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PAPERS: Sung Sug Yoon and Julie Byles Perceptions of stroke in the general public and patients with stroke: a qualitative study BMJ 2002; 324: 1065 [Abstract] [Full text]

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Usefulness of early recognizing serious dieases by general public.

Sergio Stagnaro   (3 May 2002)

Added interest - listing main symptoms of stroke

Chloe Mason, University of Technology, Sydney 2000   (3 May 2002)

stroke knowledge

ABHAYA GUPTA, PETER THOMAS   (14 May 2002)

Usefulness of early recognizing serious dieases by general public. 3 May 2002
Sergio Stagnaro, Specialist in Blood, Gastrointestinal and Metabolic Diseases. Researcher in Biophysical Semeiotics Via Erasmo Piaggio 23/8 16037 Riva Trigoso (Genoa) Italy Send response to journal: Re: Usefulness of early recognizing serious dieases by general public.	Sirs, S.S.Yoon and J.Byles’s article conclusion (1) is interesting, in my opinion, not only as far as facing stroke early diagnosis in general public is concerned, but, more remarkable, as regards perceptions in the same people of serious disease and patients involved by a large variety of grave disorders. For example, I mean thoracic and/or arm pain, appearently trivial, in patients with initial myocardial infarction. This paper intriguingly underscores the need and utility of “simple” tools and manoeuvres, reliable, at the beach as well as in the mountains, in clinical and prompt recognising serious diseases, unavoidable in order to prevent future morbidity or mortality. A 45-year long clinical experience allows me to state that general public “could” recognise, e. g., a stroke, a part from its clinical symptomatology, by the simple following manouvre: digital pressure, applied “gently” on an eye-ball (after the subject’s eyes are closed in some way,of course), homolateral to stroke site, brings about face muscles slight contractions, absent, by contrast, when digital pressure stimulates controlateral “trigger-points”. Obviously, doctors, using a stethoscope, are able to assesse a lot of biophysical-semeiotics signs during the same maneouvre, I have illustrated previously (2,3,4)(See in the site HONCode 233736, http://digilander.iol.it/semeioticabiofisica, Cerebral Tumour, and Bibliography). 1) Yoon S.S., Byles J. Perceptions of stroke in the general public and patients with stroke: a qualitative study. BMJ 2002;324:1065 ( 4 May ). 2) Stagnaro S., Auscultatory percussion of the cerebral tumour: Diagnostic importance of the evoked potentials, Biol. Med., 7, 171-175, 1985. 3) Stagnaro S., Auscultatory percussion of the cerebral tumour: Diagnostic importance of the evoked potentials, Biol. Med., 7, 171-175,1989. 4) Stagnaro S., Valutazione percusso-ascoltatoria della microcircolazione cerebrale globale e regionale. Atti, XII Congr. Naz. Soc. It. di Microangiologia e Microcircolazione. 13-15 Ottobre, Salerno, e Acta Medit. 145, 163, 1986.
Added interest - listing main symptoms of stroke 3 May 2002
Chloe Mason, Visiting Fellow Institute for Sustainable Futures, University of Technology, Sydney 2000 Send response to journal: Re: Added interest - listing main symptoms of stroke	The paper about the public understanding of symptoms of stroke has an interesting design in contrasting the views of a group of the general public with people who have had a stroke. The article would be more interesting to read (and pass around) if it had included a list of the main symptoms of stroke. For the non-clinical readership, please could you publish a list of the main symptoms? In appreciation, Chloe Mason
stroke knowledge 14 May 2002
ABHAYA GUPTA, Specialist Registrar Llandough hospital, Cardiff CF642XX, PETER THOMAS Send response to journal: Re: stroke knowledge	We read with interest the article by Yoon and Byles (1) in 4th May issue of the BMJ. The authors found their subjects had poor recognition of stroke symptoms and risk factors. Lack of knowledge results in delays in seeking medical care (2). As a result, patients with stroke may fail to gain the benefits of acute treatments eg acute thrombolysis due to the narrow therapeutic window (3). We conducted a large prospective questionnaire study amongst elderly patients attending a United Kingdom hospital clinic (4). Patients with established stroke risk factors (atrial fibrillation, diabetes, hypertension, previous stroke, TIA) were interviewed. 410 patients (mean age 78 years) gave their responses to a semi-structured questionnaire. 82% patients could identify the stroke symptoms correctly and the remainder were not sure/incorrect. 10% thought that stroke is caused by damage to the heart while 86% correctly correlated stroke with brain damage. On free recall, 65% correctly identified at least one established stroke risk factor and 35% did not know a single risk factor for stroke. The commonest perceived risk factor was ‘stress’ (reported by 52%) and the second commonest was hypertension (48%). When subjects were asked to choose stroke risk factors (on closed ended questionnaire containing both correct and incorrect responses) stress was again identified as the commonest factor (62%). A large number of subjects reported other incorrect stroke risk factors eg liver disease, cold, no rest. Only 15% patients considered themselves to be at higher risk of stroke because of underlying disease. Very few subjects (22%) had been informed by a health professional that their underlying condition predisposed them to stroke. Our results show that there is incomplete understanding about stroke symptoms, risk factors, perceived risk and organ affected amongst at risk population in a civilized world. We agree with the authors that educational strategies are urgently needed to remove misconceptions and to enable patients in seeking medical help and therefore the benefits of early stroke treatments (5). Effective educational programs could also increase public awareness of stroke in the population. References : 1. Yoon SS, Byles J. Perception of stroke in the general public and patients with stroke : a questionnaire study. BMJ 2002; 324: 1065. 2. Williams LS, Bruno A, Rouch D et al. Stroke patients knowledge of stroke : influence on time to presentation. Stroke 1997; 28:912-15. 3. National Institute of Neurological Disorders and Stroke recombinant tissue plasminogen activator Study group: TPA for acute ischaemic stroke. N Eng J Med. 1995; 333: 1581-87. 4. Gupta A, Thomas P. Knowledge of stroke among elderly patients at increased risk of stroke. Abstract. JAGS 2000; 48: S76. 5. Panicoli AM, Broderick J, Kothari R et al. Public perception of stroke warning signs and knowledge of potential risk factors. JAMA. 1998; 279(16): 1288-92.