PDF(Pubmed)
Abstract：
UNASSIGNED: Until recently, public education campaigns aimed at improving help-seeking behavior by acute stroke patients have achieved only limited or even no effects. Better understanding of psychological factors determining help-seeking behavior may be relevant in the design of more effective future campaigns.
UNASSIGNED: In this prospective, cross-sectional study, we interviewed 669 acute stroke patients within 72 h after hospital admission. The primary endpoint was the effect of psychological factors on the decision to call emergency medical services (EMS). Secondary endpoints were the effects of such factors on treatment rates and clinical improvement (difference between modified Rankin scale (MRS) scores at admission and at discharge).
UNASSIGNED: Only 48.7% of the study population called the EMS. Multivariate logistic and linear regression analyses revealed that perception of unimpaired performance of activities of daily living (ADL) was the only psychological factor that predicted EMS use and outcomes. Thus, patients who perceived only minor impairment in performing ADL were less likely to use EMS (odds ratio, 0.54 [95% confidence interval, 0.38-0.76]; p = 0.001), had lower treatment rates, and had less improvement in MRS scores (b = 0.40, p = 0.004). Additional serial mediation analyses involving ischemic stroke patients showed that perception of low impairment in ADL decreased the likelihood of EMS notification, thereby increasing prehospital delays, leading to reduced thrombolysis rates and, finally, to reduced clinical improvement.
UNASSIGNED: Perception of unimpaired performance of ADL is a crucial barrier to appropriate help-seeking behavior after acute stroke, leading to undertreatment and less improvement in clinical symptoms. Thus, beyond improving the public\'s knowledge of stroke symptoms, future public education campaigns should focus on the need for calling the EMS in case of stroke symptoms even if daily activities do not seem to be severely impaired.
UNASSIGNED: In this prospective, cross-sectional study, we interviewed 669 acute stroke patients within 72 h after hospital admission. The primary endpoint was the effect of psychological factors on the decision to call emergency medical services (EMS). Secondary endpoints were the effects of such factors on treatment rates and clinical improvement (difference between modified Rankin scale (MRS) scores at admission and at discharge).
UNASSIGNED: Only 48.7% of the study population called the EMS. Multivariate logistic and linear regression analyses revealed that perception of unimpaired performance of activities of daily living (ADL) was the only psychological factor that predicted EMS use and outcomes. Thus, patients who perceived only minor impairment in performing ADL were less likely to use EMS (odds ratio, 0.54 [95% confidence interval, 0.38-0.76]; p = 0.001), had lower treatment rates, and had less improvement in MRS scores (b = 0.40, p = 0.004). Additional serial mediation analyses involving ischemic stroke patients showed that perception of low impairment in ADL decreased the likelihood of EMS notification, thereby increasing prehospital delays, leading to reduced thrombolysis rates and, finally, to reduced clinical improvement.
UNASSIGNED: Perception of unimpaired performance of ADL is a crucial barrier to appropriate help-seeking behavior after acute stroke, leading to undertreatment and less improvement in clinical symptoms. Thus, beyond improving the public\'s knowledge of stroke symptoms, future public education campaigns should focus on the need for calling the EMS in case of stroke symptoms even if daily activities do not seem to be severely impaired.
摘要：
■直到最近，旨在改善急性中风患者寻求帮助行为的公共教育活动仅取得了有限的效果，甚至没有效果。更好地了解决定寻求帮助行为的心理因素可能与设计更有效的未来活动有关。
■在这个前景中，横断面研究，我们在入院后72小时内采访了669名急性卒中患者。主要终点是心理因素对紧急医疗服务（EMS）决定的影响。次要终点是这些因素对治疗率和临床改善的影响（入院时和出院时改良Rankin量表（MRS）评分之间的差异）。
■只有48.7%的研究人群称EMS。多变量逻辑和线性回归分析显示，对日常生活活动（ADL）未受损表现的感知是预测EMS使用和结果的唯一心理因素。因此，在进行ADL时只感觉到轻微损伤的患者不太可能使用EMS(比值比，0.54[95%置信区间，0.38-0.76]；p=0.001），治疗率较低，MRS评分改善较少（b=0.40，p=0.004）。涉及缺血性卒中患者的其他系列调解分析显示，ADL低损害的感知降低了EMS通知的可能性。从而增加院前延误，导致溶栓率降低，最后,减少临床改善。
■对ADL未受损表现的感知是急性中风后适当寻求帮助行为的关键障碍，导致治疗不足，临床症状改善较少。因此，除了提高公众对中风症状的认识，未来的公共教育活动应集中在中风症状出现时需要致电EMS，即使日常活动似乎没有受到严重损害。
■在这个前景中，横断面研究，我们在入院后72小时内采访了669名急性卒中患者。主要终点是心理因素对紧急医疗服务（EMS）决定的影响。次要终点是这些因素对治疗率和临床改善的影响（入院时和出院时改良Rankin量表（MRS）评分之间的差异）。
■只有48.7%的研究人群称EMS。多变量逻辑和线性回归分析显示，对日常生活活动（ADL）未受损表现的感知是预测EMS使用和结果的唯一心理因素。因此，在进行ADL时只感觉到轻微损伤的患者不太可能使用EMS(比值比，0.54[95%置信区间，0.38-0.76]；p=0.001），治疗率较低，MRS评分改善较少（b=0.40，p=0.004）。涉及缺血性卒中患者的其他系列调解分析显示，ADL低损害的感知降低了EMS通知的可能性。从而增加院前延误，导致溶栓率降低，最后,减少临床改善。
■对ADL未受损表现的感知是急性中风后适当寻求帮助行为的关键障碍，导致治疗不足，临床症状改善较少。因此，除了提高公众对中风症状的认识，未来的公共教育活动应集中在中风症状出现时需要致电EMS，即使日常活动似乎没有受到严重损害。
