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Frisullo G, Scala I, Di Giovanni J, Rizzo PA, Bellavia S, Broccolini A, Monforte M, Franceschi F, Gasbarrini A, Carbone L, Calabresi P, Covino M. Racial and ethnic differences in access to care and treatment in patients with suspected acute stroke: A retrospective, observational, cohort study. J Neurol Sci 2024; 466:123225. [PMID: 39270410 DOI: 10.1016/j.jns.2024.123225] [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: 07/14/2024] [Revised: 09/04/2024] [Accepted: 09/08/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Data regarding unequal diagnostic and therapeutic access in patients with acute stroke based on ethnicity and race are inconclusive in Europeans. The objectives of our study were to evaluate the effect of race/ethnicity on access to acute stroke care and treatments and outcomes. METHODS In this retrospective cohort study, we enrolled adult patients admitted to the emergency department of a comprehensive stroke center for suspected stroke. Based on race/ethnicity, patients were divided into two main groups: Western European Whites (WEW) and non-Western European Whites (nWEW). We also divided the nWEW group into four subgroups based on the Office of Management and Budget classification of human races and ethnicities (White-Others, Hispanic, Asian, Black). Univariate comparisons and logistic regression analyses were also performed. RESULTS 9167 patients were enrolled in the study: 582 in the nWEW and 8585 in the WEW group. Patients with ischemic stroke in the nWEW group were significantly younger than those in the other group (p < 0.001). Once adjusted for possible confounders, belonging to the nWEW group was found to be an independent predictor of a lower likelihood of receiving revascularization treatments (p = 0.006), regardless similar onset-to-door times. There were no differences in stroke outcomes and prevalence of stroke mimic diagnosis between the groups. CONCLUSIONS Racial/ethnic disparities in healthcare represent a challenging issue, even in universal healthcare systems, that should be addressed promptly through education campaigns of healthcare personnel and implementation measures, such as integrating readily available interpreter staff for medical emergencies.
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Affiliation(s)
- Giovanni Frisullo
- Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Irene Scala
- Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy.
| | - Jacopo Di Giovanni
- Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Pier Andrea Rizzo
- Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Simone Bellavia
- Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Aldobrando Broccolini
- Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Mauro Monforte
- Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
| | - Francesco Franceschi
- Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy; Emergency Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Antonio Gasbarrini
- Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy; Internal Medicine Unit, Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario Agostino Gemelli, 00168 Rome, Italy
| | - Luigi Carbone
- Emergency Department, Department of Emergency Medicine, Ospedale Fatebenefratelli Isola Tiberina, Gemelli Isola, Rome, Italy
| | - Paolo Calabresi
- Department of Neuroscience, Sense Organs, and Thorax, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy
| | - Marcello Covino
- Catholic University of Sacred Heart, Largo Francesco Vito 1, 00168 Rome, Italy; Emergency Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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Iskandar K, Rahme D, Salameh P, Haddad C, Sacre H, Bahlol M, Darwish RM, El Khatib S, Safwan J, Sakr F, Rahhal M, Hosseini H, Cherfane M. Evaluating the influence of a 3-min online video on the community knowledge of stroke in four Arab countries. Front Public Health 2024; 12:1342490. [PMID: 38841682 PMCID: PMC11151891 DOI: 10.3389/fpubh.2024.1342490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
Introduction Studies from developed and developing countries showed that the knowledge levels of stroke need improvement. Educational campaigns varied and were of limited influence predominantly because of their short duration and the need for financial support. The study aims to test the impact of a 3-min online video on the knowledge of stroke and factors influencing the knowledge score in four Arab countries. Methods A cross-sectional web-based pre-post study was conducted in Egypt, Jordan, Lebanon, and the United Arab Emirates. The data were collected using the snowball technique. Participants were adults aged 18 years and above. The questionnaire sequence was conducting a pretest, followed by the educational video explaining stroke occurrence, types, risks, warning signs, preventive measures, and treatment, and finally, a posttest to evaluate the differences in knowledge from baseline. Statistical analysis included paired t-tests comparing pre-post-education stroke knowledge scores, while repeated measures ANOVA, adjusting for covariates, assessed mean changes. Results The total number of participants was 2,721, mainly younger than 55 years. The majority had a university degree and were not healthcare professionals. A significant improvement was noted in the total knowledge score in all countries from a mean average (Mpretest = 21.11; Mposttest = 23.70) with p < 0.001. Identification of the stroke risks (Mpretest = 7.40; Mposttest = 8.75) and warning signs (Mpretest = 4.19; Mposttest = 4.94), understanding the preventive measures (Mpretest = 5.27; Mposttest = 5.39) and the importance of acting fast (Mpretest = 0.82; Mposttest = 0.85) improved from baseline with (p < 0.001) for all score components. Conclusion The educational tool successfully enhanced public understanding of stroke risks, the identification of stroke signs, and the critical need for emergency action. The advantages of this video include its short length, free online access, use of evidence-based content in lay language, and reflective images. The ultimate goal remains the long-term improvement of sustainability by mandating full-scale trials.
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Affiliation(s)
- Katia Iskandar
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Health and Social Work, School of Public Health, Lebanese University, Fanar, Lebanon
- Higher Institute of Public Health (ISSP), Saint Joseph University of Beirut, Beirut, Lebanon
| | - Deema Rahme
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Pharmacy Practice, School of Pharmacy, Beirut Arab University, Beirut, Beirut, Lebanon
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Faculty of Pharmacy, Lebanese University, Hadat, Lebanon
| | - Chadia Haddad
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Drug Information Center, Order of Pharmacists of Lebanon, Beirut, Egypt
- Department of Pharmaceutical management and economics, Department Pharmacy Practice and Clinical Pharmacy, Faculty of Pharmacy, Egyptian Russian University, Badr city, Cairo governorate, Egypt
| | - Mohamed Bahlol
- Department of Pharmaceutics and Pharmaceutical Technology, School of Pharmacy, The University of Jordan, Amman, Jordan
| | - Rula M. Darwish
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France
| | - Sarah El Khatib
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Department of Health and Social Work, School of Public Health, Lebanese University, Fanar, Lebanon
| | - Jihan Safwan
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Fouad Sakr
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- École Doctorale Sciences de la Vie et de la Santé, Université Paris-Est Créteil, Paris, France
- UMR U955 INSERM, Institut Mondor de Recherche Biomédicale, Université Paris-Est Créteil, Paris, France
| | - Mohamad Rahhal
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Hassan Hosseini
- INSERM U955-E01, IMRB, Henri Mondor Hospital, Créteil, France
- Department of Neurology, Henri Mondor Hospital, AP-HP, Créteil, France
| | - Michelle Cherfane
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
- Environmental and Public Health Department, College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
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Ramadan A, Kharaba Z, Ghemrawi R, Elnour AA, Hussain N, Kouhgard P, Al-Damook N, Abou Hait S, Al Ghanem L, Atassi R, Chkh Sobeh R, Z. Al Meslamani A. Assessment of Knowledge and attitude towards Stroke among the UAE population during the COVID-19 pandemic: A cross-sectional study. F1000Res 2023; 12:322. [PMID: 37854872 PMCID: PMC10579853 DOI: 10.12688/f1000research.129873.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 10/20/2023] Open
Abstract
Background: Despite significant advancements in healthcare, the burden of stroke continues to rise in the developed world, especially during the COVID-19 pandemic. Association between COVID-19 infection and stroke is well established. Factors identified for the delay in presentation and management include a lack of awareness regarding stroke. We aimed to assess the general public knowledge and attitudes on stroke and stroke risk factors in the United Arab Emirates during the COVID-19 pandemic. Methods: A cross-sectional study was conducted between September 2021 and January 2022 among adults≥ 18 years old. Participants completed a self-administered questionnaire on sociodemographic characteristics and stroke knowledge and attitudes. Knowledge and attitude scores were calculated based on the number of correct responses. Linear regression analysis was performed to determine the factors related to knowledge and attitude towards stroke. Results: Of the 500 respondents, 69.4% were females, 53.4% were aged between 18 and 25, and nearly half were students (48.4%). The mean knowledge score was 13.66 (range 2-24). Hypertension (69%), smoking (63.2%), stress (56.4%) obesity/overweight (54.4%), and heart disease (53.6%) were identified as risk factors. Overall, the knowledge of signs/symptoms was suboptimal. The mean attitude score was 4.41 (range, 1-6); 70.2% would call an ambulance if someone were having a stroke. A monthly income of 11,000-50,000 AED and being a student were associated with positive knowledge. Being a non-health worker and lacking access to electronic media sources were associated with worse attitudes. Conclusion: Overall, we identified poor knowledge and suboptimal attitudes toward stroke. These findings reflect the need for effective public health approaches to improve stroke awareness, knowledge, and attitudes for effective prevention in the community. Presently, this is of utmost necessity, given the increased occurrence of stroke and its severity among COVID-19 patients.
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Affiliation(s)
- Azza Ramadan
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
- Pharmaceutical Sciences, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Zelal Kharaba
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
- Program of Clinical Pharmacy, Al Ain University, Abu Dhbai, United Arab Emirates
- Honorary Associate Lecturer, Faculty of Medical Sciences, Newcastle University, Newcastle, UK
| | - Rose Ghemrawi
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
- Pharmaceutical Sciences, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Asim Ahmed Elnour
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
- Program of Clinical Pharmacy, Al Ain University, Abu Dhbai, United Arab Emirates
| | - Nadia Hussain
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
- Pharmaceutical Sciences, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Parisa Kouhgard
- Pharmaceutical Sciences, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Nosayba Al-Damook
- Pharmaceutical Sciences, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Shymaa Abou Hait
- Pharmaceutical Sciences, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Lena Al Ghanem
- Pharmaceutical Sciences, Al Ain University, Abu Dhabi, United Arab Emirates
| | - Rawan Atassi
- Cleveland Clinic, Cleveland Hospital, Abu Dhabi, United Arab Emirates
| | - Ranem Chkh Sobeh
- Cleveland Clinic, Cleveland Hospital, Abu Dhabi, United Arab Emirates
| | - Ahmad Z. Al Meslamani
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, United Arab Emirates
- Program of Clinical Pharmacy, Al Ain University, Abu Dhbai, United Arab Emirates
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Muacevic A, Adler JR, Kandi V. Clinical Research: A Review of Study Designs, Hypotheses, Errors, Sampling Types, Ethics, and Informed Consent. Cureus 2023; 15:e33374. [PMID: 36751199 PMCID: PMC9898800 DOI: 10.7759/cureus.33374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
Recently, we have been noticing an increase in the emergence and re-emergence of microbial infectious diseases. In the previous 100 years, there were several incidences of pandemics caused by different microbial species like the influenza virus, human immunodeficiency virus (HIV), dengue virus, severe acute respiratory syndrome Coronavirus (SARS-CoV), middle east respiratory syndrome coronavirus (MERS-CoV), and SARS-CoV-2 that were responsible for severe morbidity and mortality among humans. Moreover, non-communicable diseases, including malignancies, diabetes, heart, liver, kidney, and lung diseases, have been on the rise. The medical fraternity, people, and governments all need to improve their preparedness to effectively tackle health emergencies. Clinical research, therefore, assumes increased significance in the current world and may potentially be applied to manage human health-related problems. In the current review, we describe the critical aspects of clinical research that include research designs, types of study hypotheses, errors, types of sampling, ethical concerns, and informed consent.
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Stroke prevention and therapy awareness in a large sample of high school students: results of an educational campaign in the Northern-Western Italy. Neurol Sci 2022; 43:6847-6854. [PMID: 36087147 PMCID: PMC9463663 DOI: 10.1007/s10072-022-06372-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/25/2022] [Indexed: 10/25/2022]
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Abstract
ABSTRACT BACKGROUND: Stroke family caregivers were already struggling with unmet needs and changes in their own lives from providing care. The COVID-19 pandemic added further stress and disruption to their lives. The purpose of this study was to describe life changes in 17 stroke family caregivers specifically resulting from the COVID-19 pandemic. METHODS: This study was conducted as a secondary data analysis from an ongoing randomized controlled clinical trial testing feasibility of the Telehealth Assessment and Skill-Building Kit (TASK III). Using a multimethod design, both quantitative and qualitative data were analyzed to determine caregiver life changes. Quantitative ratings regarding life changes were obtained using 17 items adapted specifically for COVID-19 from the Bakas Caregiving Outcomes Scale. Rigorous content analysis procedures for the qualitative data were guided by a start list of codes based on the 17 items, with additional themes possible. Representative quotes were selected based on author consensus. RESULTS: Findings revealed both negative and positive life changes from the COVID-19 pandemic. Negative life changes included such things as disrupted daily routines, limited access to healthcare providers and resources (eg, food, masks, hand sanitizers), reduced family and social contact and activities, decreased emotional well-being, and problems with performing caregiving activities for the survivor. Positive life changes were increased use of the Internet and videoconferencing, closer relationships with friends, and learning how to access needed resources in new ways. CONCLUSION: Stroke family caregivers experienced both negative and positive life changes specifically as a result of the COVID-19 pandemic. Responses further indicated that COVID-19 affected most caregivers in different ways and an individualized approach is needed in dealing with caregiver life changes.
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Okonkwo UP, Uzuh FN, Nwankwo MJ, Okoye EC, Ummuna JO, Igwe ES, Maduagwu SM, Ani KU, Akobundu UN, Nwanne CA. Awareness of the risk factors of stroke among non-teaching staff of the Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [DOI: 10.1186/s43161-021-00057-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Abstract
Background
The prevalence of stroke is increasing in Nigeria due to a lack of awareness of their predisposing factors. There is therefore a need for good knowledge and awareness of stroke risk factors in the general populations. Thus, this study assessed the level of awareness of stroke risk factors among non-teaching staff in Nnamdi Azikiwe University, Nnewi Campus, Nigeria.
Results
Most of the participants were female, 89 (69%), and had a post-graduate degree, 84 (65.1%). A total of 129 participants participated in this survey, and 91 (70.5%) were familiar with the term “stroke.” The commonest risk factors were high blood pressure (86%), stress (74.4%), and lack of exercise (63.6%). The study showed that the awareness of stroke risk factors among the participants was poor (40.3%).
Conclusion
Stroke awareness was poor among the participants with the highest risk of stroke despite their high literacy level. Female participants, with a postgraduate level qualification and working as senior non-teaching staff, had a better awareness of stroke risk factors than their male colleagues. This shows a need to increase stroke awareness campaigns in the community.
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