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Hua S, Dong Z, Wang H, Liu T. Global, regional, and national burden of ischemic stroke in older adults (≥60 years) from 1990 to 2021 and projections to 2030. Front Neurol 2025; 16:1567609. [PMID: 40406698 PMCID: PMC12094992 DOI: 10.3389/fneur.2025.1567609] [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: 01/27/2025] [Accepted: 04/16/2025] [Indexed: 05/26/2025] Open
Abstract
Background Ischemic stroke is a leading cause of disability and mortality among adults worldwide, particularly in the older population (≥60 years). With the accelerating global aging population, it is crucial to analyze the trends and influencing factors of the global, regional, and national burden of ischemic stroke and forecast future trends. These insights are essential for informing the formulation of public health policies. Methods Using data from the Global Burden of Disease (GBD) 2021 database, this study examined the age-standardized incidence, age-standardized prevalence, age-standardized mortality, and age-standardized disability-adjusted life years (DALYs) of ischemic stroke in individuals aged 60 years and above from 1990 to 2021. A combination of variables, including the socio-demographic index (SDI), sex, and age groups, was applied in regression analyses and Bayesian predictive models to examine trends and forecast the burden of ischemic stroke up to 2030. Results From 1990 to 2021, despite global population growth among older adults, the age-standardized incidence, age-standardized prevalence, age-standardized mortality, and age-standardized disability-adjusted life years of ischemic stroke demonstrated an overall declining trend (all EAPCs were negative). The decline in disease burden was most pronounced in high-SDI regions, while low-SDI regions faced a significantly higher disease burden and exhibited notable regional disparities. The overall burden of ischemic stroke was higher in males than in females; however, in the 80-84 age group, females exceeded males in disease burden. Projections indicate that by 2030, the burden of ischemic stroke in older adults globally will continue to decline. Nevertheless, due to the aging population, the absolute number of patients is expected to increase. Conclusion The global burden of ischemic stroke has significantly decreased, particularly in high-SDI regions with abundant healthcare resources. However, low-SDI regions face more substantial public health challenges. It is recommended to enhance the control of high-risk factors such as hypertension, smoking, and high BMI, and to optimize healthcare services in low-income regions to further reduce the burden of ischemic stroke and improve the quality of life for older adults.
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Affiliation(s)
- Shuting Hua
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zexian Dong
- School of Medicine, Jinan University, Guangzhou, China
| | - Hui Wang
- Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China
| | - Tong Liu
- The Fifth Clinical College of Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Acupuncture and Rehabilitation, Guangdong Provincial Second Hospital of Traditional Chinese Medicine, Guangzhou, China
- Guangdong Provincial Key Laboratory of Research and Development in Traditional Chinese Medicine, Guangzhou, China
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2
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Chen C, Hou Z, Li L, Wang R, Liu H, Shen H. Stroke 1-2-0-3-6: rapid identification and timely action for stroke in China. Front Neurol 2025; 16:1537895. [PMID: 40242618 PMCID: PMC12000585 DOI: 10.3389/fneur.2025.1537895] [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] [Received: 12/02/2024] [Accepted: 03/17/2025] [Indexed: 04/18/2025] Open
Abstract
In 2016, doctors in China proposed the Chinese version of FAST, called Stroke 120, to improve stroke identification and response in the Chinese population. And we modified Stroke 120 by adding "3" and "6" which aimed to reduce the prehospital delays and improve the prognosis of patients with stroke.
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Affiliation(s)
- Chen Chen
- Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
| | - Ziwei Hou
- Shanxi Medical University, Taiyuan, China
| | - Li Li
- Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
| | - Ruiying Wang
- Department of Neurology, Changzhi No. 2 People's Hospital of Shanxi Province, Changzhi, Shanxi, China
| | - Hong Liu
- Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
| | - Hui Shen
- Department of Neurology, Shanxi Cardiovascular Hospital, Taiyuan, Shanxi, China
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Shi L, Xu M, Su Q. Research progress on influencing factors and intervention measures of pre-hospital delays in acute ischemic stroke. Technol Health Care 2025; 33:1121-1127. [PMID: 39973852 DOI: 10.1177/09287329241296739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Abstract
BackgroundStroke, a leading cause of health impairment globally, sees intravenous thrombolysis as the primary treatment during the acute phase, yet delays persist due to pre-hospital and in-hospital factors. While research has reduced in-hospital delays significantly, pre-hospital delays remain a concern both domestically and internationally.ObjectiveThis article aims to provide a comprehensive review of the research progress on the influencing factors and intervention measures of pre-hospital delays in acute ischemic stroke.MethodsBy analyzing the literature, summarize the risk factors leading to treatment delay in acute ischemic stroke (AIS), and provide a review of potential improvement methods.ResultsPre-hospital delay in acute ischemic stroke (AIS) is influenced by both objective factors like age, gender, and regional economic status, as well as subjective factors such as stroke awareness. The introduction of "Stroke 120," a stroke education slogan tailored to Chinese language habits, aims to improve stroke awareness and address delayed treatment and low AIS venous thrombolysis utilization among the Chinese publicConclusionIn conclusion, collaborative efforts from the government, society, and hospitals are essential to enhance stroke education comprehensively. This will ensure widespread awareness of stroke knowledge, facilitating timely and effective treatment for AIS patients.
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Affiliation(s)
- Liming Shi
- Department of Neurology, the Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Muqun Xu
- Department of Neurology, the Second Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Qingjie Su
- Department of Neurology, the Second Affiliated Hospital of Hainan Medical University, Haikou, China
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Ymeraj M, Kotica F, Bozzolan G, Rocco G, Virgolesi M, Alvaro R, Vellone E, Pucciarelli G. Health literacy in stroke disease: A systematic review. JOURNAL OF VASCULAR NURSING 2025; 43:33-45. [PMID: 40057351 DOI: 10.1016/j.jvn.2025.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Revised: 11/28/2024] [Accepted: 01/05/2025] [Indexed: 05/13/2025]
Abstract
BACKGROUND Health literacy has been demonstrated to be a factor that influences patients' ability to retain clinical education and counselling. AIMS To describe: (1) the importance of health literacy in the prevention of stroke; (2) the correlation of risk factors with health literacy; and (3) the importance of health literacy in post-stroke outcomes. METHODS A systematic review was conducted using the following databases: PubMed (via Medline), CINAHL (via EBSCO), PsycINFO (via EBSCO), and Web of Science (via EBSCO) for studies focused on health literacy in stroke. We included qualitative, quantitative and observational studies. The critical appraisal tool of JBI-Checklists was used to assess the methodological quality of the included studies. RESULTS Thirty-three studies, involving 35,935 participants, were selected for this systematic review. Most of the studies (41 %) were cross-sectional. Health literacy levels among the general population and stroke patients were found to be relatively low, indicating the need for increased stroke education. Hypertension and stress were the most frequently identified risk factors while pregnancy and oral contraceptives, and anticoagulants were the least. People at risk of stroke have indicated a desire for more practical information and individually tailored behavioral interventions. CONCLUSIONS The results of this study highlighted the deficiency in health literacy among different populations. We noticed that even a simple educational intervention can help to improve health literacy. Targeting the general public is important in order to rapidly translate knowledge into action and to reduce the time from symptom onset to hospital arrival as time plays an important role in stroke.
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Affiliation(s)
- Migena Ymeraj
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - Fatjon Kotica
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Giorgia Bozzolan
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gennaro Rocco
- Center of Excellence for Nursing Culture and Research, Order of Nursing Professions of Rome, Rome, Italy; International Center for Nursing Research Montianum Our Lady of Good Counsel Catholic University Tirana, Tirana, Albania
| | | | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Tan Y, Sun X, Qin F, Cai Y. Factors affecting stroke pre-hospital delay behavioral intention among community residents: A path analysis. Appl Nurs Res 2024; 78:151820. [PMID: 39053993 DOI: 10.1016/j.apnr.2024.151820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 08/01/2023] [Accepted: 06/25/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Pre-hospital delay is the major cause of stroke treatment delay, and behavioral intention is considered to be the most direct predictor of behavior. Therefore, to effectively reduce stroke pre-hospital delay, it is essential to further understand the relationship between stroke pre-hospital delay intention (SPDBI) and its social-psychological influencing factors, namely personality traits, social support and coping style. AIM This study aims at examining the relationships among personality traits, coping style, social support, and SPDBI. METHODS A cross-sectional, self-administered questionnaire was distributed to 845 residents. The content of the questionnaire included demographic information, the knowledge of "Stroke 120", Ten-Item Personality Inventory-Chinese version, Simplified Coping Style Questionnaire, Perceived Social Support Scale and SPDBI Scale. Path analysis was used to investigate the relationship among SPDBI and its psychosocial influencing factors. RESULTS The final path model showed a good fit to the data (χ2/df = 2.981, RMSEA = 0.048, GFI = 0.936, CFI = 0.941). Extroversion (β = 0.106), positive coping (β = -0.110), negative coping (β = 0.150) and the knowledge of "Stroke 120" (β = -0.152) had only direct effects on SPDBI. While agreeableness (β = 0.113), openness (β = -0.121) and social support (β = -0.118) had direct effects on SPDBI, they also had indirect effects (β = -0.009; -0.022; -0.049) on SPDBI though positive coping. CONCLUSIONS Adequate social support and positive coping of health threat may reduce residents' SPDBI. Meanwhile, the interventions to reduce SPDBI should take personality differences into consideration.
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Affiliation(s)
- Yibing Tan
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Xinglan Sun
- Guangzhou First People's Hospital, Guangzhou, Guangdong Province, China
| | - Fengyin Qin
- Xiangyang Central Hospital, Xiangyang, Hubei Province, China
| | - Yefeng Cai
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China.
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Abraham SV, Joy A, Sahu AK, Ravindra P, Dhar S, Teja R, Krishnan SV, Liu R, Rudd AG, Ford GA. Barriers to Effective Prehospital and Hyperacute Stroke Care in India: A Physician Perspective. J Emerg Trauma Shock 2024; 17:129-135. [PMID: 39552827 PMCID: PMC11563232 DOI: 10.4103/jets.jets_156_23] [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] [Received: 12/20/2023] [Revised: 01/30/2024] [Accepted: 03/01/2024] [Indexed: 11/19/2024] Open
Abstract
Introduction The incidence of stroke is increasing in India. Prehospital stroke care is crucial for reducing stroke morbidity and mortality, but its implementation in India faces several challenges. Limited original research exists on prehospital stroke care in India, making it essential to identify the problems in implementing effective prehospital stroke care. Methods A web-based survey was conducted among registered medical practitioners in India who treat acute stroke. The survey questionnaire was developed in English and included 26 questions divided into five parts: questions about the physician's practice setup/hospital in India, perception of community awareness, existing prehospital care/systems, in-hospital stroke care availability, and specific issues faced. Results Eighty-three doctors in India participated in the survey (43% response rate). Most of the respondents worked in private hospitals (68%) and urban areas (76%). While 89% of hospitals had ambulance services, over 33% reported that patients had to pay for ambulance transport. Among respondents, 12% reported a community stroke care network, with infrequent prehospital procedures such as random blood glucose measurement (22%), stroke identification (15.7%), "last seen normal" documentation (14.5%), and low prehospital notification to hospitals (5%). Delays in referral from peripheral centers were reported by 73% of respondents. Most hospitals had standard operating procedures (SOPs) (84%), computed tomography (CT) (94%), magnetic resonance imaging (MRI) (85%), and offered intravenous thrombolysis (IVT) (77%). However, 24 h availability of CT was reported only by 6%, MRI by 19% and IVT by 12%. Nearly half (45%) reported treatment with thrombolysis was not covered by insurance. Mechanical thrombectomy was available in 34% of hospitals and 63% of hospitals conducted in-hospital audits for stroke patients. Conclusions The capabilities of stroke-catering hospitals in urban settings are encouraging, with many having SOPs, imaging capabilities, and thrombolysis and mechanical thrombectomy services. However, there is much room for improvement, in making the essential stroke care services financially accessible to all and available around the clock.
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Affiliation(s)
- Siju V. Abraham
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
- The World Stroke Organization Taskforce for Prehospital Care, Geneva, Switzerland
| | - Anita Joy
- Department of Emergency Medicine, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
| | - Ankit Kumar Sahu
- Department of Emergency Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prithvishree Ravindra
- Department of Emergency Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shirshendu Dhar
- Department of Emergency Medicine, Agartala Government Medical College, Agartala, Tripura, India
| | - Ravi Teja
- Department of Emergency Medicine, Srikakulam Government Medical College, Srikakulam, Andhra Pradesh, India
| | - S. Vimal Krishnan
- Department of Emergency Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Renyu Liu
- The World Stroke Organization Taskforce for Prehospital Care, Geneva, Switzerland
- Department of Anesthesiology and Critical Care and Neurology, Perelman School of Medicine at the University of Pennnsylvania, PA, USA
| | - Anthony George Rudd
- The World Stroke Organization Taskforce for Prehospital Care, Geneva, Switzerland
- Department of Population Health Sciences, Kings College, London
| | - Gary A. Ford
- The World Stroke Organization Taskforce for Prehospital Care, Geneva, Switzerland
- Radcliffe Department of Medicine, University of Oxford and Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
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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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Cao W, Wang J, Wang Y, Hassan II, Kadir AA. mHealth App to improve medication adherence among older adult stroke survivors: Development and usability study. Digit Health 2024; 10:20552076241236291. [PMID: 38465293 PMCID: PMC10921861 DOI: 10.1177/20552076241236291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 02/14/2024] [Indexed: 03/12/2024] Open
Abstract
Background Effective medication adherence is vital for older adult stroke survivors, yet 20-33% cease treatment within a year post-discharge, increasing risks of recurrent strokes and mortality. A mobile health (mHealth) app could be a novel tool to improve medication adherence among stroke survivors because of its potential to increase patient empowerment. A few stroke-related apps provide information and support to stroke survivors. However, none have focused on medication adherence and documented their development and evaluation process, particularly those focused on this older population. Objective This study aims to design and develop a smartphone app called OASapp to improve medication adherence among older adult stroke survivors and evaluate its usability. Methods OASapp was developed in a three-phase development process. Phase 1 is the exploration phase (including a cross-sectional survey, a systematic review, a search for stroke apps on the app stores of Apple App Store and Google Play Store, and a nominal group technique). In phase 2, a prototype was designed based on the Health Belief Model and Technology Acceptance Model. In phase 3, Alpha and Beta testing was conducted to validate the app. Results Twenty-five features for inclusion in the app were collected in round one, and 14 features remained and were ranked by the participants during nominal group technique. OASapp included five core components (medication management, risk factor management, health information, communication, and stroke map). Users of OASapp were satisfied based on reports from Alpha and Beta testing. The mean Usability Metric for User Experience (UMUX) score was 71.4 points (SD 14.6 points). Conclusion OASapp was successfully developed using comprehensive, robust, and theory-based methods and was found to be highly accepted by users. Further research is needed to establish the clinical efficacy of the app so that it can be utilized to improve clinically relevant outcomes.
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Affiliation(s)
- Wenjing Cao
- Xiangnan University, Chenzhou, Hunan Province, China
- School of Health Sciences, Universiti Sains Malaysia, Kota Baru, Kelantan, Malaysia
| | - Juan Wang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Yuhui Wang
- Central South University, Changsha, Hunan Province, China
| | - Intan Idiana Hassan
- School of Health Sciences, Universiti Sains Malaysia, Kota Baru, Kelantan, Malaysia
| | - Azidah Abdul Kadir
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Liu Y, Wang D, Chu M, Yang Z, Luo Y, Wang D, Zhao J. Value of the stroke 1-2-0 prehospital stroke education system: the experience of a general practitioner team. BMC Neurol 2023; 23:431. [PMID: 38062426 PMCID: PMC10770900 DOI: 10.1186/s12883-023-03476-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Stroke is one of the leading causes of death worldwide, especially in developing countries. In China, there is an urgent need to educate people about stroke awareness and the importance of using emergency medical services (EMS) quickly after a stroke has occurred. OBJECTIVE We sought to explore the effects of the Stroke 1-2-0 Prehospital Stroke Education System based on the experience of a general practitioner team. METHOD We prospectively enrolled 119 community general practitioners to be trained in the procedures advocated by the Stroke 1-2-0 Prehospital Stroke Education System. The training content included early detection of ischemic stroke, first aid for stroke, and intravenous thrombolysis; The effects of the training were later evaluated via a before-and-after comparison. The 119 enrolled physicians formed a Stroke 1-2-0 lecturer group and taught stroke knowledge to community residents. The group remained active for 6 months, during which the medical treatment data of stroke patients (i.e., stroke onset time, prehospital delay, whether an ambulance was called, and whether thrombolytic therapy was performed) in each of 5 jurisdictions were recorded for the month before (January 2021) and that after (August 2021) the 6-month community education program. Finally, the effects of the community education program were evaluated. RESULTS The participants' understanding of intravenous thrombolysis in the treatment of acute ischemic stroke improved significantly after the training as compared with their earlier understanding (96% vs. 78.99%; P < .001), and their understanding of the time window for intravenous thrombolysis increased from 26.05% before to 72% (P < .001) after the training. Most of the participants (90% vs. 67.23%; P < .001) said that they would immediately call the 120 emergency number of China's emergency phone system if they encountered individuals who appeared to be victims of acute stroke. A total of 82 stroke patients were seen before and 67 after the community education program. As for the use of the emergency call system, more patients with stroke activated that system after the program versus before (21.95% vs. 37.31%; P = .04). The 3-hour arrival rate after the program was nearly three times higher than that before the program (62.69% vs. 19.51%; P < .001). Also, regarding receiving thrombolysis after the occurrence of a stroke, the program triggered a substantial increase compared with the total earlier (19.4% vs. 6.1%; P = .013). CONCLUSION We found that the Stroke 1-2-0 Prehospital Stroke Education System significantly improved community residents' knowledge regarding stroke.
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Affiliation(s)
- Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
| | - Daosheng Wang
- Department of Neurosurgery, Minhang Hospital, Fudan University, Shanghai, China
| | - Min Chu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Zhenzhen Yang
- Department of General Medicine, Xinzhuang Community Health Service Center, Shanghai, China
| | - Yunhe Luo
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Delong Wang
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, 201100, China.
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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: 0.5] [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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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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Yang Y, Dai J, Min J, Song Z, Zha S, Chang L, Chai J, Yang Y, Liu Y, Zhang X, Wu X, Gong Y, Wang X, Li F, Qin H. Evaluation of stroke health education for primary school students in Dali, China. Front Public Health 2022; 10:861792. [PMID: 35983366 PMCID: PMC9379307 DOI: 10.3389/fpubh.2022.861792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To provide us with some evidence to develop more targeted stroke intervention strategies, improve the health awareness of stroke among children, and advocate the health promotion campaign of “small hands holding big hands” among parents and children, we have conducted a health education program on stroke among primary school students in Dali. Methods This study has applied stratified random cluster sampling in Dali of Yunnan, China. We compared the improvement of students' knowledge of stroke before and after our health education program in primary school students of Dali in October 2020. Data were collected through 3 rounds of survey by using the same questionnaire. Results There were 215 participants aged 7–8 years old sampled in the first phase of the study and 145 participants in the follow-up study. The knowledge of stroke among the participants was relatively low in the pre-intervention survey. After the health education, all the indicators on stroke knowledge were improved. The correct rates in stroke definition, sequelae, and “1-2-0” identification were increased from 0 to 66.05%, to 53.95% and 64.19%, respectively, in both pre-intervention and post-intervention surveys. The correct rate of stroke knowledge was about 4.83–92.41% 3 months after the intervention. The mean score of the questionnaire was 4.25 ± 0.19 in the pre-intervention survey, and that was 15.85 ±0.27 in the post-intervention one. The mean score was 14.02 ± 0.28 post-3-month test. The score in the 3-month survey after the intervention was 11.55% lower than that in the post-intervention score. Conclusions The effect of stroke-related knowledge in the health education program for children is improved significantly and this can last for 3 months but it also had attenuation. We should repeat pertinent health education among students.
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Affiliation(s)
- Yunjuan Yang
- Department of School Health, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
- Public Health School, Kunming Medical University, Kunming, China
- Public Health School, Dali University, Dali, China
- *Correspondence: Yunjuan Yang
| | - Jing Dai
- School of Economics and Management, Kunming University of Science and Technology, Kunming, China
- Jing Dai
| | - Jieqing Min
- Cardiac Ultrasound Department, Kunming Children's Hospital, Kunming, China
- Jieqing Min
| | - Zhizhong Song
- Department of School Health, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Shun Zha
- Department of School Health, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Litao Chang
- Department of School Health, Yunnan Provincial Center for Disease Control and Prevention, Kunming, China
| | - Jiajia Chai
- City College, Kunming University of Science and Technology, Kunming, China
| | - Youpei Yang
- Office, Dali Centers for Disease Control and Prevention, Dali, China
| | - Yang Liu
- School of Economics and Management, Kunming University of Science and Technology, Kunming, China
| | - Xin Zhang
- School of Economics and Management, Kunming University of Science and Technology, Kunming, China
| | - Xiyun Wu
- School of Economics and Management, Kunming University of Science and Technology, Kunming, China
| | - Yuwen Gong
- School of Economics and Management, Xi'an Jiaotong University, Xi'an, China
| | - Xin Wang
- Society and People School, Renmin University of China, Peking, China
| | - Fang Li
- Public Health School, Dali University, Dali, China
| | - Haiyan Qin
- Infection Control Department, The First People's Hospital of Kunming, Kunming, China
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Shao Y, Zhang Z, Jin B, Xu J, Peng D, Geng Y, Zhang J, Zhang S. Design and validation of a new scale for prehospital evaluation of stroke and large vessel occlusion. Ther Adv Neurol Disord 2022; 15:17562864221104511. [PMID: 35795134 PMCID: PMC9251951 DOI: 10.1177/17562864221104511] [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: 02/13/2022] [Accepted: 05/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background Rapid recognition of acute stroke and large vessel occlusion (LVO) is essential in prehospital triage for timely reperfusion treatment. Objective This study aimed to develop and validate a new screening tool for both stroke and LVO in an urban Chinese population. Methods This study included patients with suspected stroke who were transferred to our hospital by emergency medical services between July 2017 and June 2021. The population was randomly partitioned into training (70%) and validation (30%) groups. The Staring-Hypertension-atrIal fibrillation-sPeech-weakneSs (SHIPS) scale, consisting of both clinical and medical history information, was generated based on multivariate logistic models. The predictive ability of the SHIPS scale was evaluated and compared with other scales using receiver operating characteristic (ROC) curve comparison analysis. Results A total of 400 patients were included in this analysis. In the training group (n = 280), the SHIPS scale showed a sensitivity of 90.4% and specificity of 60.8% in predicting stroke and a sensitivity of 75% and specificity of 61.5% in predicting LVO. In the validation group (n = 120), the SHIPS scale was not inferior to Stroke 1-2-0 (p = 0.301) in predicting stroke and was significantly better than the Cincinnati Stroke Triage Assessment Tool (C-STAT; formerly CPSSS) and the Prehospital Acute Stroke Severity scale (PASS) (all p < 0.05) in predicting LVO. In addition, including medical history in the scale was significantly better than using symptoms alone in detecting stroke (training group, 0.853 versus 0.818; validation group, 0.814 versus 0.764) and LVO (training group, 0.748 versus 0.722; validation group, 0.825 versus 0.778). Conclusion The SHIPS scale may serve as a superior screening tool for stroke and LVO identification in prehospital triage. Including medical history in the SHIPS scale improves the predictive value compared with clinical symptoms alone.
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Affiliation(s)
- Yanqi Shao
- Center for Rehabilitation Medicine, Department of Neurology, People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Zheyu Zhang
- Center for Rehabilitation Medicine, Department of Neurology, People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Bo Jin
- Center for Rehabilitation Medicine, Department of Neurology, People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Jingsi Xu
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Deqing Peng
- Center for Rehabilitation Medicine, Department of Neurosurgery, People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Yu Geng
- Center for Rehabilitation Medicine, Department of Neurology, People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Jungen Zhang
- Hangzhou Emergency Medical Center of Zhejiang Province, Hangzhou, China
| | - Sheng Zhang
- Center for Rehabilitation Medicine, Department of Neurology, People's Hospital of Hangzhou Medical College, Zhejiang Provincial People's Hospital, 158# Shangtang Road, Hangzhou 310014, Zhejiang, China
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15
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Liu X, Yao S, Ling L, Li Z. Stroke 120 or FAST (Face, Arm, Speech, Time): Which is Better in Stroke Awareness Promotion for Older Residents Living in Shanghai? J Stroke Cerebrovasc Dis 2022; 31:106490. [DOI: 10.1016/j.jstrokecerebrovasdis.2022.106490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/07/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022] Open
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Yuan J, Li M, Liu Y, Xiong X, Zhu Z, Liu F, Wang Y, Hu W, Lu ZK, Liu R, Zhao J. Analysis of Time to the Hospital and Ambulance Use Following a Stroke Community Education Intervention in China. JAMA Netw Open 2022; 5:e2212674. [PMID: 35579896 PMCID: PMC9115614 DOI: 10.1001/jamanetworkopen.2022.12674] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 03/29/2022] [Indexed: 12/03/2022] Open
Abstract
Importance Prehospital delay (time from symptom onset of stroke to the door of a hospital) in patients with stroke is long in China. With the goal of improving public awareness and knowledge of stroke recognition, Stroke 1-2-0 was developed in China as an education program to prompt rapid response to the onset of stroke based on clinical practice in China, and examination of its outcomes is needed. Objective To investigate the association of the Stroke 1-2-0 educational campaign with prehospital delay for patients with ischemic stroke. Design, Setting, and Participants In a population-based cross-sectional study, all patients with ischemic stroke events were admitted to the Minhang Hospital, which is the only tertiary care hospital with a stroke center that provides acute stroke care in Xinzhuang county, Shanghai, China. The study period was from January 1, 2016, to December 31, 2019, and data analysis was performed from January 1 to July 31, 2021. Exposures A multifaceted Stroke 1-2-0 educational campaign comprising slides, videos, brochures, and posters distributed in the community. Main Outcomes and Measures Proportion of patients with hospital arrival within 3 hours and use of an ambulance to seek medical care, as well as the odds of seeking medical attention within 3 hours after the stroke before vs after initiation of the multifaceted educational campaign. Results A total of 2857 patients (1774 men [62.1%]; mean [SD] age, 69.83 [12.66] years) with stroke were identified, including 503 in the precampaign period and 2354 in the postcampaign period. Following the multifaceted campaign, the median (IQR) prehospital delay time decreased from 18.72 (7.44-27.84) hours to 6.00 (2.00-16.35) hours (P < .001). After the implementation of the Stroke 1-2-0 campaign, the proportion of patients with hospital arrival time within 3 hours increased from 5.8% to 33.4% (P < .001) and use of an ambulance increased from 3.2% to 30.6% (P < .001). In an interrupted time series analysis, the initiation of the Stroke 1-2-0 campaign was associated with significantly increased odds of arriving at the hospital within 3 hours (odds ratio, 8.01; 95% CI, 7.17-8.95; P < .001) and use of an ambulance (odds ratio, 9.41; 95% CI, 8.24-10.74; P < .001). Conclusions and Relevance The persistent multifaceted campaign using the Stroke 1-2-0 program was associated with reduced prehospital delay and improved timely arrival rate and ambulance arrival rate for patients with stroke. These findings suggest that Stroke 1-2-0 can be adopted in other regions of China to possibly improve health outcomes and reduce clinical burdens for all patients with stroke.
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Affiliation(s)
- Jing Yuan
- Department of Clinical Pharmacy, School of Pharmacy, Fudan University, Shanghai, China
| | - Minghui Li
- Department of Clinical Pharmacy and Translational Science, University of Tennessee Health Science Center, Memphis
| | - Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Xiaomo Xiong
- Clinical Pharmacy and Outcomes Sciences Department, University of South Carolina, Columbia
| | - Zhengbao Zhu
- Department of Epidemiology, School of Public Health, Medical College of Soochow University, Suzhou, China
| | - Fangyu Liu
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yong Wang
- Department of Neurology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Wei Hu
- Department of Cardiology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
| | - Z. Kevin Lu
- Clinical Pharmacy and Outcomes Sciences Department, University of South Carolina, Columbia
| | - Renyu Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Minhang District, Shanghai, China
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Cao M, Guan T, Han X, Shen B, Chao B, Liu Y. Impact of a health campaign on Chinese public awareness of stroke: evidence from internet search data. BMJ Open 2021; 11:e054463. [PMID: 34907069 PMCID: PMC8672014 DOI: 10.1136/bmjopen-2021-054463] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Health campaigns have the potential to improve public awareness, but their impact can be difficult to assess. Internet search data provide information concerning online health information-seeking behaviour in the population and may serve as a proxy for public awareness to evaluate health campaigns. This study aimed to measure the impact of World Stroke Day (WSD) in China using Baidu search data. METHODS Daily search index values (SIV) for the term 'stroke' were collected from January 2011 to December 2019 using the Baidu Index platform. We examined the mean difference in SIV between the 4 weeks surrounding WSD (period of interest) and the rest of the year (control period) for each year by t-test analysis. The mean difference between the period of interest and the control period was also calculated. The joinpoint regression model was used to analyse the trends of internet search activity 30 days before and after WSD for each year (2011-2019). Finally, the top and rising queries related to stroke during the week of the campaign in 2020 were summarised. RESULTS A significant mean increase in SIV of 418.5 (95% CI: 298.8 to 538.2) for the period of interest surrounding WSD was observed, 36.2% greater than the SIV during the control period (2011-2019). Short-term joinpoint analysis showed a significant increase in SIV 3 days before WSD, a peak on WSD and a decrease to the precampaign level 3 days after WSD. The rising related queries suggested that the public had increasing concerns about stroke warning signs, stroke prevention and stroke recovery during the campaign. CONCLUSIONS The WSD campaign increased internet search activity. These research techniques can be applied to evaluation of other health campaigns. Advancing understanding of public demand will enable tailoring of the campaign and strengthen health management.
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Affiliation(s)
- Man Cao
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tianjia Guan
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xueyan Han
- Department of Medical Statistics, Peking University First Hospital, Beijing, China
| | - Bingjie Shen
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Baohua Chao
- National Health Commission of the People's Republic of China, Beijing, China
| | - Yuanli Liu
- School of Health Policy and Management, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
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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: 1.0] [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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Liu X, Gui H, Yao S, Li Z, Zhao J. Age-Related Disparities in Stroke Knowledge Among Community Older Adults. Front Neurol 2021; 12:717472. [PMID: 34566859 PMCID: PMC8455826 DOI: 10.3389/fneur.2021.717472] [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: 05/31/2021] [Accepted: 07/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background: This study aimed to investigate the disparities in stroke knowledge between older adults and the oldest old. Methods: Family physicians conducted a cross-sectional survey through face-to-face interviews with the older and oldest old adults of two suburban communities in the Minhang district, Shanghai between October 1, 2020, and November 30, 2020. All participants were classified as oldest old (age ≥80 years) and older adults (age 60-79 years). Between-group differences in stroke knowledge were investigated by multivariate logistic regression analysis. Results: Overall, 466 older adults including 101 (21.67%) oldest old persons were qualified. Older adults were more familiar with the risk factors and symptoms of stroke than the oldest old. By multivariable logistic regression analysis, older adults were more familiar with the following risk factors: smoking [odds ratio (OR) 0.32, 95% confidence interval (CI) 0.16-0.61], alcohol abuse (OR 0.45, 95% CI 0.23-0.87), dyslipidemia (OR 0.51, 95% CI 0.31-0.85), and obesity (OR 0.30, 95% CI 0.17-0.53) than the oldest old. Regarding stroke symptoms, older adults were more aware regarding vision alteration (OR 0.42, 95% CI 0.25-0.69) and face-drop (OR 0.57, 95% CI 0.35-0.95) than the oldest old. The oldest old were less aware of acute stroke therapy (OR 0.11, 95% CI 0.02-0.48) and calling the emergency medical service (OR 0.30, 95% CI 0.12-0.70) than older adults. Finally, the older adults used television (OR 0.53, 95% CI 0.28-1.0), WeChat (OR 0.21, 95% CI 0.05-0.89), and the community bulletin board (OR 0.43, 95% CI 0.23-0.80) as knowledge sources more than the oldest old. Conclusion: The older adults and the oldest old had significantly high disparities in stroke knowledge. Given the aging population across China, the life expectancy is expected to be longer in future decades. These differences should be addressed in stroke educational campaigns targeting the oldest old.
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Affiliation(s)
- Xiaochuan Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Huiwen Gui
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Sichen Yao
- Wujing Community Health Service Center, Shanghai, China
| | - Zhongcheng Li
- Wujing Community Health Service Center, Shanghai, China
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
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Yuan J, Shan GL, Li SD, Gao CP, Cui LY, Peng B. Impact of regional differences in stroke symptom awareness and low-income status on seeking emergency medical service in China. Chin Med J (Engl) 2021; 134:1812-1818. [PMID: 34397585 PMCID: PMC8367037 DOI: 10.1097/cm9.0000000000001604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Unawareness of stroke symptoms and low income are two barriers that affect the seeking of emergency medical service (EMS). This study aimed to assess the effect of unawareness and low income on seeking EMS and to investigate the regional distribution of the unawareness and low-income status and their associations with failing to call EMS in China. METHODS A total of 187,723 samples from the China National Stroke Screening Survey was interviewed cross-sectionally. Four status of awareness and annual income were identified: unaware and low-income, unaware-only, low-income-only, and aware and regular income. The outcomes were whether they intended to call EMS or not. The regional distribution of each status and their associations with not calling EMS were presented. RESULTS The status of unaware and low-income, unaware-only, and low-income-only accounted for 6.3% (11,806/187,673), 11.9% (22,241/187,673), and 21.5% (40,289/187,673) of the total sample, respectively. Not calling EMS was significantly associated with the status of unaware and low-income (odds ratio [OR]: 3.21, 95% confidence interval [CI]: 3.07-3.35), unaware-only (OR: 2.38, 95% CI: 2.31-2.46), and low-income-only (OR: 1.67, 95% CI: 1.63-1.71), compared with the aware and regular income status. The Midwest regions had higher percentages of people in the unaware and low-income status; the East, South, and Central had higher percentages of unaware-only status; the North and Northeast regions had a higher percentage of low-income-only status, compared with other regions. CONCLUSION The existence of the regional difference in unawareness and low income justifies the specific stroke education strategies for the targeted regions and population.
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Affiliation(s)
- Jing Yuan
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Guang-Liang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Sheng-De Li
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Chun-Peng Gao
- Disease Control and Prevention Office, Dalian Municipal Central Hospital, Dalian, Liaoning 116021, China
| | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
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Wang Y, Liu Y, Liu R, Zhao J. Cluster-randomised controlled trial of Stroke 1-2-0 education programme to reduce stroke prehospital delay in China: a study protocol. BMJ Open 2021; 11:e048064. [PMID: 34035108 PMCID: PMC8154964 DOI: 10.1136/bmjopen-2020-048064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Stroke is the leading cause of death and disability in China. The median time of stroke pre-hospital delay is more than 15 hours, mainly due to the lack of awareness on stroke symptoms and calling emergency services. We developed Stroke 1-2-0 recognition tool in China, by adapting Face, Arm, Speech and Time. Our preliminary findings suggested that Stroke 1-2-0 can improve public's knowledge of the stroke symptoms, but its impact on the prehospital delay is still unclear. Furthermore, these findings were mainly obtained from Shanghai, one of the largest metropolises in China. However, more than half of population in China lives in the rural area. Given the striking disparities in socioeconomic status and quality of stroke care across the nation, a multicentre trial is warranted. METHODS AND ANALYSIS Stroke 1-2-0 education programme will adopt a multicentre, cluster-randomised controlled design. We aimed to recruit 32 communities from 16 counties across China. Each county includes two communities having more than 100 000 residents. The two communities sampled in the same county will be randomly assigned to receive either Stroke 1-2-0 education programme or usual care. The primary objective of this study is to evaluate the impact of Stroke 1-2-0 public education programme in reducing stroke prehospital delay among adults residing in the community, compared with the usual care. The intervention will be implemented for 1 year. The primary outcomes are the symptom onset to hospital arrival time ('onset-to-door time', ODT) and 3-hour hospital arriving rate. We will use an intention-to-treat approach. A linear mixed model will be used to control for potential cluster effects. ETHICS AND DISSEMINATION This study is approved by the Shanghai Minhang District Central Hospital Institutional Review Board (Shanghai, China). The findings will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER ChiCTR2000040782.
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Affiliation(s)
- Yong Wang
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Yang Liu
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
| | - Renyu Liu
- Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jing Zhao
- Department of Neurology, Minhang Hospital, Fudan University, Shanghai, China
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Yuan J, Shan GL, Li SD, Gao CP, Cui LY, Peng B. Risk Factors Influencing Seeking Emergency Medical Service in Urban and Rural China Among Participants With a Previous Transient Ischemic Attack. Front Neurol 2021; 11:620157. [PMID: 33613421 PMCID: PMC7889803 DOI: 10.3389/fneur.2020.620157] [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: 10/22/2020] [Accepted: 12/21/2020] [Indexed: 01/10/2023] Open
Abstract
Objective: It is critical to identify factors that significantly impede the correct action of calling emergency medical service (EMS) in the high-risk population with a previous history of transient ischemic attack (TIA) and further explore the urban–rural difference in China. Methods: Participants with previous TIA from the China National Stroke Screening Survey and its branch study (FAST-RIGHT) were interviewed cross-sectionally (n = 2,036). The associations between the outcome measure of not calling EMS and multiple potential risk factors were examined, including demographic information, live (or not) with families, medical insurance type, urban or rural residence, awareness of stroke symptoms, annual personal income, presence of cardiovascular disease or risk factors, and stroke history in family members or friends. The sample was further stratified to explore the urban–rural difference by their residency. Results: The proportion of not calling EMS was 36.8% among all participants with previous TIA, and these were 21.7 and 48.4% among urban and rural participants, respectively. Among rural participants, risk factors that were significantly associated with not calling EMS included primary school education [odds ratio (OR) 2.50, 95% confidence interval (CI) 1.89–3.33], living with family (OR 2.09, 95% CI 1.33–3.36), unaware stroke symptoms (OR 2.60, 95% CI 1.81–3.78), and low income (OR 1.57, 95% CI 1.19–2.07). Among urban participants, only low income was significantly associated with an increased risk of not calling EMS (OR 1.74, 95% CI 1.10–2.72). Conclusions: Rural residents with previous TIA in China had a higher percentage of not calling EMS. Multiple risk factors have been identified that call for targeted intervention strategies.
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Affiliation(s)
- Jing Yuan
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Guang-Liang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Sheng-De Li
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Chun-Peng Gao
- Disease Control and Prevention Office, Dalian Municipal Central Hospital, Dalian, China
| | - Li-Ying Cui
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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23
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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: 3.4] [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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