Stroke - An Overview

Source: American Heart Association

About Stroke

A stroke or cerebrovascular accident occurs when the blood supply to part of the brain is suddenly interrupted or when a blood vessel in the brain bursts, spilling blood into the spaces surrounding brain cells.

Brain cells die when they no longer receive oxygen and nutrients from the blood or there is sudden bleeding into or around the brain.

Death or permanent disability can result. High blood pressure, smoking, and having had a previous stroke or heart attack increase a person’s chances of having a stroke.

Stroke is the fifth leading cause of death in the United Sates. In 2014, stroke killed more than 133,000 people, accounting for about 1 of every 20 deaths in the United States. According to the American Heart Association, about 795,000 people in the United States suffer a stroke each year (about 610,000 first attacks and 185,000 recurrent attacks). Four million Americans who have survived a stroke are living with impairments and 15% to 30% are permanently disabled. The American Heart Association also estimates that stroke cost about $33 billion in both direct and indirect costs in 2011 in the United States alone.

What Happens During a Stroke?

To understand stroke, it helps to understand something about the brain. The brain controls our movements; stores our memories; and is the source of our thoughts, emotions, and language. The brain also controls many functions of the body, like breathing and digestion.

To work properly, your brain needs oxygen. Although your brain makes up only 2% of your body weight, it uses 20% of the oxygen you breathe.1 Your arteries deliver oxygen-rich blood to all parts of your brain.

If something happens to interrupt the flow of blood, brain cells start to die within minutes because they can’t get oxygen. This is called a stroke. Sudden bleeding in the brain also can cause a stroke if it damages brain cells. A stroke can cause lasting brain damage, long-term disability, or even death.

If brain cells die or are damaged because of a stroke, symptoms of that damage start to show in the parts of the body controlled by those brain cells.

Source: CDC; Interactive Atlas of Heart Disease and Stroke

Types of Stroke

The main types of stroke are:

• Ischemic stroke.
• Hemorrhagic stroke.
• Transient ischemic attack (a warning or “mini-stroke”).

Ischemic Stroke

Most strokes (85%) are ischemic strokes. If you have an ischemic stroke, the artery that supplies oxygen-rich blood to the brain becomes blocked.

Blood clots often cause the blockages that lead to ischemic strokes. Read more about factors that increase risk for ischemic stroke.

Hemorrhagic Stroke

A hemorrhagic stroke occurs when an artery in the brain leaks blood or ruptures (breaks open). The leaked blood puts too much pressure on brain cells, which damages them.

High blood pressure and aneurysms—balloon-like bulges in an artery that can stretch and burst—are examples of conditions that can cause a hemorrhagic stroke.

There are two types of hemorrhagic strokes:

• Intracerebral hemorrhage is the most common type of hemorrhagic stroke. It occurs when an artery in the brain bursts, flooding the surrounding tissue with blood.
• Subarachnoid hemorrhage is a less common type of hemorrhagic stroke. It refers to bleeding in the area between the brain and the thin tissues that cover it.

Trancient Ischemic Attack (TIA)

A transient ischemic attack (TIA) is sometimes called a "mini-stroke." It is different from the major types of stroke because blood flow to the brain is blocked for only a short time—usually no more than 5 minutes.

It is important to know that

• A TIA is a warning sign of a future stroke.
• A TIA is a medical emergency, just like a major stroke.
• Strokes and TIAs require emergency care. Call 9-1-1 (or your National Emergency Number, red.) right away if you feel signs of a stroke or see symptoms in someone around you.
• There is no way to know in the beginning whether symptoms are from a TIA or from a major type of stroke.
• Like ischemic strokes, blood clots often cause TIAs.
• More than a third of people who have a TIA end up having a major stroke within 1 year if they don’t receive treatment, and 10%-15% will have a major stroke within 3 months of a TIA.

Recognizing and treating TIAs can reduce the risk of a major stroke. If you have a TIA, your health care team can find the cause and take steps to prevent a major stroke.

Source: CDC

Is There Any Treatment?

Generally there are three treatment stages for stroke: 

• prevention, 
• therapy immediately after the stroke, and 
• post-stroke rehabilitation. 

Therapies to prevent a first or recurrent stroke are based on treating an individual's underlying risk factors for stroke, such as hypertension, atrial fibrillation, and diabetes. 

Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot causing an ischemic stroke or by stopping the bleeding of a hemorrhagic stroke. 

Post-stroke rehabilitation helps individuals overcome disabilities that result from stroke damage.

Acting F.A.S.T. is a Key for Stroke

Acting F.A.S.T. can help stroke patients get the treatments they desperately need. The most effective stroke treatments are only available if the stroke is recognized and diagnosed within 3 hours of the first symptoms. Stroke patients may not be eligible for the most effective treatments if they don’t arrive at the hospital in time.

If you think someone may be having a stroke, act F.A.S.T. and do the following simple test:

F—Face: 

Ask the person to smile. Does one side of the face droop?

A—Arms: 

Ask the person to raise both arms. Does one arm drift downward?

S—Speech: 

Ask the person to repeat a simple phrase. Is their speech slurred or strange?

T—Time: 

If you observe any of these signs, call 9-1-1 (or your National Emergency Number, red.) immediately.

Note the time when any symptoms first appear. Some treatments for stroke only work if given in the first 3 hours after symptoms appear. Do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.

Stroke - Myth V.S. Fact

Although stroke is the fifth leading cause of death in America and a leading cause of adult disability, many myths surround this disease.

Source: National Stroke Association

Sources:

CDC - About Stroke

CDC - Types of Stroke

CDC - Stroke Signs and Symptoms

CDC - Division for Heart Disease and Stroke Prevention - Know the Signs and Symptoms of a Stroke

National Institute of Neurological Disorders and Stroke, National Institutes of Health

American Heart Association - 5 Things to Know About Stroke

National Stroke Association - Understand Stroke - What is Stroke - Stroke Facts

Pregnancy: Antenatal Care

Pregnancy is an exciting time, but it can also be stressful. Knowing that you are doing all you can to stay healthy during pregnancy and give your baby a healthy start in life will help you to have peace of mind.

Pregnancy – the nine months or so for which a woman carries a developing embryo and fetus in her womb – is for most women a time of great happiness and fulfilment. However, during pregnancy, both the woman and her developing child face various health risks. For this reason, it is important that all pregnancies should be monitored by skilled care providers.

Source: CDC

Pregnant women must be able to access the right care at the right time, says WHO

WHO has issued a new series of recommendations to improve quality of antenatal care in order to reduce the risk of stillbirths and pregnancy complications and give women a positive pregnancy experience.

Last year, 2015, an estimated 303 000 women died from pregnancy-related causes, 2.7 million babies died during the first 28 days of life and 2.6 million babies were stillborn. Quality health care during pregnancy and childbirth can prevent many of these deaths, yet globally only 64% of women receive antenatal (prenatal) care four or more times throughout their pregnancy.

Antenatal care is a critical opportunity for health providers to deliver care, support and information to pregnant women. This includes promoting a healthy lifestyle, including good nutrition; detecting and preventing diseases; providing family planning counselling and supporting women who may be experiencing intimate partner violence.

"If women are to use antenatal care services and come back when it is time to have their baby, they must receive good quality care throughout their pregnancy," says Dr Ian Askew, Director of Reproductive Health and Research, WHO. "Pregnancy should be a positive experience for all women and they should receive care that respects their dignity."

WHO recommendations on antenatal care

WHO’s new antenatal care model increases the number of contacts a pregnant woman has with health providers throughout her pregnancy from four to eight. Recent evidence indicates that a higher frequency of antenatal contacts by women and adolescent girls with the health system is associated with a reduced likelihood of stillbirths. This is because of the increased opportunities to detect and manage potential problems. A minimum of eight contacts for antenatal care can reduce perinatal deaths by up to 8 per 1000 births when compared to a minimum of four visits.

The new model increases maternal and fetal assessments to detect problems, improves communication between health providers and pregnant women, and increases the likelihood of positive pregnancy outcomes. It recommends pregnant women to have their first contact in the first 12 weeks’ gestation, with subsequent contacts taking place at 20, 26, 30, 34, 36, 38 and 40 weeks’ gestation.

"More and better quality contacts between all women and their health providers throughout pregnancy will facilitate the uptake of preventive measures, timely detection of risks, reduces complications and addresses health inequalities," says Dr Anthony Costello, Director of Maternal, Newborn, Child and Adolescent Health, WHO. "Antenatal care for first time mothers is key. This will determine how they use antenatal care in future pregnancies."

The new guidelines contain 49 recommendations that outline what care pregnant women should receive at each of the contacts with the health system, including counselling on healthy diet and optimal nutrition, physical activity, tobacco and substance use; malaria and HIV prevention; blood tests and tetanus vaccination; fetal measurements including use of ultrasound; and advice for dealing with common physiological symptoms such as nausea, back pain and constipation.

"Counselling about healthy eating, optimal nutrition and what vitamins or minerals women should take during pregnancy can go a long way in helping them and their developing babies stay healthy throughout pregnancy and beyond," says Dr Francesco Branca, Director Department on Nutrition for Health and Development, WHO.

By recommending an increase in the amount of contact a pregnant woman has with her health provider, WHO is seeking to improve the quality of antenatal care and reduce maternal and perinatal mortality among all populations, including adolescent girls and those in hard-to-reach areas or conflict settings.

WHO recommendations allow flexibility for countries to employ different options for the delivery of antenatal care based on their specific needs. This means, for example, care can be provided through midwives or other trained health personnel, delivered at health facilities or through community outreach services. 

A woman’s ‘contact’ with her antenatal care provider should be more than a simple ‘visit’ but rather the provision of care and support throughout pregnancy.

Sample recommendations include:

• Antenatal care model with a minimum of eight contacts recommended to reduce perinatal mortality and improve women’s experience of care.
• Counselling about healthy eating and keeping physically active during pregnancy.
• Daily oral iron and folic acid supplementation with 30 mg to 60 mg of elemental iron and 400 µg (0.4 mg) folic acid for pregnant women to prevent maternal anaemia, puerperal sepsis, low birth weight, and preterm birth.
• Tetanus toxoid vaccination is recommended for all pregnant women, depending on previous tetanus vaccination exposure, to prevent neonatal mortality from tetanus.
• One ultrasound scan before 24 weeks’ gestation (early ultrasound) is recommended for pregnant women to estimate gestational age, improve detection of fetal anomalies and multiple pregnancies, reduce induction of labour for post-term pregnancy, and improve a woman’s pregnancy experience.
• Health-care providers should ask all pregnant women about their use of alcohol and other substances (past and present) as early as possible in the pregnancy and at every antenatal visit.

Antenatal care

The World Health Organization has issued a new series of recommendations to improve quality of antenatal care to reduce the risk of stillbirths and pregnancy complications and give women a positive pregnancy experience. By focusing on a positive pregnancy experience, these new guidelines seek to ensure not only a health pregnancy for mother and baby, but also an effective transition to positive labour and childbirth and ultimately to a positive experience of motherhood.

As soon as you know you are pregnant, seek antenatal care

Source: WHO

Throughout pregnancy, all women should have a minimum of 8 contacts with a health provider

Source: WHO

Regular contact with antenatal care services can protect you and your baby's health

Source: WHO

Quality antenatal care should be available for all women to ensure a positive pregnancy experience

Source: WHO

Sources:

CDC - During Pregnancy

CDC - Healthy Pregnancy Tips From the CDC

WHO - Pregnancy

WHO - Pregnant women must be able to access the right care at the right time, says WHO

WHO - Sexual and Reproductive Health - Antenatal Care

Depression at a Glance

This short video below tells the story of writer and illustrator Matthew Johnstone’s depression and how he overcame it. 

It was produced by Matthew, in collaboration with the World Health Organization, to mark World Mental Health Day 2012.

I had a black dog, his name was depression

Source: WHO

This short video below is a guide for partners, carers and sufferers of depression. 

It provides advice for those living with and caring for people with depression on what to do, what not to do, and where to go for help.

Living with a black dog

Source: WHO

Living with a black dog was produced by writer and illustrator Matthew Johnstone, in collaboration with the World Health Organization.

Source: WHO

What is Depression:

• Depression is an illness characterized by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to      carry out daily activities, for at least two weeks.
• In addition, people with depression normally have several of the following: a loss of energy; a change in appetite; sleeping more or less; anxiety; reduced concentration; indecisiveness; restlessness; feelings of worthlessness, guilt, or hopelessness; and thoughts of self-harm or suicide.
• Something that can happen to anybody.
• Not a sign or weakness.
• Treatable, with talking therapies or antidepressant medication or a combination of these.

What you can do if you think you are depressed

• Talk to someone you trust about your feelings. Most people feel better after      talking to someone who cares about them.
• Seek professional help. Your local health-care worker or doctor is a good place to start.
• Remember that with the right help, you can get better.
• Keep up with activities that you used to enjoy when you were well.
• Stay connected. Keep in contact with family and friends.
• Exercise regularly, even if it’s just a short walk.
• Stick to regular eating and sleeping habits.
• Accept that you might have depression and adjust your expectations. You may not be able to accomplish as much as you do usually.
• Avoid or restrict alcohol intake and refrain from using illicit drugs; they can worsen depression.
• If you feel suicidal, contact someone for help immediately.

Remember: 

Depression can be treated. If you think you have depression, seek help.

WHO have developed a set of posters Depression: Let's talk for use in campaign activities and beyond.

Each poster depicts a conversation between two people about depression: 

A mother and daughter

Source: WHO

A mother with her young baby and a health-care worker

Source: WHO

A student and teacher

Source: WHO

Two men at work

Source: WHO

An older women with a younger woman

Source: WHO

Cultural variations will soon be available for each scenario.

Sources:

WHO - WHO Videos about Depression

WHO - Depression: What you should know

WHO - Global Health Days - Posters

WHO - Handouts on Depression

WHO Global Report on Access to Hepatitis C Treatment - Focus on Overcoming Barriers

On October 2016, WHO published Global report on access to hepatitis C treatment, focus on overcoming barriers.

Source: WHO

Overview

This is the first-ever global report on treatment access to hepatitis C medicines. The report provides the information that countries and health authorities need to identify the appropriate HCV treatment, and procure it at affordable prices. The report uses the experience of several pioneering countries to demonstrate how barriers to treatment access can be overcome.

It also provides information on the production of new hepatitis C drugs and generic versions worldwide, including where the drugs are registered, where the drugs are patented and where not, and what opportunities countries have under the license agreements that were signed by some companies as well as current pricing of all recommended direct-acting antivirals (DAAs), including by generic companies all over the world.

You could download the report from the link below:

Global report on access to hepatitis C treatment - Focus on overcoming barriers

Sources:

WHO - Global report on access to hepatitis C treatment - Focus on overcoming barriers

The Importance of Sleep

Sleep plays a vital role in good health and well-being throughout your life. Getting enough quality sleep at the right times can help protect your mental health, physical health, quality of life, and safety.

Source: National Heart, Lung, and Blood Institute, National Institutes of Health

The way you feel while you're awake depends in part on what happens while you're sleeping. During sleep, your body is working to support healthy brain function and maintain your physical health. In children and teens, sleep also helps support growth and development.

The damage from sleep deficiency can occur in an instant (such as a car crash), or it can harm you over time. For example, ongoing sleep deficiency can raise your risk for some chronic health problems. It also can affect how well you think, react, work, learn, and get along with others.

Insufficient sleep is associated with a number of chronic diseases and conditions—such as diabetes, cardiovascular disease, obesity, and depression—which threaten our nation’s health. Aside from these insufficient sleep is also responsible for motor vehicle and machinery-related crashes, causing substantial injury and disability each year.

Healthy Brain Function and Emotional Well-Being

Sleep helps your brain work properly. While you're sleeping, your brain is preparing for the next day. It's forming new pathways to help you learn and remember information.

Studies show that a good night's sleep improves learning. Whether you're learning math, how to play the piano, how to perfect your golf swing, or how to drive a car, sleep helps enhance your learning and problem-solving skills. Sleep also helps you pay attention, make decisions, and be creative.

Studies also show that sleep deficiency alters activity in some parts of the brain. If you're sleep deficient, you may have trouble making decisions, solving problems, controlling your emotions and behavior, and coping with change. Sleep deficiency also has been linked to depression, suicide, and risk-taking behavior.

Children and teens who are sleep deficient may have problems getting along with others. They may feel angry and impulsive, have mood swings, feel sad or depressed, or lack motivation. They also may have problems paying attention, and they may get lower grades and feel stressed.

Physical Health

Sleep plays an important role in your physical health. For example, sleep is involved in healing and repair of your heart and blood vessels. Ongoing sleep deficiency is linked to an increased risk of heart disease, kidney disease, high blood pressure, diabetes, and stroke. 

Sleep deficiency also increases the risk of obesity. For example, one study of teenagers showed that with each hour of sleep lost, the odds of becoming obese went up. Sleep deficiency increases the risk of obesity in other age groups as well.

Sleep helps maintain a healthy balance of the hormones that make you feel hungry (ghrelin) or full (leptin). When you don't get enough sleep, your level of ghrelin goes up and your level of leptin goes down. This makes you feel hungrier than when you're well-rested.

Sleep also affects how your body reacts to insulin, the hormone that controls your blood glucose (sugar) level. Sleep deficiency results in a higher than normal blood sugar level, which may increase your risk for diabetes.

Sleep also supports healthy growth and development. Deep sleep triggers the body to release the hormone that promotes normal growth in children and teens. This hormone also boosts muscle mass and helps repair cells and tissues in children, teens, and adults. Sleep also plays a role in puberty and fertility.

Your immune system relies on sleep to stay healthy. This system defends your body against foreign or harmful substances. Ongoing sleep deficiency can change the way in which your immune system responds. For example, if you're sleep deficient, you may have trouble fighting common infections.

Daytime Performance and Safety

Getting enough quality sleep at the right times helps you function well throughout the day. People who are sleep deficient are less productive at work and school. They take longer to finish tasks, have a slower reaction time, and make more mistakes.

After several nights of losing sleep—even a loss of just 1–2 hours per night—your ability to function suffers as if you haven't slept at all for a day or two.

Lack of sleep also may lead to microsleep. Microsleep refers to brief moments of sleep that occur when you're normally awake.

You can't control microsleep, and you might not be aware of it. For example, have you ever driven somewhere and then not remembered part of the trip? If so, you may have experienced microsleep.

Even if you're not driving, microsleep can affect how you function. If you're listening to a lecture, for example, you might miss some of the information or feel like you don't understand the point. In reality, though, you may have slept through part of the lecture and not been aware of it.

Some people aren't aware of the risks of sleep deficiency. In fact, they may not even realize that they're sleep deficient. Even with limited or poor-quality sleep, they may still think that they can function well.

For example, drowsy drivers may feel capable of driving. Yet, studies show that sleep deficiency harms your driving ability as much as, or more than, being drunk. It's estimated that driver sleepiness is a factor in about 100,000 car accidents each year, resulting in about 1,500 deaths.

Drivers aren't the only ones affected by sleep deficiency. It can affect people in all lines of work, including health care workers, pilots, students, lawyers, mechanics, and assembly line workers.

As a result, sleep deficiency is not only harmful on a personal level, but it also can cause large-scale damage. For example, sleep deficiency has played a role in human errors linked to tragic accidents, such as nuclear reactor meltdowns, grounding of large ships, and aviation accidents.

For More...

What should I do if I can't sleep?

Sources:

National Heart, Lung, and Blood Institute, National Institutes of Health - Why Is Sleep Important?

National Heart, Lung, and Blood Institute, National Institutes of Health - Sleep Disorders & Insufficient Sleep: Improving Health through Research

CDC - Sleep and Sleep Disorders

CDC - What Should I Do If I Can't Sleep