Negotiation
After some time (usually around three months, depending on the individual), differences between the old and new culture become apparent and may create anxiety. Excitement may eventually give way to unpleasant feelings of frustration and anger as one continues to experience unfavorable events that may be perceived as strange and offensive to ones cultural attitude. Language barriers, stark differences in public hygiene, traffic safety, food accessibility and quality may heighten the sense of disconnection from the surroundings.While being transferred into a different environment puts special pressure on communication skills, there are practical difficulties to overcome, such as circadian rhythm disruption that often leads to insomnia and daylight drowsiness; adaptation of gut flora to different bacteria levels and concentrations in food and water; difficulty in seeking treatment for illness, as medicines may have different names from the native countrys and the same active ingredients might be hard to recognize. Still, the most important change in the period is communication: People adjusting to a new culture often feel lonely and homesick because they are not yet used to the new environment and meet people with whom they are not familiar every day. The language barrier may become a major obstacle in creating new relationships: special attention must be paid to ones and others culture-specific body language signs, linguistic faux pas, conversation tone, linguistic nuances and customs, and false friends. In the case of students studying abroad, some develop additional symptoms of loneliness that ultimately affect their lifestyles as a whole.
Low doses of aspirin (for example 75–150 mg) are as effective as high doses but have fewer side effects; the lowest effective dose remains unknown. Thienopyridines (clopidogrel, ticlopidine) might be slightly more effective than aspirin and have a decreased risk of gastrointestinal bleeding, but are more expensive. Both aspirin and clopidogrel may be useful in the first few weeks after a minor stroke or high risk TIA. Clopidogrel has less side effects than ticlopidine. Dipyridamole can be added to aspirin therapy to provide a small additional benefit, even though headache is a common side effect. Low-dose aspirin is also effective for stroke prevention after having a myocardial infarction.Those with atrial fibrillation have a 5% a year risk of stroke, and this risk is higher in those with valvular atrial fibrillation. Depending on the stroke risk, anticoagulation with medications such as warfarin or aspirin is useful for prevention. Except in people with atrial fibrillation, oral anticoagulants are not advised for stroke prevention—any benefit is offset by bleeding risk.In primary prevention, however, antiplatelet drugs did not reduce the risk of ischemic stroke but increased the risk of major bleeding. Further studies are needed to investigate a possible protective effect of aspirin against ischemic stroke in women. Surgery
Carotid endarterectomy or carotid angioplasty can be used to remove atherosclerotic narrowing of the carotid artery. There is evidence supporting this procedure in selected cases. Endarterectomy for a significant stenosis has been shown to be useful in preventing further strokes in those who have already had one.