World Stroke Research Articles

How can the World Stroke Organization (WSO) optimize education in stroke medicine around the world? Report of the 2018 WSO Global Stroke Stakeholder Workshop.

Education in stroke is relevant to stroke survivors, clinicians, care providers, and healthcare system administrators and is of special importance in resource-limited settings. The World Stroke Organization Education Committee undertook a program of work, culminating in a focused workshop, to establish the key educational priorities, and work toward maximizing the WSOs impact on the global burden of stroke. A facilitated workshop took place during the World Stroke Congress in Montreal, Canada in October 2018. The workshop was developed using opinions on priority topics for World Stroke Organization educational activities obtained from web-based surveys of World Stroke Organization Members, supplemented by interviews with international stroke support organizations. The workshop included over 50 international participants, selected to represent a balance of age, gender, geographical region, and different levels of health resources. Participants also included members of the World Stroke Organization Education Committee, the World Stroke Academy, stroke support organizations, and the International Journal of Stroke editorial board. The workshop focused on understanding more about educational needs (at all levels), with emphasis on resource-limited settings. Three broad questions were posed: (1) What are the key educational needs: (a) in your region, (b) from your perspective (e.g. stroke support organization)? (2) Do the current educational activities offered by World Stroke Organization and WSA meet your needs? (3) What could World Stroke Organization/World Stroke Academy offer in your region that would meet your needs? The facilitated discussions were recorded, and the results transcribed and summarized by members of the World Stroke Organization Education Committee. Five key needs were identified: 1. Collaborative interdisciplinary, training in both stroke care and how to advocate for stroke. 2. Educational materials provided in a wider range of formats that could be adapted to local circumstances and clinical practices. 3. Educational activities for healthcare providers and stroke support organizations organized regionally, with the World Stroke Organization providing organizational support, and a pool of experts, therapists, nurses, etc. to deliver locally relevant materials. 4. Clear and authoritative online resources, where it is easy to find key policy and protocol guidance. 5. A range of online interactive education and training resources to help build knowledge and competence in stroke care. The results of the workshop have been presented to the World Stroke Organization Board and will be used to help to guide the educational initiatives of the World Stroke Organization and World Stroke Academy going forward.

Multi-level community interventions for primary stroke prevention: A conceptual approach by the World Stroke Organization.

An effective primary stroke prevention strategy on a global scale should integrate pharmacological (polypill) and lifestyle modifications (motivational population-wide strategy) interventions. Side effects of such an integrative approach are expected to be minimal and the benefits among individuals at low-to-moderate risk of stroke could be significant. In the future, pragmatic field trials will provide more evidence.

Top 10 global educational topics in stroke: A survey by the World Stroke Organization.

As part of a program of work to develop an educational strategy and implementation plan for the World Stroke Organization, we conducted a survey of World Stroke Organization members (health professionals, laypersons (Stroke Support Organizations)) to identify their potential educational needs. We developed a questionnaire to identify priority educational needs in consultation with the World Stroke Organization Education Committee. The World Stroke Organization invited all individual members and associated Stroke Support Organizations to complete the questionnaire via a web-based survey. Survey responses were supplemented by questionnaires emailed directly to key persons in Stroke Support Organizations and information from semi-structured telephone interviews, where necessary. The questionnaire asked respondents to prioritize topics in diagnosis, management of acute stroke, stroke care services, stroke rehabilitation, and stroke prevention. Free-text responses were assessed with word cloud. The online survey was completed by 264 respondents from 60 countries; 19.1% were from low- and middle-income countries, 59% were stroke specialist physicians, 28% allied health professionals or nurses, 9% Stroke Support Organizations, 4% general physicians. Fifteen Stroke Support Organizations from 11 countries responded to the emailed survey. Seven Stroke Support Organizations' members were interviewed by telephone; one was interviewed in-person. We highlight the two highest priority topics in each of the five questionnaire domains. The 10 priority topics were all applicable in a low- or middle-income setting: setting up and delivering stroke diagnosis, treatment, rehabilitation and prevention services, and emphasized the most basic elements of care. The survey participants have identified a number of key topics that merit inclusion in stroke teaching materials and courses, especially those aimed at practitioners working in resource-limited settings.

Needs and rights awareness of stroke survivors and caregivers in urban and rural China: a cross-sectional, multiple-centre questionnaire survey

ObjectivesStroke survivors require assistance and support in their daily lives. This survey aims to investigate the needs and rights awareness in Chinese stroke survivors and caregivers in rural and urban...

Abstract TP172: Global Insight into Long-term Stroke Outcomes Using the Post Stroke Checklist

Objectives: There are long-term consequences following an individual suffering from a stroke. Despite clinical recommendations, there remains an absence of continued follow-up support for patients in most regions of the world. Estimates in the current literature estimate that 50% of patients are discharged without rehabilitation input and within two weeks, 50% of patients report having unmet needs. The Post Stroke Checklist (PSC) was designed for the long-term surveillance of continuing difficulties post stroke. This study aimed to evaluate international patterns of unmet needs following stroke, using the PSC. Methods: The PSC (endorsed by the World Stroke Organization and incorporated into the Canadian Stroke Best Practice Recommendations) identifies common long-term problems after stroke and appropriate referral pathways to address them. The PSC has been administered internationally including publications from Italy, Singapore and the UK’s stroke populations. This study follows this succession and trialed the PSC in an Australian (n=112) and Chinese (n=97) population at six months post stroke. Results: Between the samples (n=209), adjusted comparisons found a significantly higher proportion of unmet needs in China (mean= 4.67) compared with Australia (mean= 3.49). On the PSC, the most common unmet needs for both countries were similar including: absence of information regarding secondary prevention of stroke, cognitive difficulties and difficulties participating in life activities. The proportions affected on the PSC items differed between the two countries; with significantly greater difficulties in daily living activities, mobility, mood changes for China (p<.05). In Australia, greater incidences were reported for spasticity, incontinence (p<.05) and communication. The paper will also contrast these results with the other published international studies. Conclusion: Recording long-term functional disability post stroke highlights specific unmet needs and can encourage better support for community follow-up from governments, funding agencies and clinical programs. Providing international perspectives on these outcomes can also inspire changes in the post-hospital phase where pathways for treatment remain disjointed.

World Stroke Award 2017

World Stroke Award 2017

The convergence of stroke and dementia.

Neurological disorders account for the most Disability Adjusted Life Years (DALY's) -of the Global Burden of Disease (10%). More than half of neurological DALY's result from the combination of stroke (42%) and dementia (10%). The two pose risk for each other and share the same predisposing factors. A stroke doubles the risk of dementia. The close interactions call for convergent approaches. Stroke and dementia also converge at the microscopic level. The neurovascular unit has emerged as a key organizational structure of the brain. Involvement of any of its elements affects all the others. Thus, neurodegeneration impairs the microcirculation and disturbances of the microcirculation accelerate neurodegeneration. Evolving technologies allow "in vivo" imaging of the usual mixture of vascular and neurodegenerative pathology of the elderly that makes them prone to stroke and dementia. Since they occur together, they should be prevented together with a multimodal approach of lifestyle changes and mechanistic therapeutic targets. The two fields are also converging at the policy level. The World Stroke Organization has updated its Proclamation to include potentially preventable dementias that has been endorsed by Alzheimer Disease International, The World Federation of Neurology, the American Academy of Neurology and 20 international, regional and national organizations. Those interested in stroke and those dealing with dementia should work together where they can, differ where they must, with the common aim of preventing jointly, both stroke and dementia.

Difference in Stroke Knowledge between Rural and Urban Communities in a Developing Country after Community-Based Stroke Educational Campaigns: Results from a Cross-Sectional Study

Background: Ischemic stroke is a leading cause of disability and death in Mexico. Poor ability to identify signs and symptoms of ischemic stroke leads to longer hospital arrival times and precludes prompt treatment. The knowledge of stroke risk factors and warning signs in rural population is scarce. Since 2010, Stroke Education Campaigns are performed with a community-based approach. The aim of this study was to assess and compare stroke knowledge in rural and urban communities. Methods: During World Stroke Campaign, a standardized questionnaire to assess knowledge of stroke risk factors and warning signs was applied in urban and non-urban communities of Nuevo Leon, Mexico. Results: A total of 4,144 surveys were collected. Mean age was 44.2 ± 16.1 and 75.9% were women. People from rural and semi-urban areas mentioned > 3 risk factors (p < 0.001) and warning signs (p < 0.001) compared to the urban area. After logistic regression analysis, having received previous information about stroke remained significant for the knowledge of > 3 stroke risk factors and warning signs (p < 0.001; 95% CI 1.997–2.727; p < 0.001; 95% CI 1.880–3.787) respectively. Conclusions: Rural and semi-urban regions performed better than the urban population. Receiving stroke information is a determinant factor for stroke knowledge. Stroke Educational Campaigns are a cost-effective method for raising stroke awareness, thus reducing stroke burden.

Implementing the proclamation of stroke and potentially preventable dementias.

Brain health plays a central role in well-being and in the management of chronic diseases. Stroke and dementia pose the two greatest threats to brain health, but recent developments suggest the possibility that preventing stroke may also prevent some dementias: (a) A large population study showed a 32% decrease in the incidence of stroke and a concomitant 7% reduction in the incidence of dementia; (b) the treatment of atrial fibrillation resulted not only in stroke reduction, but also a 48% decrease in dementia; (c) the hypothesis-free analyses have shown that the first phase of Alzheimer disease involves vascular dysregulation, opening the door to new therapeutic approaches; (d) cognitive impairment, often treatable and reversible, accompanies heart and kidney failure. These developments, combined with the knowledge that stroke, dementia, and heart disease share the same major treatable risk factors, particularly hypertension, offer an opportunity for their joint prevention. This aspiration is expressed by a Proclamation of the World Stroke Organization on Stroke and Potentially Preventable Dementias and endorsed by the World Heart Federation, the World Hypertension League, Alzheimer Disease International, and 18 other international, regional, and national organizations as a call for action.

Implementing the Proclamation of Stroke and Potentially Preventable Dementias.

Brain health plays a central role in wellbeing and in the management of chronic diseases. Stroke and dementia pose the two greatest threats to brain health, but recent developments suggest the possibility that preventing stroke may also prevent some dementias: 1. A large population study showed a 32% decrease in the incidence of stroke and a concomitant 7% reduction in the incidence of dementia; 2. Treatment of atrial fibrillation resulted not only in stroke reduction, but a 48% decrease in dementia; 3. A hypothesis free analyses has shown that the first phase of Alzheimer disease involves vascular dysregulation, opening the door to new therapeutic approaches; 4. Cognitive impairment, often treatable and reversible, accompanies heart and kidney failure. These developments, combined with the knowledge that stroke, dementia and heart disease share the same major treatable risk factors, particularly hypertension, offers an opportunity for their joint prevention. This aspiration is expressed by a Proclamation of the World Stroke Organization on Stroke and Potentially Preventable Dementias and endorsed by the World Heart Federation, the World Hypertension League, Alzheimer Disease International and 18 other international, regional and national organizations as a call for action.

World Stroke Congress Abstracts, 2018 – Late breaking submissions

Free accessAbstractFirst published online October 20, 2018World Stroke Congress Abstracts, 2018 – Late breaking submissionsVolume 13, Issue 2_supplhttps://doi.org/10.1177/1747493018802481

World Stroke Congress Abstracts, 2018

World Stroke Congress Abstracts, 2018

World Stroke Congress Abstracts, 2018 – Late registration

World Stroke Congress Abstracts, 2018 – Late registration

Stroke Care Services in Brazil

The burden of stroke in Brazil, as in other developing countries, has considerably increased over the past years. With incidence rates ranging from 105 to 137 cases per 100 000 persons per year and mortality reaching 24%, stroke is a major public health issue in this continental country. Although most strokes in Brazil can be attributed to classic treatable cardiovascular risk factors, infectious diseases such as Chagas disease, arboviruses hemorrhagic fevers, neurocysticercosis, and malaria are also important risk factors. Socioeconomic disparities and population unawareness about stroke symptoms are great challenges in Brazil. There was an improvement in stroke awareness after the Brazilian Stroke Society and the World Stroke Organization launched several campaigns throughout the country. Another important step was taken in 2012, when the Brazilian Ministry of Health published the Brazilian National Stroke Act, including reimbursement for rtPA, creation of stroke centers qualified according to the hospital complexity, integration of the Brazilian Emergency Medical System, establishment of a budget for the rehabilitation system, and education and training of healthcare professionals and of the population. Since these measures, the number of stroke centers increased from 35 in 2008 to 149 in 2017 and stroke mortality in public stroke centers decreased from 17.9% in 2010 to 12.8% in 2014. Although much has improved, Brazil still has major social inequalities and further measures are needed to guarantee a high-quality stroke care.

HUBUNGAN PELAKSANAAN SCREENING TEST MENELAN DENGAN KEJADIAN DISFAGIA PADA PASIEN BARU YANG MENDERITA STROKE AKUT

According to the NINDS 2015, States that a stroke occurs when the blood supply to brain fails suddenly interrupted due to a blockage or rupture of blood vessels were. Basic Health Research results that show an increase in the prevalence of stroke symptoms in Indonesia increased from 8.3 at 1000 in 2007 to 12.1 and at 1000 in 2013. One of the problems that arise due to stroke is a disorder of swallowing or dysphagia. According to the World Stroke Academy Learning Moduls in 2012 the prevalence of dysphagia in stroke sufferers range from 36 to 67%. In the year 2016 in RSSN dysphagia in stroke patients 22,94%. For early detection of dysphagia screening test required to swallow as a first step in identifying the risks due to dysphagia and aspiration in stroke patients. The purpose of this research is to know the relationship of the implementation of the screening test to swallow with dysphagia in acute stroke patients in the room just entered inpatient Neurology RSSN Bukittinggi in 2017. This research method using analytic, descriptive, then the data was processed using the Chi Square test. The sample in this study as many as 54 people respondents. Test result statistics retrieved value p value = 0.002 (p &lt; α) then it can be inferred the existence of a relationship between the implementation of the screening test to swallow with dysphagia in acute stroke patients the new entry. Analysis of the results obtained OR = 9.281 meaning respondents who perform screening test procedures in accordance with the swallow has a chance of 9.281 times in detecting the occurrence of dysphagia. Suggestions in this study is the implementation of a screening test this swallow can be included in SPO for nurses in Bukittinggi in the room especially RSSN Neurology in detecting the onset of dysphagia in acute stroke patients.

Implementing Evidence-Based Practices for Acute Stroke Care in Low- and Middle-Income Countries.

Most strokes occur in low- and middle-income countries where resources to manage patients are limited. We explore the resources required to providing optimal acute stroke care and review barriers to implementing evidence-based stroke care in settings with limited resources using the World Stroke Organization's Global Stroke Services Action Plan framework. Major advances have been made during the past few decades in stroke prevention, treatment, and rehabilitation. These advances have been translated into practice in many high-income countries, but their uptake remains suboptimal in low- and middle-income countries. The review highlights the resources required to providing optimal acute stroke care in settings with limited resources. These resource levels were divided into minimal, essential, and advanced resources depending on the availability of stroke expertise, diagnostics, and facilities. Resources were described for the three stages of acute care: early diagnosis and management, acute management and prevention of complications, and early discharge and rehabilitation. Barriers to providing acute care at each of these stages in low- and middle-income countries are reviewed, explaining that some barriers persist in essential or advanced settings where some aspects of organized stroke units are available.

Public stroke knowledge, awareness, and response to acute stroke: Multi-center study from 4 Egyptian governorates

Background and purposeAcute stroke treatment has significantly improved over the years in Egypt. However, there is often notable delay in pre-hospital and in-hospital management of acute stroke patients. The delay may be largely attributed to poor stroke knowledge and awareness of the general public and this study was aimed at the evaluation of the abovementioned factors. MethodsDescriptive cross-sectional study involving 1154 participants from 4 governorates using a questionnaire in Arabic, collecting sociodemographic data, participants' risk factors, and knowledge and stroke awareness (risk factors, symptoms, prevention, treatment and prognosis, action in response to acute stroke). Data were collected during the World stroke day October 29, 2015. ResultsStudy participants were found to have a low level of awareness of stroke with median percent score of 35.7% and interquartile range (IQR) of 17.86. Higher income, level of education, having risk factors and knowing someone with stroke were significant predictors of a higher level of stroke awareness. ConclusionIn general, low public stroke awareness has been detected among Egyptians, and this is a call for healthcare authorities to invest in public education programmes among the Egyptian population.

Asset Literacy Following Stroke: Implications for Disaster Resilience.

The World Stroke Organization "1 in 6" campaign aims to raise awareness that 1 in 6 persons will experience a stroke during their lifetime. With aging populations and improved survival rates, an increased number of survivors live with functional limitations and require supportive care. This has important implications for implementing an all-of-society approach to disaster risk reduction. In this study, we explore the assets that stroke survivors and caregivers consider useful in supporting their capacity to manage routine activities and independent living and to respond to a disaster. Transcripts from interviews with stroke survivors and caregivers were analyzed by use of content analysis. Assets were categorized into 4 classes: social, physical, energy, and personal characteristics and are presented as a household map. Emergent themes suggested that understanding how to mobilize assets is complicated yet essential for building resilience. Household resilience requires people have self-efficacy and motivation to move from awareness to action. The findings informed development of a conceptual model of asset literacy and household resilience following stroke. Interventions to enhance asset literacy can support an all-of-society approach to disaster risk reduction through awareness, empowerment, participation, innovation, and engagement. (Disaster Med Public Health Preparedness. 2018; 12: 312-320).

Needs and rights awareness of stroke survivors and caregivers: a cross-sectional, single-centre questionnaire survey

ObjectivesThe needs and rights awareness of stroke survivors have not been reported in China. This study investigated the needs and rights awareness of stroke survivors and caregivers in Tianjin, China.SettingA...

Hospital-Based Study of the Frequency and Risk Factors of Stroke Recurrence in Two Years in China

Stroke causes death and disability throughout the world and recurrent stroke events are more likely to be disabling or fatal. We conducted a hospital-based study to investigate the frequency and influence factors of stroke recurrence in China. Data from patients hospitalized with stroke between January 2007 and December 2010 of 109 tertiary hospitals in China were used. Stroke recurrence and associated factors were ascertained. The zero-inflated model was used to evaluate the factors of recurrence. Of 101,926 discharged patients, the cumulative 2-year stroke recurrence rate was 3.80% for subarachnoid hemorrhage (SAH), 5.31% for intracerebral hemorrhage (ICH), and 8.71% for ischemic stroke (IS), respectively. Among patients with stroke recurrence, 54.11% with SAH, 60.42% with ICH, and 92.92% with IS relapsed for the same type of the first-onset stroke. For discharged patients with SAH with middle cerebral artery aneurysm clipping or artery aneurysm embolization, it was less likely to stroke relapse, but the times of recurrence would increase if 1 recurrence appeared. Cerebral artery aneurysms and hypertension were risk factors for recurrence frequency. For ICH, protective factors for recurrence were trepanation and drainage of intracranial hematoma, cerebral angiography, puncture and drainage of intracranial hematoma, and length of stay (LOS). But rheumatic heart disease and atrial fibrillation would further the relapse frequency. For IS, age and LOS were protective factors, but recurrence frequency would increase if the first recurrence happened. Cervical spondylopathy, male gender, and diabetes were risk factors for frequency of relapse. Associated factors were different for recurrence frequency among different stroke types.