Knowledge of Stroke, Its Warning Symptoms, Risk Factors and Treatment among the General Public and General Practitioners in a South Asian Population.

BACKGROUND: An adequate stroke literacy among the general public and first-contact physicians is an essential prerequisite to ensure timely treatment and prevention of stroke. Knowledge on stroke pathophysiology, warning symptoms, risk factors and treatment, and its determinants was assessed among general public and general practitioners (GPs) in a South Asian population. METHODS: A cross-sectional study was conducted among relatives of nonstroke patients admitted to the apex tertiary-care hospital in Sri Lanka. Trained doctors administered pretested, structured, open- and close-ended questionnaires. A postal survey using self-administered questionnaires was conducted among all registered GPs in Sri Lanka. RESULTS: The sample of general public (51.7% males; mean age = 40.7 years) from 21 of 25 districts of Sri Lanka was 840 (response-rate = 97.4%) while the sample of GPs (77.6% males; mean age = 59.63 years) was 98 (response-rate = 30%). Of the general public, 83.2% were aware of a vascular aetiology of stroke, but only 46.8% were aware that the affected organ was the brain while 67.5% believed that either the heart or limb muscles die as sequalae of stroke. Over 50% correctly identified stroke warning symptoms while 84.7% would seek immediate Western medical treatment. Approximately, 32%-46% were not aware of the major stroke risk factors. Lower education (adj. OR = 1.7; 95% CI = 1.3-2.3), absence of stroke risk factors (2.6; 1.9-3.7) and nonutility of information sources (1.5; 1.0-2.0) determined poor knowledge on risk factors. Only about 1 in 8 GPs accurately defined stroke and TIA while only 43.9% correctly classified stroke subtypes. Only 1 in 10 GPs were aware of the recommended therapeutic window for thrombolysis. Older age (P = 0.01) and longer service (P = 0.04) of GPs were associated with not requesting brain imaging in stroke. CONCLUSIONS: Strategies to educate both the public and first-contact physicians to improve stroke literacy need to be an integral part of programmes that aim to reduce the burden of stroke in any population.

Cardiovascular risk in lupus nephritis: Do renal disease-related and other traditional risk factors play a role?

This study was performed to evaluate the prevalence of thickened carotid intima media thickness (CIMT) in a Sri Lankan cohort of lupus nephritis (LN) patients and to identify associations between traditional cardiovascular disease (CVD) and LN-related risk factors with increased CIMT. Consecutive patients with biopsy-proven LN were evaluated for conventional CVD risk factors, renal parameters and extent of organ involvement in this cross-sectional study. Current disease activity and damage were assessed by the British Isles Lupus Activity Group (BILAG) score and the Systemic Lupus International Collaborative Clinics/American College of Rheumatology (SLICC/ACR) damage index, respectively. CIMT was assessed by B Mode grey scale ultrasonography. Increased CIMT was defined as CIMT more than the 75th percentile based on cutoffs from the "Carotid Atherosclerosis Progression Study." Forty patients (98% female), with a mean age of 38 years (age range of 20-50) and of South Asian descent, were evaluated. The mean duration of disease of 6.15 years (SD = 4.66). The overall prevalence of cardiovascular events was low and included previous acute coronary syndromes in 7.5%, stable angina in 5%, cerebrovascular accidents in 7.5% and transient ischemic attacks in 2.5% of the patients; 72.5% had hypertension (HTN) [mean blood pressure (BP) 140/80 mm Hg]; 32.5% had dyslipidemias (mean serum cholesterol 5.9; SD = 5.6) and 25% had diabetes (mean blood sugar 103.7; SD = 15.6). Forty percent were obese and 20% were overweight (Asian cutoffs). Increased CIMT (57.5%) and atherosclerotic plaques (15.36%) indicated a high CVD risk in this cohort. Diabetes (P = 0.016), HTN (P = 0.002), dyslipidemia (P = 0.002) and obesity (P = 0.048) were associated with thickened CIMT. The only LN-related risk factor associated with thickened CIMT (P <0.05) was the SLICC/ACR damage index. The independent predictors of thickened CIMT determined by logistic regression analysis were HTN and dyslipidemia.

Awareness of breast cancer among adolescent girls in Colombo, Sri Lanka: a school based study.

BACKGROUND: Breast cancer is the commonest cancer in women worldwide. Although programmes promoting breast cancer awareness are being carried out throughout Sri Lanka, few have targeted school students. We conducted this study to assess the knowledge, attitudes and practices regarding breast cancer with reference to screening, services available, breast self-examination, and sources of information, among adolescent schoolgirls in the Colombo District of Sri Lanka. METHODS: The knowledge, attitudes and practices related to breast cancer were assessed among 859 adolescent girls in schools within the Colombo District, using a self-administered questionnaire. Classes and students were selected using multi-stage stratified cluster sampling. RESULTS: Of the total sample, approximately 60% of respondents identified 'history of breast lump', 'family history of breast cancer' & 'exposure to irradiation' as risk factors for breast cancer. Although most were aware that the presence of a breast lump was an important warning sign, awareness of other warning signs was poor. Only 35.6% identified mammogram as an effective screening method. One third of the sample maintained that they are unaware of symptoms, diagnostics and treatment of breast cancer. Of those who were aware, 90.6% named surgery as a treatment option for breast cancer, 79.4% were unaware that chemotherapy is used. Of the total sample, 17.1% knew how to perform breast self-examination, and only 9.4% were aware of currently available breast cancer screening services. Knowledge was significantly better among students who had a relative with breast cancer. CONCLUSIONS: There were significant deficiencies in knowledge, attitudes and practices on breast cancer in the study population. In particular, knowledge on breast self examination was poor. There is a need for awareness programs aimed specifically at this important target group.