Stroke awareness in Brazil: alarming results in a community-based study.
OBJECTIVE
Stroke is the leading cause of death in Brazil. This community-based study assessed lay knowledge about stroke recognition and treatment and risk factors for cerebrovascular diseases and activation of emergency medical services in Brazil.


METHODS
The study was conducted between July 2004 and December 2005. Subjects were selected from the urban population in transit about public places of 4 major Brazilian cities: São Paulo, Salvador, Fortaleza, and Ribeirão Preto. Trained medical students, residents, and neurologists interviewed subjects using a structured, open-ended questionnaire in Portuguese based on a case presentation of a typical patient with acute stroke at home.


RESULTS
Eight hundred fourteen subjects were interviewed during the study period (53.9% women; mean age, 39.2 years; age range, 18 to 80 years). There were 28 different Portuguese terms to name stroke. Twenty-two percent did not recognize any warning signs of stroke. Only 34.6% of subjects answered the correct nationwide emergency telephone number in Brazil (#192). Only 51.4% of subjects would call emergency medical services for a relative with symptoms of stroke. In a multivariate analysis, individuals with higher education called emergency medical services (P=0.038, OR=1.5, 95%, CI: 1.02 to 2.2) and knew at least one risk factor for stroke (P<0.05, OR=2.0, 95% CI: 1.2 to 3.2) more often than those with lower education.


CONCLUSIONS
Our study discloses alarming lack of knowledge about activation of emergency medical services and availability of acute stroke treatment in Brazil. These findings have implications for public health initiatives in the treatment of stroke and other cardiovascular emergencies.
Pontes-Neto
Octávio Marques
OM
Department of Neurology, University of São Paulo, School of Medicine at Ribeirão Preto, Ribeirão Preto, Campus Universitário, CEP 14049-900, Brazil. octaviopontes@rnp.fmrp.usp.br
Silva
Gisele Sampaio
GS
Feitosa
Marley Ribeiro
MR
de Figueiredo
Nathalie Lôbo
NL
Fiorot
José Antonio
JA
Rocha
Talitha Nery
TN
Massaro
Ayrton Roberto
AR
Leite
João Pereira
JP
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001938:Brazil / Q000453:epidemiology; D003625:Data Collection; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006266:Health Education / Q000706:statistics & numerical data*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009462:Neurology / Q000706:statistics & numerical data*; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000628:therapy*; D011795:Surveys and Questionnaires