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Prevention of stroke

A study design

Cardiovascular Diseases
The leading cause of death among the whole world population. Linked with nutrition, physical activity and tobacco consumption.

Affect individuals in middle and old age and mostly in the developing countries

Cerebrovascular disease
Is ranked as the 2nd leading cause of death Is the leading cause of disability in adults. Surviving stroke patients will have to depend on other people`s continuous support to survive

Stroke
The blood vessels branch off and get smaller and smaller, until tiny blood vessels supply oxygen and nutrients to all parts of the brain. If this process is interrupted, damage is made to the brain tissue causing a stroke.

Risk factors for stroke


Tobacco smoking Unhealthy diet Physical inactivity Old age High blood pressure Previous stroke Diabetes mellitus High cholesterol level

How, when and who?


Long-term interventions Sustainable solutions Age over 40 Primary care physicians

Hypothesis
Patients who will be reffered to specialists by family phisicians to change unhealthy behaviors will reduce the risk factors more than patients who will only receive flyers and brochures about stroke

Eligibility
Elevated cholesterol, high blood pressure, abdominal obesity, tobacco and alchohol consumption. Eligible-at least 3 risk factors

Excluded-previous episode of stroke or heart attack

Self monitoring
Day 1 Weight Food and drinks 110 kg 2 fruits 3 vegetables Fast food Healthy food Water Alcohol Juice Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 8

Physical activity

30 minutes

Timeline
One year intervention Study group:
Personal monitoring using diet log Once every 2 weeks consultations with specialists Once every month visits to the family doctor Motivational interview

Control group:
Flyers and brochures at the begining of the intervention After one year, all participants will be checked to see the differences.

Intervention
Identify potential patients Assign them to either study or control group Individual counseling Motivational interview All nonsmokers will be encouraged not to start smoking. All smokers will be strongly encouraged to quit smoking Encouraged to reduce total fat and saturated fat intake Encouraged to reduce daily salt intake Encouraged to eat at least 5 fruits and vegetables and whole grains daily Encouraged to make at least 30 minutes of daily physical Reduce alcohol consumption Drug treatment for high blood pressure

Limitations
Lack of adequate health systems infrastructure Lack of trained workforce and sufficient supplies Low literacy levels and the human being factor Lack of incentives for physicians and patients

Conclusion
Intervention for CVDs is needed Family physicians can facilitate the intervention Helping patients in changing behaviors may be more effective than just informing them

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