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What is the cost of first time stroke in Australia?
in 1997 555 mill
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What is the present value of lifetime cost of stroke?
1.3 billion
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what is the cost of informal care for stroke survivors?
21.7 million in the first yr after stroke
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What are the risks of recurrent stroke in the first year?
- - 10% will have another stroke within a year
- - 5% will have subsequent year for 5
- - 5-10% suffer a heart attack each yr
- If pt manages risk factor decreases the chance of getting another stroke
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what is primary stroke prevention?
- preventing people having a stroke eg people with high BP
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what is secondary stroke prevention?
when pt has had a stroke and you are trying to prevent another
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stroke prevention
- - risk factors multiply the risk of stroke
- - reducing one risk factor can significantly reduce stroke risk
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Why is it important we understand the stats about strokes?
- - only 31% of stroke survivors identified HTN as a risk for stroke
- - you will probably spend more time with then than any other clinician
- - statistically if their risk factor are not managed we will see them in rehab again
- - 85% of people who have a stroke have high BP
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what is the behavioural stroke risk?
- - tobacco smoking
- - high alcohol use
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what are the clinical risk factor classification?
- high blood pressure
- - high cholesterol
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What are the non modifiable risk factors for stroke?
- - age- 55+ risk of stroke doubles every decade
- - gender- men higher, but women live longer and have more
- - ethnicity- indigenous increase stroke,asain and afican high incidence of haem stroke
- - family history
- - previous stroke
- - socio-economic status
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what are the physiological modifiable risk factors for stroke?
- - HTN- increase risk factor 85%, it causes a variety of structural changes, associated with ischemic stroke
- - hypercholesterolaemia- ischemic
- - obestiy
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What are the risk factors for modifiable clinical disorders for stroke?
- - AF and CHD- coronary heart disease
- - diabetes
- - carotid atheroscleorisis
- - TIA
- - ABCDD
- - Age > 60 1 point
- - BP > 140/90 Hg 1 point
- - diabetes 1 point
- - unilateral weakness (2 points)
- - speech imapirements
- - duration of symptoms 10-59 min 1 point > 60 2 points
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what are the risk factors for stroke?
- - sleep apnoea- can be a symptom
- - depression- can be symptom
- - excessive alcohol-increase blood volume
- - smoking
- - unhealthy diet
- - lack of physical activity
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why does smoking increase stroke risk?
- - inflames and irritates the blood vessel walls
- - increase blood aggregability
- - less oxygen is being transported around the body, this leads to increased stress in blood vessels
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what advice do u offer a smoker?
- - your best chance of managing your smoking is using combination nicotine replacement therapy
- - at least 7 weeks
- - that is a combination of patches and/ or gums and/ or lozenges and/ or inhalers
- - call quitline
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What is zyban?
- - an effective nicotine replacement therapy in quitting
- - it is a prescription drug
- - only works in 1/4 people
- - if it is going to work it will work within 2 weeks
- - cheapest way of quiting
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tips for quitting smoking?
- - halve your caffine as zyban doubles ur absorption of cafine
- - eat brekky- sugar helps decrease desire to smoke
- - reduce alcohol- none for the first two weeks
- - caution with warfarin- talk to dr as INR will go up. INR 2-3 = 2 x thinner than normal. More INR = thinner blood
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how does diet affect stroke risk?
- - low intake of fruit and veg increases your risk of stroke
- - anti- oxidants
- - folate (B vitamin)
- - potassium- helps controls sodium
- - fibre- help absorbs cholesterol in gut
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What are your aims for fruit and veg intake?
- Aim
- - 5 serves vegies and 2 fruits a day
- - people who have > 5 serves of fruit and veg/ day have a 26% stroke risk reduction
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What do dairy products relate with stroke?
- - calcium and potassium in dairy products help with BP
- - 2-3 serves a day
- - 1 serve = 250ml cup of milk
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How much bread and cereals should u have a day?
- 58 serves a day
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meat/ fish/ chicken/ eggs
- we need at least 1 serve a day for good health
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Nuts- contain antioxidants and can lower cholesterol
fats- small amount is needed in a healthy diet
salt- can increase high BP, most salt in our diets comes from packaged foods
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implications of being physically inactive and stroke?
- - inactivity accounts for 3- fold increase in risk of stroke
- - PWD more at risk
- - inactivty ranks first as the leading contributor to preventable illness and morbidity in women
- - most studies have focused on endurance type activities
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How does exercise prevent stroke?
- - diabetes
- - obesity
- - cholesterol- exercise increases good chol
- - BP
- - depression and social isolation
- - falls and injuries from falls
- But the benefits go once you stop exercise
- 49% are not active enough in aust
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How mch exercise should you have?
- national stroke recommendations:
- - 30 mins of moderate intensity activity on most days
- - can be accumulated with no less than 10 min at a time
- mm strengthening exercise- 2/3 days a week, flex and balance 10 min 2/3 days a week hold stretch 10-30 sec
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Measuring activity
- dimensions:
- - energy expenditure- DLW, calorimetric methods (heat loss), HR- not accurate
- - type
- - frequency
- - intensity
- - duration
- - distance etc
- - direct obs
- - motion sensors
- - self report- diaries
- - you must consider all your stroke clincets for ongoing exercise for secondary prevention
- - the clinet must be aware of the exercise prescription guidelines and how to meausre if they are achieving them
- - link you clients with programs and follow them up
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