Stroke Awareness Campaigns Research Articles

311 Older Adults Awareness and Response to Stroke in Ireland.

Abstract Background Early recognition of stroke symptoms and immediate response is necessary to ensure timely access to treatment of stroke. However, many individuals fail identify symptoms of stroke or delay in seeking medical attention. The Irish Heart Foundation launched the “Act Fast” campaign which included three waves of broadcasting on national television and radio, throughout 2010 and 2011. Stroke awareness campaigns may have the potential to influence behaviour and response to stroke. Methods A non-experimental, descriptive, quantitative, cross-sectional study was conducted. The Stroke Action Test (STAT)1 was used to investigate how participants would respond to specific symptoms of stroke. A convenience sample (n=89) of older adults attending an outpatient clinic in a university teaching hospital completed the questionnaire. The mean age of respondents was 79.6 years (SD =9.3). Results Just 4.5% (n=4) of respondents identified what all 4 letters of FAST represent. Overall, 48% (n=43) of respondents recognised all 6 symptoms of stroke and 100% (n=89) recognised at least 2 symptoms of stroke as per STAT. The stroke symptom most frequently recognised was sudden numbness of the face, arm or leg at 99% (n=88). The stroke symptom least frequently recognised was sudden trouble seeing in one or both eyes at 56% (n=50). Despite this 81% (n=64) of respondents would not respond appropriately to 50% of symptoms of stroke described in the STAT. 52% (n=46) of respondents identified irregular heart beat as a risk factor for stroke. Finally, 29% (n=26) of respondents had heard of thrombolysis while just 2% (n=2) had heard of thrombectomy. Conclusion Awareness of stroke symptoms does not necessarily influence response to stroke in older adults. Future stroke awareness campaigns should consider FAST2 which speaks to treatment (thrombolysis or thrombectomy) as well as time.

Outlining Stroke Infodemiology.

e-Health is becoming increasingly relevant in stroke awareness campaigns and clinical management. In our statement, we focus on a basic strategy to trace the global information flow generated on the internet about stroke, and how to better understand the interest surrounding stroke in the community as well as the effects of warning campaigns.

Planning a campaign to fight stroke: an educational pilot project in La Spezia, Italy.

Best medical treatments of ischemic stroke are admission to stroke unit, intravenous thrombolysis and, in selected cases, thrombectomy. Time from symptom onset to interventions is the best predictor of clinical outcome. In order to verify the effectiveness of an active education programme of awareness on the knowledge of stroke, we performed a local campaign "on the field". We selected 101 subjects from the general population who took part in the "stroke awareness campaign" organised by the Italian Association for the fight against stroke (A.L.I.Ce). Mean age was 59years (50% female; 50% male); 55% of the sample reported a high level of education (> 8years: high school or university degree). After a short multiple-choice questionnaire, we administered a face-to-face standard educational protocol (15min). The efficacy of that educational intervention was then verified after a period of 12months, by telephone interview. There was improvement both in the definition of stroke (66% vs. 92%, p < .001) and in recognizing symptoms and signs (19% vs. 72%, p < .001). Knowledge of the importance of stroke unit in the acute treatment of stroke did not improve, as it was already high on baseline (92% vs. 97%, p: n.s.). The improvement was evident in particular in younger and higher educated people, without difference in gender. There was no difference based on risk factor profiles of participants. Our results suggest that a personalised education can improve knowledge on stroke symptoms and signs, independently of gender and personal risk factors. The results should be verified in larger and less selection population.

Abstract TP223: Increasing Stroke and MI Awareness in School Children

Background: Lack of response to stroke symptoms is one of the most important reasons for patients late arrival to hospital. After we documented that stroke awareness campaign have very little effect on adults, we have developed program aiming to increase response to stroke symptoms in school children. Our study previously showed that, after one 45-minutes lesson, knowledge in stroke and MI in children increases, but does not retain at 3 months. Here we present results after additional lesson at 6 month was introduced. Methodology: Computer based 45 minutes lesson includes a) educational e-learning part and b) video records demonstrating different symptoms of stroke or MI to pretest and posttest the knowledge. Effect of two lessons at baseline and 6 months was tested as % of correct response to 8 questions/simulation video records. Results: Knowledge of 429 participating children increased by 8% (baseline pretest=62%; baseline posttest=70%, p&lt;0.05) after the first lesson. The knowledge decreased after 6 months but increased again by 6% after the repeated lesson at 6 month (from 67% to 73 %, p&lt;0.05). Conclusion: Retention at 6 months was moderate and second lesson at 6 month further but modestly improved children’s knowledge/response to stroke symptoms. One lesson is not enough; two lessons are better but still have moderate cumulative effect.

Abstract TP338: Knowledge of Stroke Core Symptoms Are Important for Help-seeking Behavior and Receiving Reperfusion Therapy

Introduction: We investigated the association between pre-stroke core symptom knowledge and recognition of core symptoms at stroke onset, with prehospital delay and receiving reperfusion therapies. Core symptoms are defined as facial palsy, palsy of extremities and aphasia/dysarthria. Methods: A cross-sectional study of consecutive patients with acute stroke and TIA admitted at two stroke centres in the Central Denmark Region, between January 28 th 2018 and May 10 th 2018. Structured interviews of patients and bystanders (separately), combined with clinical information from the Danish stroke registry were obtained. Eligible patient were &gt; 18 years, independent in daily activities (mRS&lt;3) with stroke onset-to-interview ≤7 days. Results: We included 469 of 1210 stroke/TIA patients in the period with a median (IQR) age of 71 (61-80). Median (IQR) admission-to-interview time was 1 (1-1) day. Pre-stroke knowledge of ≥ 1 core symptom was 46 % for patients and 71 % for bystanders. Knowledge of ≥ 2 core symptoms was 22 % and 52 % respectively. Pre-stroke knowledge in patients was not significantly associated to EMS contact, onset-to admission &lt; 3 hours or reperfusions therapy, but in bystanders pre-stroke knowledge of ≥ 2 core symptoms was associated with increased EMS contact OR (95% CI) 2,35 (1,24-4.45) and receiving reperfusion therapy 1,94 (1,04-3.61). Help-seeking based on ≥ 1 observed core symptom at onset by bystanders and ≥ 2 core symptoms experienced by patients were significantly associated with a direct EMS contact, onset-to admission &lt; 3 hours and receiving reperfusions therapy. Conclusions: Pre-stroke knowledge and help-seeking based on observed core symptoms at onset is essential reducing prehospital delay and increasing reperfusion rates. The pivotal role of bystanders “to act” should be a target for future stroke awareness campaigns.

Abstract WP232: Targeted Mass Stroke Education Improves Knowledge of Stroke Signs in Georgia

Introduction: Acute stroke patients must be transported to stroke-ready facilities swiftly for better patient outcomes. Public knowledge of stroke signs and the need to call emergency medical services (EMS) is critical to ensure that stroke patients get to hospital timely. This study assesses the impact of a targeted stroke awareness campaign launched by the Georgia Department of Public Health (DPH) in 2017. Method: From May to September 2017, the Georgia DPH launched a multipronged public stroke education campaign involving public service announcements, posters on mass transport systems, billboards on highways, and digital displays at sport events. The campaign targeted African-Americans because of their higher risk for stroke. Four questions about stroke signs (facial droop, arm weakness and slurred speech) and the importance of calling 911 were added to the 2017 Georgia Behavioral Risk Factor Surveillance System (BRFSS) survey. The pre and post-campaign levels of knowledge of stroke signs, as determined by answers to BRFSS questions, were compared among different race groups using SAS-callable SUDDAN software and applying logistic regressions for model adjusted prevalence differences. Results: In general, a 3.8% to a 5.5% improvement in knowledge was documented for each sign of stroke. The proportion of adult Georgians who knew all three signs of stroke included in the campaign and the importance of calling 911 increased from 49.9% pre-campaign to 56.0% post-campaign. However, the improvement was significant and more pronounced among African Americans (16%, SE=7%) than among Whites (1%, SE=4%), and Hispanics (3%, SE=10%) controlling for other potential predictors. Moreover, relatively fewer Hispanics (29%; 95%CI: 19%, 41%) provided the correct answers to the four questions than African-Americans (58%; 95%CI: 51%, 64%) and Whites (62%, 95%CI: 58%, 67%) post-campaign. Conclusion: The Georgia DPH’s targeted mass educational campaign was effective in improving the knowledge of stroke signs among the public and the need to call EMS. The Department must continue its education effort to improve public’s knowledge with emphasis on reaching the Hispanic population.

Late Hospital Arrival for Thrombolysis after Stroke in Southern Portugal: Who Is at Risk?

Background: Delayed hospital arrival remains the main reason for the low rates of thrombolysis in eligible acute ischemic stroke (AIS) patients. The role of socioeconomic and clinical factors for the prehospital delay of AIS remains poor and has never been studied in Portugal. Objectives: Describe the socioeconomic and clinical factors leading to delayed hospital admission of AIS patients eligible to thrombolysis. Methods: A case-control study with a consecutive thrombolyzed AIS patients from 2010 to 2015. Controls were patients who did not receive thrombolysis because of late hospital arrival. Logistic regression with stepwise forward regression analysis was used to identify independent predictors of delayed admission to receive thrombolysis with intravenous tissue-type plasminogen activator (rtPA). Results: Of the 1247 patients admitted with AIS, 76 (6%) arrived on-time and received intravenous rtPA. Controls were 65.8% (146/222) of the total number of patients included in the study. Overall, the mean age was 73 years (±11, 61), a minority were below 60 years, and 43.7% were women. Being beneficiary of social insertion income (odds ratio [OR]: .286; .124-.662, P = .003), not having any telephone contact (OR: .145; .039-.536, .004) or having exclusive landline (.055; .014-.210, <.001) and posterior circulation stroke (OR: .266; .087-.811, P = .020) decreased the likelihood of hospital arrive on-time rtPA. The use of prehospital ambulance services increased (OR: 6.478; 2.751-15.254, P < .001) the odds of ER on-time arrival for thrombolysis. Conclusions: Poverty, lack of stroke awareness, or difficulties in requesting immediate medical help are the main factors implicated in late-hospital admission for thrombolysis in AIS. Stroke awareness campaigns, promotion of activation of national emergency number and stroke code can increase the rate of thrombolysis.

Childhood Stroke: Awareness, Interest, and Knowledge Among the Pediatric Community.

Objective: Acute childhood stroke is an emergency requiring a high level of awareness among first-line healthcare providers. This survey serves as an indicator of the awareness of, the interest in, and knowledge of childhood stroke of German pediatricians.Methods: Thousand six hundred and ninety-seven physicians of pediatric in- and outpatient facilities in Bavaria, Germany, were invited via email to an online-survey about childhood stroke.Results: The overall participation rate was 14%. Forty-six percent of participants considered a diagnosis of childhood stroke at least once during the past year, and 47% provide care for patients who have suffered childhood stroke. The acronym FAST (Face-Arm-Speech-Time-Test) was correctly cited in 27% of the questionnaires. Most commonly quoted symptoms of childhood stroke were hemiparesis (90%), speech disorder (58%), seizure (44%), headache (40%), and impaired consciousness (33%). Migraine (63%), seizure (39%), and infections of the brain (31%) were most frequently named as stroke mimics. Main diagnostic measures indicated were magnetic resonance imaging (MRI) (96%) and computer tomography (CT) (55%). Main therapeutic strategies were thrombolysis (80%), anticoagulation (41%), neuroprotective measures, and thrombectomies (15% each). Thirty-nine percent of participants had taken part in training sessions, 61% studied literature, 37% discussed with colleagues, and 25% performed internet research on childhood stroke. Ninety-three percent of participants approve skill enhancement, favoring training sessions (80%), publications (43%), and web based offers (35%). Consent for offering a flyer on the topic to caregivers in facilities was given in 49%.Conclusion: Childhood stroke constitutes a topic of clinical importance to pediatricians. Participants demonstrate a considerable level of comprehension concerning the subject, but room for improvement remains. A multi-modal approach encompassing an elaborate training program, regular educational publications in professional journals, and web based offers could reach a broad range of health care providers. Paired with a public adult and childhood stroke awareness campaign, these efforts could contribute to optimize the care for children suffering from stroke.

Stroke Literacy in a South Brazilian City: A Community Based Survey

This community-based and cross-sectional study was performed in a Brazilian city and aimed to evaluate stroke literacy. A stroke knowledge survey was administered to passersby of a public square from December 2015 to October 2016, in Santa Maria, Rio Grande do Sul. Convenience sampling was performed. A total of 633 respondents completed the survey. Of the respondents, 33% knew the meaning of "AVC"; 29.5% incorrectly localized stroke in the heart. Any warning sign of stroke (open-ended question) could not be remembered by 50.7% of the respondents; individuals with a higher level of schooling (>7 years of education) and those who localized stroke in the brain were more likely to call an emergency in the case of a stroke (adjusted odds ratio [OR] 1.040, 95% confidence interval [CI] 1.004-1.078 for years of schooling; adjusted OR 1.542, 95% CI 1.102-2.156 for replying "yes" to brain as the organ affected in stroke). Brazilian public knowledge about stroke is still scarce, even in a population with levels of formal education above the national average or in a city where annual promotion of Stroke Awareness Campaigns have taken place for almost a decade. Thus, it might be necessary to design different informative strategies targeted to our study's population to improve stroke campaigns in Brazil. In Brazil, increasing awareness of stroke focused on stroke prevention and recognition of its warning signs should be a national priority in public health as the access to stroke treatment remains limited.

Investigation of the cardiovascular risk profile in a south Brazilian city: surveys from 2012 to 2016.

The aim of this study was to investigate the cardiovascular risk profile of the participants recruited from stroke awareness campaigns in Santa Maria RS, Brazil, from 2012 to 2016, using the simplified version of the Framingham Risk Score (FRS). Questionnaires were used to evaluate 1,061 participants from 20 to 74 years old. Data on cardiovascular risk factors were obtained. The prevalence of risk factors and mean FRS for men and women were estimated. The FRS for women was 11.8% (moderate risk) and 24.7% for men (high risk). The vascular age for women was 61.6 years, whereas the vascular age for men was 66 years. Two percent of women had hypertension and diabetes, while both these risk factors were present in 5% of men. Based on the data, the prevalence of stroke risk factors is worrisome, as are the numbers of individuals with moderate and high cardiovascular risk in Santa Maria.

Assessment of the Efficiency of Stroke Awareness Campaigns in Hungary

The critical period of stroke management lies between the disease onset and the time of the emergency call, relying on stroke-related knowledge of the population. Public campaigns play a role in spreading relevant health information. Due to the substantial expenses of these campaigns, the assessment of their efficiency is reasonable. We assessed the number of thrombolytic treatments performed in Hungary, subjected to national media coverage and in particular in Budapest, being the location of the Stroke Day campaign, in the period between 2008 and 2015. We compared the change in the daily mean number of thrombolytic treatments performed during the preceding and following day, week, and month. Data were also compared with annual means. No meaningful changes can be seen in the number of thrombolytic treatments on the days immediately following Stroke Days, and casual differences can be seen in the following week. The comparison of the numbers of thrombolytic treatments performed in the postcampaign months with the monthly means in the corresponding years revealed a positive effect in each year except for 2012, 2014, and 2015. Regarding the whole examined period, however, the effect is not statistically significant, neither for data obtained from Hungary nor from Budapest. Better outcomes were observed 1 month after a campaign than more immediately. This can be partly explained by ongoing media coverage in a given period rather than exposure of the public on a single Stroke Day.

Abstract WP176: Temporal Trends in Public Awareness of Stroke: Knowledge is Key

Introduction: Recognition of stroke symptoms is vital for accessing medical care and administration of thrombolytics and/or endovascular therapy for ischemic stroke. Awareness of stroke warning signs and risk factors is key to treatment and prevention, respectively. Methods: Surveys were conducted in 1995, 2000, 2005, 2011 and 2016 to respondents randomly drawn to reflect the age, race and sex distribution of the ischemic stroke population in the Greater Cincinnati/ Northern Kentucky Stroke Study. All surveys are based in the same biracial population of 1.3 million, subjects were contacted using random-digit dialing. Open-ended questions regarding stroke risk factors and warning signs were asked and demographic and stroke risk factor information collected. Multiple regression was used to examine changes over time and adjust for covariates. Results: Over the 20-year period, 10,393 surveys were completed. Survey respondents were 60% female, 27% black, with median age 67 years. As depicted in the Table, knowledge of risk factors and warning signs has significantly increased over time, however not within the past 5 years. This is also true after adjustment for age, race, sex and education of the respondents. Female sex and higher education levels were significantly associated with higher knowledge, but age and race had no independent effect. Conclusions: Public awareness of stroke risk factors and warning signs has improved over the past 20 years, although progress has slowed during the past five years despite numerous national and regional stroke awareness campaigns. Knowledge of risk factors continues to be significantly worse than knowledge of warning signs. Further study of the effectiveness of stroke public awareness campaigns are needed.

Does stroke health promotion increase awareness of appropriate behavioural response? Impact of the face, arm, speech and time (FAST) campaign on population knowledge of stroke risk factors, warning signs and emergency response.

Inability to identify stroke warning signs accurately is an important cause of delay in seeking medical attention, leading to potential ineligibility for acute intervention. We report on post-campaign findings (wave 2) of national surveys to estimate changes in population knowledge following a media-based Face, Arm, Speech, Time stroke awareness campaign, comparing findings to those of a pre-campaign population survey (wave 1).Participants and methods: One thousand and ten randomly selected adults (18+) completed the Stroke Awareness Questionnaire on knowledge of warning signs, risk factors and response to stroke at wave 2 and findings were compared to wave 1 survey results. Logistic regression was used to examine the association between demographic characteristics and self-reported risk factors with knowledge of stroke and emergency response. No significant differences existed in the ability of respondents to define stroke or to identify two or more stroke risk factors between waves 1 and 2 surveys (71% and 70%, respectively). Respondents to the wave 2 survey were five times more likely (odds ratio 4.9, p < .001) than those responding at wave 1 to know at least two warning signs of stroke (67% vs. 31%, respectively), specifically those targeted by the Face, Arm, Speech, Time campaign. While significant improvement in intention to call an ambulance was noted (odds ratio 1.5, p < .001, 57% at wave 2 compared to 47% at wave 1), for almost half of respondents (43%) this would not have been their first response to stroke. Less than 5% of respondents to both surveys identified thrombolysis as an emergency treatment for stroke (3.9% at wave 2 compared to 1.8% at wave 1). Although significant improvements were made in several areas of stroke knowledge and intended response, awareness of acute stroke interventions was poor and intended behavioural response was suboptimal. Findings from this study indicate need for targeted campaigns to improve population understanding of the reasons underlying the importance of rapid emergency response to stroke.

Response to Symptoms and Prehospital Delay in Stroke Patients. Is It Time to Reconsider Stroke Awareness Campaigns?

Despite recent advances in acute stroke care, reperfusion therapies are given to only 1%-8% of patients. Previous studies have focused on prehospital or decision delay. We aim to give a more comprehensive view by addressing different time delays and decisions. A total of 382 patients with either acute stroke or transient ischemic attack were prospectively included. Sociodemographic and clinical parameters and data on decision delay, prehospital delay, and first medical contact were recorded. Multivariate logistic regression analyses were conducted to identify factors related to decision delay of 15 minutes or shorter, calling the Extrahospital Emergency Services, and prehospital delay of 60 minutes or shorter and 180 minutes or shorter. Prehospital delay was 60 minutes or shorter in 11.3% of our patients and 180 minutes or shorter in 48.7%. Major vascular risk factors were present in 89.8% of patients. Severity was associated with decision delay of 15 minutes or shorter (odds ratio [OR] 1.08; confidence interval [CI] 1.04-1.13), calling the Extrahospital Emergency Services (OR 1.17; CI 1.12-1.23), and prehospital delay of 180 minutes or shorter (OR 1.08; CI 1.01-1.15). Adult children as witnesses favored a decision delay of 15 minutes or shorter (OR 3.44; CI 95% 1.88-6.27; P < .001) and calling the Extrahospital Emergency Services (OR 2.24; IC 95% 1.20-4.22; P = .012). Calling the Extrahospital Emergency Services favored prehospital delay of 60 minutes or shorter (OR 5.69; CI 95% 2.41-13.45; P < .001) and prehospital delay of 180 minutes or shorter (OR 3.86; CI 95% 1.47-10.11; P = .006). Severity and the bystander play a critical role in the response to stroke. Calling the Extrahospital Emergency Services promotes shorter delays. Future interventions should encourage immediately calling the Extrahospital Emergency Services, but the target should be redirected to those with known risk factors and their caregivers.

Study on stroke awareness among caregivers of stroke patients

Background: Stroke related morbidity and mortality could be minimised with early medical interventions. Lack of awareness on stroke warning signs and risk factors are significant reasons for delay in seeking medical care and resultant adverse outcome. The caregiver knowledge on stroke is important in early detection of stroke, hence the study. Aims: To assess the knowledge on warning signs and risk factors of stroke among caregivers of stroke patients. Materials & methods: This cross-sectional questionnaire based study was done over 6 months among 50 caregivers of hospitalized stroke patients. Questionnaire adopted from Leicester Stroke Awareness Campaign Study was administered to the participants and their response was recorded andanalyzed using Microsoft SPSS-IV software. Results: In the study 62 % participants were females; most in the age group of 41-60 years. Term called stroke and brain as the affected organ was known to 70% and 94% of subjects respectively. Sudden onset weakness of arm and leg was identified as a warning sign by 82% and 80% of caregivers. High blood pressure was the most identified (78 %) risk factor. Knowledge on stroke warning signs and risk factors were found to be good in 34% and 46% of subjects respectively. This knowledge was found to be significantly higher among educated and younger subjects. Conclusion: Caregivers of stroke patients had good knowledge of stroke warning sign and risk factors. Caregivers education on stroke might be of great utility to spread the stroke awareness in society.

Abstract WMP96: Stroke Warning Signs In Spanish Speaking Communities: Camaleon Strategy Proposal

Introduction: early recognition of stroke signs lead to a better opportunity for acute management, to decrease morbidity and mortality impact. Public awareness campaigns have been developed with English language acronyms for recognition of these signs, but language and cultural differences should be taken into account for these educational strategies. Hypothesis: we assessed the hypothesis that there is a need for a validated tool for Spanish speaking population for early recognition of stroke warning signs. Material and methods: a 12-item electronic and paper-based survey for non-health related professionals evaluated the knowledge of early stroke signs in a Costa Rican sample. Using data from the FAST acronym, we developed a Spanish based acronym focused on the 3 most common symptoms, which was evaluated with medical professionals and non-medical population for clarity of message and informative content through a 10-item survey. Results: 706 non-medical professional subjects answered the evaluation survey (56.7% female, median age 33 years [IQR 24-43 years]), with 76.2% answering that they were not capable of diagnose an acute stroke, and 97.2% considering the necessity of develop an educational campaign for acute stroke signs recognition. CAMALEON acronym (CAra [face], MAno/brazo [hand/arm], LEnguaje [language] and teléfONo [telephone]) was created adapting FAST acronym to Spanish. 25 medical professionals evaluated the medical content of the Spanish acronym (based on an educational video) with a 95% of acceptance of its content to explain medical symptoms; also 91% of 100 non-medical subjects were able to recognize adequately the symptoms after viewing the video material. This academic initiative is endorsed by the World Stroke Academy from the World Stroke Organization. Conclusion: CAMALEON strategy is an adequate acronym for early recognition of acute stroke signs for Spanish speaking countries that should be validated in stroke awareness campaigns.

Abstract WP377: Stroke Awareness in the Age of Social Media

Background: May is recognized as Stroke Awareness month and many stroke programs design public awareness campaigns to provide education about the signs and symptoms of stroke and modifiable risk factors. An essential element of any stroke program includes the education of the community about stroke prevention, recognition, and early activation. Prior to 2016, community education consisted of blood pressure and risk factor screening by in various community settings. In 2016, the health system incorporated internet and social media components to education and community outreach during Stroke Awareness Month. Purpose: The purpose of this project was to analyze the added impact of incorporating interactive internet education and risk factor identification during Stroke Awareness Month. Methods: In 2016 we conducted a stroke awareness campaign of traditional screening and education events in the community. At these events, persons were offered a blood pressure measurement, asked about risk factors, and educated on the signs of stroke. Persons were also directed to a stroke risk profiler on the health system stroke center page that stratified their risk and possible interventions to reduce risk. Additional outreach and education efforts included an internet campaign directing persons to the risk profiler via internal health system media and social media. Paid social media, search and display ads for stroke signs and stroke risk also directed persons to the stroke risk profiler. Results: Traditional methods of education and screening yielded contact with 193 community members requiring approximately 50 hours of volunteer time. During May the web-based, interactive stroke risk assessment profiler was visited by 6,010 persons, and 1,570 fully completed the profiler. In subsequent months following the web-based community outreach campaign, traffic on the health system stroke center webpage remained at the high level of activity during May, and over 200% higher than traffic the previous year. Conclusions: Stroke awareness education and risk assessment is feasible and efficient via the internet and using social media. Using the internet and social media expands the size and increases the interaction of the community reached during Stroke Awareness Month.

Changes in stroke incidence, outcome, and associated factors in Porto between 1998 and 2011.

Objective Year 2000 marked a turning point in stroke prevention and treatment in Portugal. In face of high incidence rates stroke awareness campaigns, close surveillance of vascular risk factors and implementation of hospital stroke units were advanced by the National Health Authorities. To understand the effect of such measures, we assessed changes in stroke incidence and short-term outcome using data from two community-based registers undertaken in Porto in 1998-2000 and 2009-2011. Methods We used standard diagnostic criteria and multiple overlapping sources of case-ascertainment for first-ever strokes. Short-term outcome was measured by the modified Rankin Scale; disabling stroke was defined whenever post-stroke mRS score>pre-stroke mRS and >1. Results Globally, 462 and 405 first-ever stroke cases were registered in 1998-2000 and 2009-2011, respectively. Stroke incidence decreased by 23%, from 261 to 203/100,000 after adjustment for the Portuguese population. Significant reduction was found in those aged <75 years (31%) and in women (32%). Incidence of disabling strokes was reduced by 29%. Fatal strokes decreased by 46%, while intracerebral hemorrhage decreased by 51%. Risk of disability from stroke decreased by 11% (RR = 0.89; 95%CI, 0.81-0.98) in 2009-2011, as found after adjusting for patient/stroke characteristics in a Poisson model. Moreover, when patients arrived hospital within 3 h from stroke onset, the risk of disabling stroke was 0.76 (95%CI, 0.67-0.87) in 2009-2011 vs. 1998-2000, compared to 1.03 (95%CI, 0.89-1.12) for late arrival. Conclusion Risk of stroke, mainly of hemorrhagic stroke, was substantially reduced over time. Timely action in acute phase was responsible for the decline in disability across periods.

Abstract TMP75: The Georgia Stroke Professional Alliance (GA-SPA) - a Six Year Review, of a Collaborate, State-wide Stroke Professional Network, Reaching Across State-lines and the Nation to Improve Stroke Care, Professional Education, and Community Outreach

Background: In 2009, the Georgia Stroke Professional Alliance (GA-SPA) was established. GA-SPA success has been marked by unsurpassed transparency and collaboration among the members and their partners. GA-SPA continues to make professional stroke education and community outreach as one of their greatest priorities. A focus and commitment to improvements of stroke care is an underpinning for sustained success. Purpose: To expand the state-wide collaboration of health care professionals committed to improving the quality of stroke care and stroke education throughout the region. Methods: GA-SPA members meet regularly at varying locations throughout the state and participate in exchanges of professional knowledge, provide clinical expertise regarding process improvement and best practices. GA-SPA collaborates closely with key stakeholders like the AHA/ASA, the Georgia Coverdell Acute Stroke Registry, the Department of Public Heath, the State Office of EMS, and key industry supporters to provide up to date stroke education and community outreach efforts. Results: GA-SPA serves as a subject matter resource on the delivery of stroke care and prevention for healthcare professionals across the continuum of care. Web based communication, a Facebook page and a membership list serve enhances the experience of professional collaboration and information exchange. Accomplishments: Proclamation by the Governor for a Stroke Awareness Day, FAST regional stroke awareness campaign, and annual community events with the Atlanta Braves, partnering with schools for stroke education, SCRN and CNRN review courses, promoting ASLS, ISC presentations. Mentoring amongst GA-SPA members has contributed to the successful certification and re-certification for many of the 35 certified Primary Stroke Centers and 4 Comprehensive Stroke Centers in Georgia, and 4 Remote Stroke Treatment Centers. GA-SPA consults with other states interested in these common goals, and assist with the creation of similar alliances. Conclusion: An alliance of state wide health professionals has been an effective method to promote professional stroke education and community stroke outreach. Other states should consider creating similar professional alliances to advance stroke care.

Hackathon as a way to raise awareness and foster innovation for stroke.

The 'Time is Brain" concept has been a major focus in the World Stroke Awareness Campaign. We describe our experience with a Hackathon (junction of hack+marathon), a 24 hour event of innovation- and technology-based project development, focused around detecting stroke. The Hackathon was held during a Brazilian Student's union (BRASA) congress involving students from engineering and other technological disciplines. Four teamscompleted the 24-hour challenge; two teams opted the stroke challenge. One team proposed improving detection using a mobile sensor Fit-Bit combined with a smart-phone to contact emergency dispatch. The other team developed a game, in which kids would play a role as a neurologist; to diagnosis stroke with objective to increase awareness. Hackathons can focus attention on innovation and improvement opportunities to support the World Stroke Campaign, as well as other campaigns to raise awareness for other health or social problems.