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Objective Evidence supporting lifestyle modification in vascular risk reduction is limited, drawn largely from primary prevention studies. To advance the evidence base for non-pharmacological and non-surgical stroke secondary prevention (SSP), empirical research is needed, informed by a consensus-derived definition of SSP. To date, no such definition has been published. We used Delphi methods to generate an evidence-based definition of non-pharmacological and non-surgical SSP. Results The 16 participants were members of INSsPiRE (International Network of Stroke Secondary Prevention Researchers), a multidisciplinary group of trialists, academics and clinicians. The Elicitation stage identified 49 key elements, grouped into 3 overarching domains: Risk factors, Education, and Theory before being subjected to iterative stages of elicitation, ranking, discussion, and anonymous voting. In the Action stage, following an experience-based engagement with key stakeholders, a consensus-derived definition, complementing current pharmacological and surgical SSP pathways, was finalised: Non-pharmacological and non-surgical stroke secondary prevention supports and improves long-term health and well-being in everyday life and reduces the risk of another stroke, by drawing from a spectrum of theoretically informed interventions and educational strategies. Interventions to self-manage modifiable lifestyle risk factors are contextualized and individualized to the capacities, needs, and personally meaningful priorities of individuals with stroke and their families.

Compound-specific amino acid carbon-isotope compositions have shown particular promise for elucidating dietary behaviors in complex environmental contexts, and may also be able to mitigate the effect of many of the limitations inherent to palaeodietary reconstructions. Here, we investigate the efficacy of compound-specific amino acid isotopic proxies in characterizing the consumption of different dietary protein sources using amino acid carbon-isotope compositions for humans and fauna from Rössberga (Early to Middle Neolithic), Köpingsvik (Mesolithic and Middle Neolithic), and Visby (Medieval Period), Sweden. We also assess the explanatory capabilities of an isotopic mixing model when used with essential amino acid carbon-isotope compositions of humans and local fauna. All three isotopic proxies distinguished among humans from the three sites consistently and informatively, and were able to enhance the broad interpretations made using bulk isotopic compositions. The mixing model palaeodietary reconstruction revealed considerable diversity in relative protein source contributions among individuals at both Köpingsvik and Visby. Comparing the mixing model for bulk carbon- and nitrogen-isotope compositions to the model for essential amino acid isotopic compositions further demonstrated the likelihood of underestimation and overestimation of marine protein consumption for both aquatic-dominant and mixed marine-terrestrial diets when using bulk isotopic compositions.

Background There is a lack of evidence-based health services to reduce the impact of stroke in low-income countries at a personal, family or community level. The aim was to evaluate the feasibility of: i) a mobile phone supported family-centred intervention (F@ce™), and ii) the study design for evaluating the effects of the intervention on the perceived impact of stroke; perceived participation in everyday life; and self-efficacy in everyday activities amongst persons with stroke and their families in Uganda. Methods The study comprised a pre-post design with an intervention group (IG) receiving the F@ce™ and a control group (CG). The inclusion criteria’s were: a) confirmed stroke diagnosis, b) access to and ability to use a mobile phone, c) ability to communicate in English and/or Luganda, d) > 18 years, e) residents in Kampala, and f) a Modified Rankin Scale level 2 to 4. The aim of the F@ceTM was to increase functioning in daily activities for persons living with the consequences of stroke, and participation in everyday life for persons with stroke and their families. The F@ce™ was an eight-week family-centred intervention, which entailed goal setting and problem-solving strategies, daily reminders and self-rated follow-ups of performance by short message service (SMS). Data were collected in the participants’ home environment at baseline and after eight weeks. Data on acceptability of the F@ce™ and study procedures were collected by log-books and the responses of the SMS follow ups on the server. The primary outcomes were performance and satisfaction of valued daily activities in everyday life using the Canadian Occupational Performance Measure (COPM), self-efficacy in performance of activities in daily life. Results The IG comprised n = 13 and the CG n = 15. There were differences between the IG and CG in changes between baseline and follow-up in the primary outcomes COPM (performance component) and self-efficacy in favour of F@ce™. Overall with minor modifications the intervention and the study design were feasible for all participants involved. Conclusion The results support the need for further research to rigorously evaluate the effects of F@ce™ since the intervention appears to be feasible for persons with stroke and their family members. Electronic supplementary material The online version of this article (10.1186/s12992-018-0400-7) contains supplementary material, which is available to authorized users.