Background: Spanish is the second most-spoken language in the world. Spanish-speaking populations (SSP) have heterogeneous cultural backgrounds, racial and ethnical origins, economic status, and access to health care systems. There are no published reviews about stroke knowledge in SSP. We reviewed the existing literature addressing stroke knowledge among SSP and propose here some future directions for research. Summary: We identified 18 suitable studies by searching PubMed, Lilacs, Scopus, Embase, Cochrane and Scielo databases, and by looking at reference lists of eligible articles. We also included 2 conference abstracts. Data related to stroke knowledge from studies of Spanish-speakers were analyzed. Key Messages: Little is known about stroke knowledge in SSP, especially in Latin America. Information is lacking even among subjects at risk, stroke patients, stroke survivors, and health care providers. ‘Ictus', the word used for stroke in Spanish, is largely unrecognized among subjects at risk. Furthermore, access to medical care and the availability of neurologists are suboptimal in many regions. There are several potential issues to solve regarding stroke knowledge and stroke care in SSP. Programs to educate the general population and non-neurologists medical providers in stroke and telemedicine may be better ways of improving the present situation.

Keywords:
Stroke knowledge, Stroke literacy, Spanish-speakers, Spain, Latin America
1.
Feigin VL, Forouzanfar MH, Krishnamurthi R, Mensah GA, Connor M, Bennett DA, Moran AE, Sacco RL, Anderson L, Truelsen T, O'Donnell M, Venketasubramanian N, Barker-Collo S, Lawes CM, Wang W, Shinohara Y, Witt E, Ezzati M, Naghavi M, Murray C: Global and regional burden of stroke during 1990-2010: findings from the global burden of disease study 2010. Lancet 2014;383:245-254.
2.
Murray CJ, Lopez AD: Measuring the global burden of disease. N Engl J Med 2013;369:448-457.
3.
Tissue plasminogen activator for acute ischemic stroke. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. N Engl J Med 1995;333:1581-1587.
4.
Hacke W, Kaste M, Bluhmki E, Brozman M, Davalos A, Guidetti D, Larrue V, Lees KR, Medeghri Z, Machnig T, Schneider D, von Kummer R, Wahlgren N, Toni D: Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008;359:1317-1329.
5.
Nasr DM, Brinjikji W, Cloft HJ, Rabinstein AA: Utilization of intravenous thrombolysis is increasing in the United States. Int J Stroke 2013;8:681-688.
6.
Navarrete-Navarro P, Murillo-Cabeza F, Bono-de-Seras R, Rodriguez-Romero R, Rodriguez-Zarallo A, Vazquez-Mata G: Development of an acute ischemic stroke management course for hospital physicians in emergency departments and intensive care units. Eur J Emerg Med 2012;19:108-111.
7.
Rosamond WD, Gorton RA, Hinn AR, Hohenhaus SM, Morris DL: Rapid response to stroke symptoms: the delay in accessing stroke healthcare (DASH) study. Acad Emerg Med 1998;5:45-51.
8.
Feldmann E, Gordon N, Brooks JM, Brass LM, Fayad PB, Sawaya KL, Nazareno F, Levine SR: Factors associated with early presentation of acute stroke. Stroke 1993;24:1805-1810.
9.
Williams LS, Bruno A, Rouch D, Marriott DJ: Stroke patients' knowledge of stroke. Influence on time to presentation. Stroke 1997;28:912-915.
10.
Wester P, Radberg J, Lundgren B, Peltonen M: Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA: a prospective multicenter study. Seek-medical-attention-in-time study group. Stroke 1999;30:40-48.
11.
Clark JM, Renier SA: A community stroke study: factors influencing stroke awareness and hospital arrival time. J Stroke Cerebrovasc Dis 2001;10:274-278.
12.
Schroeder EB, Rosamond WD, Morris DL, Evenson KR, Hinn AR: Determinants of use of emergency medical services in a population with stroke symptoms: the second delay in accessing stroke healthcare (DASH II) study. Stroke 2000;31:2591-2596.
13.
Kothari R, Sauerbeck L, Jauch E, Broderick J, Brott T, Khoury J, Liu T: Patients' awareness of stroke signs, symptoms, and risk factors. Stroke 1997;28:1871-1875.
14.
Centers for Disease Control and Prevention (CDC): Awareness of stroke warning symptoms - 13 states and the district of Columbia, 2005. MMWR Morb Mortal Wkly Rep 2008;57:481-485.
15.
Miyamatsu N, Okamura T, Nakayama H, Toyoda K, Suzuki K, Toyota A, Hata T, Hozawa A, Nishikawa T, Morimoto A, Ogita M, Morino A, Yamaguchi T: Public awareness of early symptoms of stroke and information sources about stroke among the general Japanese population: the acquisition of stroke knowledge study. Cerebrovasc Dis 2013;35:241-249.
16.
Ellis C, Barley J, Grubaugh A: Poststroke knowledge and symptom awareness: a global issue for secondary stroke prevention. Cerebrovasc Dis 2013;35:572-581.
17.
List of languages by number of native speakers, 2014.
18.
Paul LM, Simons GF, Fennig CD (eds): Ethnologue: Languages of the World. Dallas, Texas, SIL International, 2014, 2015.
19.
Lutfiyya MN, Bardales R, Bales R, Aguero C, Brady S, Tobar A, McGrath C, Zaiser J, Lipsky MS: Awareness of heart attack and stroke symptoms among Hispanic male adults living in the United States. J Immigr Minor Health 2010;12:761-768.
20.
Romano JG, Sacco RL: Quantifying and addressing persistent stroke disparities in Hispanics. Ann Neurol 2013;74:759-761.
21.
Cruz-Flores S, Rabinstein A, Biller J, Elkind MS, Griffith P, Gorelick PB, Howard G, Leira EC, Morgenstern LB, Ovbiagele B, Peterson E, Rosamond W, Trimble B, Valderrama AL; American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, Council on Quality of Care and Outcomes Research: Racial-ethnic disparities in stroke care: the American experience: a statement for healthcare professionals from the American heart association/American stroke association. Stroke 2011;42:2091-2116.
22.
Nasr DM, Brinjikji W, Cloft HJ, Rabinstein AA: Racial and ethnic disparities in the use of intravenous recombinant tissue plasminogen activator and outcomes for acute ischemic stroke. J Stroke Cerebrovasc Dis 2013;22:154-160.
23.
DuBard CA, Garrett J, Gizlice Z: Effect of language on heart attack and stroke awareness among U.S. Hispanics. Am J Prev Med 2006;30:189-196.
24.
Ferris A, Robertson RM, Fabunmi R, Mosca L; American Heart Association; American Stroke Association: American heart association and American stroke association national survey of stroke risk awareness among women. Circulation 2005;111:1321-1326.
25.
Smith MA, Lisabeth LD, Bonikowski F, Morgenstern LB: The role of ethnicity, sex, and language on delay to hospital arrival for acute ischemic stroke. Stroke 2010;41:905-909.
26.
Montaner J, Vidal C, Molina C, Alvarez-Sabin J: Selecting the target and the message for a stroke public education campaign: a local survey conducted by neurologists. Eur J Epidemiol 2001;17:581-586.
27.
Oró M, Sanahuja-Montesinos J, Hernández L, Setó E, Purroy F: [The extent of knowledge about strokes among the population of a rural area in the province of Lleida]. Rev Neurol 2009;48:515-519.
28.
Palomeras E, Fossas P, Quintana M, Monteis R, Sebastián M, Fábregas C, Ciurana A, Ribó M, Cano A, Sanz P, Floriach M, Alvarez-Sabín J: Emergency perception and other variables associated with extra-hospital delay in stroke patients in the maresme region (Spain). Eur J Neurol 2008;15:329-335.
29.
Segura T, Vega G, López S, Rubio F, Castillo J: Public perception of stroke in Spain. Cerebrovasc Dis 2003;16:21-26.
30.
Montaner J, Mauleón A, Vidal a C, Molina C, Alvarez-Sabín J: [Stroke: a stranger among the people]. Rev Neurol 1998;27:943-947.
31.
Pérez-Lázaro C, Iñíguez-Martínez C, Santos-Lasaosa S, Alberti-González O, Martínez-Martínez L, Tejero-Juste C, Mostacero-Miguel E: [Study into what the population knows about strokes and vascular risk factors]. Rev Neurol 2009; 49:113-118.
32.
Bruera G, Arca A, Sposato L, Ameriso SF, Zurru MC: Día mundial del ataque cerebral en Argentina: evaluación del impacto educacional en una población. Neurol Argent 2010;P44.119.
33.
Hawkes M, Calandri I, Farez M, Arena J, Pujol Lereis V, Ameriso A: Perception of stroke symptoms and utilization of emergency medical systems in Argentina (P7.132). Neurology 2014;82:6-12.
34.
Lavallée PC, Meseguer E, Abboud H, Cabrejo L, Olivot JM, Simon O, Mazighi M, Nifle C, Niclot P, Lapergue B, Klein IF, Brochet E, Steg PG, Lesèche G, Labreuche J, Touboul PJ, Amarenco P: A transient ischaemic attack clinic with round-the-clock access (SOS-TIA): feasibility and effects. Lancet Neurol 2007;6:953-960.
35.
Doldán L, Fernández-Suárez M, Hawkes M, Pujol Lereis V, Povedano GP, Ameriso SF: Diagnóstico y manejo temprano del accidente isquémico transitorio. Neurol Argent 2011;P4.10.
36.
Díaz Cabezas R, Ruano Restrepo MI: Knowledge of symptoms and risk factors for stroke in an urban population in Colombia. Acta Neurol Colomb 2011;27:195-204.
37.
Ellis C, Wolff J, Wyse A: Stroke awareness among low literacy Latinos living in the South Carolina low country. J Immigr Minor Health 2009;11:499-504.
38.
Willey JZ, Williams O, Boden-Albala B: Stroke literacy in Central Harlem: a high-risk stroke population. Neurology 2009;73:1950-1956.
39.
Góngora-Rivera F, Gutiérrez-Jiménez E, Zenteno MA; GEPEVC Investigators: Knowledge of ischemic stroke among a Mexico city population. J Stroke Cerebrovasc Dis 2009;18:208-213.
40.
Gutiérrez-Jiménez E, Góngora-Rivera F, Martínez HR, Escamilla-Garza JM, Villarreal HJ; GECEN Investigators: Knowledge of ischemic stroke risk factors and warning signs after a health education program by medical students. Stroke 2011;42:897-901.
41.
Lundelin K, Graciani A, García-Puig J, Guallar-Castillón P, Taboada JM, Rodríguez-Artalejo F, Banegas JR: Knowledge of stroke warning symptoms and intended action in response to stroke in Spain: a nationwide population-based study. Cerebrovasc Dis 2012;34:161-168.
42.
Goldstein LB, Silberberg M, McMiller Y, Yaggy SD: Stroke-related knowledge among uninsured Latino immigrants in Durham county, North Carolina. J Stroke Cerebrovasc Dis 2009;18:229-231.
43.
Pontes-Neto OM, Silva GS, Feitosa MR, de Figueiredo NL, Fiorot JA Jr, Rocha TN, Massaro AR, Leite JP: Stroke awareness in Brazil: alarming results in a community-based study. Stroke 2008;39:292-296.
44.
Atallah AM, Fustinoni O, Zurru MC, Beigelman R, Cirio J, S.F. A, Burry G: Identifying barriers in acute stroke therapy in Argentina. ARENAS registry (P2.014). Neurology 2014;82:P2.014.
45.
Geffner D, Soriano C, Pérez T, Vilar C, Rodríguez D: Delay in seeking treatment by patients with stroke: who decides, where they go, and how long it takes. Clin Neurol Neurosurg 2012;114:21-25.
46.
Díez-Ascaso O, Martinez-Sánchez P, Fuentes B, Díez-Tejedor E: Sociocultural study on the self-perception of stroke and an analysis of doctor-patient communication. Neurologia 2011;26:81-91.
47.
Palomeras Soler E, Fossas Felip P, Quintana Luque M, Monteis Cahis R, Sebastián Salvatierra M, Fábregas Casarramona C, Ciurana Ortells A, Cano Orqaz AT, Sanz Cartagena P, Floriach Robert M, Alvarez Sabin J: [Knowledge about stroke symptoms and attitude towards them in the population]. Neurologia 2007;22:434-440.
48.
Atlas: Country Resources for Neurological Disorders; Geneva, World Health Organization and World Federation of Neurology, 2004, pp 28-29.
49.
Harbison J, Hossain O, Jenkinson D, Davis J, Louw SJ, Ford GA: Diagnostic accuracy of stroke referrals from primary care, emergency room physicians, and ambulance staff using the face arm speech test. Stroke 2002;34:71-76.
50.
Moulin T, Sablot D, Vidry E, Belahsen F, Berger E, Lemounaud P, Tatu L, Vuillier F, Cosson A, Revenco E, Capellier G, Rumbach L: Impact of emergency room neurologists on patient management and outcome. Eur Neurol 2003;50:207-214.
51.
García-Zamora S, Elías R, Schipper NP, Palameta F, Parodi R, Gallo R, Greca A: Conocimiento de escalas de evaluación inicial de accidente cerebrovascular por médicos de guardia en tres provincias argentinas. Revista Medica de Rosario Rosario 2013;79:62-72.
52.
Ellis C, Egede LE: Ethnic disparities in stroke recognition in individuals with prior stroke. Public Health Rep 2008;123:514-522.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.