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Neurology India, Vol. 54, No. 2, April-June, 2006, pp. 156 Invited Comments Invited Comments Derex Laurent Unite Neurovasculaire, Hopital Neurologique, 59 boulevard Pinel, 69003 Lyon Code Number: ni06045 Related article: ni06044 This is the first study to assess knowledge of stroke warning symptoms and risk factors in Northwest Indian stroke and transient ischemic attack (TIA) patients and their relatives. This is obviously a crucial issue as increased awareness may lead to improved acute management and better prevention of cerebrovascular diseases. The present paper demonstrates an urgent need for public education, similar to what has been observed in the Western countries; lower educational status was associated with poor stroke awareness, only 33% of individuals could correctly identify brain as the involved organ in stroke and the majority of patients did not realize that they were experiencing symptoms of stroke. Reducing delays in patient response to stroke symptoms may have the greatest impact on emergency treatment rates (thrombolysis for ischemic stroke and ultra-early hemostatic therapy for intracerebral hemorrhage in the future). The California Acute Stroke Pilot Registry Investigators have recently shown that if all ischemic stroke patients whose strokes did not occur overnight had attributed their symptoms to stroke and had made an immediate call to Emergency Medical Services (EMS), the rate of thrombolytic treatment would have been as high as 29%.[1] Potential strategies for increasing the rate of thrombolysis for stroke include educating people at risk of stroke and the general public about the stroke warning signs and the immediate proper response, improving emergency responses to calls and improving in-hospital management of stroke. However, optimizing patient response and reducing delays in seeking help may be difficult. The discontinuity between knowledge, attitude and behaviour change has long been discussed by health educators. More important than stroke awareness is probably behaviour in the event of a stroke. Indeed, knowledge of stroke symptoms has not been consistently associated with early admission[2] and it has recently been shown that perceptual, social and behavioral factors are associated with delays in seeking medical care in patients with symptoms of acute stroke.[3] The patient′s perception of the severity of his symptoms and the extent of perceived control over them influence "reaction times". In the setting of TIA, despite the high risk of stroke in the hours and days after TIA, an English study has demonstrated that patients delay seeking medical attention irrespective of correct recognition of symptoms.[4] Educational programs should not only increase awareness about the recognition of stroke symptoms but also about the appropriate response. We are facing a communication challenge to develop simple and repetitive messages in order to change behaviours related to stroke. In particular, the benefits associated with behaviour change must be clearly presented. Mass media is most frequently named as a source of information about stroke. However, health education programs should be adapted to population social and cultural characteristics. They should focus on population groups at risk for lack of knowledge about stroke, such as older people or those from an impaired socioeconomic background, who are also at an increased risk of stroke.[5] Patience is required as public education tends to work slowly and behaviour changes are often the result of consistent campaigns over many years. References
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