Search PubMed⌕ Search

Biomedical subjects

S Ebrahim

Publications and source records attributed to S Ebrahim.

At least 199 records · Page 11Linked to original sources
PubMed1995

Respiratory function and risk of stroke.

BACKGROUND AND PURPOSE: This report examines the relationship between lung function and risk of major stroke events (fatal and nonfatal). METHODS: We completed a prospective study of 7735 men aged 40 to 59 years at screening selected at random from one general practice in each of 24 British towns. RESULTS: During the mean follow-up period of 14.8 years, there were 277 major stroke events in the 7650 men with data on forced expiratory volume in 1 second (FEV1). After exclusion of 499 men with definite myocardial infarction, stroke, or atrial fibrillation at screening, 7151 men experienced 239 major stroke events. Lower levels of FEV1 were associated with a significant increase in risk of stroke even after adjustment for age, smoking, social class, physical activity, alcohol intake, systolic blood pressure, antihypertensive treatment, diabetes, and preexisting ischemic heart disease. Relative risk in the low third (< 3.10 L) versus high third (> 3.65 L) was 1.4 (95% confidence interval, 1.0 to 2.0). The inverse association between FEV1 and stroke was only apparent in older men, current nonsmokers, hypertensive men, and men with preexisting ischemic heart disease. Lower FEV1 was associated with higher rates of stroke in hypertensive men irrespective of smoking status. Inclusion of FEV1 in a risk score for stroke provided only a small increase in the absolute risk or the yield of cases in the top fifth of the score distribution during the follow-up period. CONCLUSIONS: Lower levels of FEV1 are associated with an increased risk of stroke in those already at high risk, eg, those with ischemic heart disease or hypertension. However, the association is not strong enough to warrant the use of FEV1 in making clinical decisions regarding the treatment of hypertension as it relates to the prevention of stroke.

Adult↗
PubMed1995

Serum bilirubin and risk of ischemic heart disease in middle-aged British men.

The possibility that low concentrations of serum bilirubin may be associated with increased risk of ischemic heart disease has been examined in a prospective study of 7685 middle-aged British men. During 11.5 years there were 737 major ischemic heart disease (IHD) events. A U-shaped relationship was observed between serum bilirubin and risk of IHD. Low bilirubin was associated with several cardiovascular risk factors, in particular smoking, low concentrations of high-density lipoprotein cholesterol, low forced expiratory volume in 1 s, and low serum albumin. The U-shaped relationship persisted even after adjusting for several risk factors. Compared with men in the lowest fifth of the distribution (bilirubin < 7 mumol/L), those in the middle range (8-9 mumol/L) showed a 30% reduction in relative risk [RR = 0.68 (95% confidence intervals 0.51-0.89)] in IHD, whereas men in the top fifth (> 12 mumol/L) showed similar risk to the lowest fifth [RR = 0.99 (95% confidence intervals 0.73-1.34)], which persisted after exclusion of men with bilirubin > 17 mumol/L. The significance of this U-shaped relationship is unclear, but it could be interpreted as support for the role of endogenous antioxidants in the etiology of IHD.

Adult↗
PubMed1995

Scoring system to identify men at high risk of stroke: a strategy for general practice.

BACKGROUND: The major risk factors for stroke are well described and there is good evidence that the risks associated with hypertension and cigarette smoking are reversible by appropriate interventions. However, if disease prevention measures are to be efficient, it is important that a system which can identify individuals at high risk of stroke be available for use in general practice. AIM: A study was therefore undertaken to design an effective and practical system for detecting men aged 40 to 59 years at high risk of stroke in primary care. METHOD: Stroke incidence and risk factor data were examined in a cohort of 7735 men aged 40 to 59 years who had taken part in the British regional heart study. Analysis was performed using data from initial entry into the study and then from five and 11.5 years of follow up. Subjects were randomly selected from the age-sex register of one general practice in each of 24 different towns throughout the United Kingdom, representing the full range of cardiovascular mortality rates. RESULTS: A simple scoring system derived from logistic regression using age, systolic blood pressure, current cigarette consumption, and evidence of anginal chest pain was able to detect more than 80% of all strokes occurring within five years in the top fifth of the score distribution. The inclusion of other risk factors for stroke did not increase the score's predictive ability. The combination of smoking and hypertension, while much less sensitive than the scoring system, was a better indicator of risk than any single risk factor, all of whose predictive values were poor. CONCLUSION: Based on readily measured variables, this scoring system could be used in general practice to identify men at high risk of stroke who would benefit from further intervention. Effective identification of high risk individuals requires assessment of the combined effects of multiple risk factors.

Adult↗
PubMed1994

The meaning of activities of daily living in a Thai elderly population: development of a new index.

Activities of daily living (ADL) of 703 Thai elderly people (aged 60+ years) living in a Bangkok slum community were studied with the aims of describing the prevalence of disability, considering the appropriateness of Western ADL scales and developing a new ADL index for Asian populations. The levels of disability found were higher than in industrial populations and the important areas of disability were in instrumental ADLs. The mean (SD) Barthel ADL Index (BAI) for the group was 19.5 (1.2) with a range of 10-20. The mean (SD) Office of Populations Censuses and Surveys (OPCS) disability score was 4.8 (1.9) with a range of 0-10 but was unsuitable for use in Thailand because of misinterpretation of behavioural and intellectual disability leading to 99% of subjects being scored as disabled. An analysis of the underlying dimensions making up ADL was conducted using factor analysis. Four dimensions of ADL were found: basic self-care ADLs, extended ADLs, mobility ADLs and continence. An extended ADL index suitable for use in developing countries was developed (the Chula ADL Index) which had strong hierarchical properties and high correlations with both the OPCS disability score and the Barthel ADL Index. Analysis of data derived from ADL instruments should consider each ADL dimension separately. The BAI is useful as an index of self-care ADL but the behaviour and intellectual disability sub-scales of the OPCS scale require further development for cross-cultural applications.

Activities of Daily Living↗
PubMed1994

Assessing the effectiveness of audit in long-stay hospital care for elderly people.

We wished to assess the impact of an audit package (the Royal College of Physicians CARE scheme) on outcomes in institutional care for elderly people. We compared patients in audited and unaudited units in four hospital continuing-care wards and a National Health Service nursing home. Ninety-three hospital long-stay patients and 26 nursing home patients were observed. Changes in disability (measured using the Barthel Index, Clifton Assessment Procedure for the Elderly and Crichton Royal Behaviour Rating Scale), deaths, satisfaction with life, and relative's satisfaction with care were recorded. Odds ratios for unfavourable outcomes were calculated after adjusting for potential confounders. Initial disability was similar on two audited wards and two control wards, but significantly less in the (audited) nursing home; 11% of patients died on the control wards, compared with 35% on the audited wards (p = 0.02). There were no consistent differences between changes in disability or satisfaction scores on the intervention and control units, although confidence intervals were wide. Staff attitudes towards the scheme were positive. We conclude that audit in long-term care was not associated with measurable improvements in outcomes. Intermediate process indicators of the impact of audit are needed. Positive staff attitudes to audit were encouraging, and suggest that further modifications of the CARE scheme should be evaluated.

Activities of Daily Living↗
PubMed1994

Development and reliability of the Royal College of Physicians stroke audit form. UK Stroke Audit Group.

This article reports the development of an audit form for assessing the quality of stroke care from medical records. A consensus conference to define standards was followed by testing of pilot versions of the audit form. Then formal assessment of inter-rater reliability was carried out in four centres using 76 medical records, each assessed by two of eight auditors. Inter-rater reliability was acceptable, especially when medically qualified auditors were used.

Aged↗
PubMed1994

Look After Your Heart programme: impact on health status, exercise knowledge, attitudes, and behaviour of retired women in England.

OBJECTIVES: To evaluate the impact of the Health Education Authority's 20 hour Look After Your Heart health promotion course on a large group of retired women. DESIGN: Three groups of retired women were compared: group 1 women, drawn from 12 retirement groups, participated in the programme; group 2, drawn randomly from the same groups, declined; group 3, selected randomly from 12 different retirement groups matched for geographical area, were not offered the course. SETTING: Twenty four retirement groups established by a major national retail company in England. SUBJECTS: A total of 739 women with a mean age of 66 years participated. Altogether 200 women were in group 1, 192 in group 2, and 347 in group 3. MAIN OUTCOME MEASURE: The Nottingham Health Profile was administered and exercise knowledge, attitudes, and behaviour of the three groups were assessed using a validated, reliable questionnaire. RESULTS: Group 1 had significantly better self-perceived health, indicated by lower Nottingham Health Profile scores, more exercise knowledge, and positive exercise attitudes and they did more exercise than the other two groups. The responses of groups 2 and 3 were similar. Time since completion of the programme did not have any effect on Nottingham Health Profile scores, exercise knowledge, and behaviour. CONCLUSION: The Look After Your Heart programme is associated with beneficial and persistent effects in retired women. Detailed studies are needed to confirm whether these associations are due to the programme or reflect the selection of fitter, healthier subjects.

Aged↗
PubMed1994

Handicap one year after a stroke: validity of a new scale.

The aim was to determine the handicap experienced by subjects one year after a stroke, and assess the acceptability, validity, and reliability of a new handicap measurement scale. A cross sectional survey of 141 survivors of a cohort of consecutive hospital admissions with acute stroke was undertaken. The London handicap scale (a new health outcome measurement scale), Barthel index, Nottingham extended activities of daily living scale, Nottingham health profile, Geriatric depression score, and a global life satisfaction scale were used. 94 subjects (67%) responded to a single mailing; 89 (95%) responses were usable. Mean handicap was 0.40 (range 0.06-1.0, SD 0.20) on a scale of 0 (maximum handicap) to 1 (no handicap). All handicap dimensions showed a wide range of problems, with physical independence and occupation particularly affected. Correlations between handicap score and other outcome measures were all in the expected direction and of about the strength expected (0.36 < r < 0.69). The reliability coefficient was 0.91, limits of agreement +/- 0.19. The measurements demonstrated substantial handicap one year after a stroke, reflecting considerable unmet rehabilitation needs. The scale proved acceptable to subjects, and the results were consistent with good validity.

Activities of Daily Living↗
PubMed1994

Predicting stroke outcome: Guy's prognostic score in practice.

This study aimed to cross validate the Guy's prognostic score in a new sample of patients of all ages admitted to hospital with a stroke and to devise and test a simpler version (the G-score). 361 consecutive acute patients with stroke who had been admitted to the acute hospitals in two adjacent health districts in East London were recruited and followed up for six months after the stroke. The G-score was derived by simplifying the weights used in calculating the Guy's score. With the conventional threshold of 0 for the Guy's score and 3 (out of 7) for the G-score, the sensitivity of both scores for predicting a bad outcome (death or Barthel score < 13 out of 20 at six months) was 0.72 and specificity was 0.63. The likelihood ratio for the Guy's score was 1.97 and for the G-score 1.95. Both versions of the score performed better than conscious level alone at predicting the outcome (sensitivity 0.47, specificity 0.73, likelihood ratio 1.74). Similar data are presented for different thresholds and prior probabilities. In addition, the G-score permits direct estimation of 95% confidence intervals for the probability of a bad outcome for five grades of stroke severity. Outcome prediction with multivariate techniques has the potential to improve and inform clinical decision making. The G-score should be used to define stroke severity for individual patients and for case mix adjustment.

Activities of Daily Living↗
PubMed1994

Measuring handicap: the London Handicap Scale, a new outcome measure for chronic disease.

OBJECTIVE: To develop a handicap measurement scale in a self completion questionnaire format, with scale weights allowing quantification of handicap at an interval level of measurement. DESIGN: Adaptation of the International Classification of Impairments, Disabilities and handicaps into a practical questionnaire incorporating the dimensions of handicap mobility, occupation, physical independence, social integration, orientation, and economic self sufficiency and scale weights derived from interviews with a general population sample, with the technique of conjoint analysis. SETTING: Two general practices in different areas of London. SUBJECTS: 240 adults aged 55-74 years randomly selected from the practices, 101 (42%) of whom agreed to be interviewed, and 79 (78%) of whom completed the exercise. MAIN MEASURES: Rating of severity of handicap associated with 30 hypothetical health scenarios on a visual analogue scale, from which was derived a matrix of scale weights ("part utilities") relating to different levels of disadvantage on each dimension, with a formula for combining them into an overall handicap score. Severity scores measured directly for five scenarios not used to derive the scale weights were compared with those calculated from the formula to validate the model. RESULTS: The part utilities obtained conformed with the expected hierarchy for each dimension, confirming the validity of the method. The measured severities and those calculated from the formula for the five scenarios used to validate the model agreed closely (Pearson's r = 0.98, p = 0.0009; Kendall's tau = 1.00, p = 0.007). CONCLUSIONS: This interval level handicap measurement scale will be useful in assessing both specific therapies and health services, in clinical trials, in analyses of cost effectiveness, and in assessments of quality assurance.

Activities of Daily Living↗
PubMed1994

Views of survivors of stroke on benefits of physiotherapy.

OBJECTIVE: To describe the components of physiotherapy valued by survivors of a stroke. DESIGN: Qualitative study using in-depth interviews. SETTING: Two adjacent districts in North East Thames Regional Health Authority. PATIENTS: 82 survivors of stroke taken consecutively from a stroke register when they reached the tenth month after their stroke, 40 of whom agreed to be interviewed. MAIN MEASURES: Content analysis of interviews. RESULTS: Patients who agreed to the interview were significantly less likely to be disabled 12 months after stroke than those who did not. Twenty four patients had received physiotherapy, and these were more disabled than those who had not. Patients appreciated physiotherapy. It was believed to bring about functional improvement; the exercise component was valued because it was perceived to keep them active and busy and exercise programmes to follow at home were also valued for the structure they gave to each day; and therapists were considered a source of advice and information and a source of faith and hope. CONCLUSIONS: Many of the positive aspects of caring which patients described in the context of physiotherapy could be incorporated into the mainstream of rehabilitation care and training. However, health professionals need to be careful not to promote false expectations about recovery. IMPLICATIONS: The outcome of treatment is of critical importance to patients and should become a central dimension of patient satisfaction questionnaires. The impact of physiotherapy is not confined to reducing physical disability but may also affect wellbeing. The choice of outcome measures in rehabilitation research should reflect this situation.

Adult↗