World Stroke Day 2019 to focus on stroke risk and prevention
The World Stroke Organization has announced the theme for World Stroke Day 2019. With a focus on stroke prevention, the ‘Don’t be the One’ campaign aims to raise awareness of our individual lifetime risk of stroke and to equip as many people as possible with potentially life-saving prevention information and tools.
The rationale for the campaign message is the recent WSO analysis of the Global Burden of Disease, which shows that globally the lifetime risk of stroke has risen and now stands at 1 in 4. Combined with the Interstroke findings that showed around 90% of strokes are linked to a small number of easily addressed risk factors, the potential impact of public understanding of stroke risk and prevention awareness is clear.
Speaking about the World Stroke Day campaign theme, World Stroke Organization Vice President and Campaign Committee co-Chair, Sheila Martins said ‘For me the 29th October is always such an exciting day for the stroke community – it’s the one day of the year that we can come together globally and to make as many people as possible aware of stroke. This year our message When it comes to stroke, think prevention – Don’t be the one.’ is relevant and essential to everyone and we look forward to seeing the stroke community taking up the campaign in countries around the world!’
Co-Chair Deidre De Silva and a leading awareness campaigner Singapore ‘Our team strived to deliver a campaign that will resonate with diverse populations around the world. Stroke is not prevented by hoping it will never happen to you. The campaign encourages everyone to be proactive by understanding their stroke risk and taking the steps to prevent stroke and its devastating consequences.’
World Stroke Day Campaign Resources
A campaign guide for members and the public will provide guidance on how to join the global prevention awareness effort. This will be available from the revamped World Stroke Day website. Members and partners will have access to campaign resources including the campaign video, gifs, editable posters, infographics, social media posts and translated prevention factsheets.
Stroke Riskometer
The Campaign team is also working in close partnership with the Stroke Riskometer team at Auckland University of Technology to promote the WSO endorsed Stroke Riskometer as a tool to understand individual stroke risk and to identify individual risk factors. Riskometer users will be encouraged to conduct their own risk assessment and to share the app on social media tagging four friends. If one person who is tagged downloads and uses the app, they will have free access to an app upgrade that will support them to take appropriate action to reduce their stroke risk.
The Campaign Committee is reaching out to members and supporters asking you to mobilise your global stroke ambassador and influencer network to help us get our potentially life-saving message to as many people as possible.
“Patients’ families have even less support than patients themselves and are often left alone to manage their life and organise the life of their family member with stroke.” said Milan Čuček, President of the Slovenian Stroke Support Organisation and the Vice President Tatjana Erjavec added “It is challenging for carers to assist them with integration into relevant social networks. Stroke support organisation is currently trying to bridge this gap.”
This week we are investigating what is the main after-stroke problem from the patients’ perspective in Slovenia.
SAFE: What is one issue related to the life after stroke in your country that you think needs special attention?
Stroke Care starts in hospitals and majority will have multidisciplinary teams to take care of stroke survivors. Patients with severe disabilities and rehabilitation potential will continue their rehabilitation either at the Rehabilitation Institute or in dedicated Spa’s around Slovenia. This process takes up to 6 weeks. Nowadays, stroke survivors have the possibility for ongoing visits to neurologists. Systematic rehabilitation support is, however, lacking.
Majority of stroke survivors return to their homes with limited access to further rehabilitation programmes. There is a possibility for subsides home help for maximum 20 hours per week and if medical condition requires, also visits from nurses. Primary level provides physiotherapy across Slovenia, but only on the outpatient basis and in limited amount. Occupational therapy is only available in three primary level institutions around country and it is delivered in patients’ homes. Psychology and speech therapy is virtually not available in the community. Private services are possible and this creates imbalance considering access to health services in favor of those who are financially stronger. Majority of stroke survivors are retired and with lower pensions and have therefore limited access to private therapies. In addition, it is observed that central Slovenia and bigger cities have better long-term support comparing to rural parts around country and North West part of Slovenia.
SAFE: What would be the solution, i.e. what is your organisation’s position regarding this issue?
Slovenia is a small country with population of 2 million and a good network of primary care. So far, primary care provides social service, limited access to physiotherapy and limited occupational therapy services. Ministry of Health has appointed special group, dealing with organisation of long term support for stroke survivors and creating a document for local long-term multidisciplinary stroke care. In addition, the legislation, dealing with long-term home care also includes multidisciplinary care. The challenge remains implementation of both, related to provide enough financial resources.
Slovenia has well developed Spa rehabilitation. Stroke survivors have an access to Spa rehabilitation in acute stage. Regular access to Spa rehab in sub-acute and chronic stage is not guaranteed by insurance. Stroke Support Organisation highly value this rehabilitation programs for stroke survivors and their relatives and therefore enables it for 100 members per year, being aware that this is not enough.
Ongoing support for carers is essential and it could be organised via educational sessions, self-help groups, organised respite care.
Patient organisations, providing social and health support in public interest, should have an ongoing financial support. Accessing finances via public calls requires professionally that can hardly work voluntarily all the time.
SAFE: Please tell us more about your organisation.
Slovenian Stroke Support Organisation is going to celebrate 30 years of its existence. It operates through 22 stroke clubs around Slovenia and it has 3000 members; mainly stroke survivors and relatives, but also few professionals (volunteers) and other supporters. Leaders of local stroke clubs are stroke survivors. Registered is as a Humanitarian organisation working in public interest. Main financing comes on annual basis from National lottery (FIHO). Additional income comes from local municipalities where clubs are operating, public calls for NGOs, memberships, donations and sponsorship, collaboration in research projects.
Main activities are enabling long-term rehabilitation support via SPA’s, organised physiotherapy in stroke clubs, sport activities, organized exercises (Nordic walking), organized walks. In addition, social networking, educational sessions for stroke survivors and families, organised creative workshop. In last years we provide workshops about self-care and aphasia group. Each year is organised National gathering and this year it will be in Postojna cave for over 370 members. Twice per year, journal KAPNIK is published and the website is constantly updated.
With respect to promotion we organize several events, including traditional walk around Ljubljana, for the European stroke day. Several events are also organized around World Stroke Day. The WSO has given award to our SSO for the best campaign in high income countries for year 2018.
SAFE is delighted to share the news of Stroke Society of Slovenia being awarded with the World Stroke Award in the High-Income Country category.
World Stroke Awards are given to organisations and individuals who have demonstrated high levels of commitment and creativity in support of the objectives and messages of the World Stroke Campaign.
The Campaign Working Group and Committee selected the Stroke Society of Slovenia, for an award based on their impressive outreach programme and development of local partnerships that will do much to raise awareness of stroke and to build an understanding of the challenges of stroke survivors.
The Committee were impressed by the reach of Slovenian campaign, and strategic engagement of faith based organizations and media that will help to support future advocacy and public awareness campaigns in Slovenia.
Did you know that sitting for long periods of time increases your risk of heart disease and stroke?
It is recommended that we get 30 minutes of moderate intensity activity at least five days a week. However, this does not cancel out the damage caused to our health by sitting for long periods of time.
A recent survey by the Irish Heart Foundation revealed that the average person in Ireland sits down for 7.3 hours a day. The Irish Heart Foundation will run the campaign ‘Escape your Chair’ throughout the month of September. The campaign aims to inform and advise about the dangers of sitting too much and provide useful resources to help reduce your sitting time by making your working day, commute and leisure time more active.
Helping you Escape Your Chair and move more, the campaign also aims to reduce your risk of heart disease and stroke.
To learn more about this campaign, please visit www.irishheart.ie.
Each stroke survivors’ journey is a different story. The terrible and terrifying experience changes lives forever, but sometimes people choose to focus on positive things and look forward, redefining their views on life and establishing to so called “new normal”. One of these remarkable people, David Festenstein from the UK, shared with us his life story and how his stroke journey led to a recovery programme called “7 steps to recovery“.
SAFE: How old were you and how did you feel when stroke happened to you? DF: I was 54 years old, that’s 11 years ago, I can not believe it was such a long time ago as it is always vivid in my mind when I think about it. At the time I could not understand why it happened to me as I lived such a healthy life style. I swam most days. I was going to weight-watchers and almost at my ideal body weight. I was also a non-smoker, a moderate drinker, my blood pressure was normal and there was no history of stroke in our family.
On the day of the stroke, I was very frightened I remember shaking in the bay of the stroke ward wondering what would become of me. Would I ever walk again, work again? To go from being able bodied to loosing half the movement in my body, I became numb with the uncertainty. At first I had been told that they thought I had had a stroke as a result of a blood clot and that they would be able to carry out the procedure of thrombolysis (a clot busting drug) that would allow the movement to slowly come back. So I began to run a film of getting better, but this was not to be as they discovered after a scan that it was a bleed and so they could not carry it out. They had said they would have to admit me to the stroke ward and “take it from there” so at this point I felt really terrible, hence the feelings described above.
SAFE: How did the ‘7 steps to recovery’ idea emerged? DF: The “ 7 steps to recovery” originated from the diary and journal which I kept during my stay in hospital. The idea of the diary was to maintain my focus on gratitude, ie what I still had rather than what I had lost. At the same time holding a vision of being a better man back with my wife and children living a normal life again.
I would log the day’s events, highlighting what went well, what worked, what did not work and any overall learning. Also it gave me the opportunity to vent my frustration when I had really difficult days.
The journal allowed me to record any additional learning or observations, especially when I was learning to walk again.
My consultant was fascinated by how I applied my coaching and communication background to my recovery. He said that he thought I was one of the best recoveries he had ever seen. He thought they could learn a lot from my recovery. Firstly how my strategies could be applied to less resourceful patients than myself and secondly how they as health professionals could reflect on what they could do differently to improve the stroke recovery process overall. As a result he invited me to come back to present to the medical team when I was better.
In April 2009 and I went back to the stroke ward and presented to my consultant Dr David Collas and his medical team. In consolidating my notes I discovered there were seven distinct steps that I had taken to support my recovery. They were very excited as they could see the potential for these steps to be applied not only to stroke recovery but in fact any severe health set back.
Finally these videos are the videos that were developed in association with Oxford Brookes University for the content for the 7 Steps recovery app in 2014/15.
SAFE: How difficult was it for you to get back to your regular life after stroke, considering that you were one of the ‘lucky ones’- your recovery was remarkable, you live in the 1st world country where you can get the maximum care etc.? DF: Although I had mobility and I could walk, I could not walk any significant distances without getting very tired. Also the way in which I was walking was far from right so I fought hard to get further physiotherapy because as far I was concerned, there was much more improvement needed. However in contrast the Physiotherapist who was treating me said “I had reached a plateau and that was a good as it gets”
I refused to accept this and as the number of sessions had run out and they would not give me any more, I engaged the Neuro physiotherapist who had treated me in hospital and the quality of my walking improved dramatically.
She had discovered that the former Physiotherapist was giving me “strengthening exercises” rather than “Neuro ones”, so no wonder I was not improving very much and reaching “this plateau”.
The other difficulty that I suffered for a long time was getting tired easily, i.e. fatigue. Furthermore as a result of having my stoke I had lost the work I had before the stroke. As I work for myself I had to start prospecting for work from scratch again and did not start working properly until April of 2009.
SAFE: In conclusion, what would be your one take away message that summarises your seven steps as you describe them in your Youtube videos? DF: The one take away message would be that summarises the 7 steps is that at some level you can take control with your mind and begin to set the intent for your recovery and then create a vision for your life after your stroke.
Written by: Prof. Anita Arsovska, MD, PhD, Macedonian Organization for a fight against stroke, SAFE Board Member
Stroke is a severe impairment of brain functions due to acute brain circulation disorder. The highest percentage of strokes (80-85%) is due to thrombosis or embolism of the blood vessels, resulting in ischemia of the brain tissue. Approximately 10-15% of strokes are due to rupture of the blood vessel in the brain, with blood flowing into the brain, causing intracerebral, intraventricular or subarachnoid bleeding.
The symptoms of stroke are:
– weakness or paralysis of the arm and leg on one side
– paralysis of the face
– inability to speak and understand one’s speech
– headache, dizziness, blurred vision
– unstable or impossible walking
– nausea, vomiting (not related to food intake)
– consciousness impairment
There are so called risk factors that lead to stroke. Risk factors that may be modified are: elevated blood pressure, elevated levels of blood sugar and lipids, heart and blood vessel diseases, smoking, overweight (especially abdominal obesity), physical inactivity, excessive consumption of alcohol and narcotics, inadequate nutrition (excessive intake of salt, sugar and fat).
Aims of nutrition therapy
– primary and secondary prevention of stroke
– regulation of elevated blood pressure, elevated levels of blood sugar and lipids, overweight
The results of numerous epidemiological studies show that nutrition affects the pathogenesis of stroke and therefore, dietary changes can be preventive. For the prevention of stroke, the Mediterranean diet, consisting of olive oil, canola oil, omega-3 fish oil, balsamic vinegar, vitamins and antioxidants, is recommended while reducing the intake of trans fats, unhealthy fats of animal origin and cholesterol. This diet is characterized by the substitution of various harmful products with nutritionally healthy alternatives, such as canola margarine instead of butter, alpha-linolenic acid instead of animal fat, whole grains, fiber and phytoestrogens instead of other derivatives.
Lipids
Previous studies on the impact of blood lipid levels and risk of stroke show different results. For example, in the Honolulu study, 7850 patients over 18 years were followed and have shown a positive correlation between elevated serum cholesterol levels and stroke. Another study analyzed 707 fatal strokes among 350,977 patients and found an increased incidence of ischemic strokes in patients with elevated serum cholesterol levels. A similar positive association was found in Oslo and Copenhagen, where 19,699 patients were followed up over a 10-year period, 693 of which have had a stroke. Most researchers believe that elevated blood cholesterol concentrations (> 8 mmol / L) are an important risk factor for stroke, especially ischemic stroke. It has been found that lowering LDL levels can prevent stroke in 35% – 80% of the cases, reducing the risk by 48% in patients with diabetes and 25% in patients with coronary artery disease.
Atkinson et al. found no increase or decrease in morbidity and mortality from stroke in middle-aged men when cholesterol concentrations decreased below 5.0 mmol / L. There are epidemiological studies that have shown a higher incidence of intracerebral (but not subarachnoidal) haemorrhage in patients with low serum total cholesterol. Low serum cholesterol levels below <4.62 mmol / L were associated with a significantly increased risk of intracerebral haemorrhage in men over 65 years of age. Increased risk was also seen in older women with low cholesterol levels, whereas no such association was seen in men and women aged 40-64 years.
Remember: There is a link between blood cholesterol levels and stroke. Cholesterol intake of up to 300 mg / day is recommended.
Cholesterol is found in egg yolk, brain, liver, kidneys, red meat (beef, veal, pork, lamb), game meat (roe, rabbit, etc.). The least cholesterol and saturated fat is found in fish, chicken and turkey breast. Saturated fat in high concentration is found in butter, sweet and sour cream, whole fat and melted cheeses, pork fat, pâté, meat cans, bacon, cheeses, sausages, salami, beef and mutton.
Frying should be avoided. If fats should be used, these should be solely of vegetable origin, such as olive oil, or soybean butter, sunflower seeds, or wheat germ, which contain linoleic acid. It should be noted that reheating the butter (eg in a deep-fryer) is not recommended, because this is increasing its hydrogenation which is very bad.
Sugar, protein, fish, meat
Studies show that high glycemic index foods increased the risk of stroke mortality (ischemic and hemorrhagic) in women in Japan, while higher sugar intake was associated with a higher risk of hemorrhagic stroke in middle-aged women and older women. Consumption of rice has been associated with an increased risk of stroke in China’s aging population and a reduced risk of cardiovascular disease in Japan.
The origin of the protein is very important in the nutrition. For example, it has been s shown that consuming fish has a protective effect against stroke. A repeated meta-analysis of 15 studies found that eating three fish during the week reduced the risk of stroke by 6%, while another study found that the risk of stroke was reduced by 17% by consuming fish on a daily basis.
Remember: Consumption of fish, especially blue fish (mackerel, anchovy, tuna, herring, salmon) is recommended for prevention of stroke, at least 2-3 times per week.
A meta-analysis of 20 studies to evaluate the effects of red meat consumption showed that the risk increased by 24% with daily consumption. The data indicate that the high intake of red meat (1 meal / day) is associated with an increased risk of stroke, while the high intake of poultry meat (1 meal / day) is associated with a 27% reduction in risk; the consumption of low fat dairy products is associated with a 11% reduction in the risk of stroke, the consumption of dairy products with whole fat, with a 10% reduction in the risk, and the consumption of nuts with a 17% reduction in the risk.
Fruits and vegetables
Greater use of fruits and vegetables in the diet is recommended, since it is associated with a reduced risk of stroke. For each supplement of fruits or vegetables per day, the risk of stroke is reduced by 6%. A meta-analysis of 9 studies, with a total of 257,551 participants (of whom 4,917 had a stroke), followed over a 13-year period, showed that consuming more than 5 servings of fruits and vegetables during the day could reduce the incidence of a stroke. Vegetables that are green in color and with leaves (such as herbs, broccoli, turnips), together with the nuts and citron juice, protect against stroke.
Whole grains
In the prevention of stroke, it is recommended to use products that contain whole grains of cereals, such as black and integral beans, cereals in various forms for breakfast, rice with husk etc. In the meta-analyzes, the introduction of whole grain products was shown to be associated with a downward trend in the incidence of stroke.
Remember: Consumption of fruits and vegetables, as well as whole grain cereals, is recommended for the prevention of stroke.
Current studies have shown that high intake of sodium is associated with an increased risk of stroke, while higher intake of potassium through fruits and vegetables is associated with a reduced risk of stroke.
Remember: Increased salt intake is a risk factor for stroke.
Therefore, for stroke prevention, moderate consumption of salt is recommended, as well as not adding salt in the food.
The recommended intake of sodium is <2.3 g / day and the recommended intake of potassium is> 4.7 g / day.
A meta-analysis showed that the use of magnesium reduced the risk of stroke, especially of ischemic stroke. The effect of calcium use is uncertain, although meta-analysis data speak in favor against its use.
Multivitamins and antioxidants
A meta-analysis of 68 randomized studies with a total of 232,606 participants concluded that beta carotene, vitamin A and vitamin E supplements, alone or in combination, may increase stroke mortality, while the potential role of vitamin C and selenium require further research. Two further meta-analyzes for Vitamin E showed that this increased the risk of haemorrhagic stroke by 22% and decreased the risk of ischemic stroke by 10%. In randomized studies, vitamin C, vitamin B, and folic acid have not been shown to have a protective effect in relation to stroke. However, there is a positive correlation between homocysteine level and stroke. For this reason, the use of folic acid and B vitamins is recommended for patients who have elevated levels of homocysteine. Frequently, vitamin B12 levels are lower in aged population, so the use of this vitamin is justified. Numerous studies have shown that low levels of vitamin D are associated with hypertension, atherosclerosis, and cardiovascular disease. The results suggest that a high intake of vitamin D (≥600 IU / day) is associated with a lower incidence of coronary heart disease and stroke in men, but not in women.
Alcohol and caffeine
Excessive alcohol consumption increases the risk of hemorrhagic stroke, and the results of ischemic stroke are different. According to the recommendations for prevention of stroke, it is allowed to consume up to a maximum of 2 alcoholic beverages per day for men and 1 alcoholic beverage for non-pregnant women. Consumption of coffee (3-4 cups) and tea (> 3 cups) is associated with a reduction in stroke risk (17% and 21%, respectively).
Special recommendations
– It is advised to maintain body weight close to ideal
– Moderate physical activity
– Stop smoking
– Proper medical treatment
– Regulating other risk factors
– Adopt a healthy lifestyle
Conclusion
Nutrition Recommendations for Stroke Prevention:
– To limit the use of saturated and trans fatty acids to a minimum, to avoid fried foods, fatty meat, butter and margarine and creamy or whole fat dairy products (instead of consuming lean meat, chicken meat, fish, vegetables and soya products);
– To minimize the use of highly processed, preserved and frozen products;
– Limit salt use to 2300 mg per day and substitute other spices and additives;
– To limit the use of alcohol to two beverages per day, and 1 beverage for women and especially low body weight (1 beverage = 340 ml beer, 140 ml wine or 40 ml 80% alcohol);
– To choose low-fat dairy products or low-fat products instead of high-fat dairy products;
– It is important to read the labels of the products and to choose the ones that contain “whole grain”, that is, use the whole, pasta and flour of “whole grain” instead of the products with white color;
– To consume a variety of fruit fruits (if the act of swallowing is normal)
References
Popovski A, Arsovska A. Clinical neurology-special part. Cerebrovascular diseases, NIP Studentski zbor. Skopje, 2002; 288-379 (in Macedonian)
Fischer M, Lees K,Spence JD.Nutrition and stroke Stroke. 2006; 37: 2430–2435
Sofi F, Cesari F, Abbate R, Gensini GF, Casini A.Adherence to Mediterranean diet and health status: meta-analysis. Br Med J. 2008; 337: a1344
Hankey GJ.Nutrition and the risk of stroke. Lancet Neurol. 2012; 11: 66–81
He FJ, Nowson CA, MacGregor GA.Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet. 2006; 367: 320–326
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The Campaign Working Group and Committee selected the Stroke Society of Slovenia, for an award based on their impressive outreach programme and development of local partnerships that will do much to raise awareness of stroke and to build an understanding of the challenges of stroke survivors.
A recent survey by the Irish Heart Foundation revealed that the average person in Ireland sits down for 7.3 hours a day. The Irish Heart Foundation will run the campaign ‘Escape your Chair’ throughout the month of September. The campaign aims to inform and advise about the dangers of sitting too much and provide useful resources to help reduce your sitting time by making your working day, commute and leisure time more active.
SAFE: How old were you and how did you feel when stroke happened to you?
