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,*,Haga clic para modificar el estilo de texto del patrn,Segundo nivel,Tercer nivel,Cuarto nivel,Quinto nivel,Haga clic para cambiar el estilo de ttulo,STROKE:SECONDARY PREVENTION THE WHO PREMISE STUDYMARGARITA E.DAZ,CENTRE FOR ACADEMIC MEDICAL RESEARCHMontevideo Uruguay,DEFINITION,Stroke is defined as an episode of focal or global neurological deficit of rapid onset and lasting over 24 hours or leading to death,with no cause apparent other than a vascular one.,IS STROKE A FREQUENT PHENOMENON?,WORLDWIDE PERCENTAGES OF DEATHS,Stroke and other leading causes 2002,Source,Mackay,J,Mensah,G.,The,Atlas,of,Heart,Disease,and,Stroke,.WHO-CDC,2004.,Total number of Deaths:57 million,Stroke is the 3,rd,most common cause of death,50 million have suffered a stroke,5 million die each year because of a stroke,WORLDWIDE IMPACT OF STROKE,WORLDWIDE CONSEQUENCES OF STROKE,Almost 33%of those who present a stroke die in 3 weeks,50%of survivors are left with physical and/or mental disability,20%of survivors suffer another stroke within 5 years,PREVALENCE OF RECURRENT STROKE,Hier,DB et al Stroke 1991;22:155-161.,Onset,6,months,1,year,0.00,0.02,0.04,0.06,0.08,0.10,0.12,0.14,18,months,2,years,Cumulative,distribution,Time,after first stroke,WHO PREMISE,Study,of secondary prevention of stroke,Causes of stroke and its established risk factors,Non-modifiable and modifiable risk factors,Results of the WHO PREMISE,Study,Prevalence of the most important risk factors,Use of medication from the WHO PREMISE,Study,By socio-demographic characteristics,According to risk factors,By clinical characteristics,Predictors for the use of medication,Perspectives of pharmacological intervention,Clinical trials with universal treatment,Specific treatment according to diagnosis:,isquemic/hemorrhaegic,stroke,Compliance,OBJECTIVES OF THE WHO PREMISE STUDY,PHASE 1,To assess current practice patterns related to secondary prevention of coronary heart disease and,cerebrovascular,disease(,CeVD,)in primary,secondary and tertiary health care settings,Learn about patient behaviour and compliance in the 3 years after an event,Implement strategies to strengthen the health care system with interventions based in primary care and community based action,CRUDE PREVALENCE OF STROKE IN THE PARTICIPATING COUNTRIES IN THE WHO-PREMISE STUDY,n=10 855,Population,In Millions (2002),Sample size,(n),Prevalence,of stroke(%),Brazil,180,996,16.1,Egypt,71,996,21.3,India,1 000,1 013,8.0,Indonesia,234,999,44.3,Iran,68,916,4.4,Pakistan,156,1 007,13.2,Russia,143,993,7.5,Sri Lanka,19,1 038,24.0,Tunisia,9,999,5.5,Turkey,68,1 000,6.0,Uruguay,3,898,25.0,WHO PREMISE,Study of secondary prevention of stroke,Causes of stroke and its established risk factors,Non-modifiable and modifiable risk factors,Results of the WHO PREMISE,Study,Prevalence of the most important risk factors,Use of medication from the WHO PREMISE,Study,By socio-demographic characteristics,According to risk factors,By clinical characteristics,Predictors for the use of medication,Perspectives of pharmacological intervention,Clinical trials with universal treatment,Specific treatment according to diagnosis:,isquemic/hemorrhaegic,stroke,Compliance,NON-MODIFIABLE RISKFACTORS FOR STROKE,Age,sex,Heredity,Ethnicity,Previous stroke,ESTABILISHED MODIFIABLE RISK FACTORS FOR STROKE,Hypertension,Chronic renal insufficiency,Carotid,stenosis,Smoking,Heavy alcohol consumption,Physical inactivity,Dyslipidaemia,Diabetes mellitus,CANDIDATE RISK FACTORSFOR STROKE,Migraine,Oral contraceptives,Sleep,apnoea,Cocaine and amphetamines,Certain infections,Elevated,homocysteine,MODIFIABLE CARDIAC,RISK FACTORS FOR STROKE,Coronary heart disease,Myocardial infarction,Congestive heart failure,Left ventricular,disfunction,/mural thrombus,Mitral,stenosis,Atrial,fibrillation,RATES of MORTALITY for CEREBROVASCULAR DISEASE by age and sex group,Canada,Health Canada,1999,PREDICTORS OF DEATH FROM STROKE IN ITALY,Percentage increased risk of death from stroke in people aged 65 years and above,2001,Number of deaths from Stroke in 2002:69.075,Source,Mackay,J,Mensah,G.,The,Atlas,of,Heart,Disease,and,Stroke,.WHO-CDC,2004.,WHO PREMISE Study of secondary prevention of stroke,Causes of stroke and its established risk factors,Non-modifiable and modifiable risk factors,Results of the WHO-PREMISE Study,Prevalence of the most important risk factors,Use of medication from the WHO PREMISE Study,By,socio-demographic,characteristics,According to risk factors,By clinical characteristics,Predictors for the use of medication,Perspectives of pharmacological intervention,Clinical trials with universal treatment,Specific treatment according to diagnosis:,isquemic,/,hemorrhaegic,stroke,Compliance,TOTAL NUMBER OF PARTICIPANTS,OF CORONARY,HEART DISEASE(CHD)AND STROKE,IN THE WHO-PREMISE STUDY,AGE GROUPS FOR MALES AND FEMALES,TOTAL NUMBER OF PARTICIPANTS,OF CHD AND STROKE,BY AGE AND SEX,IN THE WHO-PREMISE STUDY,CeVD,:,Cerebrovascular,disease,REPORTED HISTORY OF RISK FACTORS IN PERCENTAGES AMONG
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