Reducing recurrent stroke: Methodology of the motivational interviewing in stroke (MIST) randomized clinical trial

Rationale Recurrent stroke is prevalent in both developed and developing countries, contributing significantly to disability and death. Recurrent stroke rates can be reduced by adequate risk factor management. However, adherence to prescribed medications and lifestyle changes recommended by physicians at discharge after stroke is poor, leading to a large number of preventable recurrent strokes. Using behavior change methods such as Motivational Interviewing early after stroke occurrence has the potential to prevent recurrent stroke. Aims and/or hypothesis The overall aim of the study is to determine the effectiveness of motivational interviewing in improving adherence to medication and lifestyle changes recommended by treating physicians at and after hospital discharge in stroke patients 12 months poststroke to reduce risk factors for recurrent stroke. Design Recruitment of 430 first-ever stroke participants will occur in the Auckland and Waikato regions. Randomization will be to intervention or usual care groups. Participants randomized to intervention will receive four motivational interviews and five follow-up assessments over 12 months. Nonintervention participants will be assessed at the same time points. Study outcomes Primary outcome measures are changes in systolic blood pressure and low-density lipoprotein levels 12 months poststroke. Secondary outcomes include self-reported adherence and barriers to prescribed medications, new cardiovascular events (including stroke), changes in quality of life, and mood. Discussion The results of the motivational interviewing in stroke trial will add to our understanding of whether motivational interviewing may be potentially beneficial in the management of stroke and other diseases where similar lifestyle factors or medication adherence are relevant

Methodology of a population-based stroke and TIA incidence and outcomes study: The Auckland Regional Community Stroke Study (ARCOS IV) 2011–2012

Background Stroke is a leading cause of death and disability worldwide. Stroke burden is immense as it leads to premature deaths, leaves survivors with ongoing disabilities, and has a major financial impact on the individual, their families, and the community. Reliable, high-quality evidence is needed on stroke risk factors, incidence, and outcomes to provide information on how best to reduce this burden. Population-based studies are regarded as the ‘gold-standard’ of measuring disease burden but are not common due to the logistical and financial challenges they present. The Auckland Regional Community Stroke Studies are among a few in the world that have been carried out at a population level and at regular intervals. Aim The aim of the fourth Auckland Regional Community Stroke Studies IV is to examine the current measures of stroke incidence, prevalence, and outcomes as well the trends over four decades. This article describes the methodology of the Auckland Regional Community Stroke Studies IV with stroke and transient ischemic attacks cases registered over a 12-month period from March 1, 2011 to February 29, 2012. Conclusions The methodology described may be used as a guide in order to design similar population-based stroke incidence and outcome studies in other countries and populations, thus facilitating the collection of most consistent and accurate stroke epidemiological data

30-Year Trends in Stroke Rates and Outcome in Auckland, New Zealand (1981-2012): A Multi-Ethnic Population-Based Series of Studies.

BackgroundInsufficient data exist on population-based trends in morbidity and mortality to determine the success of prevention strategies and improvements in health care delivery in stroke. The aim of this study was to determine trends in incidence and outcome (1-year mortality, 28-day case-fatality) in relation to management and risk factors for stroke in the multi-ethnic population of Auckland, New Zealand (NZ) over 30-years.MethodsFour stroke incidence population-based register studies were undertaken in adult residents (aged ≥15 years) of Auckland NZ in 1981-1982, 1991-1992, 2002-2003 and 2011-2012. All used standard World Health Organization (WHO) diagnostic criteria and multiple overlapping sources of case-ascertainment for hospitalised and non-hospitalised, fatal and non-fatal, new stroke events. Ethnicity was consistently self-identified into four major groups. Crude and age-adjusted (WHO world population standard) annual incidence and mortality with corresponding 95% confidence intervals (CI) were calculated per 100,000 people, assuming a Poisson distribution.Results5400 new stroke patients were registered in four 12 month recruitment phases over the 30-year study period; 79% were NZ/European, 6% Māori, 8% Pacific people, and 7% were of Asian or other origin. Overall stroke incidence and 1-year mortality decreased by 23% (95% CI 5%-31%) and 62% (95% CI 36%-86%), respectively, from 1981 to 2012. Whilst stroke incidence and mortality declined across all groups in NZ from 1991, Māori and Pacific groups had the slowest rate of decline and continue to experience stroke at a significantly younger age (mean ages 60 and 62 years, respectively) compared with NZ/Europeans (mean age 75 years). There was also a decline in 28-day stroke case fatality (overall by 14%, 95% CI 11%-17%) across all ethnic groups from 1981 to 2012. However, there were significant increases in the frequencies of pre-morbid hypertension, myocardial infarction, and diabetes mellitus, but a reduction in frequency of current smoking among stroke patients.ConclusionsIn this unique temporal series of studies spanning 30 years, stroke incidence, early case-fatality and 1-year mortality have declined, but ethnic disparities in risk and outcome for stroke persisted suggesting that primary stroke prevention remains crucial to reducing the burden of this disease

NGA TEORIA E PARIMEVE DHE E PARAMETRAVE TEK TEORIA E MINIMALIZMIT: FRAZA KAUZATIVE

Questo breve articolo considera tre diverse strutture causative della lingua albanese che differiscono rispetto alla posizione del soggetto della frase subordinata. Nella prima, il soggetto subordinato ha caso nominativo ed è realizzato in posizione preverbale. Nel secondo tipo, il soggetto occupa la posizione finale. Nel terzo tipo, il soggetto subordinato ha caso accusativo e segue il verbo causativo. Viene analizzata la struttura interna di tutti e tre i tipi nell'ambito della Teoria dei Principi e Parametri e della Teoria Minimalista

Crude, age-specific and age-standardised annual stroke mortality rates per 100,000 people in Auckland, New Zealand across four study periods (1981–1982, 1991–1992, 2002–2003 and 2011–2012) by sex and ethnicity.

<p>* 16–64 in 2011–2012,</p><p>^<b>§</b> Age-standardised to WHO world population</p><p>Crude, age-specific and age-standardised annual stroke mortality rates per 100,000 people in Auckland, New Zealand across four study periods (1981–1982, 1991–1992, 2002–2003 and 2011–2012) by sex and ethnicity.</p

Forest plot of stroke incidence and attack rate ratios (2011–2012 compared with 1981–1982), with rates age-adjusted to the WHO world population.

<p>Forest plot of stroke incidence and attack rate ratios (2011–2012 compared with 1981–1982), with rates age-adjusted to the WHO world population.</p

Stroke incidence rates over 3 decades by ethnicity.

<p>Stroke incidence rates over 3 decades by ethnicity.</p

Annual age-adjusted stroke incidence rates in population-based studies[14,26–32,48–51] carried out in high-income countries in 2000–2014.

<p>Annual age-adjusted stroke incidence rates in population-based studies[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134609#pone.0134609.ref014" target="_blank">14</a>,<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134609#pone.0134609.ref026" target="_blank">26</a>–<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134609#pone.0134609.ref032" target="_blank">32</a>,<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134609#pone.0134609.ref048" target="_blank">48</a>–<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134609#pone.0134609.ref051" target="_blank">51</a>] carried out in high-income countries in 2000–2014.</p

Stroke incidence rates over 3 decades by 4 age groups.

<p>Stroke incidence rates over 3 decades by 4 age groups.</p