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Waweru PK, Yulu E, Matuja SS, Gatimu SM. UPESI: Swahili translation of the FAST acronym for stroke awareness campaigns in East Africa. Afr J Emerg Med 2024; 14:141-144. [PMID: 38974391 PMCID: PMC11226961 DOI: 10.1016/j.afjem.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 05/03/2024] [Accepted: 05/27/2024] [Indexed: 07/09/2024] Open
Abstract
Introduction Despite stroke being a leading cause of death and disability in sub-Saharan Africa, stroke awareness remains a major hurdle to early stroke response and care in the region. To improve stroke awareness, we endeavoured to borrow a leaf from initiatives in high-income countries, beginning with the translation and dissemination of the acronym, FAST (Face, Arms, Speech, Time) to Swahili. Methods We formed a translation group consisting of two stroke physicians, one nurse and two professional translators, all native Swahili speakers. Forward translation of the original document from English to Swahili was done by one Swahili translator; followed by a backward translation by another translator. Clinician reviews and cognitive reviews were then done, and a final translation was developed. Results We developed the acronym UPESI, a Swahili translation of the word, FAST. The acronym stands for U so kupooza upande mmoja; P ooza mkono/mguu (au kupoteza hisia); ugumu ku- E leza/kuongea; SI mu upesi translating to face drooping, arm/leg paralysis, difficulty in speaking/explaining and fast to the phone. Conclusion The result of this process is a Swahili translation of the FAST tool for stroke awareness campaigns. The translation will improve communication during stroke campaigns and increase awareness of stroke.
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Affiliation(s)
- Peter Kuria Waweru
- Department of Neurosurgery, Kenyatta University Teaching, Referral and Research Hospital, Nairobi, Kenya
- Department of Stroke Research, Pan-African Centre for Health Equity, Nairobi, Kenya
- Nairobi Stroke Clinic, Nairobi, Kenya
| | - Elijah Yulu
- Department of Stroke Research, Pan-African Centre for Health Equity, Nairobi, Kenya
- Department of Family Medicine, AIC Kijabe Mission Hospital, Kijabe, Kenya
| | - Sarah Shali Matuja
- Department of Internal Medicine, Catholic University of Health and Allied Sciences-Weill Bugando, Mwanza, Tanzania
| | - Samwel Maina Gatimu
- Department of Stroke Research, Pan-African Centre for Health Equity, Nairobi, Kenya
- Research Department, Diabetes Foot Foundation of Kenya, Nairobi, Kenya
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Ambarika R, Said MSM, Adiutama NM, Anggraini NA, Poddar S, Abdullah BF. Knowledge and awareness of stroke in rural and urban communities. ENFERMERIA CLINICA (ENGLISH EDITION) 2024; 34:168-176. [PMID: 38641005 DOI: 10.1016/j.enfcle.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 04/21/2024]
Abstract
INTRODUCTION The average stroke morbidity rate, especially in rural communities, is higher when compared to the national average. OBJECTIVE Identify the profile of knowledge and awareness of stroke in rural and urban communities and analyze the differences between the two. METHOD Respondents who met the requirements answered a questionnaire containing a total of 41 items regarding knowledge and awareness of stroke. Characteristic data obtained includes age, gender, education, occupation, and ethnicity. Differences in characteristics were analyzed using Mann-Whitney, and the profiles of knowledge and awareness of stroke in rural and urban groups were analyzed using independent t tests to see differences between the two. RESULT Differences in the characteristics of rural and urban groups were only in education (p = 0.036) and occupation (p = 0.021). The mean score of the knowledge domain for the rural group was 72.53 (SD = 11.04), for the urban group it was 81.06 (SD = 11.12). The mean score awareness of stroke domain in the rural group was 72.18 (SD = 11.01), the urban group was 85.51 (SD = 11.67). The profile of knowledge and awareness of stroke in rural communities was significantly lower than in urban communities. The significance value was (p = 0.004) for knowledge and (p = 0.002) for awareness of stroke. CONCLUSION Based on the findings, it is reasonable to suspect that educational and occupational factors contribute to differences in the profile of knowledge and awareness of stroke in the two groups. Therefore, the stroke awareness campaign strategy for rural communities needs to be specifically designed by emphasizing/considering educational and occupational factors.
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Affiliation(s)
| | | | | | | | - Sandeep Poddar
- Lincoln University College, Petaling Jaya, Selangor, Malaysia
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Liu R, Zhao J, Pandian JD, Ford GA, Ji Q, Abraham SV, Ji X, Rudd A. Expert opinions from the 2024 closed door round table discussion on improving stroke prehospital care globally. CNS Neurosci Ther 2024; 30:e14746. [PMID: 38727596 PMCID: PMC11086018 DOI: 10.1111/cns.14746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/16/2024] [Indexed: 05/12/2024] Open
Affiliation(s)
- Renyu Liu
- Department of Anesthesiology and Critical CarePerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Jing Zhao
- Department of NeurologyMinhang Hospital Affiliated to Fudan UniversityShanghaiChina
| | | | - Gary A Ford
- Radcliffe Department of MedicineUniversity of Oxford, UKOxfordUK
| | - Qiuhong Ji
- Department of NeurologyNantong University School of MedicineNantongChina
| | - Siju V. Abraham
- Department of Emergency MedicineJubilee Mission Hospital, Medical College & Research InstituteKeralaIndia
| | - Xunming Ji
- Department of NeurosurgeryXuanwu Hospital, Capital UniversityBeijingChina
| | - Anthony Rudd
- Stroke Research Group and Division for Health & Social Care ResearchKing's College LondonLondonUK
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Zhao J, Yuan J, Lu K, Rudd A, Liu R. Why we should raise stroke awareness in the younger population? CNS Neurosci Ther 2023; 29:757-759. [PMID: 36628543 PMCID: PMC9928542 DOI: 10.1111/cns.14067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- Jing Zhao
- Department of Neurology, Minhang HospitalFudan UniversityShanghaiChina
| | - Jing Yuan
- Minhang Hospital, School of PharmacyFudan UniversityShanghaiChina
| | - Kevin Lu
- University of South CarolinaColumbiaSouth CarolinaUSA
| | | | - Renyu Liu
- Departments of Anesthesiology and Critical Care, and NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Melifonwu R, Onwuekwe I, Zhao J, Liu R. Prehospital stroke care in Africa: The reality and potential solutions. CNS Neurosci Ther 2022; 29:5-7. [PMID: 36317707 PMCID: PMC9804051 DOI: 10.1111/cns.14005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 10/11/2022] [Indexed: 01/01/2023] Open
Affiliation(s)
- Rita Melifonwu
- Life after Stroke CentreStroke Action NigeriaOnitshaNigeria,Department of Nursing ScienceNnamdi Azikiwe UniversityAwkaNigeria
| | - Ikenna Onwuekwe
- Department of Medicine, Faculty of Medical Sciences, College of MedicineUniversity of NigeriaNsukkaNigeria
| | - Jing Zhao
- Department of NeurologyMinhang Hosptial, Fudan UniversityShanghaiChina
| | - RenYu Liu
- Department of Anaesthesiology and Critical CarePerelman School of Medicine at the University of PhiladelphiaPhiladelphiaPennsylvaniaUSA,Department of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
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Liu R, Zhao J, Li X, Messe S, Fisher M, Rudd A. To use stroke 911 to improve stroke awareness for countries where 911 is used as an emergency phone number. CNS Neurosci Ther 2022; 28:1473-1475. [PMID: 35924380 PMCID: PMC9437232 DOI: 10.1111/cns.13931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/17/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Renyu Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.,Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jing Zhao
- Department of Neurology, Minhang Hosptial, Fudan University, Shanghai, China
| | - Xiaobin Li
- Internal Medicine and President, Everest Medical Group, Philadelphi, Pennsylvania, USA
| | - Steven Messe
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony Rudd
- Stroke Medicine, Kings College London, London, UK
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Tsakpounidou K, van der Merwe J, Klinke ME, Webb C, Ouriques Martins SC, Proios H. FAST Heroes: Results of Cross-Country Implementation of a Global School-Based Stroke Education Campaign. Front Public Health 2022; 10:849023. [PMID: 35509512 PMCID: PMC9058110 DOI: 10.3389/fpubh.2022.849023] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundEducating the at-risk population about stroke symptoms and requirement of calling an ambulance when stroke strikes is challenging. This exploratory cross-country study provides insights to the FAST Heroes educational campaign and outcomes hitherto achieved.AimsThe primary aim of the study was to measure the transfer of stroke-related knowledge to parents after a global school-based FAST Heroes educational campaign for 5- to 9-year-old children in 14 different countries. The secondary aim was to evaluate parents and teachers' acceptability toward the program.MethodsThe duration of the program was 5 h; 1 h per week, joining face-to-face educational sessions with workbooks, cartoons, web-based learning, and other fun activities. Outcomes were measured before implementation (t1), after implementation (t2), and at 6-month follow-up (t3). Program acceptability and stroke knowledge were evaluated by feedback surveys for teachers and parents.ResultsWorldwide, 4,202 parents completed the program with their children and answered surveys at t1 and t2. They increased their knowledge of three stroke symptoms from 48 to 83% (p < 0.001). All three surveys were completed by 86 parents, who improved their knowledge of stroke symptoms, 55% (t1), 79% (t2), and 94% (t3) (p < 0.001). Overall, the educational messages were successfully passed onward.ConclusionsFindings confirm the primary aim of the study that is knowledge about stroke transfer well from children to their families through the FAST Heroes program. Second, parents and teachers globally consider the program feasible and worthwhile. The results will inform further rollout of the campaign.
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Affiliation(s)
- Kalliopi Tsakpounidou
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
- *Correspondence: Kalliopi Tsakpounidou
| | - Jan van der Merwe
- Boehringer Ingelheim International Gesellschaft mit Beschränkter Haftung (GmbH), Healthcare Affairs and Patient Engagement, Ingelheim am Rhein, Germany
| | | | | | - Sheila Cristina Ouriques Martins
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Hospital Moinhos de Vento, Neurology, Porto Alegre, Brazil
| | - Hariklia Proios
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
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Ling L, Li Z, Yao S, Liu X, Zhao J. Poor awareness of stroke educational tools among older adults in China. Brain Behav 2021; 11:e2357. [PMID: 34520639 PMCID: PMC8553324 DOI: 10.1002/brb3.2357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 08/21/2021] [Accepted: 08/23/2021] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- Ling Ling
- Department of General Medicine, Qibao Community Health Service Center, Shanghai, China
| | - Zhongcheng Li
- Department of General Medicine, Wujing Community Health Service Center, Shanghai, China
| | - Sichen Yao
- Department of General Medicine, Wujing Community Health Service Center, Shanghai, China
| | - Xiaochuan Liu
- WanNan Medical College, Anhui, China.,Department of Neurology, Minhang hospital, Fudan university, Shanghai, China
| | - Jing Zhao
- Department of Neurology, Minhang hospital, Fudan university, Shanghai, China
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Tsakpounidou K, Psomiadis S, Pourliaka T, Akritidou M, Proios H. Baseline Stroke Literacy of Young Children Based on "FAST 112 Heroes" Program. Front Public Health 2021; 9:638516. [PMID: 34055715 PMCID: PMC8160088 DOI: 10.3389/fpubh.2021.638516] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/22/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Young children are often unaware of emergency health conditions, such as stroke, and could serve as important vehicles to save the lives of their grandparents, who are more likely to suffer a stroke. An important aspect for the evaluation of public awareness on stroke signs and related emergency procedures is to examine the level of baseline stroke knowledge children have and whether they understand when to seek medical care on time. Objective: To examine the level of stroke symptomatology knowledge in children as well as evaluate their preparedness in stroke response before their participation in the educational program “FAST (Face, Arms, Speech, Time) 112 Heroes.” Methods: For the purpose of this work, a questionnaire was developed and adapted to preschoolers' needs. The present study involved 123 children (65 boys, 58 girls, aged 4–6.5 years; mean age: 5.30, S.D.: 0.59) from two cities in Greece. Five multiple-choice animated pictures, that were age-appropriate, were administrated to each child, along with verbal explanations provided by the investigator. Results: More than half of the participants (n = 65, 52.8%) could recognize the symptom of face drooping, 53 children (43.1%) could identify the symptom of arm hemiparesis/hemiplegia and 92 children (74.8%) were able to answer the question regarding speech disturbances. However, the number of correct answers to the question regarding the appropriate course of action in case of a stroke was the lowest among all the questions (10.6% of participants gave a correct answer). Furthermore gender and age did not play a significant role (p = 0.571 and 0.635, respectively). Conclusion: Although more than half of the enrolled preschool children could recognize stroke symptoms before their participation in the educational program, their baseline stroke knowledge, prior to their training, is low. Concurrently, they do not have sufficient knowledge on how to react appropriately in the event of a stroke. Therefore, awareness programs focusing on developing stroke literacy to children are needed, to ensure children will seek urgent medical care in case of a stroke.
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Affiliation(s)
- Kalliopi Tsakpounidou
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
| | - Socrates Psomiadis
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
| | - Tatiana Pourliaka
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
| | | | - Hariklia Proios
- Department of Educational and Social Policy, University of Macedonia, Thessaloniki, Greece
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Comparison of FAST and Stroke-112: A randomized study in Taiwan. J Formos Med Assoc 2021; 121:187-192. [PMID: 33736903 DOI: 10.1016/j.jfma.2021.02.018] [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: 12/13/2020] [Revised: 02/17/2021] [Accepted: 02/22/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND/PURPOSE FAST and Stroke-112 are two campaigns to reduce the emergency room arrival time of stroke patients. No study has compared the effectiveness of these campaigns. This study aimed to compare recalling capacity of people in these two campaigns. METHODS A prospective, open-label randomized study was conducted in 2019. Recall ability for the items of the two campaigns on the 5th and 30th days post-education was compared using non-parametric methods. Subject characteristics including age, education level, presence of stroke in co-residents, and habitual language were evaluated using multiple ordered logistic regression. RESULTS There were 202 participants in FAST group and 193 participants in Stroke-112 group who completed the study. No differences were observed between the two groups in recall ability, either on day 5 or day 30 after receiving education. For both campaigns, recall ability was better for signs in the face (FAST: 87.1%, Stroke-112: 86.5%) and the arm (FAST: 87.1%, Stroke-112: 88.1%) than for abnormality in speech (FAST: 78.7%, Stroke-112: 76.7%) on day 5. Recall ability on day 30 remained the same only for the arm item (FAST: 86.1%, Stroke-112: 88.6%). The recall ability was correlated to education level equal or more than 7 years in FAST group, and was inversely correlated to age and being a stroke patient in Stroke-112 group. CONCLUSION We found no difference in recall ability between the 2 campaigns. Education level was associated with recallability of FAST, and age and stroke history were associated with recallability of Stroke-112.
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Liu R, Fisher M, Rudd A, Zhao J. Speech disturbance plays critical role in stroke recognition during COVID-19 pandemic. CNS Neurosci Ther 2021; 27:267-269. [PMID: 33452869 PMCID: PMC7871789 DOI: 10.1111/cns.13608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Renyu Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Anthony Rudd
- Stroke Medicine, Kings College London, London, UK
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
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Pu C, Guo JY, Yu-Hua-Yeh, Sankara P. Comparison of knowledge on stroke for stroke patients and the general population in Burkina Faso: a cross-sectional study. AIMS Public Health 2020; 7:723-735. [PMID: 33294477 PMCID: PMC7719564 DOI: 10.3934/publichealth.2020056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/07/2020] [Indexed: 11/18/2022] Open
Abstract
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.
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Affiliation(s)
- Christy Pu
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Jiun-Yu Guo
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Hua-Yeh
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
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Liu R, Zhao J, Fisher M. The global impact of COVID-19 on acute stroke care. CNS Neurosci Ther 2020; 26:1103-1105. [PMID: 32725844 PMCID: PMC7539838 DOI: 10.1111/cns.13442] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/06/2020] [Accepted: 07/11/2020] [Indexed: 01/11/2023] Open
Affiliation(s)
- Renyu Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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14
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Zhao J, Li H, Kung D, Fisher M, Shen Y, Liu R. Impact of the COVID-19 Epidemic on Stroke Care and Potential Solutions. Stroke 2020; 51:1996-2001. [PMID: 32432997 PMCID: PMC7258753 DOI: 10.1161/strokeaha.120.030225] [Citation(s) in RCA: 240] [Impact Index Per Article: 60.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 04/30/2020] [Accepted: 05/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE When the coronavirus disease 2019 (COVID-19) outbreak became paramount, medical care for other devastating diseases was negatively impacted. In this study, we investigated the impact of the COVID-19 outbreak on stroke care across China. METHODS Data from the Big Data Observatory Platform for Stroke of China consisting of 280 hospitals across China demonstrated a significant drop in the number of cases of thrombolysis and thrombectomy. We designed a survey to investigate the major changes during the COVID-19 outbreak and potential causes of these changes. The survey was distributed to the leaders of stroke centers in these 280 hospitals. RESULTS From the data of Big Data Observatory Platform for Stroke of China, the total number of thrombolysis and thrombectomy cases dropped 26.7% (P<0.0001) and 25.3% (P<0.0001), respectively, in February 2020 as compared with February 2019. We retrieved 227 valid complete datasets from the 280 stroke centers. Nearly 50% of these hospitals were designated hospitals for COVID-19. The capacity for stroke care was reduced in the majority of the hospitals. Most of the stroke centers stopped or reduced their efforts in stroke education for the public. Hospital admissions related to stroke dropped ≈40%; thrombolysis and thrombectomy cases dropped ≈25%, which is similar to the results from the Big Data Observatory Platform for Stroke of China as compared with the same period in 2019. Many factors contributed to the reduced admissions and prehospital delays; lack of stroke knowledge and proper transportation were significant limiting factors. Patients not coming to the hospital for fear of virus infection was also a likely key factor. CONCLUSIONS The COVID-19 outbreak impacted stroke care significantly in China, including prehospital and in-hospital care, resulting in a significant drop in admissions, thrombolysis, and thrombectomy. Although many factors contributed, patients not coming to the hospital was probably the major limiting factor. Recommendations based on the data are provided.
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Affiliation(s)
- Jing Zhao
- From the Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China (J.Z.)
| | - Hang Li
- Department of Cerebrovascular Disease, Henan Provincial People’s Hospital, Zhengzhou, China (H.L.)
| | - David Kung
- Department of Neurosurgery and Interventional Neuroradiology (D.K.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Marc Fisher
- Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (M.F.)
| | - Ying Shen
- Department of Traditional Chinese Medicine, Xuanwu Hospital Capital Medical University, Beijing, China (Y.S.)
| | - Renyu Liu
- Department of Anesthesiology and Critical Care (R.L.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia
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Vrudhula A, Zhao J, Liu R. Too Young to Have a Stroke?-a Global Health Crisis. Stroke Vasc Neurol 2019; 4:173-175. [PMID: 32030199 PMCID: PMC6979873 DOI: 10.1136/svn-2019-000295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/13/2022] Open
Abstract
This editorial discusses the importance of improving awareness of stroke in young individuals. Stoke can occur in any age group and is not restricted to elderly populations. Today, the average age of the first-time stroke patient continues to decrease. However, the incidence of stroke in seemingly healthy, young adults remains neglected, and stroke awareness among young patients remains poor, even in well-developed countries. Education targeting two common barriers to stroke care, identification and rescue, should be implemented for both medical professionals and the public domain. Only through education can we reduce preventable stroke-related death and damage in young patients moving forward.
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Affiliation(s)
- Amey Vrudhula
- Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jing Zhao
- Minhang Hospital, Fudan University, Shanghai, China
| | - Renyu Liu
- Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Liu X, Weng Y, Liu R, Zhao J. Significant Stroke Knowledge Deficiencies in Community Physician Improved with Stroke 120. J Stroke Cerebrovasc Dis 2019; 28:104323. [PMID: 31562040 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104323] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/16/2019] [Accepted: 07/25/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND AND PURPOSE In the existing model of community health service in China, community general practitioners play important roles in health promotion as well as prehospital stroke recognition and management. We recently engineered Stroke 120 based on FAST for China. This investigation aimed to investigate its acceptance in community physicians and promote their stroke related knowledge. METHODS We conducted an stroke education session to community physicians or family doctors (total of 435 participants), teaching both FAST and Stroke 120. Online survey was distributed to the participants before and after the education session to evaluate the awareness of stroke and the acceptance of the stroke recognition tool. RESULTS Significant stroke knowledge deficiencies were found in community physicians. After the education session, percent of the participants knew that the thrombolytic therapeutic window (<4.5 hours) was improved from 54.0% to 91.6% (P < .001). A total of 88.5% of them would send their patients who had stroke to the nearest hospital with stroke center by emergency medical service, compared to baseline (64.4%, P < .001). In total, 95.2% of them would recommend thrombolytic therapy in the treatment of acute ischemic stroke compared to 82.7% (baseline P < .001). Although majority mastered both FAST (95.5%) and Stroke 120 (98.0%) through our education session, 96.3% of them believe that Stroke 120 is the most suitable for Chinese in stroke education. CONCLUSIONS Stroke 120 strategy was well accepted by the community physicians in China and in the meantime improved knowledge regarding stroke was observed.
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Affiliation(s)
- Xiaochuan Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China; Wannan Medical College, Anhui, China.
| | - Yingfeng Weng
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Renyu Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China; Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China.
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Bray JE, Finn J, Cameron P, Smith K, Straney L, Cartledge S, Nehme Z, Lim M, Bladin C. Temporal Trends in Emergency Medical Services and General Practitioner Use for Acute Stroke After Australian Public Education Campaigns. Stroke 2018; 49:3078-3080. [PMID: 30571429 DOI: 10.1161/strokeaha.118.023263] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Janet E Bray
- From the Department of Epidemiology and Preventive Medicine (J.E.B., J.F., P.C., K.S., L.S., S.C., Z.N.), Monash University, Melbourne, Victoria, Australia.,Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.).,Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., P.C., M.L.)
| | - Judith Finn
- From the Department of Epidemiology and Preventive Medicine (J.E.B., J.F., P.C., K.S., L.S., S.C., Z.N.), Monash University, Melbourne, Victoria, Australia.,Prehospital, Resuscitation and Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.)
| | - Peter Cameron
- From the Department of Epidemiology and Preventive Medicine (J.E.B., J.F., P.C., K.S., L.S., S.C., Z.N.), Monash University, Melbourne, Victoria, Australia.,Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., P.C., M.L.)
| | - Karen Smith
- From the Department of Epidemiology and Preventive Medicine (J.E.B., J.F., P.C., K.S., L.S., S.C., Z.N.), Monash University, Melbourne, Victoria, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia (K.S., Z.N., C.B.)
| | - Lahn Straney
- From the Department of Epidemiology and Preventive Medicine (J.E.B., J.F., P.C., K.S., L.S., S.C., Z.N.), Monash University, Melbourne, Victoria, Australia
| | - Susie Cartledge
- From the Department of Epidemiology and Preventive Medicine (J.E.B., J.F., P.C., K.S., L.S., S.C., Z.N.), Monash University, Melbourne, Victoria, Australia.,Department of Community Emergency Health and Paramedic Practice (K.S., Z.N.), Monash University, Melbourne, Victoria, Australia.,Institute for Physical Activity and Nutrition, Deakin University, Burwood, Australia (S.C.)
| | - Ziad Nehme
- From the Department of Epidemiology and Preventive Medicine (J.E.B., J.F., P.C., K.S., L.S., S.C., Z.N.), Monash University, Melbourne, Victoria, Australia.,Department of Community Emergency Health and Paramedic Practice (K.S., Z.N.), Monash University, Melbourne, Victoria, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia (K.S., Z.N., C.B.)
| | - Michael Lim
- Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., P.C., M.L.)
| | - Christopher Bladin
- Eastern Health Clinical School (C.B.), Monash University, Melbourne, Victoria, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Doncaster, Australia (K.S., Z.N., C.B.).,Florey Institute, Melbourne, Victoria, Australia (C.B.)
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