Knowledge of signs and symptoms of heart attack and stroke among Singapore residents

Prehospital stroke care in Singapore

ABSTRACT

Due to the narrow window of opportunity for stroke therapeutics to be employed, effectiveness of stroke care systems is predicated on the efficiency of prehospital stroke systems. A robust prehospital stroke system of care that provides a rapid and well-coordinated response maximises favourable poststroke outcomes, but achieving this presents a unique set of challenges dependent on demographic and geographical circumstances. Set in the context of a highly urbanised first-world nation with a rising burden of stroke, Singapore's prehospital stroke system has evolved to reflect the environment in which it operates. This review aims to characterise the current state of prehospital stroke care in Singapore, covering prehospital aspects of the stroke survival chain from symptom onset till arrival at the emergency department. We identify areas for improvement and innovation, as well as provide insights into the possible future of prehospital stroke care in Singapore.

Age and healthy lifestyle behavior's disparities and similarities on knowledge of myocardial infarction symptoms and risk factors among public and outpatients in a resource-limited setting, cross-sectional study in greater Gaborone, Botswana

OBJECTIVES

In this cross-sectional study from Botswana, we investigated knowledge of myocardial infarction (MI) symptoms and risk factors among the general public and outpatients with MI risk factors based on age and lifestyle behaviors, in addition to assessing associations with sociodemographic and MI risk factors.

METHOD

Open-ended questionnaires about 8 MI symptoms and 10 risk factors, were administered by research assistants to a representative selection of outpatients (n = 525) and the public (n = 2248). Weight and height were measured in all participants and BMI was calculated. Knowledge scores were compared between the two groups. We examined whether sociodemographic and MI risk factors had impact on the scores. Analyses were further adjusted for lifestyle behavior (smoking status, dietary status and physical activities).

RESULTS

The valid response rate was 97.9% comprising 97.8% for the public (n = 2199) and 98.1% for outpatients (n = 515). Public respondents (35.2 ± 12.3 years) were younger than outpatients (38.5 ± 12.6 years). The public comprised 56.9% females while outpatients 54.6%. In general, outpatients had higher knowledge of MI symptoms than the public, with mean scores ± SD of 3.49 ± 2.84 vs 2.80 ± 2.54. Outpatients also had higher knowledge score of MI risk factors than the public, with mean scores, 5.33 ± 3.22 vs 3.82 ± 3.07. For MI symptoms, outpatients were more aware than the public for chest pains among all ages, for arm pain/ numbness, neck/ jaw pain radiating to/ from chest, and feeling sick or looking pallor on the skin among those aged 35-49 years. Among both the public and outpatients, lower knowledge of both MI symptoms and risk factors was associated with primary education, not residing/working together, history of hypertension, no history of heart disease/stroke, and obesity. There were similarities and disparities on MI knowledge among respondents with various numbers of healthy lifestyle behaviours.

CONCLUSION

Results call for urgent educational campaigns on awareness and knowledge of MI and using strategies based on age and lifestyle behavior.

Assessing the Awareness on Symptoms and Risk Factors of Stroke amongst Rural Community in Central Region of Malaysia: A Cross-Sectional Survey

Background

As the third leading cause of mortality in Malaysia, stroke is recognised as a medical emergency which requires urgent medical attention within a limited timeframe to prevent exacerbation of the brain damage and death in patients. Recent report revealed a high prevalence of pre-hospital delay amongst the stroke patients due to the lack of awareness on symptoms and risk factors of stroke, as well as poor understanding on appropriate action towards stroke. A number of studies had assessed stroke awareness amongst urban population residing in central region of Malaysia but yet amongst rural population.

Methods

A cross-sectional survey was conducted amongst individuals residing in rural districts of Selangor by using a set of questionnaires assessing the sociodemographic characteristics, as well as the awareness and action towards stroke symptoms and risk factors.

Results

All 343 respondents were able to recognise at least one modifiable risk factor for stroke. Meanwhile, only 36.44% were able to identify all the stroke symptoms. Despite majority of them were familiar with the stroke term, less than half of the respondents were aware of calling the emergency medical service as the appropriate action towards stroke symptoms.

Conclusion

The present study indicated a poor level of awareness and action towards stroke symptoms and risk factors amongst rural population residing in Selangor.

Knowledge of cardiovascular disease risk factors among caregivers of cardiology patients attending Jordan University Hospital

Cardiovascular disease (CVD) is an umbrella term that includes various pathologies involving the heart and the vasculature system of the body. CVD is the leading cause of death worldwide, accounting for an estimated 32% of all deaths. More than 40% of annual deaths in Jordan are due to CVD; this number is further expected to rise, particularly in the Eastern Mediterranean region where Jordan is located. Due to the chronic nature of CVD, the presence of a caregiver who can help mitigate the challenges patients face is essential, and their level of knowledge determines the quality of care they can provide. Hence, this cross-sectional study was conducted in the cardiology clinics at Jordan University Hospital (JUH). Questionnaires were distributed to 469 participants, defined in this study as the caregivers escorting patients with established coronary heart disease (CHD). The self-administered questionnaire included three sections: sociodemographic and health factors, knowledge of CVD risk factors, and CHD symptoms. The mean age of the study population was 44.38 years ± 15.92 and 54.2% of participants were males. Regarding knowledge of CVD risk factors, 84.6% of participants answered more than 70% of the questions correctly. More than 95% knew that chest pain is a symptom of an acute cardiovascular event. However, only 53.5% and 74.8% of the participants reported that jaw pain and arm pain are symptoms of an acute event, respectively. Several factors influenced the caregiver's knowledge, such as age, income, frequent health checkups, having a history of CVD, CKD, or DM, and their relationship to the patient. This study sheds light on the importance of caregiver knowledge in patient care. By improving the caregivers' knowledge, identifying their role in patient care, and raising CVD awareness in susceptible populations, healthcare professionals can improve the patients' quality of life. Overall, assessing caregivers' knowledge pertaining to CVD can provide invaluable data, which may enhance patient care by educating their caregivers.

Identifying and Solving Gaps in Pre- and In-Hospital Acute Myocardial Infarction Care in Asia-Pacific Countries

Acute myocardial infarction (AMI) is a major cause of morbidity and mortality in the Asia-Pacific region, and mortality rates differ between countries in the region. Systems of care have been shown to play a major role in determining AMI outcomes, and this review aims to highlight pre-hospital and in-hospital system deficiencies and suggest possible improvements to enhance quality of care, focusing on Korea, Japan, Singapore and Malaysia as representative countries. Time to first medical contact can be shortened by improving patient awareness of AMI symptoms and the need to activate emergency medical services (EMS), as well as by developing robust, well-coordinated and centralized EMS systems. Additionally, performing and transmitting pre-hospital electrocardiograms, algorithmically identifying patients with high risk AMI and developing hospital networks that appropriately divert such patients to percutaneous coronary intervention-capable hospitals have been shown to be beneficial. Within the hospital environment, developing and following clinical practice guidelines ensures that treatment plans can be standardised, whilst integrated care pathways can aid in coordinating care within the healthcare institution and can guide care even after discharge. Prescription of guideline directed medical therapy for secondary prevention and patient compliance to medications can be further optimised. Finally, the authors advocate for the establishment of more regional, national and international AMI registries for the formal collection of data to facilitate audit and clinical improvement.

Engaging social activities prevent stroke and myocardial infraction by raising awareness of warning symptoms: A cross-sectional survey study

Background

Stroke and myocardial infarction (MI) are medical emergencies, and early treatment within the golden hour is crucial for good prognosis. Adequate knowledge about the warning symptoms can shorten the onset-to-door time. Various factors affect the level of awareness, including social activity. This study aimed to determine if engaging in social activity is associated with the awareness of the warning symptoms of stroke and MI.

Methods

This cross-sectional study analyzed 451,793 participants from the 2017 and 2019 Korea Community Health Survey. Based on five questions for each of stroke and MI symptoms, participants were divided into an awareness group (replied "Yes" to all five questions) and unawareness group. Engagement in social activities (i.e., religious, friendship, leisure, and volunteer activity) was evaluated through a questionnaire. Multiple logistic regression analysis was performed to evaluate the relation between social activity and awareness of warning symptoms.

Results

Overall, 52.6% participants were aware of the warning symptoms of stroke, and 45.8% of MI. Regular engagement in at least one social activity, particularly friendship or volunteer activity, was associated with better awareness of the warning symptoms, both stroke (OR: 1.21, 95% CI: 1.20-1.23) and MI (OR: 1.22, 95% CI: 1.20-1.24). Additionally, more diverse types of social activities were associated with higher levels of awareness. Relationship between social activity and awareness showed positive association with participants older than 60 years, rural residents, or with low socioeconomic status.

Conclusion

Engagement in social activity was significantly associated with better knowledge about the warning symptoms of stroke and MI. For early hospital treatment after symptom onset, participation in social activities could be beneficial.

Latent class cluster analysis of knowledge on acute myocardial infarction in community residents: a cross-sectional study in Tianjin, China

OBJECTIVE

Public knowledge of early onset symptoms and risk factors (RF) of acute myocardial infarction (AMI) is very important for prevention, recurrence and guide medical seeking behaviours. This study aimed to identify clusters of knowledge on symptoms and RFs of AMI, compare characteristics and the awareness of the need for prompt treatment.

DESIGN

Multistage stratified sampling was used in this cross-sectional study. Latent GOLD Statistical Package was used to identify and classify the respondent subtypes of the knowledge on AMI symptoms or modifiable RFs. Multivariable logistic regression was performed to identify factors that predicted high knowledge membership.

PARTICIPANTS

A structured questionnaire was used to interview 4200 community residents aged over 35 in China. 4122 valid questionnaires were recovered.

RESULTS

For AMI symptoms and RFs, the knowledge levels were classified into two or three distinct clusters, respectively. 62.7% (Symptom High Knowledge Cluster) and 39.5% (RF High Knowledge Cluster) of the respondents were able to identify most of the symptoms and modifiable RFs. Respondents who were highly educated, had higher monthly household income, were insured, had regular physical examinations, had a disease history of AMI RFs, had AMI history in immediate family member or acquaintance or had received public education on AMI were observed to have higher probability of knowledge on symptoms and RFs. There was significant difference in awareness of the prompt treatment in case of AMI occurs among different clusters. 'Calling an ambulance' was the most popular option in response of seeing others presenting symptoms of AMI.

CONCLUSIONS

A moderate or relatively low knowledge on AMI symptoms and modifiable RFs was observed in our study. Identification of Knowledge Clusters could be a way to detect specific targeted groups with low knowledge of AMI, which may facilitate health education, further reduce the prehospital delay in China and improve patient outcomes.

Knowledge of Symptoms of Acute Myocardial Infarction, Reaction to the Symptoms, and Ability to Perform Cardiopulmonary Resuscitation: Results From a Cross-sectional Survey in Four Regions in Germany

Background

Ischemic heart disease affects 126 million individuals globally which illustrates the importance of finding ways to decrease mortality and morbidity in case of an acute myocardial infarction (AMI). Since knowledge of symptoms, correct reaction to symptoms, and ability to perform cardiopulmonary resuscitation (CPR) decreases the time from symptoms-onset to reperfusion, which leads to lower AMI mortality, we aimed to examine those factors and identify predicting variables in regions with low and high AMI mortality rates.

Methods

We conducted a cross-sectional online survey including 633 respondents from the general population in four federal states in Germany with low and high AMI mortality and morbidity rates. We used uni- and multivariable regressions to find health-related and sociodemographic factors associated with knowledge, reaction to symptoms, and skills in CPR.

Results

Out of 11 symptoms, the mean of correctly attributed AMI symptoms was 7.3 (standard deviation 1.96). About 93% of respondents chose to call an ambulance when witnessing an AMI. However, when confronted with the description of a real-life situation, only 35 and 65% of the participants would call an ambulance in case of abdominal and chest pain, respectively. The predicting variables for higher knowledge were being female, knowing someone with heart disease, and being an ex-smoker compared to people who never smoked. Higher knowledge was associated with adequate reaction in the description of a real-life situation and ability to perform CPR. Prevalence ratio for being able to perform CPR was lower in females, older participants, and participants with low educational level. About 38% of participants state to know how to perform CPR. Our results indicate rather no difference regarding knowledge, reaction to AMI symptoms, and ability to perform CPR among different regions in Germany.

Conclusions

Knowledge of symptoms and first responder reaction including skills in CPR is inadequate when confronted with the description of a real-life situation. Educational health campaigns should focus on conveying information close to real-life situations. Interventions for enhancing ability to perform CPR should be compulsory in regular intervals. Interestingly, we found no difference regarding the factors in regions with high and low AMI mortality rates in Germany.

Implementation of a Heart Disease Risk Prediction Model Using Machine Learning

Cardiovascular disease prediction aids practitioners in making more accurate health decisions for their patients. Early detection can aid people in making lifestyle changes and, if necessary, ensuring effective medical care. Machine learning (ML) is a plausible option for reducing and understanding heart symptoms of disease. The chi-square statistical test is performed to select specific attributes from the Cleveland heart disease (HD) dataset. Support vector machine (SVM), Gaussian Naive Bayes, logistic regression, LightGBM, XGBoost, and random forest algorithm have been employed for developing heart disease risk prediction model and obtained the accuracy as 80.32%, 78.68%, 80.32%, 77.04%, 73.77%, and 88.5%, respectively. The data visualization has been generated to illustrate the relationship between the features. According to the findings of the experiments, the random forest algorithm achieves 88.5% accuracy during validation for 303 data instances with 13 selected features of the Cleveland HD dataset.

Exploring the degree of nicotine dependence and willingness to quit smoking in Chinese smoking patients with stroke: A cross-sectional survey

Smoking is closely related to the occurrence of stroke. The degree of nicotine dependence and willingness to quit smoking are key factors that determine whether a smoker can successfully quit smoking. Few studies have been conducted on factors affecting the willingness to quit smoking among smokers who suffered from stroke.Although the smoking rate has declined, it is still the main changeable risk factor for cerebrovascular diseases. We aimed to investigate the current status of nicotine dependence and willingness to quit smoking among patients who suffered from stroke. We also clarified factors that affect the willingness to quit smoking among stroke patients and provide evidence for quitting smoking.Convenience sampling methods were used to conduct cross-sectional studies. A questionnaire survey was administered to 215 stroke patients who smoked. A general information questionnaire as well as patient smoking and cessation status questionnaire were used. Nicotine dependence test scale, smoking attitude factor score, and tobacco harm perception scale were applied for investigation. Logistic regression was used to analyze factors related to patients' willingness to quit smoking.Statistically significant differences in willingness to quit smoking were found among stroke patients with different ages, household registration status, education levels, marital status, occupation, smoking attitude, and nicotine dependence (P < .05). About 34.4%, 39.1%, and 26.5% of smoking patients had low, moderate, and severe nicotine dependence, respectively. Logistic analysis showed that compared with other occupations, workers, retirees, farmers, and freelancers compared with other people (0.050, 0.081, 0.053, 0.048) had a negative impact on the willingness to quit smoking among stroke patients. Compared with positive attitudes, negative and neutral smoking attitudes (0.190, 0.048) had a negative impact on the willingness to quit smoking among stroke patients. Compared with high nicotine dependence, low and moderate nicotine dependence (4.628, 2.596) had a positive impact on willingness to quit smoking.Smoking patients in neurology department are more willing to quit smoking (67.9%). Factors such as occupation, smoking attitude, and nicotine dependence should be considered when establishing smoking cessation interventions for stroke smokers.

A Community-Based, Cross-Sectional Study Assessing the Level of Awareness and Insight Related to Cardiovascular Diseases

Objective

The disease outcome had been shown to improve with improving patient knowledge. The study had two objectives, firstly to assess the level of knowledge about cardiovascular diseases (CVDs) in the general population, and secondly, to provide written educational material regarding the risk factors, major symptoms, and the prevention of CVDs.

Method

The target population was the residents living in the Western region of Saudi Arabia, aged 18 years and above. All were invited to participate voluntarily. A pre-structured questionnaire was designed to collect data related to age, gender, marital status, education level, occupation, lifestyle habits, and a history of heart diseases, as well as cardiac symptoms, and risk factors. The educational material was provided after the questionnaire.

Results

The majority of the participants were female (74.8%). The risk factors most frequently identified were lack of exercise, stress, and obesity. Chest pain was recognized as a major symptom (87.6%). Other symptoms included dyspnea, syncope, and excessive sweating. The level of knowledge regarding the risk factors for cardiovascular disease was poor. Only 18.5% were knowledgeable about the risk factors. The majority (60%) could identify the preventable factors, including smoking cessation (92.2%), a high level of cholesterol (88.6%), and hypertension (78.7%). The majority (83.7%) read the educational material and 99% reported that the lecture increased their knowledge about cardiovascular disease.

Conclusion

Although cardiovascular risk factors are common, there is a big gap in the knowledge in our population. Further, alarming symptoms that bring the patients to medical care are also deficient. A call for action at different levels is urgent. Simple educational material in a basic language and virtual education are useful and cheap tools that must be practiced wherever possible. Education is welcomed by the participants.

Current status of cardiac regenerative medicine; An update on point of view to cell therapy application

Cardiovascular diseases (CVDs) are the leading cause of death globally. Because of the economic and social burden of acute myocardial infarction and its chronic consequences in surviving patients, understanding the pathophysiology of myocardial infarction injury is a major priority for cardiovascular research. MI is defined as cardiomyocytes death caused by an ischemic that resulted from the apoptosis, necrosis, necroptosis, and autophagy. The phases of normal repair following MI including inflammatory, proliferation, and maturation. Normal repair is slow and inefficient generally so that other treatments are required. Because of difficulties, outcomes, and backwashes of traditional therapies including coronary artery bypass grafting, balloon angioplasty, heart transplantation, and artificial heart operations, the novel strategy in the treatment of MI, cell therapy, was newly emerged. In cell therapy, a new population of cells has created that substitute with damaged cells. Different types of stem cell and progenitor cells have been shown to improve cardiac function through various mechanisms, including the formation of new myocytes, endothelial cells, and vascular smooth muscle cells. Bone marrow- and/or adipose tissue-derived mesenchymal stem cells, embryonic stem cells, autologous skeletal myoblasts, induced pluripotent stem cells, endothelial progenitor cells, cardiac progenitor cells and cardiac pericytes considered as a source for cell therapy. In this study, we focused on the point of view of the cell sources.

Public knowledge of stroke and heart attack symptoms in China: a cross-sectional survey

OBJECTIVE

Stroke and ischaemic heart disease have become the leading causes of death in China. We evaluated recognition of stroke and heart attack symptoms and stroke treatment-seeking behaviour in a large representative sample of the Chinese adult population and explored characteristics associated with recognition rates.

DESIGN

Cross-sectional survey.

SETTING

Household interviews.

PARTICIPANT

3051 Chinese adults aged between 18 and 69 (50.7% female) were interviewed between January and March 2019.

PRIMARY AND SECONDARY OUTCOME MEASURES

Primary measures include recognitions of stroke and heart attack symptoms and stroke treatment-seeking behaviour. Secondary measures include numeracy level, sociodemographics and prior history of cardiovascular diseases and high blood pressure.

RESULTS

Participants on average recognised 5.2 out of 14 stroke symptoms and 2.6 out of 6 heart attack symptoms. In the presence of stroke symptoms, three quarters of participants would take immediate action and call an ambulance, yet the second most common action was to advise the person to see a doctor (59%) rather than to consult a doctor immediately (34%). Recognition of atypical heartattack symptoms, such as nausea and feeling of anxiety, was poor. Symptom recognition rates were higher in females, people with a personal or family/friend history of cardiovascular events, those with higher numeracy scores, and for stroke symptoms, participants with high (versus low) education level. Furthermore, symptom recognition rate was negatively correlated with burden of cardiovascular diseases across the four economic regions of China.

CONCLUSION

Recognition of stroke and heart-attack symptoms was moderate and there remains a gap between recognising symptoms and taking immediate action. Interventions focusing on simple symptom detection tools and on building numerical competencies may help reduce the burden of cardiovascular diseases in China.

Knowledge of Stroke Risk Factors and Signs in Parakou, a Northern City of Benin in West Africa

INTRODUCTION

We aimed to determine knowledge of stroke risk factors and signs in an urban population of northern Benin.

METHODS

A door-to-door purposeful sampling survey was conducted in resident population (age ≥15 years) of the district of Titirou in the city of Parakou (N = 255,478) in Benin between March 15 and July 15, 2016. In-person interviews were conducted with data collection on structured questionnaires with close and open questions, according to standard definitions. Multivariable logistic regression was used to assess predictors of good knowledge, defined by provision of a correct response in pre-defined set of questions on stroke risk factors and warning signs.

RESULTS

Of 4,671 participants (mean age 27.7 ± 12.9 years; females 50.6%), only 404 (8.6%) knew at least 1 stroke risk factor. Knowledge level of stroke risk factors (odds ratio, 95% confidence interval) was related to age (1.37, 1.27-1.48), level of education (2.54, 1.73-3.72), and family history of stroke (3.01, 2.08-4.26). Only 230 (4.9%) were able to cite at least 1 stroke symptom, and this knowledge was great with increasing age (1.04, 1.02-1.06), family (3.63, 2.41-5.49) and personal history of stroke (3.71, 1.86-7.42), and high level of education (4.35, 2.68-7.07).

CONCLUSION

Knowledge of stroke risk factors and signs is low in northern Benin. Greater public education and awareness campaigns are required to address the burden of stroke.

Public Awareness of and Action towards Heart Attack Symptoms: An Exploratory Study

Background: Cardiovascular disease (CVD) is still the leading cause of mortality worldwide, and Malaysia is not an exception in this regard. The current research is an attempt to explore symptom awareness of and necessary actions in response to heart attack (HA) among lay public. Methods: This is a cross-sectional study design, and a survey was conducted from May to July 2018 among general public in Kuantan, Pahang state, Malaysia. Results: A total of 393 respondents recruited. Slightly more than one-fourth of the respondents (26.35%) were aware of HA symptoms like pain and/or discomfort in the jaw, neck, or back, while 71.65% showed awareness only of chest pain or discomfort as symptoms. Only 35.6% reported to call an ambulance if they experience someone suffering from HA symptoms, while 82% recognized ≥1 symptom, and only 11.5% recognized all five HA symptoms. Very few respondents, i.e., 1.3% reported awareness about correct recognition of all five HA symptoms. Respondents who had diabetes and hypercholesteremia were more likely to recognize all five HA symptoms. For those who had excellent awareness of all five HA symptoms, the odds ratio (OR) were significantly higher among single respondents (OR 0.023; 95% CI 0.001–0.594), Malay (OR 0.376; 95% CI 0.193–0.733), and those who received information associated with HA (OR 7.540; 95% CI 2.037–27.914). However, those who were aware that HA requires quick treatment had significantly low odds ratio (OR 0.176; 95% CI 0.044–0.710). Conclusions: The awareness of and action towards the signs and symptoms of HA among the public were poor.

Cardiac symptom attribution and knowledge of the symptoms of acute myocardial infarction: a systematic review

BACKGROUND

Since the knowledge of the symptoms of acute myocardial infarction (AMI) may reduce the decision time for patients to seek help in case of an AMI, we aimed to summarize evidence on the knowledge of the AMI symptoms and the symptom attribution in case of an acute coronary syndrome (ACS).

METHODS

Therefore, we systematically searched the databases PubMed, CINAHL, Embase, and Cochrane Library for relevant studies published between January 1, 2008 and 2019 (last search August 1, 2019).

RESULTS

A total of 86 studies were included, with a composite sample size of 354,497 participants. The weighted mean of the knowledge scores for the symptoms of AMI of 14,420 participants from the general population, was 42.1% (when maximum score was considered 100%) and 69.5% for 7642 cardiac patients. There was a substantially better level of knowledge for six symptoms ('chest pain or discomfort', 'shortness of breath', 'pain or discomfort in arms or shoulders', 'feeling weak, lightheaded, or faint', 'pain or discomfort in the jaw, neck, or back', and 'sweating') (49.8-88.5%) compared to the four less obvious/atypical symptoms 'stomach or abdominal discomfort', 'nausea or vomiting', 'headache', and 'feeling of anxiety' (8.7-36.7%). Only 45.1% of 14,843 patients, who experienced ACS, have correctly attributed their symptoms to a cardiac cause.

CONCLUSION

In conclusion, we found a moderate to good knowledge of "classic" and insufficient knowledge of less obvious symptoms of AMI. This might suggest that increasing knowledge about less obvious symptoms of AMI could be beneficial. It appears also important to address cardiac attribution of symptoms.

Development of questionnaire on awareness and action towards symptoms and risk factors of heart attack and stroke among a Malaysian population

Background

The awareness of symptoms and action towards heart attack and stroke is important to reduce the morbidity and mortality in both developed and developing countries. The aim of this study was to develop a questionnaire on awareness and action towards symptoms and risk factors of heart attack and stroke among lay public in Malaysia. The questionnaire was developed in both English and Bahasa Melayu.

Methods

Primarily the questions were generated in English. Face and content validity were performed by five experts in Pharmacy Practice and Medicine. A translation as per guidelines into Malay language was performed; followed by face-to-face interview of 96 lay public in Kuantan, Pahang, Malaysia. For internal consistency, reliability was assessed utilizing Cronbach’s alpha.

Results

The mean ± SD of the awareness and action towards heart attack symptoms and risk factors was 65.52 ± 6.3, with a good internal consistency (Cronbach’s alpha = 0.75), whereas the mean of the awareness and action towards stroke symptoms and risk factors was 61.93 ± 7.11, with an accepted internal consistency (Cronbach’s alpha = 0.86).

Conclusion

The current validation research showed that the developed questionnaire is valid and reliable for assessing the awareness and action towards symptoms and risk factors of heart attack and stroke among lay public in Malaysia.

Low level of knowledge of heart attack symptoms and inappropriate anticipated treatment-seeking behaviour among older Chinese: a cross-sectional survey

BACKGROUND

Prehospital delay of acute myocardial infarction (AMI) is common globally, and Hong Kong-home of a rapidly ageing Chinese population-is not an exception. Seeking emergency medical care promptly is important for patients. Treatment-seeking behaviours have been shown to be associated with knowledge of AMI symptoms and specific cultural beliefs. This study aimed to assess the level of knowledge of AMI symptoms and expected treatment-seeking behaviour among older Chinese in Hong Kong.

METHODS

A cross-sectional population-based survey was conducted at the Elderly Health Centres in Hong Kong from March to September 2016. Face-to-face interviews were conducted with a structured questionnaire based on previous studies and local adaptations.

RESULTS

Among 1804 people aged 65 years and above who completed the questionnaire, chest pain (80.2%), palpitations (75.8%) and fainting (71.9%) were the major symptoms recognised as AMI related. Meanwhile, stomach ache (46.9%), coughing (45.4%) and neck pain (40.8%) were recognised as not AMI related. The mean expected discomfort intensity during AMI onset was 7.7 out of 10 (SD=2.1). Regarding the expected treatment-seeking behaviour, seeking non-emergent medical care was the most popular action when AMI symptoms emerged during the day, without chest pain or with lower discomfort intensity, whereas calling an ambulance was the most common option when AMI symptoms emerged at night or with high discomfort intensity.

CONCLUSIONS

To minimise delays in seeking treatment, future health education should focus on increasing the public knowledge of AMI symptoms and the need to call an ambulance during an emergency.

Health literacy and health-promoting behaviours among Australian-Singaporean communities living in Sydney metropolitan area

Background:

Health literacy affects how individuals navigate and make decisions within the healthcare system and has been recognized to influence health behaviours. However, less is known about its associations with health-promoting behaviours amongst Australian migrant populations. This study is an attempt to fill this gap by investigating the level of health literacy and its associations with physical activity, healthy diet, smoking and health services utilization among Australian-Singaporean communities.

Methods:

A total of 157 participants were recruited from Singaporean communities living in Sydney metropolitan areas, New South Wales, Australia. Data was collected through a cross-sectional online survey from January 2016 to August 2016.

Results:

Most of the respondents were female (56.1%), employed (70.7%) and had lived in Sydney for >5 years (80.3%). About 60% of the participants were inadequately health-literate (Brief Health Literacy Screening Tool score ≤ 16). The level of health literacy varied significantly based on participants’ socioeconomic status. Regression analysis indicated that health literacy was a reliable predictor of health-promoting behaviours including diet, body mass index, smoking and alcohol consumption, physical activity and having a medical check-up.

Conclusions:

This study’s findings have significant implications for health policy makers and suggest that health literacy should be encouraged and included in any health-promoting behaviour interventions amongst migrant populations.

Knowledge of warning signs, presenting symptoms and risk factors of coronary heart disease among the population of Dubai and Northern Emirates in UAE: a cross-sectional study

BACKGROUND

To evaluate the level of knowledge regarding warning signs, presenting symptoms and risk factors associated with coronary heart disease (CHD) among population of Dubai and Northern Emirates in UAE.

MATERIALS AND METHODS

A cross sectional survey of 1367 residents of Dubai and Northern Emirates was conducted using a self-administered questionnaire.

RESULTS

Respondents were classified into two groups: Young Adult Population (YAP; 18-24 years of age) and General Population (GP; 25 years and older). Majority of participants were males (56.7%) and of South Asian (57.5%) or Middle-Eastern (30.8%) ethnicity. Regarding presenting symptoms of CHD, chest pain was identified by around 80% of population, whereas pain in the left shoulder was recognized by 61% of GP and 44% of YAP. Atypical symptoms were poorly identified. Regarding risk factors, only one-fourth population knew that males were at higher risk compared to premenopausal females. Few knew that the risk increases in females after menopause and that the risk is higher for females who smoke and use oral contraceptives. 62% knew that the survivors of a heart attack are at high risk of recurrences. Except for tobacco smoke, hypercholesterolemia and hypertension, knowledge of other risk factors was not satisfactory. Older adults and females had comparatively higher level of knowledge.

CONCLUSION

Knowledge level of many of the symptoms and risk factors of CHD is unsatisfactory. There is, therefore, a need to increase the awareness in the population of UAE. The knowledge gaps identified through this study can be addressed through health campaigns to increase the awareness about warning signs, symptoms and modifiable risk factors. .