Knowledge on Signs and Risk Factors in Stroke Patients

Knowledge, attitude, practice and illness perception toward subarachnoid hemorrhage prevention and management among intracranial aneurysm patients

OBJECTIVE

This study aims to explore the knowledge, attitude, practice and illness perception toward prevention and management of subarachnoid hemorrhages (SAH) among intracranial aneurysm (IA) patients.

METHODS

A cross-sectional study was conducted between March 2023 and June 2023; demographic characteristics and KAP scores were collected by a self-administered questionnaire and analyzed by linear regression and path analysis.

RESULTS

A total of 455 patients with IA were included, of them 26.37% experienced SAH before. Mean knowledge, attitude and practice scores were 16.60 ± 5.86, 16.39 ± 1.84, and 35.07 ± 3.51, respectively. The linear regression showed ethnic minority, married, education, family members in healthcare system, monthly per capita household income, experience ruptured intracranial aneurysms, smoking, hypertension, hyperlipidemia, diabetes, and aortic lesion were associated with knowledge scores. Age, ethnic minority, urban residence, education, family members in healthcare system, monthly per capita household income, duration of IA ≥6 months, experience ruptured intracranial aneurysms, smoking, diabetes, and aortic lesion were associated with attitude scores. Age, urban residence, monthly per capita household income, duration of IA ≥6 months, experience of ruptured intracranial aneurysms, smoking, diabetes, and aortic lesion were associated with practice scores. According to the path analysis, knowledge directly affected illness perception (β=0.156, P<0.001) and attitude (β=0.708, P<0.001), while attitude (β=0.909, P<0.001) and illness perception (β=0.039, P=0.027) affected practice.

CONCLUSIONS

Patients had positive attitudes towards SAH prevention and management, but a substantial knowledge gap was found along with notably delayed medical help-seeking behavior.

Stroke signs knowledge and factors associated with a delayed hospital arrival of patients with acute stroke in Kinshasa

Background

Rapid recognition and early medical intervention are essential to reduce stroke-related mortality and long-term disability. This study aimed to evaluate awareness of stroke symptoms/signs and determine factors delaying the hospital arrival of patients with acute stroke in Kinshasa.

Methods

Patients with stroke and/or accompanying family members were interviewed using a standard questionnaire, and their medical records were reviewed. Factors independently associated with a late arrival (≥4.5 h) to the hospital were identified using the logistic regression test in forward multivariate analysis.

Results

Overall, 202 patients with an average age of 57.9 ± 13.1 years were included. Only 27 (13.4%) patients immediately associated the initial symptoms with a stroke episode. Delayed hospital arrival was observed in 180 (89.1%) patients. Unmarried status (adjusted odds ratio [aOR], 2.29; 95% confidence interval [CI], 1.17-4.88; p = 0.007), low education level (aOR, 2.29; 95% CI, (1.12-5.10; p = 0,014), absence of impaired consciousness (aOR, 3.12; 95% CI, 1.52-4.43; p = 0.005), absence of a history of hypertention (aOR, 1.85; 95% CI, 1.18-3.78; p = 0.041), absence of a history of diabetes (aOR, 1.93; 95% CI, 1.15-4.58; p = 0.013), heavy alcohol consumption (aOR, 1.83; 95% CI, 1.12-2.83; p = 0.045), absence of a severe to very severe stroke (aOR, 4.93; 95% CI, 0.82-1.01; p = 0.002), and presence of ischemic stroke (aOR, 2.93; 95% CI, 1.54-4.59; p = 0.001) were identified as independent determinants of delayed hospital arrival.

Conclusions

This study depicted a low stroke awareness rate and a much longer prehospital delay than evidence-based guidelines recommend and identified eight factors that public health actions could target to promote the earliest management of stroke.

Continuity and Change in Baseline Stroke Knowledge across the world: Second Wave of FAST Heroes campaign implementation

OBJECTIVES

In this work we present the results of the implementation of a globally representative educational school-based stroke awareness programme, FAST (Face, Arm, Speech, Time) Heroes during the second year of education (wave 2). We aimed to observe changes in baseline stroke knowledge between wave 1 and wave 2, distinguish the more fine-grained effect of the campaign on society, and evaluate changes before and after the implementation of wave 2.

MATERIALS AND METHODS

In wave 2, parents of school-aged children completed an online stroke preparedness questionnaire before (t1) and after (t2) programme implementation. Results between the time points were analyzed with descriptive statistics alongside changes in baseline knowledge between waves 1 and 2.

RESULTS

1,611 parents participated in wave 2. Parents increased their knowledge of three stroke symptoms from 69% to 87% (p<.001). Their knowledge of the designated emergency number rose from 75% (t1) to 88% (t2) (p<.001). A 17% increase in baseline knowledge occurred in stroke symptoms identified correctly between wave 1 (11 countries) and 2 (18 countries).

CONCLUSIONS

Results support the precision and usability of the data collection approach in measuring the change in stroke knowledge between implementation waves. The increased baseline knowledge concerning stroke symptoms in wave 2 needs further examination.

Translation and validation of the Chinese version of the stroke knowledge test for the hypertension patient

The measurement of hypertensive patients' stroke knowledge is an important stroke prevention indicator of health care service quality. The aim of this study was to develop a Chinese version of the Stroke Knowledge Test and examine its psychometric properties, reliability, and validity for hypertensive patients. A sample of 200 hypertensive patients completed the Chinese version of the Stroke Knowledge Test, and 30 of the participants were retested after 2 weeks. The final Chinese version of the Stroke Knowledge Test included 20 items with acceptable content validity (I-CVI = 0.88 ~ 1.00, S-CVI/Ave = 0.97). These items showed satisfactory internal reliability consistency (Kuder Richardson-20 = 0.62) and test-retest reliability was 0.77. The 40% of the difficulty index was in the acceptable range, and 25% was in the difficult range, as well as the 90% items overall values for discrimination were ranged from 0.2 to > 0.4. Known-group validity testing was performed based on the education level, and the result exhibited significant difference (F = 21.21, p < 0.001). The Chinese version of the Stroke Knowledge Test demonstrated acceptable psychometric properties, thus providing a new tool for the future care of hypertensive patients in Taiwan. It also could be as a reference for healthcare providers to educate hypertensive patients on stroke prevention.

Al Meslamani A. Assessment of Knowledge and attitude towards Stroke among the UAE population during the COVID-19 pandemic: A cross-sectional study

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.

Stroke related knowledge, prevention practices and associated factors among stroke patients in Taizhou, China

Stroke is characterized by high morbidity, high mortality and high disability rate, which is a major health problem worldwide. However, most community-based studies report a lack of public knowledge related to stroke. The aim of this study is to investigate stroke-related knowledge and prevention practices among stroke patients in Taizhou, China. A face-to-face survey was conducted and questionnaires were completed by 156 S patients from June 27 to August 30, 2022. A generalized linear model was applied to explore the factors influencing prevention practices. Among the total participants, 36.5% and 40.4% of them had good knowledge of the stroke-related warning signs and risk factors, respectively. Participants who had good stroke prevention practices accounted for 57.7%. The higher score of stroke-related knowledge among inpatients, the better their prevention practices (B = 0.16, 95 %CI: 0.05 ∼ 0.28). In addition, those with age ≥ 60 (B = 1.20, 95 %CI: 0.42 ∼ 1.97), females (B = 0.93, 95 %CI: 0.24 ∼ 1.61), having physical activities (B = 1.01, 95 %CI: 0.33 ∼ 1.68), or without underlying diseases (B = -1.67, 95 %CI:-2.42 ∼ -0.92) were also related with prevention practices. In general, this survey indicated that the stroke-related knowledge and prevention practices of participants were not good enough. Stroke related knowledge, age, sex, physical activity, and underlying disease were significant factors related to stroke prevention practices. These findings suggest the need to focus on stroke health education for stroke patients.

Stroke vs. Preeclampsia: Dangerous Liaisons of Hypertension and Pregnancy

Stroke during pregnancy and preeclampsia are two distinct but interrelated medical conditions, sharing a common denominator-blood control failure. Along with cardiovascular diseases, diabetes, dyslipidemia, and hypercoagulability, hypertension is undoubtedly a major risk factor associated with stroke. Even though men have higher age-specific stroke rates, women are facing higher life-long stroke risk, primarily due to longer life expectancy. Sex hormones, especially estrogen and testosterone, seem to play a key link in the chain of blood pressure control differences between the genders. Women affected with stroke are more susceptible to experience some atypical stroke manifestations, which might eventually lead to delayed diagnosis establishment, and result in higher morbidity and mortality rates in the population of women. Preeclampsia is a part of hypertensive disorder of pregnancy spectrum, and it is common knowledge that women with a positive history of preeclampsia are at increased stroke risk during their lifetime. Preeclampsia and stroke display similar pathophysiological patterns, including hypertension, endothelial dysfunction, dyslipidemia, hypercoagulability, and cerebral vasomotor reactivity abnormalities. High-risk pregnancies carrying the burden of hypertensive disorder of pregnancy have up to a six-fold higher chance of suffering from stroke. Resemblance shared between placental and cerebral vascular changes, adaptations, and sophisticated auto-regulatory mechanisms are not merely coincidental, but they reflect distinctive and complex cardiovascular performances occurring in the maternal circulatory system during pregnancy. Placental and cerebral malperfusion appears to be in the midline of both of these conditions; placental malperfusion eventually leads to preeclampsia, and cerebral to stoke. Suboptimal performances of the cardiovascular system are proposed as a primary cause of uteroplacental malperfusion. Placental dysfunction is therefore designated as a secondary condition, initiated by the primary disturbances of the cardiovascular system, rather than an immunological disorder associated with abnormal trophoblast invasion. In most cases, with properly and timely applied measures of prevention, stroke is predictable, and preeclampsia is a controllable condition. Understanding the differences between preeclampsia and stroke in pregnancy is vital for healthcare providers to enhance their clinical decision-making strategies, improve patient care, and promote positive maternal and pregnancy outcomes. Management approaches for preeclampsia and stroke require a multidisciplinary approach involving obstetricians, neurologists, and other healthcare professionals.

Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations

Among the high prevalence of cerebrovascular diseases nowadays, acute ischemic stroke stands out, representing a significant worldwide health issue with important socio-economic implications. Prompt diagnosis and intervention are important milestones for the management of this multifaceted pathology, making understanding the various stroke-onset symptoms crucial. A key role in acute ischemic stroke management is emphasizing the essential role of a multi-disciplinary team, therefore, increasing the efficiency of recognition and treatment. Neuroimaging and neuroradiology have evolved dramatically over the years, with multiple approaches that provide a higher understanding of the morphological aspects as well as timely recognition of cerebral artery occlusions for effective therapy planning. Regarding the treatment matter, the pharmacological approach, particularly fibrinolytic therapy, has its merits and challenges. Endovascular thrombectomy, a game-changer in stroke management, has witnessed significant advances, with technologies like stent retrievers and aspiration catheters playing pivotal roles. For select patients, combining pharmacological and endovascular strategies offers evidence-backed benefits. The aim of our comprehensive study on acute ischemic stroke is to efficiently compare the current therapies, recognize novel possibilities from the literature, and describe the state of the art in the interdisciplinary approach to acute ischemic stroke. As we aspire for holistic patient management, the emphasis is not just on medical intervention but also on physical therapy, mental health, and community engagement. The future holds promising innovations, with artificial intelligence poised to reshape stroke diagnostics and treatments. Bridging the gap between groundbreaking research and clinical practice remains a challenge, urging continuous collaboration and research.

Knowledge and awareness of stroke and associated factors in the Saudi general population: a cross-sectional study

Introduction

Stroke is a major cause of death and disability globally and in Saudi Arabia as well. Prevention and management of stroke depend highly on raising knowledge and awareness about the disease.

Purpose

The purpose of this study was to evaluate Saudi adult's knowledge and awareness about stroke and determine the associated factors.

Materials and methods

A cross-sectional online survey was conducted in May-July 2022 among Saudi citizens. Assessments of stroke knowledge about risk factors, symptoms, and response to stroke symptoms were evaluated. Logistic regression was conducted to assess the association between the socio-demographic characteristics and knowledge.

Results

A total of 389 participants were enrolled with the majority (81.7%) being male participants. Less than half of the study subjects (43.3%) identified four out of five correct answers related to general knowledge about stroke. Almost all the participants were able to identify at least one risk factor associated with stroke. The majority of the participants (81.2%) believed that physical inactivity was the most common risk factor associated with stroke. Approximately three-quarters of participants considered difficulty speaking and understanding speech, followed by the sudden loss of consciousness as the most common stroke manifestation. Participants with a history of hypertension, dyslipidemia, and obesity had significantly higher odds of identifying at least one early stroke symptom (OR 2.271 [95% CI 1.402 3.677], 2.059 [95% CI 1.273 3.328], and 2.665 [95% CI 1.431 4.963], respectively).

Conclusion

Our study revealed that participants have good knowledge about stroke. Nonetheless, further efforts are required to raise awareness and educate the public to optimize and ensure better treatment outcomes.

Clinical characteristic of a Haitian stroke cohort and a scoping review of the literature of stroke among the Haitian population

Background and Aim

There are significant disparities in stroke care and outcomes between low- and middle-income countries compared to high-income countries. Haiti, a lower-middle-income country, suffers from a lack of resources for acute stroke management. This study is the first to report the epidemiological profile of the Haitian population presenting with stroke symptoms at the largest academic hospital in the nation.

Methods

This is an observational study conducted over a period of 5 months from April 2021 to August 2021 in the Internal Medicine Department of the State University Hospital of Haiti. There were 51 included patients who were suspected to have had an acute stroke. A descriptive statistical analysis was conducted. A scoping review of the literature was also conducted.

Results

Over 50% of included patients were between 19 and 65 years old. The mean age at presentation was 61 years, and patients were predominantly female (64.7%). The prevalence of severe motor deficits was over 96%. The mean National Institutes of Health Stroke Scale was 12. Only 15.7% of patients (8/51) had a computed tomography (CT) scan during their hospitalization. The median time to CT scan was 84 h after symptom onset. About 80% of those with complications took more than 24 h to arrive at the hospital after the onset of symptoms. Eleven percent of patients had complications, and the mortality rate was 3.9%. There was a significant association between the Modified Rankin Scale and the occurrence of complications (p = 0.016). National Institutes of Health Stroke Scale (NIHSS) score had a significant association with the Glasgow score (F = 6.3; p < 0.001) where an inversely proportional correlation was observed between them (r = -0.7; p < 0.001) and a proportional correlation with the Rankin prediction score and the NIHSS (r = 0.3, p = 0.04). Little is known about the epidemiology of stroke patients in Haiti, and this limits the ability to develop targeted interventions to improve outcomes. In our scoping review, only three pertinent studies were identified over a 25-year period, this leads to a lack of data in regard to stroke care in Haiti mainly due to the absence of trained personnel.

Conclusion

In our cohort, stroke is mainly affecting female patients. The majority of stroke patients have moderate to severe motor deficits and took more than 24 h to arrive at the hospital. Urgent assistance is needed to strengthen personnel and infrastructure dedicated to stroke. Neurological assessment based on NIHSS and Rankin score should be systematic in stroke evaluation in Haiti.

Relevance for Patients

This study is relevant for patients because it emphasizes the challenges of stroke management in Haiti due to the non-availability of reference drugs, the time to arrive at the hospital to start treatment, as well as the means of diagnosis which are limited, like the CT scan. While stroke prevalence is on the rise in the country, it is the highest in the Caribbean and Latin America region.

Lifestyle, clinical, and occupational risk factors of recurrent stroke among the working-age group: A systematic review and meta-analysis

Background

Stroke recurrence is increasing in the working-age population. This study aimed to summarize and evaluate the risk factors for recurrent stroke among the working-age population.

Methods

Relevant studies were extracted from several databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Fixed- or random-effects estimates of the pooled odds ratio (OR) and 95% confidence interval (CI) of risk factors for recurrent stroke were generated based on heterogeneity. Subgroup and publication bias analyses were also performed.

Results

Seventeen studies were included in the meta-analysis. Pooled effects results revealed that the risk of recurrent stroke in the working-age group was as follows: Diabetes (OR = 1.85, 95% CI: 1.47, 2.32), hypertension (OR = 1.27, 95% CI: 1.12, 1.44), smoking (OR = 1.52, 95% CI: 1.27, 1.81), history of cardiac disease (OR = 2.86, 95% CI: 2.22, 3.67), history of stroke (OR = 2.45, 95% CI: 1.81, 3.31), and National Institutes of Health stroke severity score (OR = 1.09, 95% CI: 1.03, 1.15).

Conclusion

These findings suggest that several factors, such as diabetes, hypertension, smoking, history of cardiac disease and stroke, and severity of a stroke, are potential risk factors for recurrent stroke in the working-age group. Therefore, strategies to reduce those risk factors should be adopted and attention paid to prevent recurrent stroke among working-age populations.

Public stroke awareness among Gharbia governorate inhabitants: a cross-sectional study

Background

Stroke is the most common acquired neurological disease in the adult population worldwide with an incidence of 16 million new cases every year responsible for about 6.1 million deaths and 130.6 million disability-adjusted life-years (DALYs). The objectives of this work were to study the level of stroke awareness and the proper response for suspected stroke patients in urban and rural areas of Tanta City, Egypt. The study was conducted on 1869 Egyptian Citizens; 908 and 961 reside in urban and rural areas, respectively, who were submitted to a face-to-face interview using the stroke awareness questionnaire (Arabic version).

Results

Rural participants showed a significant reduction in acute cerebrovascular stroke (CVS) awareness and knowledge including the most affected organ by CVS, what are the risk factors, what are the early stroke symptoms, is there specific treatment for acute ischemic stroke, and what is the proper reaction when confronted with a case of acute CVS?

Conclusion

Urban populations have better recognition of stroke risk factors, early stroke symptoms, and the proper response when confronted with a case of acute CVS when compared with rural people possibly due to better socioeconomic status and higher educational levels.

Direct Mechanical Thrombectomy Versus Prior Bridging Intravenous Thrombolysis in Acute Ischemic Stroke: A Systematic Review and Meta-Analysis

BACKGROUND

The current guideline recommends using an intravenous tissue-type plasminogen activator (IV tPA) prior to mechanical thrombectomy (MT) in eligible acute ischemic stroke (AIS) with emergent large vessel occlusion (ELVO). Some recent studies found no significant differences in the long-term functional outcomes between bridging therapy (BT, i.e., IV tPA prior to MT) and direct MT (dMT).

METHODS

We conducted a systematic review and meta-analysis to compare the safety and functional outcomes between BT and dMT in AIS patients with ELVO who were eligible for IV tPA administration. Based on the ELVO location, patients were categorized as the anterior group (occlusion of the anterior circulation), or the combined group (occlusion of the anterior and/or posterior circulation). A subgroup analysis was performed based on the study type, i.e., RCT and non-RCT.

RESULTS

Thirteen studies (3985 patients) matched the eligibility criteria. Comparing the BT and dMT groups, no significant differences in terms of mortality and good functional outcome were observed at 90 days. Symptomatic intracranial hemorrhagic (sICH) events were more frequent in BT patients in the combined group (OR = 0.73, p = 0.02); this result remained significant only in the non-RCT subgroup (OR = 0.67, p = 0.03). The RCT subgroup had a significantly higher rate of successful revascularization in BT patients (OR = 0.73, p = 0.02).

CONCLUSIONS

Our meta-analysis uncovered no significant differences in functional outcome and mortality rate at 90 days between dMT and BT in patients with AIS who had ELVO. Although BT performed better in terms of successful recanalization rate, there is a risk of increased sICH rate in this group.

Prevalence and Associated Factors of Cognitive Impairment Among Stroke Survivors at Comprehensive Specialized Hospitals in Northwest Ethiopia: Multi-Centered Cross-Sectional Study

Background

Deficit in cognitive impairment is the most serious of the stroke sequelae. Post-stroke cognitive impairment is associated with impaired daily living activities and decreased capacity for independent living and functional performance. As a result, the purpose of this study was to determine the prevalence and associated factors of cognitive impairment among stroke survivors at comprehensive specialized hospitals in Ethiopia's Amhara region by 2022.

Methods

A multi-centered cross-sectional study was designed at an institution. During the study period. Data was gathered by conducting structured questionnaire interviews with participants and reviewing medical charts with trained data collectors. The participants were chosen using a systematic random sampling technique. The Montreal cognitive assessment basic was used to assess cognitive impairment. Descriptive statistics, binary and multivariate logistic regression methods were used to analyze the data. The Hosmer-Lemeshow goodness-of-fit test was used to assess the fitness of the model. The AOR with a P value of 0.05 at 95% CI was reported, and variables were considered statistically significant.

Results

This study enrolled 422 stroke survivors. Overall, 58.3% of stroke survivors had cognitive impairment (95% CI 53.4-63.0%). The study participants' age with AOR; 7.12 (4.40-11.45), being hypertensive with AOR; 7.52 (3.46-16.35), arriving at the hospital after 24 hours with AOR; 4.33 (1.49-12.05), less than three months after stroke with AOR; 4.83 (3.95-12.19), dominant hemisphere lesion with AOR; 4.83 (3.95-12.19) and being illiterate with AOR; 5.26 (4.43-18.64) were found significant factors.

Conclusion

Cognitive impairment was discovered to be relatively common among stroke survivors in this study. More than half of stroke survivors who attended comprehensive specialized hospitals during the study period were found to have cognitive impairment. Age, hypertension, arriving at the hospital after 24 hours, less than three months after stroke, dominant hemisphere lesion, and illiterate educational status were all significant factors in cognitive impairment.

One-year recurrence of stroke and death in Lebanese survivors of first-ever stroke: Time-to-Event analysis

BACKGROUND

To date, despite the application of secondary prevention worldwide, first-ever stroke survivors remain at imminent risk of stroke recurrence and death in the short and long term. The present study aimed to assess the cumulative risk rates and identify baseline differences and stroke characteristics of Lebanese survivors.

METHODS

A prospective longitudinal study was conducted among survivors ≥18 years old who were followed-up for 15 months through a face-to-face interview. Kaplan-Meier method was used to calculate the cumulative rates of stroke mortality and recurrence. Cox-regression univariate and multivariable analyses were performed to identify the predictors of both outcomes.

RESULTS

Among 150 subjects (mean age 74 ± 12 years; 58.7% men vs. 44.3% women; 95.3% with ischemic stroke vs. 4.3% with intracerebral hemorrhage), high cumulative risk rates of stroke recurrence (25%) and death (21%) were highlighted, especially in the acute phase. Survival rates were lesser in patients with stroke recurrence compared to those without recurrence (Log rank test p < 0.001). Older age was the main predictor for both outcomes (p < 0.02). Large artery atherosclerosis was predominant in patients with stroke recurrence and death compared to small vessel occlusion (p < 0.02). Higher mental component summary scores of quality of life were inversely associated with stroke recurrence (p < 0.01). Lebanese survivors exhibited the highest percentages of depression and anxiety; elevated Hospital Anxiety and Depression Scale (HADS) scores were seen in those with stroke recurrence and those who died (≥80% with mean HADS scores ≥8). Lower Mini-Mental State Examination scores at the acute phase increased the risk of both outcomes by 10% (p < 0.03). Three out of 13 mortalities (23.1%) were presented with early epileptic seizures (p = 0.012). High educational level was the protective factor against stroke recurrence (p = 0.019). Administration of intravenous thrombolysis decreased the risk of both outcomes by 10% (p > 0.05).

CONCLUSION

Higher rates of stroke recurrence and death were observed in the first year following a stroke in Lebanon. Various factors were identified as significant determinants. Thus, health care providers and officials in Lebanon can use these findings to implement effective preventive strategies to best address the management of these factors to reduce the stroke burden and improve the short and long-term prognosis of stroke survivors.

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

Objectives

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

Methods

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

Results

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

Conclusion

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

Can We Learn from Our Children About stroke? Effectiveness of a School-Based Educational Programme in Greece

OBJECTIVES

We describe new findings from the implementation of an educational school-based stroke awareness programme, FAST (Face, Arm, Speech, Time) 112 Heroes, that teaches kindergarten children about stroke symptomatology and the appropriate action plan. The goal of our study was to examine whether the population mostly affected by stroke, i.e. the elderly, can be educated by young children, who have attended the programme.

MATERIALS AND METHODS

The educational programme was implemented face-to-face in a kindergarten in Athens, Greece, once a week for five consecutive weeks for one hour per week. Preschoolers (n = 137, aged 4.1-7, mean age=5.3) were enrolled in the programme and nominated two elderly members of their extended family (grandparents) as their own superheroes. Family members received personalized stroke-related material. Stroke awareness of the grandparents was measured before programme implementation (phase 1), after (prior to receiving the printed personalized stroke-related material, phase 2) and three months after receiving the printed personalized stroke-related material (phase 3).

RESULTS

Data was obtained from 63 grandparents (48 women; aged 60-84, mean age=69.5 years). Family members demonstrated significant increases in stroke symptom knowledge (p < 0.001) and appropriate course of action (p ≤ 0.001) after participating in the program (phase 2) and receiving printed personalized stroke-related material (phase 3). The majority of the participants (86.84%) reported positive feedback about the received material, the programme, and their interaction with their grandchildren during the programme.

CONCLUSIONS

Elderly family members outside the nuclear family can be successfully educated about stroke through their grandchildren and the FAST 112 Heroes programme.

Temporal Trend of the Prevalence of Modifiable Risk Factors of Stroke: An Ecological Study of Brazilians between 2006 and 2012

Stroke is one of the leading causes of death worldwide, including in Brazil. This study aimed to analyze the temporal trend of the prevalence of modifiable risk factors of stroke from 2006 to 2012. This ecological study was conducted by secondary analysis in May 2018, using data from the surveillance of risk factors and protection for chronic diseases by telephone inquiry (VIGITEL) available in the Department of Informatics of the Unified Health System (DATASUS). The modifiable risk factors of stroke in Brazilians were systemic arterial hypertension, diabetes mellitus, abusive alcohol consumption, overweight, and obesity. Overall, there was a significant increase in the risk factors of diabetes (β = 0.30, P = 0.001, r2 = 0.99), overweight (β = 0.50, P = 0.002, r2 = 0.98), and obesity (β = 0.88, P < 0.001, r2 = 0.96). However, there was a stability in the prevalence of hypertension (β = 0.25, P = 0.320, r2 = 0.88) and alcohol abuse (β = 0.32, P = 0.116, r2 = 0.49). There was an increase in the prevalence of diabetes mellitus, overweight, and obesity, but stability in systemic arterial hypertension and abusive alcohol consumption in the Brazilian population.

Awareness of Being at Risk of Stroke and Its Determinant Factors among Hypertensive Patients in Banyumas, Indonesia

Background

The global burden of stroke is still high, particularly in developing countries, with hypertension serving as the main risk factor. The awareness of stroke among hypertensive patients is crucial for stroke prevention. This study was aimed at identifying the awareness of being at risk of stroke and its determinant factors among hypertensive patients in Banyumas, Indonesia.

Methods

This was a cross-sectional study conducted in Primary Health Centers (PHCs) in Banyumas Regency, Indonesia, from April to August 2019. A simple random sampling technique was used to select the representatives' PHCs. Hypertensive patients who came regularly to the PHCs were consecutively recruited. Data were collected through a self-reported questionnaire and medical records. The main outcome was the level of participants' awareness of being at risk of stroke. Multivariate logistic regression analysis was performed to measure determinant factors associated with the level of awareness.

Results

Out of 457 patients investigated, 77.46% had a low level of awareness. Low knowledge of hypertension, low income, and no history of previous stroke were associated with a low-level of awareness (odds ratio (OR) 1.942, 95% CI 1.195-3.158, p 0.007; OR 2.321, 95% CI 1.326-4.064, p 0.003; and OR 6.033, 95% CI 2.450-14.858, p < 0.001, respectively).

Conclusion

Majority of hypertensive patients were unaware of being at risk of stroke. Knowledge of hypertension, income, and history of previous stroke are factors that may influence the awareness of being at risk of stroke among them. This emphasizes the need to provide better campaigns and education programs to raise the awareness of stroke in a community setting, particularly for the population at risk.

Understanding the importance of recognising, treating and preventing stroke

Stroke is a medical emergency, resulting in a significant number of annual deaths in the UK and representing a major cause of disability. Early recognition of the signs and symptoms of stroke is vital to ensure effective and potentially lifesaving treatment. It is important that nurses are able to recognise the risk factors for stroke, as well as being aware of the potential treatment modalities. This article details the signs and symptoms, and risk factors for stroke, as well as outlining the treatment options. The author also explains the important role of nurses in stroke prevention and the long-term care of people who have experienced a stroke and their family members.

Awareness of the risk factors of stroke among non-teaching staff of the Nnamdi Azikiwe University, Nnewi Campus, Anambra State, Nigeria

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.

Knowledge on Stroke Warning Signs and Associated Factors Among Hypertensive Patients, Northwest Ethiopia: An Institution-Based Cross-Sectional Study

INTRODUCTION

Stroke is one of the leading causes of death globally and is a major cause of disability worldwide. It is a preventable and treatable disease by the prevention of modifiable risk factors and early recognition of warning signs, respectively.

OBJECTIVE

To assess knowledge on stroke warning signs and associated factors among hypertensive patients at South Gondar Zone Comprehensive Specialized Hospital, Northwest Ethiopia, 2020.

METHODS

An institution-based cross-sectional study was conducted in South Gondar Zone Comprehensive Specialized Hospital from June 1-30, 2020. A systematic random sampling technique was used and data were collected through face to face interviews. Data were entered into Epi data version 4.6.0.0 and exported to SPSS version 25 for cleaning and analysis. Bivariate and multivariable logistic regression analysis was used and variables with p <0.05 in the multivariable analysis were considered as statistically significant.

RESULTS

Two hundred and fifty-three hypertensive patients completed the questionnaire with a response rate of 100%. Among the total respondents, 15% (95% CI: 10.7, 19.4) of participants had good knowledge of stroke warning signs. Younger age (AOR: 2.82; 95% CI: 1.18, 6.74), urban residence (AOR: 2.9; 95% CI: 1.04, 8.11), being educated (AOR: 2.6; 95% CI: 1.09, 6.23) and having long duration hypertension follow up (AOR: 2.7; 95% CI: 1.25, 5.81) were significantly associated with good knowledge of stroke warning signs.

CONCLUSION

This study revealed that participants had poor knowledge of stroke warning signs. Younger age, urban residence, being educated and having long duration hypertension follow up were predictors of good stroke warning signs knowledge. Health information dissemination needs to be strengthened for hypertensive patients, particularly for older, rural residents, the non-educated and those having short duration of hypertension follow up.

Perceptions about the Therapeutic Itinerary after stroke: a qualitative research

OBJECTIVES

to analyze the understanding of the Therapeutic Itinerary of people affected by stroke in the Unified Health System context of a medium-sized city in the state of São Paulo.

METHODS

this is a clinical-qualitative, using in-depth semi-structured interviews, conducted in 2019 with 6 patients, a number determined by theoretical saturation.

RESULTS

qualitative content analysis allowed the construction of four categories that emerged from the data: a) You are having a stroke! - Identifying the problem; b) Anguish and expectations in waiting for assistance; c) Helplessness and guidance for rehabilitation after hospital discharge; d) Spirituality in rehabilitation after stroke.

FINAL CONSIDERATIONS

the affected people expressed feelings and meanings, such as fear, anguish, sadness, beliefs and uncertainties, in order to shed light on the complexity inherent to the experiences of Therapeutic Itinerary of stroke.

Knowledge of Risk Factors and Warning Signs of Stroke Among Patients with Heart Disease at Tikur Anbessa Specialized Hospital

BACKGROUND

Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are extensive. The inability to identify stroke warning signs accurately is an important cause of delay in seeking medical attention, leading to potential ineligibility for acute intervention and which leads to secondary complications.

PURPOSE

To identify cardiac patients' knowledge of stroke risk factors and warning signs.

PATIENTS AND METHODS

The institutional based cross-sectional study design was employed. Participants were selected using systematic random sampling. Close-ended questionnaires were pre-tested and validated for consistency before data collection. Then after data collection, data were checked and entered into Epi-data 4.6. Finally, the cleaned data were exported to SPSS version 25 for analysis. Statistical analysis using binary logistic regression was done and Predictors with a p-value of <0.05 were considered statistically significant.

RESULTS

A total of 227 patients were included in the study, of which 140 (61.7%) of them identified physical inactivity, followed by hypertension126 (55.5%) as stroke risk factor while 15.4% of them did not know any risk factor of stroke. Amongst the study participants, 45.81% of them had adequate knowledge of stroke risk factors. Regarding stroke warning signs the most identified sign was sudden unilateral weakness 142 (62.6%) while 46 (20.26%) of them did not know at least one warning sign of a stroke. Based on multivariable logistic regression analysis, higher education level AOR 3.05 (95% CI 1.62-5.74) and Urban residence area AOR 2.07 (95% CI 1.05-4.1) were significantly associated with knowledge of stroke risk factors with p-value<0.05.

CONCLUSION

Study participants had inadequate knowledge of stroke risk factors and warning signs. Educational status and information about stroke are significantly associated with adequate knowledge of stroke risk factors, raising stroke awareness is the mainstay to reduce stroke burden.