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Sambasivam R, Abdin E, AshaRani PV, Roystonn K, Devi F, Wang P, Lee ES, Sum CF, Subramaniam M. Public awareness of war on diabetes campaign and its association with behavioural outcomes. HEALTH EDUCATION RESEARCH 2024; 39:284-295. [PMID: 38394480 DOI: 10.1093/her/cyae009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
The War on Diabetes campaign was launched in 2016, encouraging Singapore residents to engage in regular exercise, adopt healthy dietary habits and screen for early detection of diabetes. This study aims to examine campaign awareness and its associations with sedentary behaviour, dietary habits and identifying diabetes. Data were obtained from the nationwide Knowledge, Attitudes and Practices study on diabetes in Singapore. A total of 2895 participants responded to a single question assessing campaign awareness. The Dietary Approaches to Stop Hypertension (DASH) diet screener assessed dietary habits, and the Global Physical Activity Questionnaire (GPAQ) measured sedentary behaviour. Recognition of diabetes was established using a vignette depicting a person with diabetes mellitus. Logistic and linear regression models were used to measure the associations. Most participants were 18- to 34-years old (29.9%) and females (51.6%). About 57.4% identified the campaign. Campaign awareness exhibited positive associations with identifying diabetes based on the vignette [odds ratio (OR): 1.5; 95% confidence interval (CI): 1.1-2.2; P = 0.022], lower odds of sedentary behaviour ≥7 h/day (OR: 0.7; CI: 0.5-0.9; P = 0.018) and higher DASH scores (β = 1.3; P < 0.001). The study recognized early significant associations between the behavioural outcomes and the campaign, emphasizing the need for ongoing campaign sustainability and evaluation of its long-term impact on population health.
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Affiliation(s)
- Rajeswari Sambasivam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Edimansyah Abdin
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - P V AshaRani
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Kumarasan Roystonn
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Fiona Devi
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Peizhi Wang
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Eng Sing Lee
- National Healthcare Group Polyclinics, 3 Fusionopolis Link , Singapore 138543, Singapore
| | - Chee Fang Sum
- Khoo Teck Puat Hospital, Diabetes Centre, 90 Yishun Central, Singapore 768828, Singapore
| | - Mythily Subramaniam
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Singapore 117549, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798, Singapore
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Andersson J, Rejnö Å, Jakobsson S, Hansson PO, Nielsen SJ, Björck L. Symptoms at stroke onset as described by patients: a qualitative study. BMC Neurol 2024; 24:150. [PMID: 38702612 PMCID: PMC11067237 DOI: 10.1186/s12883-024-03658-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/26/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Stroke is a common and severe disease that requires prompt care. Symptom expressions as one-sided weakness and speech difficulties are common and included in public stroke campaigns. For some patients stroke can present with subtle and less common symptoms, difficult to interpret. The symptom severity assessed by the National Institutes of Health Stroke Scale has decreased, and symptoms at onset may have changed. Therefore, we aimed to investigate how patients describe their symptoms at the onset of a first-time stroke. METHODS The study used a qualitative descriptive design and conventional content analysis. Data were collected through recorded interviews with 27 patients aged 18 years and older hospitalised with a first-time stroke between October 2018 and April 2020. Data were analysed on a manifest level. RESULTS Symptoms at stroke onset were presented in two themes: Altered Reality and Discomfort and Changed Body Functions and described in five categories. Various types of symptoms were found. All symptoms were perceived as sudden, persistent, and never experienced before and this appear as a "red thread" in the result. Regardless of symptom expressions, no specific symptom was described as more severe than another. CONCLUSIONS Stroke symptoms were described with a variety of expressions. Many described complex symptoms not typical of stroke, which can make it difficult to recognise the symptoms as a stroke and delay medical care. Public stroke campaigns should emphasize the importance of seeking medical care at the slightest suspicion of stroke and could be designed to help achieve this.
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Affiliation(s)
- Jenny Andersson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg and Sahlgrenska University Hospital/Östra Hospital, Diagnosvägen 11, Gothenburg, 41650, Sweden
- Region Västra Götaland, Department of Medicine Geriatrics and Emergency Medicine/Östra, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Rejnö
- Stroke unit, Department of Medicine, Skaraborg Hospital, Skövde, Sweden
- Department of Health Sciences, University West, Trollhättan, Sweden
- Skaraborg institute for Research and Development, Skövde, Sweden
| | - Sofie Jakobsson
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Per-Olof Hansson
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg and Sahlgrenska University Hospital/Östra Hospital, Diagnosvägen 11, Gothenburg, 41650, Sweden
- Region Västra Götaland, Department of Medicine Geriatrics and Emergency Medicine/Östra, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanne J Nielsen
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg and Sahlgrenska University Hospital/Östra Hospital, Diagnosvägen 11, Gothenburg, 41650, Sweden
- Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lena Björck
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg and Sahlgrenska University Hospital/Östra Hospital, Diagnosvägen 11, Gothenburg, 41650, Sweden.
- Region Västra Götaland, Department of Medicine Geriatrics and Emergency Medicine/Östra, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Liu Y, Wang D, Chu M, Yang Z, Luo Y, Wang D, Zhao J. Value of the stroke 1-2-0 prehospital stroke education system: the experience of a general practitioner team. BMC Neurol 2023; 23:431. [PMID: 38062426 PMCID: PMC10770900 DOI: 10.1186/s12883-023-03476-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Stroke is one of the leading causes of death worldwide, especially in developing countries. In China, there is an urgent need to educate people about stroke awareness and the importance of using emergency medical services (EMS) quickly after a stroke has occurred. OBJECTIVE We sought to explore the effects of the Stroke 1-2-0 Prehospital Stroke Education System based on the experience of a general practitioner team. METHOD We prospectively enrolled 119 community general practitioners to be trained in the procedures advocated by the Stroke 1-2-0 Prehospital Stroke Education System. The training content included early detection of ischemic stroke, first aid for stroke, and intravenous thrombolysis; The effects of the training were later evaluated via a before-and-after comparison. The 119 enrolled physicians formed a Stroke 1-2-0 lecturer group and taught stroke knowledge to community residents. The group remained active for 6 months, during which the medical treatment data of stroke patients (i.e., stroke onset time, prehospital delay, whether an ambulance was called, and whether thrombolytic therapy was performed) in each of 5 jurisdictions were recorded for the month before (January 2021) and that after (August 2021) the 6-month community education program. Finally, the effects of the community education program were evaluated. RESULTS The participants' understanding of intravenous thrombolysis in the treatment of acute ischemic stroke improved significantly after the training as compared with their earlier understanding (96% vs. 78.99%; P < .001), and their understanding of the time window for intravenous thrombolysis increased from 26.05% before to 72% (P < .001) after the training. Most of the participants (90% vs. 67.23%; P < .001) said that they would immediately call the 120 emergency number of China's emergency phone system if they encountered individuals who appeared to be victims of acute stroke. A total of 82 stroke patients were seen before and 67 after the community education program. As for the use of the emergency call system, more patients with stroke activated that system after the program versus before (21.95% vs. 37.31%; P = .04). The 3-hour arrival rate after the program was nearly three times higher than that before the program (62.69% vs. 19.51%; P < .001). Also, regarding receiving thrombolysis after the occurrence of a stroke, the program triggered a substantial increase compared with the total earlier (19.4% vs. 6.1%; P = .013). CONCLUSION We found that the Stroke 1-2-0 Prehospital Stroke Education System significantly improved community residents' knowledge regarding stroke.
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Affiliation(s)
- Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
| | - Daosheng Wang
- Department of Neurosurgery, Minhang Hospital, Fudan University, Shanghai, China
| | - Min Chu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Zhenzhen Yang
- Department of General Medicine, Xinzhuang Community Health Service Center, Shanghai, China
| | - Yunhe Luo
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Delong Wang
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China.
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Darehed D, Reinholdsson M, Viktorisson A, Abzhandadze T, Sunnerhagen KS. Death and ADL Dependency After Scoring Zero on the NIHSS: A Swedish Retrospective Registry-Based Study. Neurol Clin Pract 2023; 13:e200186. [PMID: 37680684 PMCID: PMC10481316 DOI: 10.1212/cpj.0000000000200186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/17/2023] [Indexed: 09/09/2023]
Abstract
Background and Objectives Of all strokes, mild strokes (defined as 5 points or less on the National Institutes of Health Stroke Scale [NIHSS]) are in the majority. However, up to one-third of patients with mild strokes still exhibit significant deficits 3 months after the stroke. Studies on the presumably mildest strokes, defined by zero points on the NIHSS (0-NIHSS) at admission, are scarce. Hence, we aimed to study patient characteristics and outcomes among patients with 0-NIHSS strokes. Methods Our retrospective registry-based study included a total of 6,491 adult patients with stroke admitted to 3 different stroke units in Gothenburg, Sweden, from November 2014 to June 2019. Our main outcome was a composite measure including death and activities of daily living (ADL) dependency 3 months after the stroke. Analyses of patient characteristics were followed by adjusted analyses including multiple confounders. Results In total, 5,945 patients had data on NIHSS at admission, of whom 1,412 (24%) presented with a 0-NIHSS stroke. Among these, the median age was 72 years, 600 (42%) were female, and 86 (6%) had a hemorrhagic stroke. Among previously ADL-independent patients, 65 (6%) were either dead or ADL-dependent 3 months after the stroke. Prestroke physical inactivity (OR 2.48, 95% CI 1.40-4.38) and age (OR 1.05 per gained year, 95% CI 1.02-1.08) significantly increased the risk of death and ADL dependency. Discussion One of 17 patients has either died or become ADL-dependent 3 months after a 0-NIHSS stroke, stressing that these strokes are not always benign. Older and physically inactive patients are at greater risk of an adverse outcome.
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Affiliation(s)
- David Darehed
- Department of Public Health and Clinical Medicine (DD), Sunderby Research Unit, Umeå University; Rehabilitation Medicine Research Group (DD, MR, AV, TA, KSS), Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, and Sahlgrenska University Hospital; Department of Occupational Therapy and Physiotherapy (MR, TA); and Rehabilitation Medicine (KSS), Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Malin Reinholdsson
- Department of Public Health and Clinical Medicine (DD), Sunderby Research Unit, Umeå University; Rehabilitation Medicine Research Group (DD, MR, AV, TA, KSS), Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, and Sahlgrenska University Hospital; Department of Occupational Therapy and Physiotherapy (MR, TA); and Rehabilitation Medicine (KSS), Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adam Viktorisson
- Department of Public Health and Clinical Medicine (DD), Sunderby Research Unit, Umeå University; Rehabilitation Medicine Research Group (DD, MR, AV, TA, KSS), Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, and Sahlgrenska University Hospital; Department of Occupational Therapy and Physiotherapy (MR, TA); and Rehabilitation Medicine (KSS), Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Tamar Abzhandadze
- Department of Public Health and Clinical Medicine (DD), Sunderby Research Unit, Umeå University; Rehabilitation Medicine Research Group (DD, MR, AV, TA, KSS), Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, and Sahlgrenska University Hospital; Department of Occupational Therapy and Physiotherapy (MR, TA); and Rehabilitation Medicine (KSS), Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Department of Public Health and Clinical Medicine (DD), Sunderby Research Unit, Umeå University; Rehabilitation Medicine Research Group (DD, MR, AV, TA, KSS), Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, University of Gothenburg, and Sahlgrenska University Hospital; Department of Occupational Therapy and Physiotherapy (MR, TA); and Rehabilitation Medicine (KSS), Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
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Ekkert A, Milmantienė D, Jokimaitytė U, Jatužis D. Posterior Circulation Stroke Patients Receive Less Reperfusion Therapy Because of Late Arrival and Relative Contraindications: A Retrospective Study. J Clin Med 2023; 12:5181. [PMID: 37629223 PMCID: PMC10455447 DOI: 10.3390/jcm12165181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Reperfusion treatment (RT) is administered to individuals with posterior circulation strokes (PCS) later and less frequently. We aimed to study the impact of demographic and clinical factors on the decision for RT in PCS. METHODS We conducted a retrospective analysis of the data from 500 subjects admitted to the tertiary stroke centre's emergency department between 2018 and 2020 due to PCS. Demographic and clinical factors were analysed among three groups: the RT group, the group with no RT because of absolute contraindications (ACI), and the group with no RT because of relative contraindications (RCI). RESULTS Of the patients, 202 (40.3%) were female. The median NIHSS was four (4), and the subjects' median age was 69 (18). RT was performed on 120 (24%) subjects. FAST symptoms (OR-5.62, 95% CI [2.90-12.28]) and higher NIHSS (OR-1.13, 95% CI [1.09-1.18]) at presentation, atrial fibrillation (OR-1.56, 95% CI [1.02-2.38]), hypertension (OR-2.19, 95% CI [1.17-4.53]) and diabetes (OR-1.70, 95% CI [1.06-2.71]) increased the chance of RT. Late arrival was the most prevalent ACI for 291 (58.2%) patients. FAST-negative subjects (OR-2.92, 95% CI [1.84-4.77]) and males (OR-1.58, 95% CI [1.11-2.28]) had a higher risk of arriving late. Because of RCI, 50 (10%) subjects did not receive RT; the majority were above 80 and had NIHSS ≤ 5. Subjects with RCI who received the RT had a higher NIHSS (4 vs. 3, p < 0.001), higher hypertension (59 (92.2%) vs. 35 (77.8%), p = 0.032) and heart failure (23 (35.9%) vs. 7 (15.6%), p = 0.018) prevalence. There was a trend for less RT in females with RCI. CONCLUSIONS Late arrival was the most common barrier to RT, and the male gender increased this risk. because of relative contraindications, 10% of subjects were not considered for RT. The presence of FAST symptoms, vascular risk factors, and a higher NIHSS increased the chance of RT.
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Affiliation(s)
- Aleksandra Ekkert
- Faculty of Medicine, Vilnius University, LT-03225 Vilnius, Lithuania; (D.M.); (U.J.); (D.J.)
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Kuang J, Zhu X, Yang L, Gao Z, Wei X, Zhou K, Xu M. Factors influencing alertness to premonitory symptoms in stroke patients with pre-hospital delay. Public Health Nurs 2022; 39:1204-1212. [PMID: 35714655 DOI: 10.1111/phn.13108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 05/01/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The purpose was to explore the alertness of premonitory symptoms in stroke patients with prehospital delay, and to analyze the influencing factors. DESIGN AND SAMPLE A cross-sectional study using the convenience sampling method was conducted in the neurology department of a general hospital between November 2018 and July 2019. A total of 352 stroke patients were participated in the survey. MEASURES A hierarchical multiple regression was performed to analyze the factors related to the alertness of premonitory symptoms (0-9 scores) in stroke patients with prehospital delay. RESULTS The alertness score was 6.53 ± 2.377. The lowest score of 0.55 ± 0.498 was for "Continuous yawning occurs continuously despite no tiredness or lack of sleep is okay, and need not be treated." The hierarchical regression results revealed that symptom onset, symptom change before admission, knowledge, social support were the influencing factors delaying the alertness of premonitory symptoms. Knowledge and support from friends could improve the alertness, while support from family and other support had a notable negative impact. CONCLUSIONS Stroke patients need to be more alert toward premonitory symptoms. This alertness is related to stroke knowledge and social support. Nurses should formulate interventions and advise stroke patients to improve their stroke knowledge and expand their social network.
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Affiliation(s)
- Jinke Kuang
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Xuemei Zhu
- School of Nursing, Harbin Medical University/The 2nd Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Li Yang
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Zihan Gao
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Xiao Wei
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Kexin Zhou
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
| | - Mengfan Xu
- School of Nursing, Qingdao University, Qingdao, Shandong Province, China
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Liu X, Yao S, Ling L, Li Z. Stroke 120 or FAST (Face, Arm, Speech, Time): Which is Better in Stroke Awareness Promotion for Older Residents Living in Shanghai? J Stroke Cerebrovasc Dis 2022; 31:106490. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/07/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022] Open
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Schnitzer S, Kohl R, Fügemann H, Gödde K, Stumm J, Engelmann F, Grittner U, Rieckmann N. Patient Navigation-Who Needs What? Awareness of Patient Navigators and Ranking of Their Tasks in the General Population in Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052846. [PMID: 35270537 PMCID: PMC8910373 DOI: 10.3390/ijerph19052846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 01/25/2023]
Abstract
The aim of the present study was to investigate the awareness of patient navigation (PN) in the general population in Germany and to assess which navigator tasks are considered most important. The analysis drew on a 2019 nationwide telephone survey of 6110 adults. We compared rankings of emotional support, administrative support and information among respondents with and without experience of patient navigation. One-fifth of the sample reported having heard of PNs; 13% of this group already had experience with PN. In both groups, the majority (>47%) considered assistance with applications to be most important. This was particularly the case among younger adults and those with a chronic disease. Within the inexperienced group, higher educated people had higher odds of ranking provision of information as most important for them, whereas women and those without a partner had higher odds of ranking emotional support as the most important task. This study shows that the majority of people predominantly expect PN services to offer administrative support, irrespective of their socioeconomic and health status. Whether these expectations are met by the diverse existing PN programs, which often have a strong focus on other tasks (e.g., increasing health literacy), has yet to be evaluated.
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Affiliation(s)
- Susanne Schnitzer
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117 Berlin, Germany;
- Correspondence:
| | - Raphael Kohl
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Medical Sociology and Rehabilitation Science, Charitéplatz 1, 10117 Berlin, Germany;
| | - Hella Fügemann
- Brandenburg Medical School Theodor Fontane, Institute of Social Medicine and Epidemiology, 14770 Brandenburg an der Havel, Germany;
| | - Kathrin Gödde
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany; (K.G.); (N.R.)
| | - Judith Stumm
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of General Practice and Family Medicine, Charitéplatz 1, 10117 Berlin, Germany;
| | - Fabian Engelmann
- Kassenärztliche Bundesvereinigung (KBV), Geschäftsbereich Sicherstellung und Versorgungsstruktur, Abteilung Versorgungsstruktur, 10592 Berlin, Germany;
| | - Ulrike Grittner
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute for Biometry and Clinical Epidemiology, Charitéplatz 1, 10117 Berlin, Germany;
- Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany
| | - Nina Rieckmann
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Institute of Public Health, Charitéplatz 1, 10117 Berlin, Germany; (K.G.); (N.R.)
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Bull Iversen A, Paaske Johnsen S, Christensen B, Bondo Christensen M, Andersen G. The impact of a Danish stroke campaign: A cross-sectional study. Acta Neurol Scand 2022; 145:102-110. [PMID: 34523120 DOI: 10.1111/ane.13531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/05/2021] [Accepted: 09/06/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To investigate the impact of the Danish stroke campaign, 1 year after initiation. MATERIALS & METHODS The campaign ran in various media during 2019-2020. We performed a two-centre, repeated cross-sectional study in 2018 (before campaign) and again in 2020 based on data from structured interviews of patients and bystanders, medical records and the Danish Stroke Registry. Primary outcomes were patient delay and system delay. Patient delay is defined as the time from symptom onset until the first contact to a healthcare professional, whereas system delay is the time from this contact until arrival at the stroke centre. Secondary outcomes were primary emergency medical services (EMS) contact, arrival at a stroke centre within 3 h of symptom onset, initiation of reperfusion therapy and knowledge of ≥2 core symptoms of stroke. RESULTS We included 852 patients with stroke or transient ischemic attack. Patient delay and system delay were a median of 166 min and 96 min before the campaign and were non-significantly reduced by 16 min (95% CI -128 to 97) and 7 min (95% CI -21 to 6) in the second period. We found no significant differences in the clinical outcomes. The knowledge of ≥2 core symptoms increased from 22% to 30% (OR 1.63; 95% CI 1.15 to 2.30) in patients and from 53% to 65% (OR 1.81; 95% CI 1.24 to 2.64) in bystanders. CONCLUSION Patient delay, system delay and clinical outcomes remained relatively unchanged. However, the knowledge of core symptoms had improved 1 year after campaign initiation.
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Affiliation(s)
- Ane Bull Iversen
- Department of Clinical Medicine—Neurology Aarhus University Aarhus N Denmark
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research Department of Clinical Medicine Aalborg University and Aalborg University Hospital Aalborg Denmark
| | - Bo Christensen
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice Aarhus C Denmark
- Department of Public Health Aarhus University Aarhus C Denmark
| | - Grethe Andersen
- Department of Clinical Medicine—Neurology Aarhus University Aarhus N Denmark
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Mannoh I, Turkson-Ocran RA, Mensah J, Mensah D, Yi SS, Michos ED, Commodore-Mensah Y. Disparities in Awareness of Myocardial Infarction and Stroke Symptoms and Response Among United States- and Foreign-Born Adults in the National Health Interview Survey. J Am Heart Assoc 2021; 10:e020396. [PMID: 34845927 PMCID: PMC9075376 DOI: 10.1161/jaha.121.020396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Atherosclerotic cardiovascular disease, defined as nonfatal myocardial infarction (MI), coronary heart disease death, or fatal or nonfatal stroke, is the leading cause of death in the United States. MI and stroke symptom awareness and response reduce delays in hospitalization and mortality. Methods and Results We analyzed cross‐sectional data from the 2014 and 2017 National Health Interview Surveys on US‐ and foreign‐born adults from 9 regions of birth (Europe, South America, Mexico/Central America/Caribbean, Russia, Africa, Middle East, Indian subcontinent, Asia, and Southeast Asia). The outcomes were recommended MI and stroke knowledge, defined as knowing all 5 symptoms of MI or stroke, respectively, and choosing “call 9‐1‐1” as the best response. We included 63 059 participants, with a mean age 49.4 years; 54.1% were women, and 38.5% had a high school education or less. Recommended MI and stroke knowledge were highest in US‐born people. In both 2014 and 2017, MI knowledge was lowest in individuals born in Asia (23.9%±2.5% and 32.1%±3.3%, respectively), and stroke knowledge lowest for the Indian subcontinent (44.4%±2.4% and 46.0%±3.2%, respectively). Among foreign‐born adults, people from Russia and Europe had the highest prevalence of recommended MI knowledge in 2014 (37.4%±5.4%) and 2017 (43.5%±2.5%), respectively, and recommended stroke knowledge was highest in people from Europe (61.0%±2.6% and 67.2%±2.5%). Improvement in knowledge was not significant in all groups between 2014 and 2017. Conclusions These findings suggest a disparity in MI and stroke symptom awareness and response among immigrants in the United States. Culturally tailored public health education and health literacy initiatives are needed to help reduce these disparities in awareness.
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Affiliation(s)
- Ivy Mannoh
- School of Medicine Johns Hopkins University Baltimore MD
| | | | | | | | - Stella S Yi
- Grossman School of Medicine New York University New York NY
| | - Erin D Michos
- School of Medicine Johns Hopkins University Baltimore MD
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11
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Barra M, Faiz KW, Dahl FA, Næss H. Stroke Mimics on the Stroke Unit - Temporal trends 2008-2017 at a large Norwegian university hospital. Acta Neurol Scand 2021; 144:695-705. [PMID: 34498731 DOI: 10.1111/ane.13527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 08/11/2021] [Accepted: 08/19/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The objective was to quantify temporal trends in stroke mimics (SM) admissions relative to cerebrovascular accidents (CVA), incidence of hospitalized SMs and characterize the SM case-mix at a general hospital's stroke unit (SU). MATERIALS & METHODS All SU admissions (n = 11240) of patients aged 15 or older to Haukeland University Hospital between 2008-2017 were prospectively included and categorized as CVA or SM. Logistic regression was used to estimate time trends in the proportion of SMs among the admissions. Poisson regression was used to estimate time trends in age- and sex-dependent SM incidence. RESULTS SMs were on average younger thaan CVA patients (68.3 vs. 71.4 years) and had a higher proportion of females (53.6% vs. 44.5%). The total proportion of SM admissions was 51.0%. There was an increasing time trend in the proportion of SM admissions, odds ratio 1.150 per year (p < 0.001), but this trend appears flattening, represented by a significant quadratic time-term, odds ratio 1.009 (p < 0.001). A higher SM proportion was also associated with the time period of a Mass Media Intervention (FAST campaign) in 2014. There was also an increasing trend in SM incidence, that remains after adjusting for age, sex, and population; also, for incidence the trend appears to be flattening. CONCLUSIONS SMs account for approximately half of the SU admissions, and the proportion has been increasing. A FAST campaign appears to have temporarily increased the SM proportion. The age- and sex-dependent incidence of SM has been increasing but appears to flatten out.
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Affiliation(s)
- Mathias Barra
- The Health Services Research Unit (HØKH) Akershus University Hospital HF Lørenskog Norway
- Institute for Global Health BCEPSUniversity of Bergen Bergen Norway
| | - Kashif Waqar Faiz
- The Health Services Research Unit (HØKH) Akershus University Hospital HF Lørenskog Norway
- Department of Neurology Akershus University Hospital HF Lørenskog Norway
| | - Fredrik Andreas Dahl
- The Health Services Research Unit (HØKH) Akershus University Hospital HF Lørenskog Norway
| | - Halvor Næss
- Department of Neurology Haukeland University Hospital HF Bergen Norway
- Centre for age‐related medicine Stavanger University Hospital Stavanger Norway
- Institute of clinical medicine University of Bergen Bergen Norway
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12
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Tan J, Ramazanu S, Liaw SY, Chua WL. Effectiveness of Public Education Campaigns for Stroke Symptom Recognition and Response in Non-Elderly Adults: A Systematic Review and Meta-Analysis. J Stroke Cerebrovasc Dis 2021; 31:106207. [PMID: 34844126 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106207] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/01/2021] [Accepted: 10/24/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES The incidence of stroke is on the rise among younger adults. Stroke educational campaigns are often used to raise public knowledge of stroke warning signs and response actions, but their effectiveness in non-elderly adults is unclear. This study investigated the effectiveness of stroke campaigns in improving stroke symptom recognition and intention to call emergency medical services in adults aged < 65 years, and described the characteristics of public stroke education in this demographic group. MATERIALS AND METHODS Seven databases (Cochrane Library, CINAHL, Embase, Medline, PsycINFO, Scopus, and ProQuest Dissertations and Theses) were searched from inception to 24 January 2021. A meta-analysis was conducted to synthesize the effects of stroke education campaigns on stroke symptom recognition and intention to call emergency medical services in adults < 65 years. A narrative synthesis approach was used to explore the types of educational content and campaign best suited to this demographic group. RESULTS Thirteen studies from 2001 to 2019 were included in this review. Out of the thirteen studies, five were included in the meta-analysis to synthesize the effects of stroke education campaigns on symptom recognition and four were included for synthesizing the effects on intention to call emergency medical services. The estimated pooled risk ratio for post-campaign compared with pre-campaign in stroke symptom recognition and intention to call emergency medical services was 1.20 (95% CI: 1.07-1.36, p = 0.002) and 1.19 (95% CI: 1.11-1.28, p < 0.00001), respectively. Usage of acronyms in broadcast and digital media campaigns appears promising in enhancing recognition of and responsiveness to stroke symptoms. CONCLUSIONS Public stroke education campaigns were found to have a significant impact on stroke symptom recognition and intention to call emergency medical services. The evidence generated from this review could be applied to inform future campaigns targeted at younger adults.
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Affiliation(s)
- Jiayi Tan
- Ng Teng Fong General Hospital, 1 Jurong East Street 21, Singapore 609606
| | - Sheena Ramazanu
- Research Fellow, National University of Singapore, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 3, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
| | - Sok Ying Liaw
- Associate Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 3, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
| | - Wei Ling Chua
- Research Fellow, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 3, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
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13
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Melak AD, Wondimsigegn D, Kifle ZD. Knowledge, Prevention Practice and Associated Factors of Stroke Among Hypertensive and Diabetic Patients - A Systematic Review. Risk Manag Healthc Policy 2021; 14:3295-3310. [PMID: 34408515 PMCID: PMC8364969 DOI: 10.2147/rmhp.s324960] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/03/2021] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Because of the inadequate level of public awareness of the disease, the incidence of stroke has been sharply rising. Eventually, due to the prehospital delay, many stroke cases could not be eligible for thrombolysis thereby poor rehabilitative outcome has been tremendously increased. Thus, this study aimed to review the level of knowledge, prevention practice, and associated factors of stroke among hypertensive and diabetic patients. METHODS A systematic review of primarily published articles (2010-2020) related to knowledge and prevention practices of stroke was performed by searching online electronic databases like PubMed, Google Scholar, Refseek, Science direct, ResearchGate, and manual Google search by using the keywords and MeSH terms. Studies conducted on knowledge and prevention practices amongst hypertensive and/or diabetic patients were included. RESULTS Out of 531 searched studies, 42 articles were identified to be reviewed. The reported overall knowledge of stroke was ranging from 4.4% to 79%. Knowledge to the signs/symptoms of stroke was 23.6% to 87%. However, 15% to 77% of subjects were also reported that they did not know any sign of stroke. The range of risk factor knowledge was 10.5% to 86.6%. The reported level of stroke prevention practice was 2.4% to 72% but physical activity and weight reduction practice were relatively low. Inadequate level of knowledge and prevention practice of stroke was related to elderly, female gender, uneducated, unmarried, rural residents, economically low, comorbidity and unemployed individuals. CONCLUSION The current finding revealed that the level of knowledge and prevention practice of stroke was inadequate. Hence, the finding highlights health educational programs should be planned as an important avenue to enhance stroke awareness among the high-risk populations.
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Affiliation(s)
- Abreham Degu Melak
- University of Gondar, College of Medicine and Health Science, School of Pharmacy, Department of Pharmacology, Gondar, Ethiopia
| | - Dawit Wondimsigegn
- University of Gondar, College of Medicine and Health Science, School of Pharmacy, Department of Pharmaceutics and Social Pharmacy, Gondar, Ethiopia
| | - Zemene Demelash Kifle
- University of Gondar, College of Medicine and Health Science, School of Pharmacy, Department of Pharmacology, Gondar, Ethiopia
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Wallace EJC, Liberman AL. Diagnostic Challenges in Outpatient Stroke: Stroke Chameleons and Atypical Stroke Syndromes. Neuropsychiatr Dis Treat 2021; 17:1469-1480. [PMID: 34017173 PMCID: PMC8129915 DOI: 10.2147/ndt.s275750] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/08/2021] [Indexed: 12/14/2022] Open
Abstract
Failure to diagnose transient ischemic attack (TIA) or stroke in a timely fashion is associated with significant patient morbidity and mortality. In the outpatient or clinic setting, we suspect that patients with minor, transient, and atypical manifestations of cerebrovascular disease are most prone to missed or delayed diagnosis. We therefore detail common stroke chameleon symptoms as well as atypical stroke presentations, broadly review new developments in the study of diagnostic error in the outpatient setting, suggest practical clinical strategies for diagnostic error reduction, and emphasize the need for rapid consultation of stroke specialists when appropriate. We also address the role of psychiatric disease and vascular risk factors in the diagnostic evaluation and treatment of suspected stroke/TIA patients. We advocate incorporating diagnostic time-outs into clinical practice to assure that the diagnosis of TIA or stroke is considered in all relevant patient encounters after a detailed history and examination are conducted in the outpatient setting.
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Affiliation(s)
- Emma J C Wallace
- Montefiore Medical Center, Albert Einstein College of Medicine, Department of Neurology, Bronx, NY, USA
| | - Ava L Liberman
- Montefiore Medical Center, Albert Einstein College of Medicine, Department of Neurology, Bronx, NY, USA
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15
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Adequate Knowledge of Stroke Symptoms, Risk Factors, and Necessary Actions in the General Population of Southern Poland. Brain Sci 2020; 10:brainsci10121009. [PMID: 33353075 PMCID: PMC7766324 DOI: 10.3390/brainsci10121009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Stroke is the third most common cause of mortality in developed countries and the primary cause of neurological disability in adults. Recombinant tissue plasminogen activator administered intravenously within 4.5 h from the onset of symptoms constitutes a gold standard in the treatment of acute ischemic stroke. Prompt hospital admission is the prerequisite of effective thrombolysis. Therefore, stroke awareness in the general population is the key factor in timely recognition of the acute stroke victims and determines proper actions. Therefore, the purpose of this study was to determine the awareness of stroke in the general population of the Silesian voivodeship, the most populated region of Poland. We assessed also the "adequate knowledge of stroke", a combined measure of the optimal level of stroke awareness, as a prerequisite for effective stroke management, and aimed to identify most impacting factor for adequate stoke knowledge, to help shaping education strategies. MATERIALS AND METHODS A proprietary anonymous questionnaire consisting of 15 items related to stroke was used in this research. A total of 1134 individuals were surveyed. Additionally to the knowledge of individual aspects of stroke, we assessed "adequate knowledge of stroke", which was combined measure of risk factors, symptoms, and actions in the case of acute stroke. RESULTS The accurate definition of stroke was selected by 834 participants (73.5%). The vast majority of them indicated that a stroke is an emergency (92.8%) and medical assistance is required (97.5%). However, 42.4% of respondents did not know any specific symptom of stroke and only 38.6% participants were able to list two or more risk factors, which resulted in only 36.3% of individuals with adequate knowledge of stroke. Education duration, previous occurrence of stroke in relatives or friends, gender and place of residence were identified as independent predictors of adequate knowledge of stroke. CONCLUSIONS 1. Knowledge of stroke in the population of southern Poland is low and may be considered insufficient to address the needs of timely management in the action chain. 2. Previous occurrence of stroke in the relatives or friends is the most impacting factor for adequate knowledge of stroke.
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Iversen AB, Blauenfeldt RA, Johnsen SP, Sandal BF, Christensen B, Andersen G, Christensen MB. Understanding the seriousness of a stroke is essential for appropriate help-seeking and early arrival at a stroke centre: A cross-sectional study of stroke patients and their bystanders. Eur Stroke J 2020; 5:351-361. [PMID: 33598553 DOI: 10.1177/2396987320945834] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/05/2020] [Indexed: 12/19/2022] Open
Abstract
Introduction Only a minority of patients with acute ischaemic stroke receive reperfusion treatment, primarily due to prehospital delay. We aimed to investigate predictors of a primary contact to the emergency medical services, arrival at stroke centre within 3 h of symptom onset and initiation of reperfusion therapy in patients with acute stroke. Patients and methods We conducted a cross-sectional study of consecutive patients with acute ischaemic stroke, intracerebral haemorrhage or transient ischaemic attack. Structured interviews of patients and bystanders were performed and combined with clinical information from the Danish Stroke Registry. Eligible patients were aged ≥18 years and were independent in activities of daily living before the stroke. Results We included 435 patients. Presence of a bystander at symptom onset and knowledge of ≥2 core symptoms of stroke were associated with a primary emergency medical services contact. Higher stroke severity and patients or bystanders perceiving the situation as very serious were associated with a primary emergency medical services contact (ORpatients 2.10; 95% CI 1.12-3.95 and ORbystanders 22.60; 95% CI 4.98-102.67), <3 h from onset to arrival (ORpatients 3.01; 95% CI 1.46-6.21 and ORbystanders 4.44; 95% CI 1.37-14.39) and initiation of reperfusion therapy (ORpatients 3.08; 95% CI 1.23-7.75 and ORbystanders 4.70; 95% CI 1.14-19.5).Conclusion: Having a bystander, knowledge of ≥2 core symptoms and understanding that stroke is a serious event are associated with appropriate help-seeking behaviour, shorter prehospital delay and higher chance of reperfusion therapy in acute stroke patients.
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Affiliation(s)
- Ane Bull Iversen
- Department of Clinical Medicine - Neurology, Aarhus University, Aarhus N, Denmark.,Research Unit for General Practice, Aarhus C, Denmark.,Department of Public Health, Aarhus University, Aarhus C, Denmark
| | | | - Søren Paaske Johnsen
- Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University and Aalborg University Hospital, Aalborg, Denmark
| | - Birgitte F Sandal
- Department of Neurology, Regional Hospital of West Jutland, Holstebro, Denmark
| | - Bo Christensen
- Research Unit for General Practice, Aarhus C, Denmark.,Department of Public Health, Aarhus University, Aarhus C, Denmark
| | - Grethe Andersen
- Department of Clinical Medicine - Neurology, Aarhus University, Aarhus N, Denmark
| | - Morten Bondo Christensen
- Research Unit for General Practice, Aarhus C, Denmark.,Department of Public Health, Aarhus University, Aarhus C, Denmark
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17
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Hansson P, Andersson Hagiwara M, Herlitz J, Brink P, Wireklint Sundström B. Prehospital assessment of suspected stroke and TIA: An observational study. Acta Neurol Scand 2019; 140:93-99. [PMID: 31009075 DOI: 10.1111/ane.13107] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 04/06/2019] [Accepted: 04/15/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Symptoms related to stroke diverge and may mimic many other conditions. AIMS To evaluate clinical findings among patients with a clinical suspicion of stroke in a prehospital setting and find independent predictors of a final diagnosis of stroke or transient ischemic attack (TIA). METHODS An observational multicenter study includes nine emergency hospitals in western Sweden. All patients transported to hospital by ambulance and in whom a suspicion of stroke was raised by the emergency medical service clinician before hospital admission during a four-month period were included. RESULTS Of 1081 patients, a diagnosis of stroke was confirmed at hospital in 680 patients (63%), while 69 (6%) were diagnosed as TIA and 332 patients (31%) received other final diagnoses. In a multiple logistic regression analysis, factors independently associated with a final diagnosis of stroke or TIA were increasing age, odds ratio (OR) per year: 1.02, P = 0.007, a history of myocardial infarction (OR: 1.77, P = 0.01), facial droop (OR: 2.81, P < 0.0001), arm weakness (OR: 2.61, P < 0.0001), speech disturbance (OR: 1.92, P < 0.0001), and high systolic blood pressure (OR: 1.50, P = 0.02), while low oxygen saturation was significantly associated with other diagnoses (OR: 0.41, P = 0.007). More than half of all patients among patients with both stroke/TIA and other final diagnoses died during the five-year follow-up. CONCLUSIONS Seven factors including the three symptoms included in the Face Arm Speech Test were significantly associated with a final diagnosis of stroke or TIA in a prehospital assessment of patients with a suspected stroke.
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Affiliation(s)
- Per‐Olof Hansson
- Sahlgrenska University Hospital and Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Magnus Andersson Hagiwara
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
| | - Johan Herlitz
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
| | - Peter Brink
- Intensive Care Unit NU‐Hospital Trollhättan Sweden
| | - Birgitta Wireklint Sundström
- Centre for Prehospital Research, Faculty of Caring Science, Work Life and Social Welfare University of Borås Borås Sweden
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18
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Bylow H, Karlsson T, Lepp M, Claesson A, Lindqvist J, Herlitz J. Effectiveness of web-based education in addition to basic life support learning activities: A cluster randomised controlled trial. PLoS One 2019; 14:e0219341. [PMID: 31295275 PMCID: PMC6622500 DOI: 10.1371/journal.pone.0219341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 06/23/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Effective education in basic life support (BLS) may improve the early initiation of high-quality cardiopulmonary resuscitation and automated external defibrillation (CPR-AED). AIM To compare the learning outcome in terms of practical skills and knowledge of BLS after participating in learning activities related to BLS, with and without web-based education in cardiovascular diseases (CVD). METHODS Laymen (n = 2,623) were cluster randomised to either BLS education or to web-based education in CVD before BLS training. The participants were assessed by a questionnaire for theoretical knowledge and then by a simulated scenario for practical skills. The total score for practical skills in BLS six months after training was the primary outcome. The total score for practical skills directly after training, separate variables and self-assessed knowledge, confidence and willingness, directly and six months after training, were the secondary outcomes. RESULTS BLS with web-based education was more effective than BLS without web-based education and obtained a statistically significant higher total score for practical skills at six months (mean 58.8, SD 5.0 vs mean 58.0, SD 5.0; p = 0.03) and directly after training (mean 59.6, SD 4.8 vs mean 58.7, SD 4.9; p = 0.004). CONCLUSION A web-based education in CVD in addition to BLS training enhanced the learning outcome with a statistically significant higher total score for performed practical skills in BLS as compared to BLS training alone. However, in terms of the outcomes, the differences were minor, and the clinical relevance of our findings has a limited practical impact.
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Affiliation(s)
- Helene Bylow
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Thomas Karlsson
- Health Metrics Unit, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Margret Lepp
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Østfold University College, Halden, Norway
- School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Andreas Claesson
- Department of Medicine, Centre for Resuscitation Science, Karolinska Institute, Stockholm, Sweden
| | | | - Johan Herlitz
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre of Registers Västra Götaland, Gothenburg, Sweden
- Prehospen-Centre of Prehospital Research; Faculty of Caring Science, Work Life and Social Welfare; University of Borås, Borås, Sweden
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19
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Nordanstig A, Palaszewski B, Asplund K, Norrving B, Wahlgren N, Wester P, Jood K, Rosengren L. Evaluation of the Swedish National Stroke Campaign: A population-based time-series study. Int J Stroke 2019; 14:862-870. [PMID: 30971191 DOI: 10.1177/1747493019840939] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Time delay from stroke onset to hospital arrival is an important obstacle to recanalization therapy. To increase knowledge about stroke symptoms and potentially reduce delayed hospital arrival, a 27-month national public information campaign was conducted in Sweden. AIM To assess the effects of a national stroke campaign in Sweden. METHODS This nationwide study included 97,840 patients with acute stroke, admitted to hospital and registered in the Swedish Stroke Register from 1 October 2010 to 31 December 2014 (one year before the campaign started to one year after the campaign ended). End points were (1) proportion of patients arriving at hospital within 3 h of stroke onset and (2) the proportion < 80 years of age receiving recanalization therapy. RESULTS During the campaign, both the proportion of patients arriving at hospital within 3 h (p < 0.05) and the proportion receiving recanalization therapy (p < 0.001) increased. These proportions remained stable the year after the campaign, and no significant improvements with respect to the two end points were observed during the year preceding the campaign. In a multivariable logistic regression model comparing the last year of the campaign with the year preceding the campaign, the odds ratio of arriving at hospital within 3 h was 1.05 (95% confidence interval (CI): 1.00-1.09) and that of receiving recanalization was 1.34 (95% CI: 1.24-1.46). CONCLUSION The Swedish National Stroke Campaign was associated with a sustained increase in the proportion of patients receiving recanalization therapy and a small but significant improvement in the proportion arriving at hospital within 3 h.
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Affiliation(s)
- Annika Nordanstig
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Bo Palaszewski
- Department of Data Management and Analysis, Region Västra Götaland, Gothenburg, Sweden
| | - Kjell Asplund
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Bo Norrving
- Department of Clinical Sciences, Section of Neurology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Nils Wahlgren
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Per Wester
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.,Department of Clinical Science, Danderyds Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Jood
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Lars Rosengren
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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20
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Hickey A, Mellon L, Williams D, Shelley E, Conroy RM. Does stroke health promotion increase awareness of appropriate behavioural response? Impact of the face, arm, speech and time (FAST) campaign on population knowledge of stroke risk factors, warning signs and emergency response. Eur Stroke J 2018; 3:117-125. [PMID: 31008344 PMCID: PMC6460411 DOI: 10.1177/2396987317753453] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 12/02/2017] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Inability to identify stroke warning signs accurately is an important cause of delay in seeking medical attention, leading to potential ineligibility for acute intervention. We report on post-campaign findings (wave 2) of national surveys to estimate changes in population knowledge following a media-based Face, Arm, Speech, Time stroke awareness campaign, comparing findings to those of a pre-campaign population survey (wave 1).Participants and methods: One thousand and ten randomly selected adults (18+) completed the Stroke Awareness Questionnaire on knowledge of warning signs, risk factors and response to stroke at wave 2 and findings were compared to wave 1 survey results. Logistic regression was used to examine the association between demographic characteristics and self-reported risk factors with knowledge of stroke and emergency response. RESULTS No significant differences existed in the ability of respondents to define stroke or to identify two or more stroke risk factors between waves 1 and 2 surveys (71% and 70%, respectively). Respondents to the wave 2 survey were five times more likely (odds ratio 4.9, p < .001) than those responding at wave 1 to know at least two warning signs of stroke (67% vs. 31%, respectively), specifically those targeted by the Face, Arm, Speech, Time campaign. While significant improvement in intention to call an ambulance was noted (odds ratio 1.5, p < .001, 57% at wave 2 compared to 47% at wave 1), for almost half of respondents (43%) this would not have been their first response to stroke. Less than 5% of respondents to both surveys identified thrombolysis as an emergency treatment for stroke (3.9% at wave 2 compared to 1.8% at wave 1). DISCUSSION Although significant improvements were made in several areas of stroke knowledge and intended response, awareness of acute stroke interventions was poor and intended behavioural response was suboptimal. CONCLUSION Findings from this study indicate need for targeted campaigns to improve population understanding of the reasons underlying the importance of rapid emergency response to stroke.
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Affiliation(s)
- Anne Hickey
- Department of Psychology, Division of Population Health
Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Lisa Mellon
- Department of Psychology, Division of Population Health
Sciences, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - David Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in
Ireland and Beaumont Hospital, Dublin, Ireland
| | - Emer Shelley
- Department of Epidemiology & Public Health Medicine,
Division of Population Health Sciences, Royal College of Surgeons in
Ireland, Dublin 2, Ireland
| | - Ronan M Conroy
- Department of Epidemiology & Public Health Medicine,
Division of Population Health Sciences, Royal College of Surgeons in
Ireland, Dublin 2, Ireland
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21
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Aked J, Delavaran H, Norrving B, Lindgren A. Temporal Trends of Stroke Epidemiology in Southern Sweden: A Population-Based Study on Stroke Incidence and Early Case-Fatality. Neuroepidemiology 2018; 50:174-182. [PMID: 29621789 DOI: 10.1159/000487948] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 02/25/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Up-to-date epidemiological stroke studies are important for healthcare planning and evaluating prevention strategies. This population-based study investigates temporal trends in stroke incidence and case-fatality in southern Sweden. METHODS First-ever stroke cases in the local catchment area of Skåne University Hospital in Lund, Sweden, between March, 2015 and February, 2016, were included from several sources, including 2 prospective hospital-based registers, retrospective screening of primary care visits, and autopsy registers. Stroke incidence and 28-day case-fatality rates were compared with data from this area obtained through similar methodology between March, 2001 and February, 2002. RESULTS Altogether, 456 and 413 first-ever stroke patients were identified during the earlier and later time periods respectively. The age- and sex-standardized stroke incidence rates decreased from 246 (95% CI 224-270) to 165 (95% CI 149-182) per 100,000 people. However, incidence remained unaltered among those <65 years. Early case-fatality decreased from 14 to 11% (p = 0.165). -Conclusion: First-ever stroke incidence in southern Sweden has decreased with 33% since the beginning of this millenni-um. Incidence rates have decreased among the elderly but remain unchanged among younger age groups. Our findings warrant further studies on trends in risk factor profiles and effects of prevention strategies, and heightened focus on stroke in the young.
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Affiliation(s)
- Joseph Aked
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Hossein Delavaran
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Bo Norrving
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Arne Lindgren
- Department of Clinical Sciences Lund, Neurology, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
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