10 Ethical Consideration
3.11 Assay Limitations
Chapter Four: Results
4.1 Socio-demographic characteristics of participants
4.2 Socioeconomic stateof Stroke and Osteoarthritis patients
4.3 Quality of life of Stroke and Osteoarthritis Patients
4.3.1 Comparison of Quality of life of Stroke and osteoarthritis patients
4.3.2 QoL of Stroke and Osteoarthritis patients across domains
4.4 Lifestyle Factors and Quality of life of Stroke Patients
4.5 Lifestyle Factors and Quality of life of Osteoarthritis patients
Chapter Five: Discussions, Conclusions and Recommendations
5.1.1 Socio-Demographic Characteristics of participants
5.1.2 Socio-economic state (SES) of stroke and osteoarthritis patients
5.1.3 Quality of Life of Stroke and Osteoarthritis patients
5.1.4 Lifestyle Factors and Quality of life of stroke patients
Table 2.1 Recommendations for Physical Activity After Stroke.
Table 4.1 Socio-demographic Characteristics of participants
Table 4.2 Socioeconomic stateof Stroke and osteoarthritis patients
Table 4.3 Quality of life of Stroke and Osteoarthritis Patients
Table 4.3.1 Comparison of Quality of life of Stroke and osteoarthritis patients
Table 4.3.2 QoL of Stroke and Osteoarthritis patients across domains
Table 4.4 Lifestyle Factors and Quality of life of Stroke Patients
Table 4.5 Lifestyle factors and Quality of life of Osteoarthritis patients
Figure 2.1 Ischemic cascade leading to cerebral damage: Ischemic stroke leads to hypo-perfusion of a brain part that initiates a series of complicated events.
Figure 2.2 Normal Joint and a Joint with OA condition
Figure 2.3 Risk factors for OA
Socio-economic state (SES), Quality of life (QoL), as well as Lifestyle factors (LFs) are very important determining factors of wellness. They play significant role in human wellness and life successes of people. This assay has determined the SES, QoL and LFs among patients of stroke and osteoarthritis in Port Harcourt. It adopted a comparative cross-sectional assay design, drawing a sample of 264 (stroke=78, osteoarthritis=186) respondents from the chosen communities in Port Harcourt. It made used of a multistage sampling pattern for both stroke and osteoarthritis patients using a Semi-Structured Questionnaire (SSQ) containing Kuppuswamy’s and WHOQOL-BREF scales for SES and QoL determination as the assay instrument. Data were worked upon using the IBM SPSS version 25. Descriptive statistics was implored to express classified variables in dimensions and continuous in mean and standard deviation while Chi-Square test statistic was implored to compare the SES, QoL and LF of stroke patients with OA patients, and also establish association between LFs and QoL of stroke and OA patients at 95% confidence intervals, and p≤ 0.05 was considered statistically significant. The results thus made it known that most of the respondents were males 161(61.0%) aged 51-60 years. Also, most of both stroke and OA patients are of middle socio-economic level 39 (56.5%) and 93 (49.7%), and also have poor QoL 53 (67.9%) and 155 (82.9%) with average scores of 2.37 ± 0.81 and 2.86 ± 0.80 for both stroke and OA respectively. The results further have shown a strong association between LFs and QoL of stroke and OA patients. The assay concluded that SES, QoL and LF are indices of public wellness importance having great association with debilitating chronic states such as stroke and OA.
Keywords: Quality of life, Socio-economic state, stroke, lifestyle factors, osteoarthritis.
Socio-economic state (SES) is one of the recognized important factors that have both social and medical implications (Erreygers, 2013). SES is described as an intricate measure of a person’s economic as well as sociological place (Winters & Miner, 2015). It is commonly used to show an economic difference in the environment holistically. It is a compound appraisal measured in numerous ways accountable for an person’s work experience as well as their social and economic position as connected to other people in the environment. In many occasion, it is rooted on income, education, as well as occupation. It is a primary determining factor of wellness. According to Erreygers (2013) postulated that as a general rule, affluent persons tend to be in better wellness than people of poorer state. SES has been greatly reported to have noticeable wellness impact on a number of diseases (Addo et al, 2012; Mapulanga, Nzala, & Mweemba, 2014; Cookson et al, 2016).
Some of the measurements of SES among others are levels of education, family backgrounds as well as education of parents, current occupation, total income, family, and wealth (assets and capital). People are usually separated into groups in accordance to this measurement, from the lowest advantaged to the highest advantaged, or low, medium, or high SES (Galobardes et al, 2006). Irrespective of the process, a lot of studies have shown a connection between SES and person wellness (Addo et al, 2012; Mapulanga et al., 2014; Cookson et al., 2016). People with certainly low SES may not have very good means to care services, or even transportation to attain wellness. Because of this, such people may not be able to properly take care of their wellness; others may not have enough education to realize the effect certain conditions have on their wellness. The stress related to person’s Socio-economic state alone may impact his or her wellness (Businelle et al, 2012). Regardless of the process, there is a strong association occurring between SES and wellness. Many assays with different clinical cases have found great implications of Socio-economic state for diseases (Bashinskaya et al, 2012). Hence, SES is one of the wellness determinants used in this assay.
Quality of life (QoL) as well has been explained as the level to which a person is considered to be of good health, comfortable, and able to take part in or enjoy life’s daily programmes (Jenkinson, 2019). The term “quality of life” is basically indistinct, as it can refer both to the experience a person has had of his or her own life and to the living standards in which people find themselves. Hence, quality of life is greatly subjective. Whereas one person may define QoL as wealth or satisfaction with life, another person may define it in terms of abilities, such that having the capability to live a better life; emotional, social and physical well-being). A disabled person may present a high quality of life, whereas a well person who recently lost a job may present a low quality of life. Within the arena of wellness, QoL is viewed as multifaceted, encompassing material, emotional, physical, as well as social well-being (Oni et al, 2018; Opara, & Jaracz, 2010).
According to public health, quality of life is mostly used to check people with chronic health challenges including stroke, osteoarthritis, obesity, diabetes as well as increased blood pressure among others. People QoL is mostly reduced with the development of disease conditions in them. Thus, poor QoL has been found to be occurrence among people with osteoarthritis, and stroke in previous literature (Oni et al., 2018; Opara, & Jaracz, 2010).
Lifestyle factors (LF), which may be due to lack of physical activities, malnutrition, smoking, alcohol consumption or drug use among others have been characterized to be risk factors for various form of diseases across the globe (Basu, Avila & Ricciardi 2016). LF is a very important consideration for both social and economic wellness of people. It is greatly believed that modification of some kind of persons’ lifestyle could alter a disease outcome (Bailey, 2016). However, LF could be the clue to the management and cure of numerous abnormalities, its adjustments is often challenging and taskful to sustain due to complicated environmental, social and personal factors. Thus, theories of proper wellness have been developed to explain how such factors influence the imposition and alteration of specific wellness behaviours, and intervention could be developed to minimise and help disease conditions by modifying lifestyle behaviours across patients’ populations and settings.
Put together, these focuses (SES, QoL, and LF) of public wellness play a significant role in the wellness and successful life of people. It has been booked that patients of both stroke and osteoarthritis usually have socio-economic fights, improper quality of life, and in most cases unwell lifestyle.
Both stroke and osteoarthritis [OA] are diseases of disabilities causing untold public fitness burdens to the patients as well as their families (WHO, 2012). The occurrence of these diseases is more noticeable in developing countries such as Nigeria. Onwuchekwa, Tobin-West, & Babatunde (2014) reported that the occurrence of stroke in Nigeria is more in poor communities, and it is very frequent among the elderly population. In another assay, Akinpelu, Alonge, Adekanla and Odole (2009) postulated that in Nigeria, for every five persons within the ages of 40years and above mostly witness symptomatic osteoarthritis, and the occurrence is at 19.6%. Stroke is referred to as a sudden death of some cells in the brain as a result of shortage of oxygen supply mainly due to loss of blood flow to the brain cells as a result of blockage, rupture of the artery supplying the brain. Due to these obstructions, there is thus this a decrease in the supply of oxygen –contain air and nutrient to the affected regions causing neuronal destruction and in some cases death (WHO, 2012).
Stroke has been defined as a clinical condition commonly affecting the motor performing ability of people who suffer from its attack (Peters et al; 2015). Thus, stroke occurred by the obstruction of blood supply to certain parts of the brain, usually as a result of blood vessel ruptures, which later leads to haemorrhagic stroke (Peters et al., 2015). The common type of stroke is termed ischemic stroke (Go et al., 2014). Haemorrhagic stroke has accounted for towards 15% of all cases of strokes worldwide (Qamar, 2011). Depending on the degree of the stroke, patients might develop a range of disabilities may include cognitive deficit, also urinary incontinence, personality changes, and as well difficulty in speech and mood disorders (Duncan, Zorowitz, Bates, et al, 2005). Worldwide, stroke has been known as the second highest leading cause of so many death and the third leading source of disability (WHO, 2012; Johnson et al, 2016; Kalavina et al; 2017). Again, 70% of all cases of strokes and as well as 87% of stroke-related deaths and disability adjusted life years, worldwide occur in developing countries. (Feigin et al, 2014). The WHO has estimated that 15 million of the total population of the world suffers from condition of stroke, with 33% become permanent disabled while 33% death occur due to stroke (Qamar, 2011).
In another way, osteoarthritis (OA) is degenerative clinical cases of the joint, and known as the most occurring joint disorder affecting man. It is defined as a slow, degenerative anomaly that is characterized by continuous cartilage destruction, changes in the subchondral bone, also marginal osteophytosis, muscle fatigue, loss of some joint space, as well as inflammation of the synovium tissues and tendons (Li et al; 2013).
Thus, both stroke and osteoarthritis are chronic non-transmissible diseases of public health concerns in developing countries (Strong, Mathers, & Bonita, 2007). They are together clinical cases associated with substantial death and socio-economic problems, disability cases and altered quality of life among patients.
Reduced Socioe-conomic state is a world problem and main social determining factor of wellness (WHO, 2012). Socio-economic state (SES) is one of the main factor that determine cure as well as rehabilitation output of debilitating severe conditions (Mensah, 2013). It’s been stated that towards two-thirds of all countries worldwide have experienced the effect of reduce SES (WHO, 2012). In Sub-Sahara Africa, low SES has been connected to poor living standards and poor cure outcomes (Mapulanga et al.; 2014). It is agrred that a good SES is a great social predictor for persons to have a reliable economic, social state, and live a well and successful life. Worldwide, low SES has been accounted for over 60% of deaths, and two-third of this is in the Sahara African region (Addo et al, 2016).
Similarly, Poor quality of life is a world major concern and has been negatively connected with destructive chronic conditions (Megari, 2013). Over 45% of all poverty worldwide has been attributed to poor quality of life, and more than half of this figure is seen in persons with damaging chronic conditions especially those in developing countries (Feigin et al, 2014).
In the same way, poor lifestyle has been found to be greatly connected to damaging chronic conditions (Chakma & Gupta, 2017). Certain lifestyle factors (LFs) such as smoking, alcohol intake, malnutrition and lack of physical activity etc, have great negative impacts on wellness (Chakma & Gupta, 2017).
Looking at the increasing population in Nigeria and the socio-economic problems, the lower class in most communities in Nigeria are patients of a wide range of diseases including chronic clinical cases including strokes and osteoarthritis (Oni et al., 2018). The socio-economic problemss of the people always have effects on their quality of life, combined with unmodified lifestyle changes, exposing them to a seies of diseases including stroke and osteoarthritis (Opara, & Jaracz, 2010). Hence, the role of SES, QoL and LFs in the assay of chronic conditions is of great public wellness importance.
Those with higher SES tend to have means to good wellness cure, and as such result have good QoL. All those with lower Socioe-conomic state may not be able to access good wellness, or lead wellness lifestyles, hence leading to reduced QoL. This is serious public wellness challenge. Hence, this assay is another step that will be useful in developing a better understanding of SES, QoL and LFs in wellness delivery, particularly in communities where wellnesscare services are limited. It is therefore, strongly agreed that the esults of this assay will provide information that will assist public wellness practitioners in the formulation and implementation of wellness policies in the prevention and management of chronic conditions such of stroke and osteoarthritis.
Conclusively, it is hoped that this assay will inspire future interests in this area and also equip the public healthcare givers and other medical professionals and members of communities, with improved knowledge with understanding of specific care needs of those prone to chronic conditions in Port Harcourt metropolis and beyond.
The general objective of the assay is to determine and compare the Socio-economic state(SES), quality of life (QoL) and Lifestyle factors (LFs) between patients of stroke and osteoarthritis (OA), as well as to establish a relationship between lifestyle factors and the Quality of life of stroke and osteoarthritis patients in Port Harcourt Metropolis.
This assay has the following specific objectives. To;-
1. Determine and compare the Socio-economic state (SES) of Stroke and Osteoarthritis patients in Port Harcourt Metropolis.
2. Determine and compare the Quality of life (QoL) of Stroke and Osteoarthritis (OA) patients in Port Harcourt Metropolis.
3. Establish the relationship between Lifestyle factors (smoking, alcohol intake, physical activity, good nutrition) and QoL of stroke patients in Port Harcourt, Metropolis.
4. Establish the link between Lifestyle factors (smoking, alcohol consumption, physical activity, good nutrition) and QoL of osteoarthritis (OA) patients in Port Harcourt, Metropolis.
In line with general and specific objectives of this assay, the following research questions were formulated:
1. What is the Socioe-conomic state (SES) of Stroke and OA patients in Port Harcourt Metropolis?
2. What is the Quality of life (QoL) of Stroke and OA patients in Port Harcourt Metropolis?
3. How do Lifestyle factors such as smoking, alcohol consumption, physical activity, and good ntrition relate to QoL of stroke patients in Port Harcourt Metropolis?
4. How do Lifestyle factors such as smoking, alcohol consumption, physical activity and good nutrition relate to QoL of OA patients in Port Harcourt, Rivers State?
In line with general and specific objectives of this assay, the following null and alternative hypotheses were formulated:
1. HO: There is no difference in SES between Stroke and Osteoarthritis in the assay.
HA: There is a difference in SES between Stroke and Osteoarthritis in the assay.
2. HO: There is no difference in QoL between Stroke and Osteoarthritis in the assay.
: There is a difference in QoL between Stroke and Osteoarthritis in the assay.
3. HO: There is no association between Lifestyle factors (LFs) and QoL of Stroke patients in the assay.
: There is an association between Lifestyle factors (LFs) and QoL of Stroke patients in the assay.
4. HO: There is no association between Lifestyle factors (LFs) and QoL of Osteoarthritis patients in the assay.
: There is an association between Lifestyle factors (LFs) and QoL of Osteoarthritis patients in the assay.
Stroke which is known as cerebrovascular accident is defined as a form of brain injury that occurs due to a sudden blockage and interruption of blood supply to the brain (Gund et al; 2013). Stroke is described as the rapid development of clinical signs of major disturbance of cerebral activities, lasting for more than 24 hours or resulting to death, with unknown cause other than that from vascular origin (Sacco et al; 2013). Stroke usually occurs when part of the brain lacks adequate amount of blood flow for certain reasons; such as the blood supply to part of the brain suddenly interrupted, and/or because certain blood vessel in the brain has been ruptured in that blood crosses barriers to surrounding regions. Mant (2011) described stroke as a disorder that is identified by a quick onset of neurological signs and may be ischaemic or haemorrhagic in naature. Other forms of stroke exist, but ischaemic or haemorrhagic strokes are the most commonly known stroke. Over 87% of strokes belongs to ischaemic, and about 9% are due to intracerebral haemorrhage while about 4% due to subarachnoid haemorrhage (Marsh & Keyrouz, 2010).
Stroke is one of the leading reasons of long-term debilitation with about 19 to 50% of stroke patients known to be left with permanent disabilities (Qamar, 2011; Center for Disease Control & Prevention [CDC], 2019). Most times, these disabilities need lifelong management from caregivers, members of family, thus, special attention, rehabilitation with proper follow-up in stroke patients are often necessary (Duncan et al., 2005). Johnson et al., (2016) mainly noted that increase blood pressure is a major risk consideration for stroke patients, which is often the cause of about 80% of stroke cases worldwide. Other risk factors connected with stroke include atrial fibrillation, frequent smoking, and cardiovascular diseases (Morris et al, 2015). Therefore, stroke is a great public wellness burden, which is certainly going to rise in the future reason being that the demographic transformation of the older population is mainly overcoming the younger population especially in developing countries (Adogu et al, 2015). Stroke has a noticeable socio-economic consequence worldwide. Chen, Lin, & Po (2013) described stroke as a leading cause of mortality, death and disability, and seeks to threaten families and wellness care systems. This threat can be controlled through quick intervention and proper management. The reduce death rate in stroke patients worldwide in recent years has added to lives being saved but it has as well led to increasing numbers of people surviving with debilitation, low quality of life to an eventual increasingly ageing population. The idea that stroke is only associated with the elderly is being questioned according to recent emerging evidence citing younger persons presentingpossible risk factors for stroke like diabetes (Feigin, Forouzanfar, Krishnamurthi et al, 2014), and faulty hearts. The emerging evidence from some assays in Nigeria have proven that stroke add noiceably to neurological admissions thus posing serious burden to caregivers due to the length of time of stay in hospital such as prolonged hospitalisation, cost effects of cure and lost of productivity (Opara & Jaracz, 2010; Oni et al., 2018). It is important to say that stroke as a disease of the heart has been linked with significant add up to psychiatric linked-morbidities (Oni et al, 2018).
Socio-economic state refers to a person’s position among certain hierarchical social structures (Erreygers, 2013). It is seen as an important factor influencing wellness, nutritional state, mortality, and death of a population. It also affects the acceptability with the affordability, accessibility, among others in health facilities (Aggarwal et al, 2005). In the healthcare settings, tests of socio-economic scales aleays show inequities in accessing wellness care. It also shows a pattern to the wellness problems occurring in a specific population in regards to their socioe-conomic state (Aggarwal et al, 2005). Socio-economic state (SES) is thus, one of the important conditions affecting the wellness condition of a person or family.
The economic and social states of people and families are examined by various parameters include income, education, occupation and others. (Winters-Miner, 2015). These stated parameters can influence family effluences, social background and participation in societal activities (Erreygers, 2013). Numerous scales have been implicated to determine the Socio-economic state of people and families in specific instances, such as in developed and under developed cities (Galobardes et al, 2006). Such scales include Kuppuswamys scale, Udai Pareekh scale, and Rahudkar scale. Jalota scale, Shrivastava scale. Kulshrestha scale, and Bharadwaj scale (Gaur, 2013). Kuppuswamy’s and Udai Pareekh scales have been used greatly in both the developed and under developed settings to determine Socio-economic state (Gaur, 2013).
The sudden rise in stroke mortality is thought to be faster in developing countries like Nigeria as compared with developed countries, hence a high occurrence of risk factors and differences in availability of primary intervention and acute care programmes design (Strong et al., 2007). The value of socio-economic considerattions as determinants of stroke cases, occurrence, morbidity, mortality, and its impact has been highly reviewed in previously assays (Johnston, Mendis; & Mathers, 2009; Kim, & Johnston, 2011).
In a related assay, Cox et al (2006) on the Socio-economic state (SES) and stroke, they constantly found a generally understood pattern of higher stroke cases and mortality in lower socio-economic groups but conflicting evidence in connection to service provision and trends in outcome between socioeconomic groups. To this, knowledge on the present difference in stroke risk is needed for effective stroke interventioning, prevention and managements.
Quality of life is described as someone’s understanding of his/her place in life in the context of the societal culture and value to the community which they live and in relation to their objectives, expectation, standard and concerns (Fallowfield, 2009). Because of recent improvement and a rise in the number of people surviving with stroke, a new development which emphasised on stroke management with alteration in the adage tagged ‘adding years to life’ to ‘adding life to years’ (Van & Triemstra, 1999). Thus, one of the goals of stroke management is to better the wellness-connected quality of life of such individuals so as to enable them accomplish aimed aspirations (Owolabi, 2011). Quality of life is a worldwide indicator of a complete sense of wellness, well-being and life satisfactions (Youssef, & Wong, 2002). Its concept is wide with so many political, philosophical and wellness related definitions (Fallowfield, 2009).
To enhance the quality of life means monitoring of areas that needed when making conclusions on cures which usually are to improving the well-being of the stroke patient (Mwangi, & Ngure, 2017). There are different parameters that can be used to categorized cure plan used for assisting stroke patients to meet up with the stroke related abnormalities. For instance, at the patient’s level, it is important to consider the medical linked condition of the stroke patients and the current wellness state in addition to wellness and safety risks, functional status such as physical, cognitive ability, emotional condition, and social state of mind. In addition, personal wellness resources, opportunities, wellness perceptions, spirituality and unmet person needs are important considerations to make when making plans on how to care for a patient who has a stroke (Theofanidis & Gibbon 2016). Intermediately, it is important to note the social and family support which are essential for the cure plan of patient, and how will these work together to help the stroke patients. All should be aimed at enhancing the productivity of the stroke patients by investing in them especially as they go through management programmes of the body functions. When the life of a stroke patient is enhanced they are able to fill well with the effect of the stroke, and be able to carry on with their activities of daily living without being completely dependent on their caregivers. Therefore, it is necessary to note any kind of aided plan for stroke patients should aim at enhancing their quality of life (Theofanidis & Gibbon 2016).
The making of a proper health decisions and maintaining continuous wellness, lifestyle modification is multasking. The decision to practise a well lifestyle should be adopted in an early age to prevent the development of stroke. Although, risk factor for the management of stroke patients using pharmacological intervention is often necessary, polypharmacy can result in a high cure burden for people with stroke (Gallacher, Batty, & McLean, 2014) and this may cause added risk for mortality and morbidity (Hayes, Klein, & Barrueto, 2007). At present, AHA has published a lot of guidelines towards healthcare professionals for the cure and management of CVS risk factors (Eckel, Jakicic, & Ard, 2013), primary stroke interventions (Meschia et al, 2014), acute management of stroke (Jauch, Saver, & Adams, 2013), and secondary stroke prevention (Kernan et al, 2014). Each of these guidelines identified lifestyle changes or modification as a major component of risk factor cure and management that should be implored as part of comprehensive all-inclusive post stroke care. Lifestyle changes can lead to increasess in hypercholesterolemia, increased blood pressure crisis and obesity, as well as glucose metabolism in cases of diabetics, which are in turn connected to reduced risk for cardiovascular related diseases and death (Smith, Jackson, & Pearson,2004). In fact, the rate of CVD mortality in people with stroke over a 10year period can be lowered by 85%-92% by engaging in lifestyle behaviours such as exercising, eating suitable fruits and vegetables, maintaining a body mass index between 18.5 and 29.9 kg/m, moderate alcohol intake, and reduction of smoking (Towfighi, Markovic, & Ovbiagele,2012). Obviously, changes of lifestyle behaviours is necessary for secondary stroke prevention. Some of the changes in person lifestyle behaviours which can affect multiple risk factor are:
Diet: Obtaining a wellness diet is important for CVS related cases and stroke intervention and prevention. As at 2013, the American Colleges of Cardiology and American Heart Associations, gave guidelines for lifestyle managements and how to lower cardiovascular risk (Eckel et al, 2013). These dietary considerations are consistent with the DASH (National Heart, Lung, and Blood Institute [NHLBI], 2016) and Mediterranean-style (Lakkur, & Judd,2015) dietary technique, which are very potent in reducing the risk of stroke (Estruch, Ros, & Salvado, 2013; Tsivgoulis, Psaltopoulou, & Wadley, 2015). These recommendations always encourage stroke patients to take vegetables, fruits, whole grains, and low fat containing dairy products, fish, poultry, legumes, vegetable oils, and nuts. Also, it limits the intake of sweets, sweetened-beverages, and red meats, as well as a reduction in sodium intake. Multiple benefits from adhering to these dietary guidelines and patterns have been observed (Bailey, 2018);
i.) Low density lipoprotein (LDL) cholesterol and Blood pressure can also be reduced with the help of the guideline (Eckel et al., 2013; Kernan et al., 2014),
ii.) Enhanced glycaemic control as well as insulin sensitivity occurred in diabetics (Shirani, Salehi-Abargouei, & Azadbakht, 2013).
iii.) Weight loss leading to decreased rates of obesity (Shai, Schwarzfuchs, & Henkin, 2008), which is important because of the strong relationship between obesity and stroke.
Another important dietary recommendation is the levels of calorie intakes. Reducing daily intake of caloric by up to 20% 25% for three months and above in obese and non-obese people can result in improved LDL level, cholesterol, and triglycerides, blood pressure, insulin resistance, and glycaemic level control (Adams, Davidson, & Litwin., 2012; Weiss, Albert, & Reeds., 2015). Adapting to a proper food eating and consuming appropriate or suitable amounts of food can rightly affect risk factors for recurring stroke.
Physical Activity: Physical inactivity is a major risk consideration for stroke (Go et al., 2014). Sadly, people with stroke spend up to 86% 88% of their time in sedentary activity (static position) compared with 57% 72% in adults with no stroke (Manns et al, 2012). One reason for decreased physical activity after stroke is reduced exercise capacity, as measured by maximum oxygen uptake (that is, VO2max). The amount of oxygen expelled during daily walking in patients with stroke is twice that of adults with no stroke; and performance of self care activities such as grooming process, bathing process, and dressing after stroke can require people to exert 66% 75% or more of their complete exercise capacity (Ivey et al, 2005). This explains how once-simple tasks become complicated after stroke. Additional barriers to physical activity after stroke include depression, deconditioning, inaccessible environments (that is, wheelchair-friendly transportation and gym equipment), poor social support, low motivation, and physical impairment (Billinger, Arena, & Bernhardt, 2014).
Even with these challenges, physical activity is central addressing stroke deformities. Moderate to hard physical activity for primary stroke intervention or prevention can lead to declined LDL level cholesterol level, blood pressure, and weight gain and increased weight loss (Eckel et al, 2013; Go et al, 2014; Kernan et al, 2014). This can also lead to increased glucose uptake and insulin sensitivity in patients with and with no diabetes (Bailey, 2018). For people with stroke, exercise training can enhance lipid profiles, glucose metabolism, increased blood pressure, and insulin sensitivity (Ivey, Ryan, Hafer-Marcko, Goldberg, & Macko, 2007; Bailey, 2018). Added benefits of exercise training after stroke may include gait speed, improved balance, and endurance and declined disability (Saunders, Greig., & Mead, 2014).
Due to the challenges linked with deconditioning and physical deficit after stroke, the AHSA have given some guidelines for wellness care professionals that outline exercise and physical activity, recommendations after stroke (see table 2.1). In addition to improving physical activities, sitting in one position and other sedentary behaviour should be lowered by performing more light intensity, non exercise physical activity, such as standing and walking (Gardiner, Eakin, Healy., & Owen, 2011).
Table 2.1: Recommendations for Physical Activity After Stroke.
Abbildung in dieser Leseprobe nicht enthalten
Source: Bailey, 2018
Smoking: This is another risk considerartion for stroke. First ischemic stroke in people that smoke is nearly four times the risk in people not smoking (Bailey, 2018). Although, available data on the risk for continuous stroke is really not much, one assay explained that the risk of repeated stroke in elderly people that smoke was double that of people that do not smoke of age category (Kaplan, Tirschwell, & Longstreth, 2005). Thus, smoking can result in acute increases in blood pressure level, heart rate level, and arterial stiffness measurement (Rhee et al, 2007; Bailey, 2018), which is dangerous for people with increased blood pressure. Furthermore, smoking is linked with insulin resistance and dyslipidemia (Bailey, 2018). Stopping, however, can reduce the risk for stroke. People that smoke who quit reduce possible risk for ischemic stroke by half, and smokers with increased blood pressure who quit experience a better benefit when compared with smokers without increased blood pressure (Bailey, 2018). Long-time smokers who quit smoking experience lowered heart rate, blood pressure, and arterial stiffness (Minami, Ishimitsu., & Matsuoka, 1999; Yu-Jie, Hui-Liang., Bing, Lu, & Zhi-Geng, 2005) and increased high density lipoprotein (HDL) cholesterol (Gepner, Piper, Johnson, Fiore, Baker, & Stein, 2011). Additionally, diabetic patients that smokes who stop smoking experience better glycaemic levels and control, LDL cholesterol level, blood pressure level, and insulin resistance (Voulgari, Katsilambros, & Tentolouris, 2011). Because of the numerous risk factors that can be enhanced by stopping smoking, people with stroke who smoke, and especially those with increase blood pressure, should be given encouragement and resources to stop this lifestyle.
Alcohol Consumption: Heavy alcohol intake suddenly increase the risk for first ever and continuous stroke (Ois, Gomis, & Rodriguez-Campello., 2008). Although the exact processs are scientifically not known, heavy alcohol consumption is linked with increased risk for diabetes and increased blood pressure (Fuchs, Chambles, Whelton, Nieto, & Heiss, 2001; Briasoulis, Agarwal, & Messerli, 2012), which are major risk factors for stroke and other cardiovascular diseases. Hence, low to moderate alcohol consumption, defined as ≤ 2 drinks for men and ≤ 1 drink for women daily (Kernan et al., 2014), is connected with reduced risk for first ever stroke (Bailey, 2018). Although further assay is needed in this condition, it is true that low alcohol intake may reduce cardiovascular risk by decreasing increased blood pressure (Briasoulis et al, 2012) and increasing HDL cholesterol level (De Oliveira et al, 2000). Reducing current levels of alcohol intake could lead to decline in blood pressure level, with higher reduction occurring in people with higher blood pressure level, which has vital repercussion for lowering stroke risk in hypertensive patients (Xin, He, Frontini, Ogden, Motsamai, & Whelton, 2001).
The pathophysiology with stroke occurrence lies on the injuring to the brain, which is as a result of vascular occlusion and/or hemodynamic disturbance from intracranial and/or extracranial vascular injury (stenosis, splitting. vasculitis). Also include interruption of cerebral blood flows or neuronic death when self regulation of blood flow and collateral circulations are thus insufficient. All these results to functional body disorders which are controlled by the damaged area or part of the brain. Thus, the primary pathophysiology of stoke is an underlying heart or blood vessel disease. While the secondary manifestation in the brain are the result of one or more of the underlying risk factors or diseases. Therefore, the primary pathologies may include atherosclerosis increased blood pressure, leading to coronary artery disease, heart disease, dyslipidemae, and hyperlipidemae. According to Mir, Al-Baradie., and Alhussainawi (2014) the ischemic cascade leads to cerebral damage and/or obstruction. Adding that ischemic stroke can lead to hypoperfusion of a brain part that can cause a number of complicated events that begin with excitotoxicity., oxidative stress., microvascular injury, blood brain barrier impairment and post ischemic inflammation leading to the ultimate death of the neuron, glia, and endothelial cells. Therefore, the degree and period of ischemia often determines the extent of cerebral damage (see figure 2.2).
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Figure 2.1. Ischemic cascade leading to cerebral damage: Ischemic stroke leads to hypo-perfusion of a brain part that initiates a series of complicated events.
Stroke is one of the main causes of death in Nigeria, (Oni et al, 2018) and in many of the developed countries of the world (Feigin et al, 2014). The occurrence of both ischaemic and haemorrhagic stroke differs worldwide. The dissimilarities can be markedly noted in areas of prognosis, the occurrence of risk factors, and other factors, and cure strategies (Krishnamurthi., Feigin, Forouzanfar, Mensah, Connor, Bennett, & O'Donnell, 2013). Between 1990-2010, there was a notable increase in the burden of ischaemic and haemorrhagic stroke worldwide in relation to both its occurrence as a disease and the caregiver burden. However, till date, stroke has remained the second cause of death worldwide. More recently, however, a more positive outcome has been noted towards a minimising its mortality rates for both ischaemic and haemorrhagic stroke (Krishnamurthi et al., 2013).
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