***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND We describe the design and baseline data of an educational intervention targeting predominantly Mexican American middle school students and their parents in an effort to improve stroke awareness . Increasing awareness in this group may increase the number of patients eligible for acute stroke treatment by encouraging emergency medical services ( EMS ) activation . METHODS This is a prospect i ve , r and omized study in which six middle schools were r and omly assigned to receive a stroke education program or the st and ard health class .  Primary outcome measures are the percentage of students and parents who recognize stroke symptoms and express the intent to activate EMS upon recognition of these findings . RESULTS A total of 547 students ( 271 control , 276 intervention ) and 484 parents ( 231 control , 253 intervention ) have been enrolled . Pretests were administered . The intervention has been successfully carried out in the parent and student cohorts over a three-year period . Posttests and persistence test results are pending . CONCLUSION Implementing a school-based stroke education initiative is feasible . Followup testing will demonstrate whether this educational initiative translates into a measurable and persistent improvement in stroke knowledge and behavioral intent to activate EMS upon recognition of stroke symptoms Background and Purpose — Reduction in the risk of stroke and increase in the speed of hospital presentation after the onset of stroke both depend on the level of knowledge of stroke in the general population . The aim of the present study was to assess baseline knowledge regarding stroke risk factors , symptoms , treatment , and information re sources . Methods — A community-based telephone interview survey was conducted in the Newcastle urban area in Australia . A total of 1278 potential participants between the ages of 18 to 80 were selected at r and om from an electronic telephone directory . A trained telephone interviewer conducted a telephone survey using the Computer-Assisted Telephone Interviewing ( CATI ) program . Results — A total of 822 participants completed the telephone interview . Six hundred three participants ( 73.4 % ) correctly identified the brain as the affected organ in stroke . The most common risk factors for stroke identified by respondents were smoking ( identified by 324 [ 39.4 % ] ) and stress ( identified by 277 [ 33.7 % ] ) . The most common warning sign of stroke described by respondents was “ blurred and double vision or loss of vision in an eye , ” listed by 198 ( 24.1 % ) . A total of 626 ( 76.2 % ) respondents correctly listed ≥1 established stroke risk factor , but only 409 ( 49.8 % ) respondents correctly listed ≥1 warning sign . Conclusions — The level of knowledge in the community of established stroke risk factors , warning signs , and treatment as indicated by this survey suggests that a community-based education program to increase public knowledge of stroke may contribute to reducing the risk of stroke and to increasing the speed of hospital presentation after the onset of stroke Background and Purpose — This study compared the psychometric properties of 3 clinical balance measures , the  Berg Balance Scale ( BBS ) , the Balance subscale of the Fugl-Meyer test ( FM-B ) , and the Postural Assessment Scale for Stroke Patients ( PASS ) , in stroke patients with a broad range of neurological and functional impairment from the acute stage up to 180 days after onset . Methods — One hundred twenty-three stroke patients were followed up prospect ively with the 3 balance measures 14 , 30 , 90 , and 180 days after stroke onset ( DAS ) . Reliability ( interrater reliability and internal consistency ) and validity ( concurrent validity , convergent validity , and predictive validity ) of each measure were examined . A comparison of the responsiveness of each of the 3 measures was made on the basis of the entire group of patients and 3 separate groups classified by degree of neurological severity . Results — The FM-B and BBS showed a significant floor or ceiling effect at some DAS points , whereas the PASS did not show these effects . The BBS , FM-B , and PASS all had good reliability and validity for patients at different recovery stages after stroke . The results of effect size demonstrated fair to good responsiveness of all 3 measures within the first 90 DAS but , as expected , only a low level of responsiveness at 90 to 180 DAS . The PASS was more responsive to changes in severe stroke patients at the earliest period after stroke onset , 14 to 30 DAS . Conclusions — All 3 measures tested showed very acceptable levels of reliability , validity , and responsiveness for both clinicians and research ers . The PASS showed slightly better psychometric characteristics than the other 2 measures Background and Purpose — Previous overt stroke and sub clinical stroke are frequent in patients with stroke ; yet , their clinical significance and effects on stroke outcome are not clear . We studied the burden and outcome after acute ischemic stroke by prevalent ischemic brain disease in a national registry of hospitalized patients with acute stroke . Methods — Patients with ischemic stroke in the National Acute Stroke Israeli prospect i ve hospital-based registry ( February to March 2004 , March to April 2007 , and April to May 2010 ) with information on previous overt stroke and sub clinical stroke per computed tomography/MRI ( n=3757 ) were included . Of them , a sub sample ( n=787 ) was followed up at 3 months .  Logistic regression models  were computed for outcomes in patients with prior overt stroke or sub clinical stroke , compared with patients with first stroke , adjusting for age , sex , vascular risk factors , stroke severity , and clinical classification . Results — Two-thirds of patients had a prior overt stroke or sub clinical stroke . Death rates were similar for patients with and without prior stroke . Adjusted odds ratios ( OR ; 95 % confidence interval [ CI ] ) for disability were increased for patients with prior overt stroke ( OR , 1.31 ; 95 % CI , 1.03–1.66 ) and sub clinical stroke ( OR , 1.45 ; 95 % CI , 1.16–1.82 ) . Relative odds of Barthel Index ⩽60 for patients with prior overt stroke ( OR , 2.04 ; 95 % CI , 1.14–3.68 ) and with prior sub clinical stroke ( OR , 2.04 ; 95 % CI , 1.15–3.64 ) were twice higher than for patients with a first stroke . ORs for dependency were significantly increased for patients with prior overt stroke ( OR , 1.95 ; 95 % CI , 1.19–3.20 ) but not for those with sub clinical stroke ( OR , 1.36 ; 95 % CI , 0.84–2.19 ) . Conclusions — In our national cohort of patients with acute ischemic stroke , nearly two thirds had a prior overt stroke or sub clinical stroke . Risk of poor functional outcomes was increased for patients with prior stroke , both overt and sub clinical BACKGROUND The ideal method of providing stroke patients with information has not been established . OBJECTIVES To evaluate the effectiveness of providing stroke patients with computer-generated tailored written information . DESIGN R and omised controlled trial with blinded assessor . SETTING Acute stroke unit . PARTICIPANTS 138 stroke patients . METHODS Patients were r and omised to receive either computer-generated tailored written information about stroke or generic written information while in hospital . Three months following discharge , a blinded assessor evaluated the outcomes of knowledge about stroke , self-efficacy ( Self-Efficacy to Perform Self-Management Behaviours Scale ) , anxiety and depression ( Hospital Anxiety and Depression ( HAD ) Scale ) , perceived health status ( COOP charts ) , satisfaction with content and presentation of the written information received ( separate 10-point visual analogue scale for content and presentation ) , and desire for additional information . RESULTS Complete data were obtained for 133 ( 96.4 % ) patients . Patients in the intervention group were significantly more satisfied with the content ( difference on a 10-point visual analogue scale was 1 , 95 % confidence interval 0.4 to 1.7 , P = 0.003 ) and presentation ( difference on a 10-point visual analogue scale was 1.2 , 95 % confidence interval 0.6 to 1.9 , P < 0.001 ) . Significantly , fewer patients in the intervention group desired additional information about stroke at follow-up than patients in the control group ( 4.5 % versus 32.8 % ; P < 0.001 ) . Anxiety change scores improved slightly more in favour of the control group ( 1.4 difference on the HAD subscale , 95 % confidence interval 0.2 to 2.8 , P = 0.03 ) . No significant differences between the groups were observed for any of the other outcome measures . INTERPRETATION Providing stroke patients with computer-generated tailored written information improved satisfaction with the information that was received and was more effective in meeting patients ' informational needs than non-tailored information , but had no effect on knowledge about stroke , self-efficacy , depression , or perceived health status Objective : To determine levels of satisfaction with information and advice received about stroke disease and relevant issues by community-dwelling stroke survivors . Design : An interview question naire survey . Setting : A family health services authority area in northern Engl and . Subjects : Stroke survivors identified by a valid screening question naire from a stratified r and om sample of 2000 subjects aged 45 years and over . Main outcome measure : Proportion of subjects interviewed responding positively to the question ' Do you think you have received enough advice and information on ... ? ' eighteen topics considered relevant to stroke survivors . Results : The screening process identified 116 stroke survivors , of whom 76 agreed to be interviewed . The majority ( > 80 % ) of patients were satisfied with information and advice received on lifestyle and health promotion issues , incontinence and their current treatment . However , satisfaction was poor for the areas of stroke disease in general , its effects , available services , and legal and financial affairs ( range , 28 - 75 % satisfied ) . Conclusion : Deficits in the provision of adequate information and advice to stroke patients on relevant issues have been identified in this study of a representative sample of community-dwelling stroke survivors . These deficits need to be addressed by those providing care for stroke patients in order to improve patient satisfaction Background and Purpose — Increased knowledge of stroke risk factors in the general population may lead to improved prevention of stroke . The objective of the present study was to assess knowledge of stroke risk factors and to determine factors associated with knowledge . Methods — In a population -based survey , we sent a question naire to r and omly selected residents in Berlin who were ≥50 years of age enquiring about knowledge of stroke risk factors .  Knowledge was assessed in an open-ended question . In addition , we enquired about the source of participants ' information . Sociodemographic factors , including age , sex , educational level , and nationality , were also assessed . Results — A total of 28 090 of 75 720 residents ( response rate , 37 % ) responded to the question naire . Of all respondents , 68 % were able to name ≥1 correct stroke risk factor , and 13 % named 4 correct risk factors . The majority of respondents named mass media as source of information ( 82 % ) , followed by family/friends ( 45 % ) and by general physicians ( 20 % ) . In multivariable analysis , increased knowledge of stroke risk factors was significantly associated with younger age , a higher educational level , not living alone , a German nationality , and having received any information about stroke during the last year . However , characteristics of respondents using the respective sources of information varied significantly . Conclusions — Mass media was most frequently named as a source of information about stroke risk factors . Source of information used varied according to population characteristics . Health education programs should take this into account and be adapted accordingly Background and Purpose — Quality of life ( QoL ) is important to stroke survivors yet is often recorded as a secondary measure in acute stroke r and omized controlled trials . We examined whether commonly used stroke outcome measures captured aspects of QoL. Methods — We examined primary outcomes by National Institutes of Health Stroke Scale ( NIHSS ) , Barthel Index ( BI ) and modified Rankin Scale ( mRS ) , and QoL by Stroke Impact Scale ( SIS  ) and European Quality of Life Scale ( EQ-5D ) from the Virtual International Stroke Trials Archive ( VISTA ) . Using Spearman correlations and logistic regression , we described the relationships between QoL mRS , NIHSS , and BI at 3 months , stratified by respondent ( patient or proxy ) . Using & khgr;2 analyses , we examined the mismatch between good primary outcome ( mRS ⩽1 , NIHSS ⩽5 , or BI ≥95 ) but poor QoL , and poor primary outcome ( mRS ≥3 , NIHSS ≥20 , or BI ⩽60 ) but good QoL. Results — Patient-assessed QoL had a stronger association with mRS ( EQ-5D weighted score n=2987 , P<0.0001 , r=−0.7 , r2=0.53 ; SIS recovery n=2970 , P<0.0001 , r=−0.71 , r2=0.52 ) . Proxy responses had a stronger association with BI ( EQ-5D weighted score n=837 , P<0.0001 , r=0.78 , r2=0.63 ; SIS recovery n=867 , P<0.0001 , r=0.68 , r2=0.48 ) . mRS explained more of the variation in QoL ( EQ-5D weighted score=53 % , recovery by SIS v3.0=52 % ) than NIHSS or BI and result ed in fewer mismatches between good primary outcome and poor QoL ( P<0.0001 , EQ-5D weighted score=8.5 % ; SIS recovery=10 % ; SIS-16=4.4 % ) . Conclusions — The mRS seemed to align closely with stroke survivors ’ interests , capturing more information on QoL than either NIHSS or BI . This further supports its recommendation as a primary outcome measure in 
    Output:
    
Conclusions : Our study revealed that current available tools are not sufficiently able to accurately and reliably assess SK to promote stroke prevention and management .