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Stro
Chiang,C
Universit
Aims&
Objectives
Discussdiscussthedemographicsofpeopl
ernSuburbs.
Discuss
the
causes
and
impact
of
stroke
in
SuburbsofSydney,Australia.
Exploreimpactofinterventionsofthishea
INTRODUCTION
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ein
Diabetic
Patients
in
th
Png,
D;
Lam,L
&
Goh
YH.
ofNewSouthWales,MedicineFaculty.Rehabilitation
livingwithdiabetesintheEast
iabetics
living
in
the
Eastern
thproblemincommunity.
RESULTS&
DISCUSSION
DEMOGRAPHICSEastern
Suburbs
(Sydney)
covers
Woollahra,
Randwick
and
inNewSouthWales.Demographicsofpatientswithdiabet
urbs(Sydney)areasfollows:
Majority had type 2 diabetes and is more common with
suburbshasmorethanathirdofitspopulation>45years.
Higherprevalenceofdiabetesinmaleswashigherthanf
DEMOGRAPHICSEastern
Suburbs
(Sydney)
covers
Woollahra,
Randwick
and
inNewSouthWales.Demographicsofpatientswithdiabet
urbs(Sydney)areasfollows:
Majority had type 2 diabetes and is more common with
suburbshasmorethanathirdofitspopulation>45years.
Higherprevalenceofdiabetesinmaleswashigherthanf
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eEastern
Suburbs
of
Sydn
department,PrinceofWalesHospital.
averly
Local
Government
Areas
sandstrokeintheEasternSub
increasing age over 45. Eastern
males,at7.6%and6.5%respec
IMPACTOF
MULTIDISCIPLINARY
INTERVENTION
Groupaffected
byinterventions
ImpactofInterventions
Thediabeticeld
erlywithstroke
inthe
Eastern
Suburbs
LifestyleIntervention
Theelderlystrugglewithcompliancedue
pcES)
Improvedhealthstatusifthereiscomplia
Increasedawarenessofbenefitsofdietc
A reventativestrate thatinvolvesnod
averly
Local
Government
Areas
sandstrokeintheEasternSub
increasing age over 45. Eastern
males,at7.6%and6.5%respec
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y
toincreasingageand/orotherculturalissues(pcCNC;
ce(Colagiuri,Thomas,&Buckley,2007)
angeandphysicalactivity(pcCNC;pcES)
rectmedicalcost Cola iuri Thomas &Buckle 2007
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Diabetesisanincreasingprevalentchronicdis
amongstAustralians*withprevalencedoubled
Easternsuburbsareatlowerriskofdiabetesc
lians,the
severity
must
not
be
overlooked
bec
Strokeisamajorcauseofmortalityandmorbi
nately,itispreventablewhenriskfactorsarei
ventions
implemented.
MATERIALSANDMETHOQuantitativeandqualitativeinformationwere
asshowninTable1.
Table1.Sourcesofinformation.
Interviews Nationalrepo
data
Endocrinespecialist
ClinicalNurse
Consultant
RehabilitationPhysician
AlliedHealthcareworker
AustralianInsti
Healthand
DiabetesAustr
AustralianBure
ll
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aseofsignificanthealthburden
inthelast20years.Residentsin
mparedtoIndigenousAustra
useof
its
aging
population.
ityindiabetespopulation.Fortu
entifiedandappropriateinter
Scollectedfromarangeofsources
tsand Webbasedlitera
turesearches
uteof
elfarelia
uSta
Medline
PubmedScopus
GoogleScholar
tively.
Population ismoreaffluentwithhighaccessibilityresulti
sityratesthatareriskfactorsfordiabetes.*
Prevalence of diabetes was higher with lower socioecon
moteareasandtheIndigenouspopulation.*
DiabetesismostprevalentinpeopleborninSouthernand
andthe
Middle
East
(6.6%),
South
East
Asia
(5.7%)
and
So
Althoughonly14.7% of people living in theEasternsub
higherpopulationnumber willmeanthatmorepeoplemi
InAustralia,
approximately
23,400
(7.2%)
males
and
31,
withdiabeteshadastrokein2003.*Thedirectorofreha
andnursesthatapproximately30%ofstrokepatientsint
bilitationwardhaddiabetes.
Young males are prone to brain haemorrhage because
habits* (Juvela, Hillbom, Numminen, & Koskinen, 1993)
populationisgenerallywelleducatedwith68.3%havingp
sumed to be wellinformed of diet and exercise, the rel
ratewithintheAustralianpopulationmaycontributetot
tively.
Population ismoreaffluentwithhighaccessibilityresulti
sityratesthatareriskfactorsfordiabetes.*
Prevalence of diabetes was higher with lower socioecon
moteareasandtheIndigenouspopulation.*
DiabetesismostprevalentinpeopleborninSouthernand
andthe
Middle
East
(6.6%),
South
East
Asia
(5.7%)
and
So
Althoughonly14.7% of people living in theEasternsub
higherpopulationnumber willmeanthatmorepeoplemi
InAustralia,
approximately
23,400
(7.2%)
males
and
31,
withdiabeteshadastrokein2003.*Thedirectorofreha
andnursesthatapproximately30%ofstrokepatientsint
bilitationwardhaddiabetes.
Young males are prone to brain haemorrhage because
habits* (Juvela, Hillbom, Numminen, & Koskinen, 1993)
populationisgenerallywelleducatedwith68.3%havingp
sumed to be wellinformed of diet and exercise, the rel
ratewithintheAustralianpopulationmaycontributetot
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g inphysical inactivityandobe
omic status, people living in re
CentralAsia(8.7%),NorthAfrica
thernand
Eastern
Europe
(4.9%)
rbs areborn in thesecountries,
htbeaffectedbydiabetes.
00(10%)
females
aged
over
50
ilitationmedicine,otherdoctors
ePrinceofWalesHospitalreha
f heavier drinking and smoking
Although the Eastern suburbs
stschooleducationandthusas
tively high alcohol consumption
eriskofstroke*.Furthermore,
Multidisciplinaryteam
Comprehensivecarebyvarioushealthcar
perhapsreturntonormalfunctioningsta
Greaterinvolvementofthepatientwhich
LocalHealth
Sys
tem
LifestyleIntervention
Requireincreasedfundingtoorganiseca
Increasedresourcesneededespecially m
Collaborationandincreasedcommunicati
cialistsand
community
health
team
(pc
Multidisciplinaryteam
Teamworkbetweenhealthprofessionals
patient.
Theoverallcostonthehealthsystemma
creaseddiscussionandreferralstoother
HealthCare
Workers
LifestyleIntervention
Extensivecontactwithindividualsrequire
astrainonhealthcareworkers(pcCNC)
Aneed
to
increase
manpower
by
hiring
m
strainonhealthcarebudget(pcCNC)
Moreeffortandtimetobeputintoeduca
Frustrationbyhealthcareworkersdueto
Multidisciplinary
team
Decreasedstressandhenceimprovedme
sionwithotherprofessionals
Goodaccesstoinformationandhenceall
g inphysical inactivityandobe
omic status, people living in re
CentralAsia(8.7%),NorthAfrica
thernand
Eastern
Europe
(4.9%)
rbs areborn in thesecountries,
htbeaffectedbydiabetes.
00(10%)
females
aged
over
50
ilitationmedicine,otherdoctors
ePrinceofWalesHospitalreha
f heavier drinking and smoking
Although the Eastern suburbs
stschooleducationandthusas
tively high alcohol consumption
eriskofstroke*.Furthermore,
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eprofessionalswhichmayimproverehabilitationand
tus
mayspeeduptreatmentandimprovecompliance
paigns,outreachprogramsandhomevisits(pcCNC)
npower(pcCNC)
nbetweenvarioushealthsectors,includingGP,spe
NC)
nddevelopingacoordinatedapproachtomanagethe
increaseandmoretimeistakenupwhenthereisin
departments.
moretimewhichwillincreaseworkloadhenceputting
orenurse
educators
etc.
and
hence
increasing
the
tingindividuals.
oncomplianceoflifestylemodifications(pcCNC)
ntalhealthforhealthcareworkersbecauseofdiscus
wbettermana ementofthe atient
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Theinformationisobtainediscriticallyapprai
dence*thatthesourceofinformationisobtai
Levels Levelsofevide
1
Metaanalysis
or
systematic
revi
2 WelldesignedRCTs
3 Welldesignedcohortorcaseco
4
Opinionsof
respected
authoritie
scriptivestudiesandcasereport
mittees.
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edaccordingtothelevelofevi
edfrom.
cebasedon
wsof
all
relevant
RCTs
trolanalyticstudies
,clinical
experience,
de
orreportsofexpertcom
intoxicationisparticularlyevidentamongyoungadultsint
CAUSESOFSTROKEINDIABETICS:MEDIALCAUSES:
Diabetesmellitusisawellestablishedindependentriskfa
withhighmortality*(Karsito&Soeatmadji,2008).
Hypercoagulabilitystateindiabeticpatientsincreasesthe
stroke* (Takenaka,Yamagishietal.2006).
Studieshavealsoestablishedthatconcomitanthypertensi
theriskofstrokeandhypertensionisfoundtobetwiceas
Sartietal.2005)
SOCIOECONOMICANDBEHAVIOURALCAUSES:
Geneticfactorsarepoorlystudiedduetoraceethnicdispa
Lowsocioeconomicstatusincludinglowliteracyrate,poo
burden
intoxicationisparticularlyevidentamongyoungadultsint
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REFERENCESAustralian
Institute
of
Health
and
Welfare
(AIHW)
(2010)
2004
National
Drug
Strategy
Household
Surve
Canberra.
Hu,G.,C.Sarti,etal.(2005)."Theimpactofhistoryofhypertensionandtype2diabetesatbaselineon
KarsitoandD.W.Soeatmadji(2008)."Diabetesandstroke."ActaMedIndones40(3):1518.
Takenaka,K.,S.Yamagishi,etal.(2006)."Roleofadvancedglycationendproducts(AGEs)inthrombog
he20s.*
torofstrokeandisassociated
usceptibiltytothromboembolic
nanddiabeteswouldincrease
ommonindiabetics.* (Hu,
rities
accesstohealthcare,financial
CONCLUSION Amultidisciplinaryteamwithanactivepatientcenteredap
outcomefor
the
patient
(Govan
et
al.,
2008).
However,theeffectivenessofamultidisciplinaryteamalso
andreasonabledistributionofworkloadtoeachhealthcare
Astudy
has
demonstrated
that
multidisciplinary
ward
rou
than case conferences and this could be implemented f
2005).
he20s.*
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y:First
Results,
Drug
Statistics
Series
13,
Australian
Institute
of
Health
and
Welfare,
theincidenceofstrokeandstrokemortality."Stroke36(12):253843.
nicabnormalitiesindiabetes."CurrNeurovascRes3(1):737.
roachinstrokemanagementwillprovidethebest
reliesstronglyontheorganisationalmanagement
worker(Smithetal.,2010).
dswill
take
better
consideration
of
patient
needs
r greater patient involvement (Monaghan et al.,
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Lifestylehabitswhichincludesinappropriatediet,i
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nadequatephysicalactivity,alcoholandsmoking.
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