Pre-Stroke Depression in Ghana and Nigeria: Prevalence, Predictors and Association With Poststroke Depression

2020 ◽  
pp. 089198872096827
Author(s):  
Akin Ojagbemi ◽  
Joshua Akinyemi ◽  
Kolawole Wahab ◽  
Lukman Owolabi ◽  
Oyedunni Arulogun ◽  
...  
Keyword(s):  
Self Report ◽  
Leafy Vegetables ◽  
Stroke Survivors ◽  
Poststroke Depression ◽  
Middle Income ◽  
Green Leafy Vegetables ◽  
Middle Income Countries ◽  
Depression Status ◽  
Research And Education ◽  
Education Network

Objectives: Depression is a risk factor for stroke. There is a knowledge gap on the predictors of prestroke depression in stroke survivors living in low- and middle-income countries (LMICs). We estimated prevalence and predictors of prestroke depression, as well as its association with poststroke depression (PSD) in the largest study of stroke in Africa. Methods: We evaluated information collected as part of the Stroke Investigative Research and Education Network (SIREN) study, a multicentre, case-control study conducted at 15 sites in Ghana and Nigeria. Prestroke depression status was ascertained in stroke survivors using a validated self-report tool, while PSD was assessed using a stroke specific screening tool for depression (“HRQOLISP-E”). Independent associations were investigated using complementary log-log regression and binary logit models. Results: Among 1,977 participants, prestroke depression was found in 141 (7.1%). In multivariate analyses, prestroke depression was significantly associated with tachycardia (OR = 2.22, 95% CI = 1.37-3.56) and low consumption of green leafy vegetables (OR = 1.91, 95% CI = 1.12-3.24). Forty-one (29.1%) of the prestroke depression sub-sample developed PSD. However, prestroke depression was not significantly associated with PSD. Conclusion: The findings should energize before-the-stroke identification and prioritization of limited treatment resources in LMICs to persons with depression who have multiple, additional, risks of stroke.

Abstract WP233: Unraveling the Profile and Risk Factors of Post-Stroke Cognitive Impairment Among West African Stroke Survivors: Data From the SIREN Study

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Rufus Akinyemi ◽  
Bruce Ovbiagele ◽  
Onoja Akpa ◽  
Fred Sarfo ◽  
Joshua Akinyemi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cognitive Impairment ◽  
Conditional Logistic Regression ◽  
Leafy Vegetables ◽  
Stroke Severity ◽  
Stroke Survivors ◽  
Community Screening ◽  
Post Stroke ◽  
Green Leafy Vegetables ◽  
Education Network

Background: There is paucity of data on the epidemiology of post-stroke cognitive impairment among African stroke survivors. The aim of this study is to report the profile and risk factors of post- stroke cognitive impairment among stroke survivors participating in the Stroke Investigative Research and Education Network (SIREN) Study. Methods: 1566 were evaluated with the Montreal Cognitive Assessment (MoCA) tool, the Community Screening Instrument for Dementia (CSID) and the Stick Design Test three months after the index stroke. Domain scores were derived for executive function, language memory and visuo-constructive/visuospatial domains. Cut off scores were derived from normative cognitive data obtained from comparable healthy stroke-free control subjects. We used conditional logistic regression to estimate odds ratios (OR) with 95% CIs. Results: Of 1566 stroke survivors [mean age 57.7 (13.4) years] who were assessed 3 months after stroke, 37% were impaired in global cognition and 18-43% were impaired in different domains of cognition (executive, memory, language and visuo-constructive). Stroke severity measured by modified NIHSS score had a strong significant negative association with cognitive function in all domains OR 1.96(1.32-2.91). Older age 1.04 (1.02-2.05), male gender 0.69 (0.50 -0.96), low intake of green leafy vegetables 2.83 (2.03 -3.95) and cardiac disease 1.86 (1.31 -2.75) were associated with poorer cognitive performance in different cognitive domains. Conclusion: The frequency of post-stroke cognitive impairment was high among African stroke survivors three months after the ictus. Diet low in green leafy vegetables is a potentially modifiable risk factor for post-stroke cognitive impairment among West Africans.

scholarly journals Global neurosurgery: a scoping review detailing the current state of international neurosurgical outreach

2020 ◽  
pp. 1-9
Author(s):  
Anthony T. Fuller ◽  
Ariana Barkley ◽  
Robin Du ◽  
Cyrus Elahi ◽  
Ali R. Tafreshi ◽  
...  
Keyword(s):  
Scoping Review ◽  
Data Extraction ◽  
Medical Personnel ◽  
The United States ◽  
Middle Income ◽  
Middle Income Countries ◽  
Gray Literature ◽  
Current State ◽  
Study Selection ◽  
Research And Education

OBJECTIVEGlobal neurosurgery is a rapidly emerging field that aims to address the worldwide shortages in neurosurgical care. Many published outreach efforts and initiatives exist to address the global disparity in neurosurgical care; however, there is no centralized report detailing these efforts. This scoping review aims to characterize the field of global neurosurgery by identifying partnerships between high-income countries (HICs) and low- and/or middle-income countries (LMICs) that seek to increase neurosurgical capacity.METHODSA scoping review was conducted using the Arksey and O’Malley framework. A search was conducted in five electronic databases and the gray literature, defined as literature not published through traditional commercial or academic means, to identify studies describing global neurosurgery partnerships. Study selection and data extraction were performed by four independent reviewers, and any disagreements were settled by the team and ultimately the team lead.RESULTSThe original database search produced 2221 articles, which was reduced to 183 final articles after applying inclusion and exclusion criteria. These final articles, along with 9 additional gray literature references, captured 169 unique global neurosurgery collaborations between HICs and LMICs. Of this total, 103 (61%) collaborations involved surgical intervention, while local training of medical personnel, research, and education were done in 48%, 38%, and 30% of efforts, respectively. Many of the collaborations (100 [59%]) are ongoing, and 93 (55%) of them resulted in an increase in capacity within the LMIC involved. The largest proportion of efforts began between 2005–2009 (28%) and 2010–2014 (17%). The most frequently involved HICs were the United States, Canada, and France, whereas the most frequently involved LMICs were Uganda, Tanzania, and Kenya.CONCLUSIONSThis review provides a detailed overview of current global neurosurgery efforts, elucidates gaps in the existing literature, and identifies the LMICs that may benefit from further efforts to improve accessibility to essential neurosurgical care worldwide.

scholarly journals Involving End Users in Adapting a Spanish Version of a Web-Based Mental Health Clinic for Young People in Colombia: Exploratory Study Using Participatory Design Methodologies

10.2196/15914 ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e15914
Author(s):  
Laura Ospina-Pinillos ◽  
Tracey A Davenport ◽  
Alvaro Andres Navarro-Mancilla ◽  
Vanessa Wan Sze Cheng ◽  
Andrés Camilo Cardozo Alarcón ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Young People ◽  
Health Professionals ◽  
Participatory Design ◽  
Self Report ◽  
User Testing ◽  
Middle Income ◽  
Web Based ◽  
Middle Income Countries

Background Health information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties. Objective Using participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C). Methods This study involved the utilization of a research and development (R&D) cycle including 4 iterative phases: co-design workshops; knowledge translation; tailoring to language, culture, and place (or context); and one-on-one user-testing sessions. Results A total of 2 co-design workshops were held with 18 users—young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions—young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup; chat; geolocation; and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context. Conclusions The application of an R&D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R&D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C—a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time.

scholarly journals Priority micronutrient density in foods

2021 ◽  
Author(s):  
Ty Beal ◽  
Flaminia Ortenzi
Keyword(s):  
Goat Milk ◽  
Food Composition ◽  
Leafy Vegetables ◽  
Food Sources ◽  
Small Fish ◽  
Micronutrient Deficiencies ◽  
Middle Income ◽  
Fresh Fish ◽  
Green Leafy Vegetables ◽  
Dark Green

Abstract Despite concerted efforts to improve diet quality and reduce malnutrition, micronutrient deficiencies remain widespread globally, especially in low- and middle-income countries and among population groups with increased needs, where diets are often inadequate in iron, zinc, folate, vitamin A, calcium, and vitamin B12. There is a need to understand the top food sources of these commonly lacking micronutrients, which are essential for optimal health. To fill this critical knowledge gap, we built an aggregated global food composition database and developed an approach to rate foods according to their density in priority micronutrients. We show that the top sources of multiple priority micronutrients are organs, small fish, dark green leafy vegetables, shellfish, beef, goat, eggs, milk, cheese, and canned fish with bones. Lamb, mutton, goat milk, and pork are also good sources, followed by yogurt, fresh fish, pulses, and teff.

scholarly journals What are the Environmental Determinants to Participate Among Stroke Survivors in Africa? a Scoping Review

2021 ◽  
Author(s):  
Yohannes Awoke Assefa ◽  
Zelalem Dessalegn Demeke
Keyword(s):  
Environmental Factors ◽  
Adult Population ◽  
Grey Literature ◽  
International Classification Of Functioning ◽  
Stroke Survivors ◽  
Environmental Determinants ◽  
African Countries ◽  
Middle Income ◽  
Middle Income Countries

Abstract Background Stroke is the main cause of serious long-term disability worldwide, and it is the second commonest cause of death and a leading cause of adult disability. Two-thirds of stroke cases occur in low- and middle-income countries, which all African countries fall. In Africa, the incidence and survival rate of stroke is increasing. Various personal and environmental factors limit the participation of stroke survivors. As a result, in this review, we aimed to review the environmental factors that are influencing the participation of stroke survivors in Africa. Methods Five electronic databases were systematically searched in August 2021 and identified articles were screened by three authors based on predetermined criteria. We followed Arksey and O'Malley (2005) framework and the whole finding is reported using PRISMA-ScR. No date restrictions were imposed, and we included any type of papers including grey literature. Results 584 articles were generated by our search, after removing duplicates, the title and abstract of 497 articles were screened. From the screening, 42 articles were selected for full article review from which 12 met the criteria to be included. We also manually searched and included one more article for the review. Conclusion Studies were mainly conducted in South Africa and assessed the adult population. We followed the International Classification of Functioning, Disability and Health (ICF) framework for the environmental determinants to present our findings. Products and Technology; Natural Environment and Human-Made Changes to Environment; and Services, Systems and Policies found to be a barrier for participation. Conversely, stroke survivors are getting good support from their immediate family and health professionals, which is found to be facilitating. This review could be used by policymakers to understand the environmental barriers that are hindering participation and help to improve the accessibility of the environment so stroke survivors can participate in the community.

scholarly journals Comparing psychotic experiences in low-and-middle-income-countries and high-income-countries with a focus on measurement invariance

2020 ◽  
pp. 1-8
Author(s):  
Edo S. Jaya ◽  
Caroline Wüsten ◽  
Behrooz Z. Alizadeh ◽  
Therese van Amelsvoort ◽  
Agna A. Bartels-Velthuis ◽  
...  
Keyword(s):  
Measurement Invariance ◽  
Community Sample ◽  
High Income ◽  
Self Report ◽  
Psychotic Experiences ◽  
Confirmatory Factor Analyses ◽  
Middle Income ◽  
Middle Income Countries ◽  
Sum Scores ◽  
Low And Middle Income

Abstract Background The prevalence of psychotic experiences (PEs) is higher in low-and-middle-income-countries (LAMIC) than in high-income countries (HIC). Here, we examine whether this effect is explicable by measurement bias. Methods A community sample from 13 countries (N = 7141) was used to examine the measurement invariance (MI) of a frequently used self-report measure of PEs, the Community Assessment of Psychic Experiences (CAPE), in LAMIC (n = 2472) and HIC (n = 4669). The CAPE measures positive (e.g. hallucinations), negative (e.g. avolition) and depressive symptoms. MI analyses were conducted with multiple-group confirmatory factor analyses. Results MI analyses showed similarities in the structure and understanding of the CAPE factors between LAMIC and HIC. Partial scalar invariance was found, allowing for latent score comparisons. Residual invariance was not found, indicating that sum score comparisons are biased. A comparison of latent scores before and after MI adjustment showed both overestimation (e.g. avolition, d = 0.03 into d = −0.42) and underestimation (e.g. magical thinking, d = −0.03 into d = 0.33) of PE in LAMIC relative to HIC. After adjusting the CAPE for MI, participants from LAMIC reported significantly higher levels on most CAPE factors but a significantly lower level of avolition. Conclusion Previous studies using sum scores to compare differences across countries are likely to be biased. The direction of the bias involves both over- and underestimation of PEs in LAMIC compared to HIC. Nevertheless, the study confirms the basic finding that PEs are more frequent in LAMIC than in HIC.

Co-existence of diabetes and TB among adults in India: a study based on National Family Health Survey data

2020 ◽  
pp. 1-15
Author(s):  
Apyayee Sil ◽  
Dinabandhu Patra ◽  
Preeti Dhillon ◽  
Padmanesan Narasimhan
Keyword(s):  
Health Survey ◽  
Family Health ◽  
State Level ◽  
Self Report ◽  
National Family Health Survey ◽  
Middle Income ◽  
Middle Income Countries ◽  
Co Morbidity ◽  
National Family ◽  
Robust Poisson Regression

Abstract Multiple studies suggest that diabetes mellitus (DM) is a potential risk factor for tuberculosis (TB) development and treatment, especially in low- and middle-income countries. The study aimed to test concomitancy between DM and TB among adults in India. Data were from the 2015–16 National Family Health Survey (NFHS-4). The study sample comprised 107,575 men aged 15–54 and 677,292 women aged 15–49 for which data on DM status were available in the survey. The association between state-level prevalence of TB and DM was examined and robust Poisson regression analysis applied to examine the effect of DM on TB. A high prevalence of TB was observed among individuals with diabetes in India in 2015–16. A total of 866 per 100,000 men and 405 per 100,000 women who self-reported having diabetes also had TB; among those who self-reported not having diabetes the ratios were 407 per 100,000 men and 241 per 100,000 women. The risk of having TB among those who self-reported having DM was higher for both men (2.03, 95% CI: 1.26, 3.28) and women (1.79, 95% CI: 1.48, 2.49) than for those who did not self-report having DM. Adults who were diagnosed with diabetes (including pre-diabetes) also had a higher rate of TB (477 per 100,000 men and 331 per 100,000 women) than those who were not diagnosed (410 per 100,000 men and 239 per 100,000 women). Adults from poor families, with lower BMIs, lower levels of literacy and who were not working had a higher risk of TB–DM co-morbidity. The state-level pattern of co-morbidity, the under-reporting of DM (undiagnosed) and TB stigmatization are discussed. The study confirms that diabetes is an important co-morbid feature with TB in India, and reinforces the need to raise awareness on screening for the co-existence of DM and TB with integrated health programmes for the two conditions.

Abstract P558: Association Between Stroke Prevalence and Depression, Functional Ability, and Cognitive Function in Six Low and Middle Income Countries: The WHO Study on Global AGEing and Adult Health

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Carin Northuis ◽  
Lama Ghazi
Keyword(s):  
Cognitive Function ◽  
Functional Ability ◽  
Stroke Survivors ◽  
Adult Health ◽  
Middle Income ◽  
Stroke Incidence ◽  
Stroke Outcomes ◽  
Middle Income Countries ◽  
Stroke Prevalence ◽  
Global Ageing

Background: There are substantial gaps in stroke morbidity in low and middle income countries (LMIC) compared to high income countries (HIC). Stroke incidence and mortality are higher in LMIC compared to HIC. While education has been associated with stroke incidence and common stroke outcomes in HIC, the pattern of this social determinant of health may be reversed in LMIC. We examined the association between stroke prevalence and depression, cognitive function and functional ability utilizing the WHO Study on Global AGEing and Adult Health (SAGE). We also assessed if education modified this association. Methods: We used data from the WHO SAGE, wave 1 (2007-10), which is a nationally representative cohort from six LMIC: China, Ghana, India, Mexico, Russia, and South Africa. Stroke prevalence was classified by self-reported stroke or stroke symptoms. Outcomes included 1) depression [ICD-10 diagnostic criteria]; 2) cognitive function [z-score of performance on executive function, verbal fluency, and memory]; and 3) functional ability [WHO Disability Assessment Schedule]. Generalized linear models were fit for the association between stroke prevalence and outcomes. For our secondary analysis, educational attainment was included as a modifier. All models were adjusted for demographics, socioeconomic status, and health variables. Results: We included 39,896 individuals who had data on their stroke status. Stroke prevalence was 5.1% (n=2,034). Stroke survivors had lower mean cognitive function (-0.1±.8 vs 0.1±0.7, p<0.001), lower functional ability (71.3±21.8 vs 84.6±17.0, p<0.001), and higher percentage of depression (13.0% vs 5.3%, p<0.001) compared to those who did not have a stroke. Prevalence of stroke was associated with significantly higher adjusted odds of depression (Odds Ratio (OR): 1.7; 95% Confidence Interval (CI): 1.3, 2.0), lower cognitive function (Risk Difference (RD): 0.07; 95% CI: -0.1, -0.03), and lower functional ability (RD: -7.4; 95% CI: -8.3, -6.5). Education modified the association of stroke with functional ability but not with depression or cognitive impairment. Stroke survivors with primary or less education had significantly lower physical function than those with tertiary or more (p for interaction=0.04). Conclusion: Stroke was associated with a higher odds of depression and higher risk of reduced cognitive function and functional ability. Unlike in HIC, these six LMIC did not display a significant inverse association between education and depression and cognitive function. Future studies should assess predictors of poorer post-stroke outcomes and if other socioeconomic measures modify consequences of stroke in LMIC.

scholarly journals ASSESSING PHARMACY STUDENTS’ MIGRATION RELATED ATTITUDES AND INTENTION TO EMIGRATE FROM LITHUANIA

2017 ◽  
Vol 27 (3) ◽  
pp. 123-128
Author(s):  
Gvidas Urbonas ◽  
Indrė Venclovaitė ◽  
Aušra Urbonienė ◽  
Loreta Kubilienė
Keyword(s):  
Pharmacy Students ◽  
Self Report ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Convenience Sample ◽  
Middle Income ◽  
High Unemployment ◽  
Personal Attitude ◽  
Middle Income Countries ◽  
Path Analysis Approach

Lithuania among the middle-income countries is experiencing the brain drain situation when high-educated professionals, including health care specialists, migrate to high-income countries in search for better economic, social and cultural life. The objective of the study was to identify the potential reasons for migration from the perspective of pharmacy students that might come into consideration after they graduate university. A convenience sample (n = 196) of pharmacy students participated in the cross-sectional survey where they gave opinion on why people emigrate from Lithuania, also expressed personal attitude towards emigration, as well as intention to emigrate after the studies on self-report scales. The nonlinear Robust Path Analysis approach was employed for data analysis. The results revealed that high unemployment conceived as a reason to emigrate from Lithuania, as well as personal attitude towards emigration was significantly linked with intent to emigrate after studies. Family or friends living abroad, adverse cultural environment, and lack of entertainment options conceived as a reason to emigrate significantly affected students personal attitude towards emigration from Lithuania. High unemployment as a reason for emigration remained the main factor directly associated with the intention to emigrate. However, investment in social, cultural and human capital should be seen as the next step to reduce the attractiveness of emigration to the future pharmacists.

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