Editorial
Stroke Association
Transient ischaemic attack: more than a stroke of bad luck
For the Not just a funny turn survey see http://www.stroke. org.uk/sites/default/files/files/ SA-The_real_impact_of_TIAReport-SP-v5.pdf For study findings on stroke awareness see Emerg Med J 2013; 30: 467–71 For the EXPRESS study see Articles Lancet 2007; 370: 1432–42 For further analysis of the EXPRESS study see Articles Lancet Neurol 2009; 8: 235–43
Transient ischaemic attack (TIA), in which clots temporarily disrupt blood supply to the brain, affects 46 000 people for the first time in the UK every year. Patients often dismiss the symptoms of TIA as a funny turn, caused by another disorder or old age. However, up to 10% of people with a TIA go on to have a stroke in the next 7 days. Although national campaigns in the UK have increased awareness of stroke symptoms, public knowledge of TIA symptoms and the importance of seeking immediate medical help remain low. In a survey by the Stroke Association (a UK charity) of 670 people with a previous TIA, 37% of respondents dismissed their symptoms or delayed seeking medical help; 44% had never heard of a TIA before. Some respondents had known about stroke, but did not seek help because their symptoms did not match those described in awareness campaigns of facial and arm weakness or slurred speech. Other study findings have shown that awareness of stroke symptoms is low in elderly people and those from black or minority ethnic backgrounds—precisely the groups at increased risk of TIA and stroke.
Although the survey was small and nonrepresentative, its findings suggest worrying gaps in care and follow-up for TIA. More than half of respondents said that they weren’t told about the increased risk of stroke after a TIA, and roughly 50% received no advice about changes in lifestyle factors to reduce stroke risk. Stroke has particularly devastating neurological consequences that can rob patients of mobility and motor tasks, as well as speech, sight, memory, and cognition. Beyond awareness campaigns, general practitioners, paramedics, emergency physicians, and stroke specialists must not only work together to establish which patients with stroke symptoms need immediate treatment, but also provide proper support to patients with TIA. Findings from the EXPRESS study, published in The Lancet, suggested that urgent assessment and treatment for TIA reduced risk of subsequent stroke by 80%, and if extended to every patient with TIA could prevent 10 000 strokes annually in the UK. Any stroke is a terrible event, but a preventable stroke is a tragedy. n The Lancet
NASA/Corbis
Human rights violations in Sri Lanka
See World Report page 1623
For more on health and development in Sri Lanka see http://www.undp.org/content/ dam/srilanka/docs/ localpublications/Sri%20 Lanka%20Human%20 Development%20Report%20 2012.pdf
1610
5 years after the end of the 26 year long civil war, Sri Lanka has yet to secure its future stability. A World Report in this week’s issue describes torture, rape, detentions, and summary executions perpetrated by the Sri Lankan Government against people suspected of involvement in the defeated Liberation Tigers of Tamil Eelam (LTTE) and government critics. Evidence suggests a state-sanctioned campaign rather than isolated incidents and, because of a culture of impunity for the perpetrators (mainly Sri Lankan army, security forces, police officers) and fear of reporting by victims, the true scale of abuse is unknown. The government and the LTTE also stand accused of committing war crimes in the escalation of violence at the end of the war, which is estimated to have claimed the lives of 40 000 people, mainly civilians. Allegations against the government include large-scale shelling of humanitarian operations and hospitals, and those against the LTTE include point-blank shooting of civilians trying to flee the conflict zone. In March, the UN Human Rights Council voted in favour of an inquiry
into suspected war crimes because the government had failed to investigate them properly. However, Sri Lanka has refused to cooperate with such an inquiry. This deplorable situation stands in stark contrast to positive achievements in health and development. Despite the war, Sri Lanka has the highest Human Development Index rank in South Asia, and the country is on track to meet most Millennium Development Goals. Challenges remain, however, including persistent health disparities between different regions and ethnic groups for indicators such as maternal mortality and infant nutrition. Health infrastructure in the northern and eastern provinces most affected by the conflict is also in need of urgent restoration. Inequalities and injustices in Sri Lanka present a threat to its future. The international community should maintain pressure on the country to rectify its appalling human rights record. Reconciliation, lasting peace, and a healthy future for all its citizens will be impossible if past and present abuses are not addressed. n The Lancet www.thelancet.com Vol 383 May 10, 2014
Stroke Association
Transient ischaemic attack: more than a stroke of bad luck
For the Not just a funny turn survey see http://www.stroke. org.uk/sites/default/files/files/ SA-The_real_impact_of_TIAReport-SP-v5.pdf For study findings on stroke awareness see Emerg Med J 2013; 30: 467–71 For the EXPRESS study see Articles Lancet 2007; 370: 1432–42 For further analysis of the EXPRESS study see Articles Lancet Neurol 2009; 8: 235–43
Transient ischaemic attack (TIA), in which clots temporarily disrupt blood supply to the brain, affects 46 000 people for the first time in the UK every year. Patients often dismiss the symptoms of TIA as a funny turn, caused by another disorder or old age. However, up to 10% of people with a TIA go on to have a stroke in the next 7 days. Although national campaigns in the UK have increased awareness of stroke symptoms, public knowledge of TIA symptoms and the importance of seeking immediate medical help remain low. In a survey by the Stroke Association (a UK charity) of 670 people with a previous TIA, 37% of respondents dismissed their symptoms or delayed seeking medical help; 44% had never heard of a TIA before. Some respondents had known about stroke, but did not seek help because their symptoms did not match those described in awareness campaigns of facial and arm weakness or slurred speech. Other study findings have shown that awareness of stroke symptoms is low in elderly people and those from black or minority ethnic backgrounds—precisely the groups at increased risk of TIA and stroke.
Although the survey was small and nonrepresentative, its findings suggest worrying gaps in care and follow-up for TIA. More than half of respondents said that they weren’t told about the increased risk of stroke after a TIA, and roughly 50% received no advice about changes in lifestyle factors to reduce stroke risk. Stroke has particularly devastating neurological consequences that can rob patients of mobility and motor tasks, as well as speech, sight, memory, and cognition. Beyond awareness campaigns, general practitioners, paramedics, emergency physicians, and stroke specialists must not only work together to establish which patients with stroke symptoms need immediate treatment, but also provide proper support to patients with TIA. Findings from the EXPRESS study, published in The Lancet, suggested that urgent assessment and treatment for TIA reduced risk of subsequent stroke by 80%, and if extended to every patient with TIA could prevent 10 000 strokes annually in the UK. Any stroke is a terrible event, but a preventable stroke is a tragedy. n The Lancet
NASA/Corbis
Human rights violations in Sri Lanka
See World Report page 1623
For more on health and development in Sri Lanka see http://www.undp.org/content/ dam/srilanka/docs/ localpublications/Sri%20 Lanka%20Human%20 Development%20Report%20 2012.pdf
1610
5 years after the end of the 26 year long civil war, Sri Lanka has yet to secure its future stability. A World Report in this week’s issue describes torture, rape, detentions, and summary executions perpetrated by the Sri Lankan Government against people suspected of involvement in the defeated Liberation Tigers of Tamil Eelam (LTTE) and government critics. Evidence suggests a state-sanctioned campaign rather than isolated incidents and, because of a culture of impunity for the perpetrators (mainly Sri Lankan army, security forces, police officers) and fear of reporting by victims, the true scale of abuse is unknown. The government and the LTTE also stand accused of committing war crimes in the escalation of violence at the end of the war, which is estimated to have claimed the lives of 40 000 people, mainly civilians. Allegations against the government include large-scale shelling of humanitarian operations and hospitals, and those against the LTTE include point-blank shooting of civilians trying to flee the conflict zone. In March, the UN Human Rights Council voted in favour of an inquiry
into suspected war crimes because the government had failed to investigate them properly. However, Sri Lanka has refused to cooperate with such an inquiry. This deplorable situation stands in stark contrast to positive achievements in health and development. Despite the war, Sri Lanka has the highest Human Development Index rank in South Asia, and the country is on track to meet most Millennium Development Goals. Challenges remain, however, including persistent health disparities between different regions and ethnic groups for indicators such as maternal mortality and infant nutrition. Health infrastructure in the northern and eastern provinces most affected by the conflict is also in need of urgent restoration. Inequalities and injustices in Sri Lanka present a threat to its future. The international community should maintain pressure on the country to rectify its appalling human rights record. Reconciliation, lasting peace, and a healthy future for all its citizens will be impossible if past and present abuses are not addressed. n The Lancet www.thelancet.com Vol 383 May 10, 2014
