Perception of stroke in Croatia - knowledge of stroke signs and risk factors amongst neurological outpatients

Knowledge and Response to Stroke Among Lebanese Adults: A Population-Based Survey

Objectives

To date, research on public awareness of stroke warning symptoms, risk factors and practice in the general adult population in Lebanon is scarce. The aim of our study is to identify the level of stroke awareness in order to develop and implement preventive measures particularly in relationship to primary stroke prevention.

Methods

It is a cross-sectional study conducted among 410 adult participants from the five main governorates of Lebanon. Stroke knowledge and practice were assessed using two validated questionnaires namely the Stroke Knowledge Test (SKT) and the Stroke Action Test (STAT). Multivariable linear regression models were conducted to examine socio-demographic, social habits, and clinical factors independently associated with the SKT and the STAT scores.

Results

The mean SKT score of the participants was 9.16. 48.5% showed a poor stroke-related knowledge level and 51.5% a good knowledge level. Living in Mount Lebanon and occasional smokers showed statistically significant lower mean SKT scores; whereas, university degree and suffering from diabetes mellitus were associated with higher mean SKT scores. The mean overall STAT score was 41.3%. For 36.8% of the stroke symptoms, respondents selected call 112. The mean STAT scores of participants who get their information from the internet was statistically significantly lower. However, no association was found between the SKT score and the STAT score.

Conclusion

Knowledge of stroke risk factors was low, as was awareness of the need to call 112 in response to stroke symptoms. Hence, it is essential to develop health education programs in order to decrease stroke morbidity and mortality.

Does socioeconomic position affect knowledge of the risk factors and warning signs of stroke in the WHO European region? A systematic literature review

Background

Strokes are one of the leading causes of death worldwide. People with a lower socioeconomic position (SEP) (i.e. with regards to education, income and occupation) are at a higher risk of having a stroke and have worse clinical outcomes compared to the general population. Good knowledge levels about stroke risk factors and warning signs are key to prolonging life and reducing health issues caused by stroke. This systematic review examined differences in knowledge of stroke risk factors and warning signs with regards to SEP in the WHO European region.

Methods

MEDLINE, Embase, Web of Science, PsycINFO and CINAHL were systematically searched using appropriate Medical Subject Headings (MeSH) terms and free text, combining search terms with Boolean operators. Two independent reviewers selected studies in two stages (title and abstract, and full-text), and screened reference lists of included studies. Only studies in English and based in the WHO European region were included.

Results

Screening identified 2118 records. In the final review, 20 articles were included, with 67,309 study participants between them. Out of 17 studies that looked at stroke risk factors, 11 found increasing knowledge to be associated with higher SEP, four found no difference by SEP, one showed a mixed pattern and one outlier study found increasing knowledge of risk factors to be associated with a lower SEP. Out of 19 studies that looked at stroke warning signs or symptoms, 15 found there to be better knowledge of warning signs with a higher SEP, three found there to be no difference, and the same outlier study found increasing knowledge of warning signs with a lower SEP. Studies that seemed to have a higher quality rating found increasing knowledge of stroke with a higher SEP. A meta-analysis was not possible due to heterogeneity of studies.

Conclusions

In the WHO European region, better knowledge of stroke risk factors and warning signs is associated with a higher SEP. Public health campaigns and educational interventions aiming to increase stroke knowledge should be targeted at people with a lower SEP.

The association between serum ferritin levels and post-stroke depression

BACKGROUND

Post-stroke depression (PSD) is a common neuropsychiatric affective disorder occurring after stroke. Elevated serum ferritin levels have been reported to contribute to depression. Our aim was to determine whether there is a relationship between serum ferritin levels and PSD.

METHODS

196 ischemic stroke patients were consecutively recruited within the first 24h of stroke onset and were followed up for 2 months. Serum ferritin levels were assayed by electrochemiluminescence immunoassay at hospital admission. Clinical depression was diagnosed according to DSM-IV criteria and a HAMD -17 score of ≥ 7. Meanwhile, 100 normal control subjects were also recruited.

RESULTS

We found that 56 stroke patients (28.6%) were diagnosed with PSD at two months. There was a significant intergroup difference in serum ferritin levels within 24h after admission (F=25.044, P<0.001). Serum ferritin levels were significantly higher at admission in PSD patients than in non-PSD patients and normal controls. There was a positive correlation between serum ferritin levels and hs-CRP at admission in PSD patients (r=0.129, P=0.042). In multivariate analyses, serum levels of ferritin ≥ 130.15 µg/L were independently associated with PSD at two months [odds ratio OR=5.388, 95%CI:1.725-16.829; P=0.004] after adjusting for all possible variables.

LIMITATIONS

We excluded patients with severe aphasia and with serious conditions.In addition, the information for dietary intake was not recorded, which may influence body iron stores.

CONCLUSION

Our findings show that elevated serum ferritin levels at admission are associated with PSD and may predict its development at 2 months post-stroke.

Patient awareness and perception of stroke symptoms and the use of 911

BACKGROUND

Response to stroke symptoms and the use of 911 can vary by race/ethnicity. The quickness with which a patient responds to such symptoms has implications for the outcome and treatment. We sought to examine a sample of patients receiving a Remote Evaluation of Acute isCHemic stroke (REACH) telestroke consult in South Carolina regarding their awareness and perception of stroke symptoms related to the use of 911 and to assess possible racial/ethnic disparities.

METHODS

As of September 2013, 2325 REACH telestroke consults were conducted in 13 centers throughout South Carolina. Telephone surveys assessing use of 911 were administered from March 2012-January 2013 among 197 patients receiving REACH consults. Univariate and multivariate logistic regression was performed to assess factors associated with use of 911.

RESULTS

Most participants (73%) were Caucasian (27% were African-American) and male (54%). The mean age was 66 ± 14.3 years. Factors associated with use of 911 included National Institutes of Health Stroke Scale scores >4 (odds ratio [OR], 5.4; 95% confidence interval [CI], 2.63-11.25), unknown insurance which includes self-pay or not charged (OR, 2.90; 95% CI, 1.15-7.28), and perception of stroke-like symptoms as an emergency (OR, 4.58; 95% CI, 1.65-12.67). African-Americans were significantly more likely than Caucasians to call 911 (62% vs. 43%, P = .02).

CONCLUSIONS

African-Americans used 911 at a significantly higher rate. Use of 911 may be related to access to transportation, lack of insurance, or proximity to the hospital although this information was not available. Interventions are needed to improve patient arrival times to telemedicine equipped emergency departments after stroke.

Health education in patients with a recent stroke or transient ischaemic attack: a comprehensive review

Health education aims at the acquisition of skills and attitudes to modify behaviour that influences health, leads to a modification of risk factors and ultimately to a decrease in disability and case fatality from stroke. Health education is an underdeveloped but important aspect of stroke care. Health education could promote compliance and healthy behaviour, improve patients' understanding of their health status and treatment options and facilitate communication. We reviewed the effect of health education in stroke and transient ischaemic attack patients, aiming at feasibility, effectiveness at the level of knowledge, attitude and skills, health behaviour changes and stroke outcome. We also describe the current status of health education for patients with recent coronary artery disease and public health education in stroke. Basic knowledge of stroke and transient ischaemic attack patients of their disease and associated risk factors is not sufficient. This is also observed in patients with coronary artery disease and in the general population. A beneficial effect of health education in stroke and transient ischaemic attack patients on health behaviour, risk reduction or stroke outcome has not been proven. Trials in patients with coronary artery disease, however, have shown that health education could result in a change of lifestyle. No specific method is superior, although the individualised, repetitive and active methods appear more successful. More intervention studies of health education in stroke and transient ischaemic attack patients are needed. Future trials should be large, have a long follow-up, should use an intensive and repetitive approach and involve patients' relatives to induce and maintain a healthy lifestyle.

Life Events and Risk of Subarachnoid Hemorrhage

Background and Purpose— Because little evidence exists and the topic often raises concerns, we aimed to determine the relationship between life events and subarachnoid hemorrhage (SAH) in a population-based case–control setting.

Methods— In 388 SAH incident cases and 473 frequency-matched community SAH-free control subjects, information on the occurrence of 12 types of adverse life events in the preceding 1 and 2 to 12 months was obtained by interview using a questionnaire based on the Social Behavior Assessment Schedule. Analyses involved logistic regression models with adjustment for confounding variables.

Results— Among 12 life events, only 2 (“financial/legal problems” and “other”) in the past month were marginally associated with SAH ( P =0.04 and 0.03, respectively), whereas “physical attack/assault” and “injury/disease of a relative/friend/pet” during the past 2 to 12 months also showed similarly marginally significant and imprecise associations (inversely) with SAH. There were no clear associations between multiple life events and SAH for both the prior month and 2 to 12 months (both P >0.4).

Conclusions— Life events are unlikely to have appreciable effects on the risk of SAH.