Australian Public’s Awareness of Stroke Warning Signs Improves After National Multimedia Campaigns

Stroke awareness in a Brazilian Northeastern capital city and the burden of the COVID-19 pandemic

BACKGROUND

 The delay in recognizing stroke symptoms is a significant obstacle to receiving acute treatment. Therefore, it is essential to understand the gaps in the knowledge about stroke among the general population and promote campaigns based on these gaps.

OBJECTIVE

 To investigate the general knowledge about stroke in a capital in Northeastern Brazil in a sample of individuals who attended a public hospital and the impacts of the coronavirus disease 2019 (COVID-19) pandemic on the use of emergency services.

METHODS

 We included patients older than 18 years of age and their family members and/or companions. After obtaining consent, the researcher presented a typical case of stroke, and the participants filled out a questionnaire divided into 2 sections: sociodemographic data and 15 questions about stroke detection and seeking health services and treatment.

RESULTS

 We included 154 individuals with a mean age of 44.45 ± 16.21 years. After presenting the case, 60.4% mentioned the acronym AVC (acidente vascular cerebral, or cerebrovascular accident [stroke], in Portuguese) as a possible explanation, and 54.5% reported that they would call the Mobile Emergency Care Service. However, 62.9% provided the incorrect telephone number for the Mobile Emergency Care Service or lacked knowledge of the accurate number. Regarding the risk factors for stroke, 27.9% did not know any of them, 65.5% were unaware of any treatment, and no reference was made to thrombolytic therapy. About their chosen conduct in the same case in the context of the COVID-19 pandemic, 98.1% of the participants would not change their behavior.

CONCLUSION

 These results can assist in the planning of public policies and campaigns emphasizing the issue of risk factors and how to access emergency medical services in the state of Alagoas, Brazil.

Recognition, reaction, risk factors and adequate knowledge of stroke: A Brazilian populational survey

INTRODUCTION

General population proper knowledge about stroke can improve stroke outcomes. We aimed to assess the awareness levels of laypeople regarding stroke recognition, reaction, risk factors, and adequate general knowledge (correct answers for those three questions) of stroke.

METHODS

Cross-sectional survey-based study enrolling community population from 12 cities of Brazil's Northeast. The volunteers were verbally exposed to a typical case of stroke and then responded to an open-ended semi-structured questionnaire to evaluate their stroke knowledge.

RESULTS

A total of 1475 subjects enrolled in this study (52.6% of women, mean±SD 36.2±15.3 years-old, 13.0±4.4 years of formal schooling). 1220/1475 (82.7%) recognized the situation as a stroke; 1148/1475 (77.8%) would react to it by taking the patient to the emergency department or calling for emergency medical assistance; 844/1475 (57.2%) knew at least one risk factor; and 190/1475 (12.9%) stated that symptoms could be reversed if the patient was treated "as soon as possible". Adequate general knowledge was found in 622/1475 (42,2%) of participants. Notably, among those who recognized the stroke, 19.9% (243/1220) would not react appropriately to it. The multivariate analysis showed that factors independently related to stroke recognition were female sex, higher education levels, private health insurance and previous experience with a similar situation. Adequate general knowledge was associated with longer school years and health insurance.

CONCLUSIONS

The frequency of stroke recognition and appropriate reaction were acceptable, however the general knowledge, knowledge of risk factors and notion that stroke treatment is time-sensitive were insufficient. Addressing the recognition-reaction gap requires targeted campaigns focusing on stroke treatment awareness.

Declining Public Awareness of Heart Attack Warning Symptoms in the Years Following an Australian Public Awareness Campaign: A Cross-Sectional Study

BACKGROUND

The National Heart Foundation of Australia's (NHFA) Warning Signs campaign ran between 2010 and 2013. This study examines trends in Australian adults' ability to name heart attack symptoms during the campaign and in the years following.

METHODS

Using the NHFA's HeartWatch data (quarterly online surveys) for adults aged 30-59 years, we conducted an adjusted piecewise regression analysis comparing trends in the ability to name symptoms during the campaign period plus one year lag (2010-2014) to the post-campaign period (2015-2020) RESULTS: Over the study period, there were 101,936 Australian adults surveyed. Symptom awareness was high or increased during the campaign period. However, there was a significant downward trend in each year following the campaign period for most symptoms (e.g., chest pain: adjusted odds ratio [AOR] =0.91, 95%CI: 0.56-0.80; arm pain: AOR=0.92, 95%CI: 0.90-0.94). Conversely, the inability to name any heart attack symptom increased in each year following the campaign (3.7% in 2010 to 19.9% in 2020; AOR=1.13, 95%CI: 1.10-1.15); these respondents were more likely to be younger, male, have less than 12 years of education, identify as Aboriginal and/or Torres Strait Islander Peoples, speak a language other than English at home and have no cardiovascular risk factors.

CONCLUSION

Awareness of heart attack symptoms has decreased in the years since the Warning Signs campaign in Australia, with 1 in 5 adults currently unable to name a single heart attack symptom. New approaches are needed to promote and sustain this knowledge, and to ensure people act appropriately and promptly if symptoms occur.

Attention to acute cerebrovascular disease in Guipúzcoa: description of the results of a reference hospital in a centralized care model

INTRODUCTION

In the last 15 years, considerable improvements have been made in acute stroke care in Guipuzkoa, including the implementation of a centralised care model at Hospital Universitario Donostia (HUD), improved coordination between professionals, early detection campaigns, new treatments, a stroke unit, and specific rehabilitation. The aim of this work is to describe the results of a reference hospital (HUD) in a centralised care model.

MATERIAL AND METHODS

We performed a retrospective observational study of a sample of patients discharged between August and December 2015 from the HUD with a diagnosis of acute stroke (ICD-9-CM codes 430-436, except 433.10). We review patients' baseline characteristics, acute-phase care, and functional outcomes and mortality at discharge and at one year.

RESULTS AND DISCUSSION

We identified 536 patients, with a mean age of 73.6 years and a high comorbidity rate. Ischaemic stroke accounted for 64.8% of patients, followed by haemorrhagic stroke (20%) and transient ischaemic attack (14.8%). A total of 53% of patients were attended in < 6 hours, with code stroke being activated in 37.1%; 52.2% of patients were admitted to the stroke unit. Intravenous therapy was administered to 8.3% of patients with ischaemic stroke, and 9.5% underwent mechanical thrombectomy. Surgery was performed in 12.1% patients with haemorrhagic stroke. Rehabilitation was started at hospital in 56% of patients, and 39.6% continued with this treatment at discharge. Mortality was 13.8% at discharge and 25.9% at one year (ischaemic stroke, 25.3%; haemorrhagic stroke, 47.5%); these figures are lower than those previously reported in Guipuzkoa. At one year, 62.5% of patients had a Barthel Index score of 95-100, and 50% a modified Rankin Scale score of 0-2.

CONCLUSIONS

After the strategic changes implemented in acute stroke care in Guipuzkoa, including the centralisation of the acute stroke care model, mortality rates at discharge and at one year are lower in 2015 than the previously reported rates, with similar rates of independence. These results are consistent with those published by other Spanish and European centres.

Attention to acute cerebrovascular disease in Guipúzcoa: Description of the results of a reference hospital in a centralized care model

INTRODUCTION

In the last 15 years, considerable improvements have been made in acute stroke care in Guipuzkoa, including the implementation of a centralised care model at Hospital Universitario Donostia (HUD), improved coordination between professionals, early detection campaigns, new treatments, a stroke unit, and specific rehabilitation. The aim of this work is to describe the results of a reference hospital (HUD) in a centralised care model.

MATERIAL AND METHODS

We performed a retrospective observational study of a sample of patients discharged between August and December 2015 from the HUD with a diagnosis of acute stroke (ICD-9-CM codes 430-436, except 433.10). We review patients' baseline characteristics, acute-phase care, and functional outcomes and mortality at discharge and at one year.

RESULTS AND DISCUSSION

We identified 536 patients, with a mean age of 73.6 years and a high comorbidity rate. Ischaemic stroke accounted for 64.8% of patients, followed by haemorrhagic stroke (20%) and transient ischaemic attack (14.8%). A total of 53% of patients were attended in <6 hours, with code stroke being activated in 37.1%; 52.2% of patients were admitted to the stroke unit. Intravenous therapy was administered to 8.3% of patients with ischaemic stroke, and 9.5% underwent mechanical thrombectomy. Surgery was performed in 12.1% patients with haemorrhagic stroke. Rehabilitation was started at hospital in 56% of patients, and 39.6% continued with this treatment at discharge. Mortality was 13.8% at discharge and 25.9% at one year (ischaemic stroke, 25.3%; haemorrhagic stroke, 47.5%); these figures are lower than those previously reported in Guipuzkoa. At one year, 62.5% of patients had a Barthel Index score of 95-100, and 50% a modified Rankin Scale score of 0-2.

CONCLUSIONS

After the strategic changes implemented in acute stroke care in Guipuzkoa, including the centralisation of the acute stroke care model, mortality rates at discharge and at one year are lower in 2015 than the previously reported rates, with similar rates of independence. These results are consistent with those published by other Spanish and European centres.

Poor awareness of stroke educational tools among older adults in China

BACKGROUND

Stroke 1-2-0 and FAST (Face, Arm, Speech, Time) are two popular stroke educational tools that have been used in many stroke promotion campaigns. However, few researchers have investigated awareness of these tools among older adults in communities.

METHODS

This study was a cross-sectional survey of community-living older adults. Two family physicians conducted face-to-face interviews with older adults living in Minhang district, Shanghai, between October 1, 2020 and November 31, 2020. The survey comprised three parts: basic information, prior medical history, and stroke awareness knowledge. We focused on the awareness of FAST and Stroke 1-2-0 and investigated factors associated with awareness of these stroke educational tools.

RESULTS

The sample of this study was 466 older adults. Their mean age was 73.45 years. Male respondents accounted for 46.14% of the total sample. More than half of the older adults surveyed had an educational background of less than 6 years. Over 90% of the older adults surveyed had never heard about Stroke 1-2-0 or FAST. The awareness rate of Stroke 1-2-0 and FAST was 7.94%, with awareness of Stroke 1-2-0 being higher than that of FAST (6.01% vs. 0.43%, p < .05). None of the respondents who had heard about the two stroke educational tools could explain the utility of either tool fully. Having a background in higher education was associated with awareness of stroke educational tools independently, with an odds ratio (OR) of 10.07, 95% confidence interval (CI) of 3.7-27.4, p < .001. In addition, Wechat (OR 6.57, 95%CI 2.65-16.27, p < .001) and the community bulletin board (OR 2.95, 95%CI 1.37-6.33, p = .005) were found to be important sources for acquiring knowledge of stroke awareness tools.

CONCLUSION

The limited awareness of Stroke 1-2-0 and FAST displayed among older adults in the community indicates that we must take action to improve education on stroke among the elderly.

Educational Program Improved Senior Preparedness to Call 911 as a Response to Stroke

OBJECTIVES

Stroke predominantly affects the elderly. Universities of the Third Age (U3A) are presented with an opportunity to target them. The goal of our study was to improve older adults' preparedness to call 911 as a response to symptoms of stroke.

MATERIALS AND METHODS

Participants were recruited from U3A in Brno, Czech Republic in year 2018. The program included an educational movie about stroke and testing with pretest posttest design. Stroke awareness was measured by Stroke Action Test and video-clips portraying stroke and stroke mimicking symptoms. Respondents had to answer close-ended questions. Composite scores were compared using paired t-test.

RESULTS

Data were obtained from 206 attendees of the program, that is 2% of all students, from 4 of 5 U3A in Brno. The mean test score improved from 80% to 87% (paired p < 0.001). Participants with a lower baseline knowledge improved by 12% (95% CI 9% to 16%) and with a higher baseline knowledge by 0% (95% CI 3% to 4%). The score for calling 911 for stroke mimicking symptoms improved from 29% to 20% (paired p < 0.001).

CONCLUSIONS

Video-based educational program improved senior preparedness to call 911 as a response to stroke. The improvement was mild, which is at least partly due to a high baseline level of preparedness of seniors active in U3A. A lower baseline knowledge was however associated with a bigger improvement, which might be important for use in a less active/educated population. Educational intervention also decreased intention to call 911 for stroke mimicking symptoms, which could have important implications for decreasing unnecessary activation of pre-hospital services.

Mechanical thrombectomy for emergent large vessel occlusion: an Australian primary stroke centre workflow analysis

BACKGROUND

Time to successful reperfusion is a critical prognostic factor for acute ischaemic stroke. Mechanical thrombectomy has become the gold standard treatment for emergent large vessel occlusion stroke. The timely delivery of this highly specialised procedure to patients outside of metropolitan centres presents a dilemma of inequity, with limited workflow data hindering benchmarking and service optimisation.

AIMS

To analyse key stroke treatment time parameters from a primary stroke centre existing in a regional centre within a hub-and-spoke delivery model in Victoria, Australia.

METHODS

Retrospective cohort study of patients transferred from a regional primary stroke centre to a metropolitan comprehensive stroke centre for mechanical thrombectomy between July 2016 and December 2018. Time workflow analysis was conducted from symptom onset to primary stroke centre departure.

RESULTS

A total of 55 patients was included in this study with an average age of 70.2 years. Median National Institutes of Health Stroke Scale score on admission was 13 (interquartile range (IQR) 7-17). Median pre-hospital time was 68 min (IQR 56-137) and median door-in-door-out time was 120.5 min (IQR 98-150), constituting 36.1% and 63.9% of total median time from symptom onset to primary stroke centre departure (188.5 min) respectively. There were no significant differences across observed cohort characteristics under linear regression analysis.

CONCLUSION

Protracted pre-hospital and primary stroke centre workflow times can delay effective treatment for patients with acute ischaemic stroke in regional areas. A systems-level approach to streamlining processes in these key areas is required to bridge this inequity in best practice care.

Comparison of knowledge on stroke for stroke patients and the general population in Burkina Faso: a cross-sectional study

Background

In many parts of Africa, there is limited information on awareness of symptoms of stroke, risk factors for stroke and willingness for stroke prevention, both in the general population and in people with stroke. Knowledge and preventive efforts for stroke in patients with a history of the illness are rarely investigated. This study aims to investigate awareness of stroke symptoms in stroke patients who were admitted to hospitals within 72 hours of a confirmed stroke event in Burkina Faso. This study also aims to investigate preventive behavior for stroke for the general population.

Methods

Face-to-face interviews were conducted with the participants. The sample included 110 first-time stroke patients who had been admitted to one of three tertiary teaching hospitals in Burkina Faso within 72 hours and 750 participants from the general population, who were recruited through clustered sampling. Knowledge of stroke warning signs and current and future efforts on stroke prevention were also assessed.

Results

Only 30.9% of the stroke patients believed that they were at risk before the stroke episode. Obvious warning signs were unfamiliar to both groups. Only 1.3% of the respondents from the general population group knew sudden weakness face arm or leg as a sign of stroke. For all future efforts in stroke prevention, stroke patients demonstrated significantly lower willingness to undertake behavioral changes than the general population. Sixty-six percent and 85% of the stroke patients and the general population, respectively, were willing to take steps to reduce blood pressure.

Conclusion

Public education on stroke warning signs and strategies to increase willingness to engage in preventive behaviors are urgent in African countries. Strategies to improve public awareness for developing countries such as Burkina Faso should be designed differently from that of developed countries to incorporate local beliefs.

Stroke literacy in the population of the Eastern Province of Saudi Arabia; immediate steps are essential to bridge the gap

BACKGROUND AND PURPOSE

Stroke is a medical emergency that demands early recognition for time sensitive acute management. Knowledge about stroke in public has not been found satisfactory in most of the studies worldwide. Studies describing the awareness of public about recognition of stroke and its treatment from Saudi Arabia (SA) are deficient. This study aimed to assess the knowledge of general population living in the Eastern Province of SA about stroke in relation to recognition of warning signs, risk factors and available acute treatment.

METHODS

A prospective, cross sectional study was conducted using a structured questionnaire distributed through an electronic web site over a period of six months. The data was analyzed with SPSS version 22.0.

RESULTS

Among a total of 1,213 respondents, 62.4% were women. Three fourth identified the affected organ correctly. Psychological stress was the most commonly identified risk factor (73.5%) followed by hypertension (63.8%). More than half of the respondents (58.5%) were not aware of diabetes mellitus as a risk factor for stroke. Speech difficulty was the most commonly identified stroke warning sign (64.4%) followed by focal weakness (62.4%). More than half (59.9%) did not recognize facial asymmetry as stroke warning sign. Nearly three fourth of the participants were unaware of t-PA (73.7%) and nearest available health care center for acute stroke management (74.9%).

CONCLUSION

Our survey found the stroke literacy in the population of the Eastern Province of SA as non- satisfactory and highlights the importance of taking immediate measure such as mass media campaign and hospital based activities to improve it.

Differences in the awareness of stroke symptoms and emergency response by occupation in the Korean general population

We evaluated the difference in awareness of stroke warning signs (SWS) and emergency response among occupational groups in the community-dwelling population. From the 2016 Korea Community Health Survey, a total of 10,445 individuals without stroke were included in the analysis. Multiple logistic regression analysis was used to explore the association of occupation with awareness of SWS and correct emergency response. SWS included the following: sudden numbness or weakness, sudden difficulty speaking or understanding speech, sudden dizziness, sudden visual impairment, and sudden severe headache. Respondents’ occupation was classified into six groups: managers and professionals (MP); clerks; service and sales workers (SSW); agricultural, forestry, and fishery workers (AFFW); mechanical and manual laborers (MML); or housewives and unemployed people (HUP). Awareness of each SWS was the same with the highest for MP and lowest for AFFW. After adjusting for socio-demographic factors, compared to MP (reference), AFFW (odds ratio 0.49; 95% confidence interval 0.36–0.67), HUP (0.55; 0.40–0.75), MML (0.57; 0.42–0.79), and SSW (0.62; 0.45–0.86) had significantly lower ORs for knowing at least one of the SWS. Additionally, AFFW (0.79; 0.66–0.96) and MML (0.76; 0.63–0.91) had significantly lower ORs for knowing all five SWS compared to MP. However, there was no significant occupational difference in correct emergency response when a stroke occurred. To improve stroke literacy and to reduce the disparity of awareness of SWS in community settings, public health efforts with an emphasis on AFFW and MML are needed.

Temporal Trends in Emergency Medical Services and General Practitioner Use for Acute Stroke After Australian Public Education Campaigns

Background and Purpose- The Australian Stroke Foundation ran annual paid advertising between 2004 and 2014, using the FAST (Face, Arm, Speech, Time) campaign from 2006 and adding the message to call emergency medical services in 2007. In this study, we examined temporal trends in emergency medical services use and referrals from general practitioners in the Australian state of Victoria to evaluate the impact of these campaigns. Methods- Using data from 33 public emergency departments, contributing to the Victorian Emergency Minimum Dataset, we examined trends in emergency department presentations for 118 000 adults with an emergency diagnosis of stroke or transient ischemic attack between 2003 and 2015. Annual trends were examined using logistic regression using a precampaign period (January 2003 to August 2004) as reference and adjusting for demographic variables. Results- Compared with the precampaign period, significant increases in emergency medical services use were seen annually between 2008 and 2015 (all P<0.001, eg, 2015; adjusted odds ratio, 1.16; 95% CI, 1.10-1.23). In contrast, a decrease was seen in patients presenting via general practitioners across all campaign years (all P<0.001, eg, 2015; adjusted odds ratio, 0.48; 95% CI, 0.44-0.53). Conclusions- Since the Stroke Foundation campaigns began, a greater proportion of stroke and transient ischemic attack patients are presenting to hospital by emergency medical services and appear to be bypassing their general practitioners.

Canadian Stroke Best Practice Recommendations for Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care, 6th Edition, Update 2018

The 2018 update of the Canadian Stroke Best Practice Recommendations for Acute Stroke Management, 6th edition, is a comprehensive summary of current evidence-based recommendations, appropriate for use by healthcare providers and system planners caring for persons with very recent symptoms of acute stroke or transient ischemic attack. The recommendations are intended for use by a interdisciplinary team of clinicians across a wide range of settings and highlight key elements involved in prehospital and Emergency Department care, acute treatments for ischemic stroke, and acute inpatient care. The most notable changes included in this 6th edition are the renaming of the module and its integration of the formerly separate modules on prehospital and emergency care and acute inpatient stroke care. The new module, Acute Stroke Management: Prehospital, Emergency Department, and Acute Inpatient Stroke Care is now a single, comprehensive module addressing the most important aspects of acute stroke care delivery. Other notable changes include the removal of two sections related to the emergency management of intracerebral hemorrhage and subarachnoid hemorrhage. These topics are covered in a new, dedicated module, to be released later this year. The most significant recommendation updates are for neuroimaging; the extension of the time window for endovascular thrombectomy treatment out to 24 h; considerations for treating a highly selected group of people with stroke of unknown time of onset; and recommendations for dual antiplatelet therapy for a limited duration after acute minor ischemic stroke and transient ischemic attack. This module also emphasizes the need for increased public and healthcare provider’s recognition of the signs of stroke and immediate actions to take; the important expanding role of paramedics and all emergency medical services personnel; arriving at a stroke-enabled Emergency Department without delay; and launching local healthcare institution code stroke protocols. Revisions have also been made to the recommendations for the triage and assessment of risk of recurrent stroke after transient ischemic attack/minor stroke and suggested urgency levels for investigations and initiation of management strategies. The goal of this updated guideline is to optimize stroke care across Canada, by reducing practice variations and reducing the gap between current knowledge and clinical practice.

Mortality Reduction for Fever, Hyperglycemia, and Swallowing Nurse-Initiated Stroke Intervention

Background and Purpose—

Implementation of nurse-initiated protocols to manage fever, hyperglycemia, and swallowing dysfunction decreased death and disability 90 days poststroke in the QASC trial (Quality in Acute Stroke Care) conducted in 19 Australian acute stroke units (2005–2010). We now examine long-term all-cause mortality.

Methods—

Mortality was ascertained using Australia’s National Death Index. Cox proportional hazards regression compared time to death adjusting for correlation within stroke units using the cluster sandwich (Huber–White estimator) method. Primary analyses included treatment group only unadjusted for covariates. Secondary analysis adjusted for age, sex, marital status, education, and stroke severity using multiple imputation for missing covariates.

Results—

One thousand and seventy-six participants (intervention n=600; control n=476) were followed for a median of 4.1 years (minimum 0.3 to maximum 70 months), of whom 264 (24.5%) had died. Baseline demographic and clinical characteristics were generally well balanced by group. The QASC intervention group had improved long-term survival (>20%), but this was only statistically significant in adjusted analyses (unadjusted hazard ratio [HR], 0.79; 95% confidence interval [CI], 0.58–1.07; P =0.13; adjusted HR, 0.77; 95% CI, 0.59–0.99; P =0.045). Older age (75–84 years; HR, 4.9; 95% CI, 2.8–8.7; P <0.001) and increasing stroke severity (HR, 1.5; 95% CI, 1.3–1.9; P <0.001) were associated with increased mortality, while being married (HR, 0.70; 95% CI, 0.49–0.99; P =0.042) was associated with increased likelihood of survival. Cardiovascular disease (including stroke) was listed either as the primary or secondary cause of death in 80% (211/264) of all deaths.

Conclusions—

Our results demonstrate the potential long-term and sustained benefit of nurse-initiated multidisciplinary protocols for management of fever, hyperglycemia, and swallowing dysfunction. These protocols should be a routine part of acute stroke care.

Clinical Trial Registration—

URL: http://www.anzctr.org.au . Unique identifier: ACTRN12608000563369.

Barriers to evidence-based acute stroke care in Ghana: a qualitative study on the perspectives of stroke care professionals

OBJECTIVE

Despite major advances in research on acute stroke care interventions, relatively few stroke patients benefit from evidence-based care due to multiple barriers. Yet current evidence of such barriers is predominantly from high-income countries. This study seeks to understand stroke care professionals' views on the barriers which hinder the provision of optimal acute stroke care in Ghanaian hospital settings.

DESIGN

A qualitative approach using semistructured interviews. Both thematic and grounded theory approaches were used to analyse and interpret the data through a synthesis of preidentified and emergent themes.

SETTING

A multisite study, conducted in six major referral acute hospital settings (three teaching and three non-teaching regional hospitals) in Ghana.

PARTICIPANTS

A total of 40 participants comprising neurologists, emergency physician specialists, non-specialist medical doctors, nurses, physiotherapists, clinical psychologists and a dietitian.

RESULTS

Four key barriers and 12 subthemes of barriers were identified. These include barriers at the patient (financial constraints, delays, sociocultural or religious practices, discharge against medical advice, denial of stroke), health system (inadequate medical facilities, lack of stroke care protocol, limited staff numbers, inadequate staff development opportunities), health professionals (poor collaboration, limited knowledge of stroke care interventions) and broader national health policy (lack of political will) levels. Perceived barriers varied across health professional disciplines and hospitals.

CONCLUSION

Barriers from low/middle-income countries differ substantially from those in high-income countries. For evidence-based acute stroke care in low/middle-income countries such as Ghana, health policy-makers and hospital managers need to consider the contrasts and uniqueness in these barriers in designing quality improvement interventions to optimise patient outcomes.

Public Awareness of Stroke and Its Predicting Factors in Korea: a National Public Telephone Survey, 2012 and 2014

The aim of this study was to investigate time trends in the public awareness of stroke and its predicting factors. The target population was 9,600 community-dwelling adults, aged 19-79 years, in 16 metropolitan cities and provinces in Korea. The survey samples in 2012 and 2014 were selected separately (entirely different sets of subjects) using a proportionate quota sampling method. Information concerning knowledge of stroke and demographics was collected by trained telephone interviewers using random digit dialing. After excluding subjects with a non-response or refusal to answer any question, the analyses included 8,191 subjects in 2012 and 8,127 subjects in 2014. Respondents' awareness of stroke warning signs (numbness or weakness, difficulty speaking or understanding speech, dizziness, visual impairment, and severe headache) was highest for difficulty speaking or understanding speech (80.9% in 2012 and 86.4% in 2014). There were significant increases in the proportion of respondents understanding the appropriate action (i.e., calling an ambulance) at the time of stroke occurrence (59.6% to 67.1%), and in the proportion aware of the general need for prompt treatment (86.7% to 89.8%). In multivariable logistic regression analysis, older age, higher education level, higher household income, current non-smoking, exposure to stroke-related public relations materials, and experience of stroke education were significantly associated with both high knowledge of stroke warning signs and awareness of the need for prompt treatment. Between 2012 and 2014, the public's awareness of stroke increased significantly. More specialized interventions, including public relations materials and education, should focus on subgroups who have lower stroke knowledge.

Improving stroke knowledge through a 'volunteer-led' community education program in Australia

BACKGROUND

Public awareness of stroke risks and warning signs remains poor. The National Stroke Foundation (NSF) in Australia has been undertaking a StrokeSafe Ambassador Education program to raise awareness of stroke. The format includes presentations by volunteers trained to be 'ambassadors' to spread standard information about stroke to the public. Our aim was to determine the change in knowledge of participants who attended presentations.

METHODS

Participants completed questionnaires before immediately after presentations, and at 3months following the presentation. Information was collected on knowledge of risk factors and signs of stroke. McNemar's test was used to compare paired-responses over time. A p value of <0.05 was considered significant.

RESULTS

Between March and April 2014, 591 participants attended 185 presentations and 591 (100%) completed them before and immediately after presentation questionnaires: 68% were female and 75% were aged 65years or more. 258 consented for further follow-up with 192 completing follow-up. Comparing immediately after with before presentation showed significantly improved knowledge for all 10 stroke risk factors and all signs of stroke. Significantly improved knowledge for 7/10 risk factors and 1/3 signs of stroke was found when comparing follow-up and immediately after presentation results. Knowledge of 5/10 risk factors and 2/3 signs of stroke improved when comparing follow-up and before presentation.

CONCLUSION

This study describes a novel approach to support the use of trained volunteers to provide a community-based, standardised education program for stroke. This program shows that community presentations can improve immediate and short-term knowledge of signs and risk factors for stroke.

Stroke preparedness in children: translating knowledge into behavioral intent: a systematic review and meta-analysis

BACKGROUND

If translated into behavioral intent, improving stroke knowledge may potentially impact on better outcomes. Children are an attractive target population since they can drive familial behavioral changes. However, the impact of interventions on stroke knowledge among children is unclear. We performed a systematic review and meta-analysis to investigate whether educational interventions targeting children improve stroke knowledge and lead to behavioral changes.

METHODS

We searched Ovid, PubMed, and Embase between January 2000 and December 2014. We included studies written in English reporting the number of children aged 6-15 years undergoing educational interventions on stroke and providing the results for baseline and early and late postintervention tests. We compared the proportion of correct answers between baseline, early, and late responses for two endpoints: knowledge and behavioral intent.

RESULTS

Of the initial 58 articles found, we included nine that met the inclusion criteria. Compared with baseline tests (51·7%, 95% confidence interval 40·9-62·4), there was improvement in stroke knowledge in early (74·0%, 95% confidence interval 64·4-82·5, P = 0·002) and late (67·3%, 95% confidence interval 55·4-78·2, P = 0·027) responses. There was improvement in the early (92·1%, 95% confidence interval 86·0-96·6, P < 0·001) and late (83·9%, 95% confidence interval 73·5-92·1, P = 0·001) responses for behavioral intent compared with the baseline assessment (63·8%, 95% confidence interval 53·5-73·4).

CONCLUSION

Children are a potentially attractive target population for improvement in stroke knowledge and behavioral intent, both in the short and long term. Our findings may support the implementation of large-scale stroke educational initiatives targeting children.

Effect of Public Awareness Campaigns on Calls to Ambulance Across Australia

Background and Purpose—

The National Stroke Foundation of Australia has run 12 public awareness campaigns since 2004. Campaign exposure and funding has varied annually and regionally during this time. The aim of this study was to measure the effect of campaigns on calls to ambulance for stroke across Australia in exposed regions (paid or pro bono advertising).

Methods—

All ambulance services in Australia provided monthly ambulance dispatch data between January 2003 and June 2014. We performed multivariable regression to measure the effect of campaign exposure on the volume of stroke-related emergency calls, after controlling for confounders.

Results—

The final model indicated that 11 of the 12 National Stroke Foundation campaigns were associated with increases in the volume of stroke-related calls (varying between 1% and 9.9%) in regions with exposure to advertising. This increase lasted ≈3 months, with an additional 10.2% relative increase in the volume of the calls in regions with paid advertising. We found no significant additional effect of the campaigns on stroke calls where ambulance services are publicly funded.

Conclusions—

The National Stroke Foundation stroke awareness campaigns are associated with increases to calls to ambulance for stroke in regions receiving advertising and promotion. Research is now required to examine whether this increased use in ambulance is for appropriate emergencies.

Stroke education for multidisciplinary medical personnel in a rural area of Japan for promotion of hospital visit of acute stroke patients

BACKGROUND

There are few studies of stroke education suitable for multidisciplinary medical personnel. A reorganization of the management of acute stroke and stroke education for multidisciplinary medical personnel started since 2013 in our hospital located in a rural area of Japan. This study aimed to examine the effect of our stroke education on changing the number of visits of acute stroke patients to our hospital and to test the stroke knowledge of medical personnel.

METHODS

The stroke education, composed of a 20-minute lecture, was given by a stroke neurologist to 217 medical personnel (age, 49 ± 10 years; male, 70%). Posters printed with the FAST message were given to the participants at the end of the lesson: F, facial drooping; A, arm numbness or weakness; S, slurred speech or difficulty speaking or understanding; T, a time to call an ambulance. Participants completed questionnaires on stroke knowledge at baseline and 3 months after the lesson.

RESULTS

The number of participants who remembered correctly the FAST mnemonic at 3 months was significantly higher than at baseline (78 vs. 90%, P = .006). The correct answer rate for stroke symptoms other than FAST such as vision loss was approximately 50% at 3 months. The number of visits of acute stroke patients to our hospital, particularly patients with transient ischemic attack, increased significantly compared with that before the stroke education.

CONCLUSIONS

Our stroke education method using the FAST mnemonic designed for multidisciplinary medical personnel improved their stroke knowledge. Reorganization of the management of acute stroke and greater stroke knowledge for medical staff are necessary to increase the visits of acute stroke patients in the rural areas.

Evidence-to-practice gaps in post-stroke management: a focus on care in a stroke unit and anticoagulation to prevent death, disability and recurrent stroke

ABSTRACT: 

The global burden of stroke is large. Over the last 15 years significant advances have been made to improve acute stroke care and prevention management providing the ability to mitigate much of this burden. In this article, we describe the importance of two main elements of stroke care: stroke units to reduce death and disability and anticoagulation therapy to prevent recurrent, often fatal or disabling, cardioembolic stroke. We also describe the issues related to translating these interventions into practice and the related economic implications. Despite the proven effectiveness and cost–effectiveness of these and other interventions, many people experiencing stroke are not receiving these interventions. Effective evidence translation initiatives and routine monitoring of healthcare is needed to address important gaps in stroke management in promoting societal well-being.

Effects of stroke education using an animated cartoon and a manga on elementary school children

BACKGROUND

Stroke education for the youth is expected to reduce prehospital delay by informing the bystander of appropriate action to take and providing knowledge to prevent onset of stroke in future. Previously, we developed effective teaching materials consisting of an animated cartoon and a Manga for junior high school students. The aim of this study was to evaluate the feasibility and effectiveness of our educational materials for stroke education taught by schoolteachers to elementary school children.

METHODS

Using our teaching materials, a 30-minute lesson was given by trained general schoolteachers. Questionnaires on stroke knowledge (symptoms and risk factors) and action to take on identification of suspected stroke symptoms were filled out by school children before, immediately after, and at 3 months after completion of the lesson.

RESULTS

A total of 219 children (aged 10 or 11 years) received the stroke lesson. Stroke knowledge significantly increased immediately after the lesson compared with before (symptoms, P < .001; risk factors, P < .001); however, correct answer rates decreased at 3 months immediately after completion of the lesson (symptoms, P = .002; risk factors, P = .045). The proportion of the number of children calling emergency medical service on identifying stroke symptoms was higher immediately after the lesson than baseline (P = .007) but returned to the baseline at 3 months after the lesson.

CONCLUSIONS

Stroke lesson by schoolteachers using our teaching materials consisting of an animated cartoon and a Manga that was previously used for junior high school students was feasible for elementary school children. However, revision of the materials is required for better retention of stroke knowledge for children.

Translation of the 'time is brain' concept into clinical practice: focus on prehospital stroke management

Acute stroke is one of the main causes of death and chronic disability. Thrombolysis with recombinant tissue plasminogen activator within the first hours after onset of symptoms is an effective therapeutic option for ischemic stroke. However, fewer than 2% to 7% of patients receive this treatment, primarily because most patients reach the hospital too late for the initiation of successful therapy. Several measures can reduce detrimental delay until treatment. It is of importance to use continual public awareness campaigns to reduce delays in patients' alarm of emergency medical services. Further relevant measures are repetitive education of emergency medical services teams to ensure the systematic use of scales designed for recognition of stroke symptoms and the proper triage of patients to stroke centers. A most important time-saving measure is prenotification of the receiving hospital by the emergency medical services team. In the future, treatment already at the emergency site may allow more than a small minority of patients to benefit from available treatment.