Physical inactivity can have major implications for cardiovascular disease and diabetes, which are leading causes of morbidity among African-American women. Recruiting in rural populations can present challenges and strategies that work... more
Physical inactivity can have major implications for cardiovascular disease and diabetes, which are leading causes of morbidity among African-American women. Recruiting in rural populations can present challenges and strategies that work in one community but may not be successful in another community. This study examined the feasibility, acceptability, and implementation of community-based screening using an abbreviated Racial and Ethnic Approaches to Community Health (REACH) Risk Factor self-report survey in a geographic region where these data were previously unavailable. Participants (N = 32) included African-American/Black women, 21 years of age or older, who attended health screening events in a rural county in South Carolina. Findings from this study demonstrated the feasibility of community-based cardiometabolic risk screenings using an abbreviated REACH Risk Factor survey and linking participants to follow-up primary care. Findings also provide insight into recruitment strategies in this geographic region.
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Community-engagement is a key step in conducting research which is impactful for patients and communities. The Delaware Clinical and Translational Research (DE-CTR), Accelerating Clinical and Translational Research (ACCEL) program has... more
Community-engagement is a key step in conducting research which is impactful for patients and communities. The Delaware Clinical and Translational Research (DE-CTR), Accelerating Clinical and Translational Research (ACCEL) program has implemented several successful approaches to engage our community, and to educate and motivate our researchers in this area. Increased participation in community-engaged research and community-based participatory research was accomplished through DE-CTR/ACCEL using multiple methods detailed in this manuscript. The community engagement infrastructure has fostered community involvement in translational research including capacity development, implementation, evaluation and dissemination. Academic-community partnerships for research, such as those implemented in ACCEL will be crucial to addressing health disparities and health priorities.
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Among stroke survivors, achieving consistency of blood pressure (BP) control lowers risk of recurrent stroke, myocardial infarction, and other vascular events [1] [2]. However, less than one third of recent stroke survivors have BP... more
Among stroke survivors, achieving consistency of blood pressure (BP) control lowers risk of recurrent stroke, myocardial infarction, and other vascular events [1] [2]. However, less than one third of recent stroke survivors have BP controlled ≥75% of the time [2]. Key factors responsible for suboptimal BP control are medication non-adherence and failure to intensify therapy in a timely manner (i.e., therapeutic inertia). [3,4] Efficacious BP control programs are needed which are feasible, and sustainable [1]. Mobile health (mHealth) technology may offer a promising approach towards enhancing BP control after stroke [5,6]. mHealth tools provide an easy to use self-management framework that permits optimal medication adherence guided by patients' physiological data [5,6]. This technology is relatively inexpensive and provides real-time personalized feedback to boost patient self-efficacy. Automated summary reports of patients' adherence and BP can be readily uploaded to providers' networks, helping mitigate clinical inertia by reducing regimen alteration time [5,6]. Recently, as part of a hospital quality improvement (QI) initiative, we evaluated the feasibility and preliminary signals of clinical outcomes of a mHealth medication and BP self-management system for recent ischemic stroke patients with uncontrolled hypertension encountered at a tertiary medical center. A smartphone enabled medication adherence and BP self-management system [7,8], was adapted for utilization by stroke patients using a patient and provider based design. A 3-month pilot quality improvement initiative was conducted in 24hypertensive post-stroke patients. Eight patientswere randomly selected to receive the mHealth program involving a GSM enabled electronic medication tray (MedMinder, Maya, Inc., Needham, MA); a wireless Bluetooth enabled BP monitor (A&D model UA767PlusBT San Jose, CA, USA); and a 4G smartphone (if needed) that received and transmitted encrypted physiological data and delivered text message reminders tomeasure BP. Culturally-attunedmotivational and reinforcement text messages were sent based upon medication adherence rates [7,8]. Following instruction on usage of the devices, they (and in 2 cases, a caregiver) were required to provide a successful demonstration before completion of their visit. Primary care providers received weekly summary reports of mHealth patients' medication adherence and BP readings. For the mHealth program, at the prescribed dosing day/time, a blinking light from the tray's specific dose compartment came on. If,
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Background: Using tailored mobile health interventions to improve global vascular risk awareness and control is yet to be investigated for primary stroke prevention in Africa. Methods: This 2-arm pilot randomized controlled trial involved... more
Background: Using tailored mobile health interventions to improve global vascular risk awareness and control is yet to be investigated for primary stroke prevention in Africa. Methods: This 2-arm pilot randomized controlled trial involved 100 stroke-free adults with at least 2 vascular risk factors for stroke. Eligible participants were assigned randomly to a control arm offering 1-time counseling (n=50) or a 2-month educational intervention arm (n=50) comprising a stroke video and riskometer app aimed at improving stroke risk factor awareness and health-seeking behavioral modification to control total vascular risk. Reduction in total stroke risk score was the primary outcome while feasibility and process measures were secondary outcomes. Results: All enrolled participants completed the 2-month follow-up (retention rate=100%). The mean (SD) age of participants was 59.5 (±12.5) years, 38% were males. The mean change in stroke risk score at 2 months was −11.9% (±14.2) in the intervention arm versus −1.2% (±9.1) in the control arm, P =0.0001. Stroke risk awareness improved by 16.1% (±24.7) in the intervention arm versus 8.9% (±24.7) in the control arm, P =0.08. The intervention arm had 11.1 mm Hg reduction in systolic blood pressure compared with 4.8 mm Hg reduction in the control arm. Conclusions: The intervention demonstrated a positive signal of effect over a 2-month period. A definitive clinical trial with a longer duration of follow-up is warranted on the premise of these promising findings from this pilot randomized clinical trial. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT05619406.
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Introduction Genomic research and neurobiobanking are expanding globally. Empirical evidence on the level of awareness and willingness to donate/share biological samples towards the expansion of neurobiobanking in sub-Saharan Africa is... more
Introduction Genomic research and neurobiobanking are expanding globally. Empirical evidence on the level of awareness and willingness to donate/share biological samples towards the expansion of neurobiobanking in sub-Saharan Africa is lacking. Aims To ascertain the awareness, perspectives and predictors regarding biological sample donation, sharing and informed consent preferences among community members in Ghana and Nigeria. Methods A questionnaire cross-sectional survey was conducted among randomly selected community members from seven communities in Ghana and Nigeria. Results Of the 1015 respondents with mean age 39.3 years (SD 19.5), about a third had heard of blood donation (37.2%, M: 42.4%, F: 32.0%, p = 0.001) and a quarter were aware of blood sample storage for research (24.5%; M: 29.7%, F: 19.4%, p = 0.151). Two out of ten were willing to donate brain after death (18.8%, M: 22.6%, F: 15.0%, p<0.001). Main reasons for unwillingness to donate brain were; to go back to God...
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Background Baseline stroke severity is probably partly responsible for poor stroke outcomes in sub‐Saharan Africa. However, there is a paucity of information on determinants of stroke severity among indigenous Africans. We sought to... more
Background Baseline stroke severity is probably partly responsible for poor stroke outcomes in sub‐Saharan Africa. However, there is a paucity of information on determinants of stroke severity among indigenous Africans. We sought to identify the factors associated with stroke severity among West Africans in the SIREN (Stroke Investigative Research and Educational Networks) study. Methods and Results Stroke was diagnosed clinically and confirmed with brain neuroimaging. Severe stroke was defined as a Stroke Levity Scale score of ≤5. A multivariate logistic regression model was constructed to identify factors associated with stroke severity at 95% CI and a nominal cutoff of 5% type 1 error. A total of 3660 stroke cases were included. Overall, 50.7%% had severe stroke, including 47.6% of all ischemic strokes and 56.1% of intracerebral hemorrhage. Factors independently associated with severe stroke were meat consumption (adjusted odds ratio [aOR], 1.97 [95% CI, 1.43–2.73]), low vegetabl...
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Stroke is a major cause of death in Sub-Saharan Africa (SSA) and genetic factors appear to play a part. This has led to stroke biobanking and genomics research in SSA. Existing stroke studies have focused on causes, incidence rates,... more
Stroke is a major cause of death in Sub-Saharan Africa (SSA) and genetic factors appear to play a part. This has led to stroke biobanking and genomics research in SSA. Existing stroke studies have focused on causes, incidence rates, fatalities and effects. However, scant attention has been paid to the legal issues in stroke biobanking and genomics research in the sub-region. Therefore, this article examines the legal implications of stroke biobanking and genomics research in SSA. The article adopts a textual analysis of primary and secondary sources in law. It reports that there are laws from the perspectives of human right, the common law, and intellectual property. However, there are gaps to be filled. The article therefore argues for legislative intervention. It concludes that pending the time the statute will be enacted, genomics researchers in Africa should adopt the ethical guidelines prepared by Human Heredity and Health in Africa (H3 Africa).
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Background—Inherited genetic variations offer a possible explanation for the observed peculiarities of stroke in sub – Saharan African populations. Interleukin–6 polymorphisms have been previously associated with ischemic stroke in some... more
Background—Inherited genetic variations offer a possible explanation for the observed peculiarities of stroke in sub – Saharan African populations. Interleukin–6 polymorphisms have been previously associated with ischemic stroke in some non-African populations. Aim—Herein we investigated, for the first time, the association of genetic polymorphisms of IL-6 and CDKN2A- CDKN2B and other genes with ischemic stroke among indigenous West African participants in the Stroke Investigative Research and Education Network (SIREN) Study. Methods—Twenty-three previously identified single nucleotide polymorphisms (SNPs) in 14 genes of relevance to the neurobiology of ischemic stroke were investigated. Logistic regression models adjusting for known cardiovascular disease risk factors were constructed to assess the associations of the 24 SNPs in rigorously phenotyped cases (N=429) of ischemic stroke (Men = 198; Women = 231) and stroke– free (N=483) controls (Men = 236; Women = 247). Results—Interle...
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Stroke is a major cause of death in Sub-Saharan Africa (ssa) and genetic factors appear to play a part in its pathogenesis. This led to the development of stroke biobanking and genomics research in ssa. Existing stroke studies have... more
Stroke is a major cause of death in Sub-Saharan Africa (ssa) and genetic factors appear to play a part in its pathogenesis. This led to the development of stroke biobanking and genomics research in ssa. Existing stroke studies have focused on causes, incidence rates, fatalities and effects. However, scant attention has been paid to the legal issues about stroke biobanking and genomics research in the sub-region. Therefore, this article examines the legal implications of stroke biobanking and genomics research in Sub-Saharan Africa from a human rights perspective. The study argues that the right to dignity of the human person, the right to privacy, the right to freedom of information, the right to freedom from discrimination, the right to own property, the right to self-determination and the right to health may be implicated. The study concludes that the court may have to be involved in balancing one right against the other which may prove somewhat herculean depending on the circumst...
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Background: Regional and geographical variations exist in stroke burden and risk factor distribution. The unique and dominant risk factors for stroke among people of African ancestry where the burden of stroke is escalating, are poorly... more
Background: Regional and geographical variations exist in stroke burden and risk factor distribution. The unique and dominant risk factors for stroke among people of African ancestry where the burden of stroke is escalating, are poorly understood. Such information is crucial in prioritizing tailor-made interventions to tackle the menace of stroke in developing countries. Purpose: We aimed to identify and quantify the contributions of the topmost modifiable risk factors for stroke occurrence in people of African ancestry within the context of the Stroke Investigative Research and Educational Network (SIREN), the largest study of stroke in Africa. Methods: The SIREN study is an ongoing, multicenter, case-control study involving several sites in Nigeria and Ghana. Cases included adults aged >18 years with first clinical stroke within 8 days of current symptom onset with CT scan confirmation. Controls were stroke-free adults, mostly from the communities in the catchment areas of the ...
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Despite projections of stroke being a leading cause of mortality in Africa, reliable estimates of stroke burden on the continent using rigorous methods are not available. We aimed to implement a mobile-Health community-based interactive... more
Despite projections of stroke being a leading cause of mortality in Africa, reliable estimates of stroke burden on the continent using rigorous methods are not available. We aimed to implement a mobile-Health community-based interactive Stroke Information and Surveillance System to sustainably measure stroke burden and improve stroke health literacy and outcomes in urban and rural sites in Nigeria. African Rigorous Innovative Stroke Epidemiological Surveillance (ARISES) is an observational cohort study, which will be conducted in urban (Ibadan North LGA Ward 3) and rural (Ibarapa Central LGA) sites with a combined base population of over 80,000 people. The study will use a consultative approach to establish an mHealth-based Stroke Information and Surveillance System comprising a Stroke Alert System and a Stroke Finding System. These systems will enable the community to report stroke events and the research team/health workers find stroke cases using phone calls, short message servic...
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Previous genome-wide association studies (GWAS) of stroke, the second leading cause of death, have been conducted in populations of predominantly European ancestry.1,2 We undertook cross-ancestry GWAS meta-analyses of stroke and its... more
Previous genome-wide association studies (GWAS) of stroke, the second leading cause of death, have been conducted in populations of predominantly European ancestry.1,2 We undertook cross-ancestry GWAS meta-analyses of stroke and its subtypes in 110,182 stroke patients (33% non-European) and 1,503,898 control individuals of five ancestries from population- and clinic-based studies, nearly doubling the number of cases in previous stroke GWAS. We identified association signals at 89 independent loci, of which 61 were novel. Effect sizes were overall highly correlated across ancestries. Cross-ancestry fine-mapping, in silico mutagenesis analysis using a novel machine-learning approach,3 transcriptome and proteome-wide association analyses revealed putative causal genes (e.g. SH3PXD2A and FURIN) and variants (e.g. at GRK5 and NOS3). Using a novel three-pronged approach,4 we provided genetic evidence for putative drug effects, highlighting F11, KLKB1, PROC, GP1BA, and VCAM1 as possible ta...
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BACKGROUND Post-stroke seizures (PSS) are associated with significant morbidity and mortality across the globe. There is a paucity of data on PSS in Africa. PURPOSE To assess the frequency and factors associated with PSS by stroke types... more
BACKGROUND Post-stroke seizures (PSS) are associated with significant morbidity and mortality across the globe. There is a paucity of data on PSS in Africa. PURPOSE To assess the frequency and factors associated with PSS by stroke types across 15 hospitals in Nigeria and Ghana. METHODS We analyzed data on all stroke cases recruited into the Stroke Investigative Research and Educational Network (SIREN). We included adults aged ≥18 years with radiologically confirmed ischemic stroke (IS) or intracerebral hemorrhage (ICH). PSS were defined as acute symptomatic seizures occurring at stroke onset and/or during acute hospitalization up until discharge. We used logistic regression to estimate adjusted odds ratios (aOR) with 95% Confidence Interval. RESULTS Among 3344 stroke patients, 499 (14.9%) had PSS (95% CI: 13.7-16.2%). The mean duration of admission in days for those with PSS vs no PSS was 17.4 ± 28.6 vs 15.9 ± 24.7, p = 0.72. There were 294(14.1%) PSS among 2091 ischemic strokes and 159(17.7%) among 897 with ICH, p = 0.01. The factors associated with PSS occurrence were age < 50 years, aOR of 1.59 (1.08-2.33), National Institute of Health Stroke Score (NIHSS), 1.29 (1.16-1.42) for each 5 units rise and white cell count 1.07 (1.01-1.13) for each 10^3 mm3 rise. Factors associated with PSS in ischemic were NIHSS score, aOR of 1.17 (1.04-1.31) and infarct volume of 10-30 cm3 aOR of 2.17(1.37-3.45). Among ICH, associated factors were alcohol use 5.91 (2.11-16.55) and lobar bleeds 2.22 (1.03-4.82). CONCLUSION The burden of PSS among this sample of west Africans is substantial and may contribute to poor outcomes of stroke in this region. Further longitudinal studies are required to understand the impact on morbidity and mortality arising from PSS in Africa.
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Data on the burden of hypertension among people living with HIV (PLWH) in Africa are limited, especially after new expert consensus hypertension guidelines were published in 2017. The authors sought to assess the prevalence and factors... more
Data on the burden of hypertension among people living with HIV (PLWH) in Africa are limited, especially after new expert consensus hypertension guidelines were published in 2017. The authors sought to assess the prevalence and factors associated with hypertension among PLWH. This is a cross‐sectional study involving PLWH on combination antiretroviral therapy (cART) (n = 250) compared with sex‐matched cART‐naïve PLWH (n = 201) in Ghana. Hypertension was defined as blood pressure ≥ 140/90 mm Hg or use of antihypertensive drugs. The authors also assessed the prevalence and predictors associated with hypertension using the recent guideline recommended cutoff BP ≥ 130/80 mm Hg. Multivariate logistic regression models were fitted to identify factors associated with hypertension among PLWH. The mean age of PLWH on cART was 45.7 ± 8.6 years, and 42.9 ± 8.8 years among PLWH cART‐naive with 81% of study participants being women. The prevalence of hypertension among PLWH on cART and PLWH cART...
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Background and Purpose: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans. Methods: The SIREN (Stroke... more
Background and Purpose: To identify the qualitative and quantitative contributions of conventional risk factors for occurrence of ischemic stroke and its key pathophysiologic subtypes among West Africans. Methods: The SIREN (Stroke Investigative Research and Educational Network) is a multicenter, case-control study involving 15 sites in Ghana and Nigeria. Cases include adults aged ≥18 years with ischemic stroke who were etiologically subtyped using the A-S-C-O-D classification into atherosclerosis, small-vessel occlusion, cardiac pathology, other causes, and dissection. Controls were age- and gender-matched stroke-free adults. Detailed evaluations for vascular, lifestyle, and psychosocial factors were performed. We used conditional logistic regression to estimate adjusted odds ratios with 95% CI. Results: There were 2431 ischemic stroke case and stroke-free control pairs with respective mean ages of 62.2±14.0 versus 60.9±13.7 years. There were 1024 (42.1%) small vessel occlusions, 4...
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Cardiology, Neurology, Atherosclerosis, Medicine, Stroke, and 14 moreInternal Medicine, Hypertension, Diabetes mellitus, Psychosocial, Ischemic Stroke, Risk factors, Two Stroke Engine, Clinical Sciences, Risk Factor, Odds ratio, Dyslipidemia, Risk Factors, Neurosciences, and Cardiovascular medicine and haematology
Objectives To explore the prevalence and risk factors of obesity among older adults from low- and middle-income countries (LMICs). Methods This is a secondary analysis of data obtained from the SIREN study through in-person interviews and... more
Objectives To explore the prevalence and risk factors of obesity among older adults from low- and middle-income countries (LMICs). Methods This is a secondary analysis of data obtained from the SIREN study through in-person interviews and measurements from healthy stroke-free older adults (≥60 years). Overweight/obesity was defined as body mass index ≥25 kg/m2. Abdominal obesity was defined as waist-to-hip ratio (WHR) of >0.90 for males and >0.85/females or waist circumference (WC) of >102 cm for males/>88 cm for females. Adjusted odds ratio (aORs) with 95% confidence interval (CIs) of the relationship between obesity and sociodemographic factors were assessed at P < 0.05. Results Overall, 47.5% of participants were overweight/obese, 76.6% had a larger than recommended WHR, and 54.4% had a larger than recommended WC. Abdominal obesity (WC; aOR: 9.43, CI: 6.99–12.50), being a Nigerian (aOR: 0.55; CI: 0.42–0.72), living in an urban setting (aOR: 1.92; CI: 1.49–2.46 ), ...
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BACKGROUND Stroke risk can be quantified using risk factors whose effect sizes vary by geography and race. No stroke risk assessment tool exists to estimate aggregate stroke risk for indigenous African. OBJECTIVES To develop Afrocentric... more
BACKGROUND Stroke risk can be quantified using risk factors whose effect sizes vary by geography and race. No stroke risk assessment tool exists to estimate aggregate stroke risk for indigenous African. OBJECTIVES To develop Afrocentric risk-scoring models for stroke occurrence. MATERIALS AND METHODS We evaluated 3533 radiologically confirmed West African stroke cases paired 1:1 with age-, and sex-matched stroke-free controls in the SIREN study. The 7,066 subjects were randomly split into a training and testing set at the ratio of 85:15. Conditional logistic regression models were constructed by including 17 putative factors linked to stroke occurrence using the training set. Significant risk factors were assigned constant and standardized statistical weights based on regression coefficients (β) to develop an additive risk scoring system on a scale of 0-100%. Using the testing set, Receiver Operating Characteristics (ROC) curves were constructed to obtain a total score to serve as cut-off to discriminate between cases and controls. We calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) at this cut-off. RESULTS For stroke occurrence, we identified 15 traditional vascular factors. Cohen's kappa for validity was maximal at a total risk score of 56% using both statistical weighting approaches to risk quantification and in both datasets. The risk score had a predictive accuracy of 76% (95%CI: 74-79%), sensitivity of 80.3%, specificity of 63.0%, PPV of 68.5% and NPV of 76.2% in the test dataset. For ischemic strokes, 12 risk factors had predictive accuracy of 78% (95%CI: 74-81%). For hemorrhagic strokes, 7 factors had a predictive accuracy of 79% (95%CI: 73-84%). CONCLUSIONS The SIREN models quantify aggregate stroke risk in indigenous West Africans with good accuracy. Prospective studies are needed to validate this instrument for stroke prevention.
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Sub-Saharan Africa has the highest incidence, prevalence, and fatality from stroke globally. Yet, only little information about context-specific risk factors for prioritising interventions to reduce the stroke burden in sub-Saharan Africa... more
Sub-Saharan Africa has the highest incidence, prevalence, and fatality from stroke globally. Yet, only little information about context-specific risk factors for prioritising interventions to reduce the stroke burden in sub-Saharan Africa is available. We aimed to identify and characterise the effect of the top modifiable risk factors for stroke in sub-Saharan Africa. The Stroke Investigative Research and Educational Network (SIREN) study is a multicentre, case-control study done at 15 sites in Nigeria and Ghana. Cases were adults (aged ≥18 years) with stroke confirmed by CT or MRI. Controls were age-matched and gender-matched stroke-free adults (aged ≥18 years) recruited from the communities in catchment areas of cases. Comprehensive assessment for vascular, lifestyle, and psychosocial factors was done using standard instruments. We used conditional logistic regression to estimate odds ratios (ORs) and population-attributable risks (PARs) with 95% CIs. Between Aug 28, 2014, and Jun...
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Ghana, Nigeria, Medicine, Stroke, Humans, and 9 moreFemale, Male, Risk factors, Two Stroke Engine, Aged, Middle Aged, Risk Factors, Elsevier, and Case Control Studies
<p>Overview of steps in the siren focus group process for reporting, analyzing and reporting findings [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0206548#pone.0206548.ref037"... more
<p>Overview of steps in the siren focus group process for reporting, analyzing and reporting findings [<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0206548#pone.0206548.ref037" target="_blank">37</a>].</p
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The ethical, legal, and social implications (ELSI) of emerging neurobiobanks and data resources are unclear in an African scientific landscape with unique cultural, linguistic, and belief systems. The overarching goal of the African... more
The ethical, legal, and social implications (ELSI) of emerging neurobiobanks and data resources are unclear in an African scientific landscape with unique cultural, linguistic, and belief systems. The overarching goal of the African Neurobiobank for Precision Stroke Medicine–—ELSI Project is to identify, examine, and develop novel approaches to address ELSI issues of biobanking and stroke genomic research in sub-Saharan Africa (SSA). To accomplish the goal we will (1) explore knowledge, attitude, perceptions, barriers, and facilitators influencing ELSI issues related to biobanking and stroke genomic research; (2) use information obtained to craft a community intervention program focused on ELSI issues; and (3) build capacity and careers related to genomics and biobanking for effective client/community engagement while enhancing regulatory, governance, and implementation competences in biobanking science in SSA. A community-based participatory research and mixed-methodological approa...
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Background and Purpose— The interplay between sex and the dominant risk factors for stroke occurrence in sub-Saharan Africa has not been clearly delineated. We compared the effect sizes of risk factors of stroke by sex among West... more
Background and Purpose— The interplay between sex and the dominant risk factors for stroke occurrence in sub-Saharan Africa has not been clearly delineated. We compared the effect sizes of risk factors of stroke by sex among West Africans. Methods— SIREN study (Stroke Investigative Research and Educational Networks) is a case-control study conducted at 15 sites in Ghana and Nigeria. Cases were adults aged >18 years with computerized tomography/magnetic resonance imaging confirmed stroke, and controls were age- and sex-matched stroke-free adults. Comprehensive evaluation for vascular, lifestyle, and psychosocial factors was performed using validated tools. We used conditional logistic regression to estimate odds ratios and reported risk factor specific and composite population attributable risks with 95% CIs. Results— Of the 2118 stroke cases, 1193 (56.3%) were males. The mean±SD age of males was 58.1±13.2 versus 60.15±14.53 years among females. Shared modifiable risk factors for ...
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Schistosomiasis is a highly prevalent parasitic disease in Senegal. The early symptoms are hematuria and dysuria. Children's comprehension of the disease is fundamental to preventing the infection. The aim of this study was to... more
Schistosomiasis is a highly prevalent parasitic disease in Senegal. The early symptoms are hematuria and dysuria. Children's comprehension of the disease is fundamental to preventing the infection. The aim of this study was to investigate the knowledge attitudes, and practices related to schistosomiasis among schoolchildren in 2 rural villages in Northern Senegal and to evaluate their impact on the disease. A cross-sectional study was conducted. Data about children's knowledge of schistosomiasis, behavior, and preventive measures were collected through a questionnaire. Questionnaire responses from 575 schoolchildren were analyzed. Correct answers about risky behavior for schistosomiasis were associated with early symptoms (P = 0.010). Wearing shoes and washing hands with soap were associated with not having hematuria and dysuria (P = 0.007 and 0.049, respectively). Playing in rivers was associated with the aforementioned symptoms (P < 0.001). Children who had good knowled...
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Geography, Medicine, Multidisciplinary, European Public Health Policies, Senegal, and 13 moreBiological Sciences, Schools, Students, Humans, Child, Schistosomiasis, Female, Animals, Schistosoma Mansoni, Cross Sectional Studies, Surveys and Questionnaires, Rural Population, and Medical and Health Sciences
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African Studies, Cardiology, Epidemiology, Magnetic Resonance Imaging, Ghana, and 15 moreMedicine, Electrocardiography, Brain, Humans, Internal Medicine, Female, Male, Heart rate, Africans, Middle Aged, Cardiac Arrhythmias, Electrocardiogram, Elsevier, Hypertrophic Cardiomyopathy, and Cross Sectional Studies
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Approximately 21 million persons have diabetes and account for 11.9% of all emergency department (ED) visits for a total cost of $14.1 billion. Nonemergent visits for ambulatory-sensitive conditions that could be managed by the primary... more
Approximately 21 million persons have diabetes and account for 11.9% of all emergency department (ED) visits for a total cost of $14.1 billion. Nonemergent visits for ambulatory-sensitive conditions that could be managed by the primary care provider make up almost one-third of the ED visits. African Americans comprise approximately 30% of South Carolina׳s population but make up approximately 50% of the ED visits for diabetes. The purpose of the research was to explore the experiences of 20 African-American adults with diabetes with ambulatory-sensitive ED use. The research design for this study is grounded theory with dimensional analysis methods. Following ethics approval and informed consent, interviews were conducted, recorded and transcribed verbatim, and themes were analyzed to form the explanatory framework or matrix for ED use. The framework of context, conditions, processes and consequences provides a key for understanding the themes of the story embedded in the descriptive ...
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Background: As the second leading cause of death and the leading cause of adult-onset disability, stroke is a major public health concern particularly pertinent in Sub-Saharan Africa (SSA), where nearly 80% of all global stroke... more
Background: As the second leading cause of death and the leading cause of adult-onset disability, stroke is a major public health concern particularly pertinent in Sub-Saharan Africa (SSA), where nearly 80% of all global stroke mortalities occur, and stroke burden is projected to increase in the coming decades. However, traditional and emerging risk factors for stroke in SSA have not been well characterized, thus limiting efforts at curbing its devastating toll. The Stroke Investigative Research and Education Network (SIREN) project is aimed at comprehensively evaluating the key environmental and genomic risk factors for stroke (and its subtypes) in SSA while simultaneously building capacities in phenomics, biobanking, genomics, biostatistics, and bioinformatics for brain research. Methods: SIREN is a transnational, multicentre, hospital and community-based study involving 3,000 cases and 3,000 controls recruited from 8 sites in Ghana and Nigeria. Cases will be hospital-based patien...