Search

Rationale Stroke is a major cause of death and disability worldwide, yet 80% of strokes can be prevented through modifications of risk factors and lifestyle and by medication. While management strategies for primary stroke prevention in high cardiovascular disease risk individuals are well established, they are underutilized and existing practice of primary stroke prevention are inadequate. Behavioral interventions are emerging as highly promising strategies to improve cardiovascular disease risk factor management. Health Wellness Coaching is an innovative, patient-focused and cost-effective, multidimensional psychological intervention designed to motivate participants to adhere to recommended medication and lifestyle changes and has been shown to improve health and enhance well-being. Aims and/or hypothesis To determine the effectiveness of Health Wellness Coaching for primary stroke prevention in an ethnically diverse sample including Māori, Pacific Island, New Zealand European and Asian participants. Design A parallel, prospective, randomized, open-treatment, single-blinded end-point trial. Participants include 320 adults with absolute five-year cardiovascular disease risk ≥ 10%, calculated using the PREDICT web-based clinical tool. Randomization will be to Health Wellness Coaching or usual care groups. Participants randomized to Health Wellness Coaching will receive 15 coaching sessions over nine months. Study outcomes A substantial relative risk reduction of five-year cardiovascular disease risk at nine months post-randomization, which is defined as 10% relative risk reduction among those at moderate five-year cardiovascular disease risk (10–15%) and 25% among those at high risk (>15%). Discussion This clinical trial will determine whether Health Wellness Coaching is an effective intervention for reducing modifiable risk factors, and hence decrease the risk of stroke and cardiovascular disease. [ABSTRACT FROM AUTHOR]

Background: Depression and anxiety are the two most frequently studied emotional outcomes of stroke. However, few previous studies have been carried out at a population level or beyond 6 months post stroke. The aim of this study was to describe depression and anxiety across the first year following incident ischemic stroke (IS), and identify predictive factors in a population-based study.Method: The Hospital Anxiety Depression Scale (HADS) was administered at baseline (within 2 weeks of onset), and again at 1-month, 6-months and 12-months after IS in a sample (N = 365) drawn from a population-based study.Results: Over 75% of those assessed experienced depression or anxiety symptoms below cut-offs for probable disorder across the year post stroke. Moderate to severe symptoms for anxiety were approximately twice as likely (range 4.1%–10.6%) as compared to depression (range 2.5%–5.0%) at each assessment. The greatest improvement in anxiety occurred within the first month post stroke. In contrast, the greatest reduction in depression occurred between 1- to 6-months post stroke.Conclusions: Anxiety symptoms in the moderate to severe range were twice as common as depression, and improved over the first month post stroke, whilst depression symptoms persisted for up to 6 months, indicating a need to target these two issues at different points in the recovery process. [ABSTRACT FROM AUTHOR]

Streamside management zones (SMZs) are a common best management practice (BMP) used to reduce water quality impacts from logging. The objective of this research was to evaluate the impact of varying SMZ configurations on water quality. Treatments (T1, T2, and T3) that varied in SMZ width, canopy retention within the SMZ, and BMP utilization were applied at the watershed scale to two watersheds each. Watersheds with wider SMZs (T3: 110 ft, 100% canopy retention) and improved crossings were not significantly different from unharvested control (C) watersheds for all parameters except nitrate and diurnal stream temperatures. Changes in total suspended solids, turbidity, nitrate, dissolved oxygen, and maximum stream temperature were detected for watersheds treated with the current recommended minimum SMZ configurations (T1: 55 ft, 50% canopy retention) and watersheds with unharvested SMZs (T2:55 ft, 100% canopy retention) and improved crossings. [ABSTRACT FROM AUTHOR]

Background: Insufficient 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. Methods: Four 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. Results: 5400 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. Conclusions: In 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Most states in the United States have established streamside management zone (SMZ) recommendations for minimizing the impacts of forest operations on water quality and aquatic habitat. However, guidelines generally focus more on impacts to perennial streams than on ephemeral streams. An experiment was conducted to evaluate SMZ effectiveness on ephemeral streams in southeastern Kentucky. Ephemeral SMZ treatments included (1) harvest with no equipment limitation, no forest overstory retention, and use of unimproved stream crossings (noSMZ); (2) harvest with no equipment limitation, retention of channel bank trees, and use of improved stream crossings (SMZ1 ); (3) harvest with equipment restrictions within 7.6 m of the channel, retention of channel bank trees, and use of improved stream crossings (SMZ2); and (4) no harvest (control). Each treatment was replicated a minimum of three times (n of 3 to 6; 18 sites total) at the subwatershed level (0.75 to 8.92 ha). The improved stream crossing types studied included wooden portable skidder bridges, steel pipe/culverts, and PVC pipe bundles. Water samples were taken during storm flows and were analyzed for total suspended solids (TSS), turbidity, settleable solids, and sediment transport rate. Both the SMZ1 and SMZ2 treatments significantly reduced TSS and turbidity over the noSMZ treatment. Water in the SMZ1 treatment exhibited higher TSS and turbidity than the control, whereas the SMZ2 treatment was no different than the control for TSS but higher for turbidity. Use of any improved crossing in ephemeral streams significantly lowered TSS and turbidity compared to unimproved fords. Bridges yielded similar TSS and sediment transport levels as those exhibited by the control but turbidity was slightly higher. [ABSTRACT FROM AUTHOR]