Continuity and Change in Baseline Stroke Knowledge across the world: Second Wave of FAST Heroes campaign implementation.

OBJECTIVES: In this work we present the results of the implementation of a globally representative educational school-based stroke awareness programme, FAST (Face, Arm, Speech, Time) Heroes during the second year of education (wave 2). We aimed to observe changes in baseline stroke knowledge between wave 1 and wave 2, distinguish the more fine-grained effect of the campaign on society, and evaluate changes before and after the implementation of wave 2. MATERIALS AND METHODS: In wave 2, parents of school-aged children completed an online stroke preparedness questionnaire before (t1) and after (t2) programme implementation. Results between the time points were analyzed with descriptive statistics alongside changes in baseline knowledge between waves 1 and 2. RESULTS: 1,611 parents participated in wave 2. Parents increased their knowledge of three stroke symptoms from 69% to 87% (p<.001). Their knowledge of the designated emergency number rose from 75% (t1) to 88% (t2) (p<.001). A 17% increase in baseline knowledge occurred in stroke symptoms identified correctly between wave 1 (11 countries) and 2 (18 countries). CONCLUSIONS: Results support the precision and usability of the data collection approach in measuring the change in stroke knowledge between implementation waves. The increased baseline knowledge concerning stroke symptoms in wave 2 needs further examination.

Can We Learn from Our Children About stroke? Effectiveness of a School-Based Educational Programme in Greece.

OBJECTIVES: We describe new findings from the implementation of an educational school-based stroke awareness programme, FAST (Face, Arm, Speech, Time) 112 Heroes, that teaches kindergarten children about stroke symptomatology and the appropriate action plan. The goal of our study was to examine whether the population mostly affected by stroke, i.e. the elderly, can be educated by young children, who have attended the programme. MATERIALS AND METHODS: The educational programme was implemented face-to-face in a kindergarten in Athens, Greece, once a week for five consecutive weeks for one hour per week. Preschoolers (n = 137, aged 4.1-7, mean age=5.3) were enrolled in the programme and nominated two elderly members of their extended family (grandparents) as their own superheroes. Family members received personalized stroke-related material. Stroke awareness of the grandparents was measured before programme implementation (phase 1), after (prior to receiving the printed personalized stroke-related material, phase 2) and three months after receiving the printed personalized stroke-related material (phase 3). RESULTS: Data was obtained from 63 grandparents (48 women; aged 60-84, mean age=69.5 years). Family members demonstrated significant increases in stroke symptom knowledge (p < 0.001) and appropriate course of action (p ≤ 0.001) after participating in the program (phase 2) and receiving printed personalized stroke-related material (phase 3). The majority of the participants (86.84%) reported positive feedback about the received material, the programme, and their interaction with their grandchildren during the programme. CONCLUSIONS: Elderly family members outside the nuclear family can be successfully educated about stroke through their grandchildren and the FAST 112 Heroes programme.

FAST Heroes: Results of Cross-Country Implementation of a Global School-Based Stroke Education Campaign.

Background: Educating the at-risk population about stroke symptoms and requirement of calling an ambulance when stroke strikes is challenging. This exploratory cross-country study provides insights to the FAST Heroes educational campaign and outcomes hitherto achieved. Aims: The primary aim of the study was to measure the transfer of stroke-related knowledge to parents after a global school-based FAST Heroes educational campaign for 5- to 9-year-old children in 14 different countries. The secondary aim was to evaluate parents and teachers' acceptability toward the program. Methods: The duration of the program was 5 h; 1 h per week, joining face-to-face educational sessions with workbooks, cartoons, web-based learning, and other fun activities. Outcomes were measured before implementation (t1), after implementation (t2), and at 6-month follow-up (t3). Program acceptability and stroke knowledge were evaluated by feedback surveys for teachers and parents. Results: Worldwide, 4,202 parents completed the program with their children and answered surveys at t1 and t2. They increased their knowledge of three stroke symptoms from 48 to 83% (p < 0.001). All three surveys were completed by 86 parents, who improved their knowledge of stroke symptoms, 55% (t1), 79% (t2), and 94% (t3) (p < 0.001). Overall, the educational messages were successfully passed onward. Conclusions: Findings confirm the primary aim of the study that is knowledge about stroke transfer well from children to their families through the FAST Heroes program. Second, parents and teachers globally consider the program feasible and worthwhile. The results will inform further rollout of the campaign.

Baseline Stroke Literacy of Young Children Based on "FAST 112 Heroes" Program.

Background: Young children are often unaware of emergency health conditions, such as stroke, and could serve as important vehicles to save the lives of their grandparents, who are more likely to suffer a stroke. An important aspect for the evaluation of public awareness on stroke signs and related emergency procedures is to examine the level of baseline stroke knowledge children have and whether they understand when to seek medical care on time. Objective: To examine the level of stroke symptomatology knowledge in children as well as evaluate their preparedness in stroke response before their participation in the educational program "FAST (Face, Arms, Speech, Time) 112 Heroes." Methods: For the purpose of this work, a questionnaire was developed and adapted to preschoolers' needs. The present study involved 123 children (65 boys, 58 girls, aged 4-6.5 years; mean age: 5.30, S.D.: 0.59) from two cities in Greece. Five multiple-choice animated pictures, that were age-appropriate, were administrated to each child, along with verbal explanations provided by the investigator. Results: More than half of the participants (n = 65, 52.8%) could recognize the symptom of face drooping, 53 children (43.1%) could identify the symptom of arm hemiparesis/hemiplegia and 92 children (74.8%) were able to answer the question regarding speech disturbances. However, the number of correct answers to the question regarding the appropriate course of action in case of a stroke was the lowest among all the questions (10.6% of participants gave a correct answer). Furthermore gender and age did not play a significant role (p = 0.571 and 0.635, respectively). Conclusion: Although more than half of the enrolled preschool children could recognize stroke symptoms before their participation in the educational program, their baseline stroke knowledge, prior to their training, is low. Concurrently, they do not have sufficient knowledge on how to react appropriately in the event of a stroke. Therefore, awareness programs focusing on developing stroke literacy to children are needed, to ensure children will seek urgent medical care in case of a stroke.

Aphasia and Math: Deficits with Basic Number Comprehension and in Numerical Activities of Daily Living.

OBJECTIVE: In the present study, we explored numerical problems in individuals with aphasia. We investigate whether numerical deficits, usually accompanying aphasia, can be observed on number comprehension tasks that do not necessarily require an oral response. METHOD: Individuals with aphasia were classified into anterior, posterior, and global subgroups according to the lesion type. To investigate numerical cognition, we used a relatively recent tool, the Numerical Activities of Daily Living (NADL). RESULTS: The results showed that individuals with aphasia have problems with tasks of basic number comprehension as well as in most NADL. In the formal part of the NADL, anterior aphasic patients made comparatively more errors than the posterior aphasic patients. Global aphasic patients presented an invariably poor performance on almost all tasks. CONCLUSION: The results provide insight into how numerical deficits may impair an individual with aphasia in activities of daily living. This study is a preliminary attempt to start the validation process of the NADL for the Greek population.

The physiological experiments of Constantin von Economo on the central pathways of mastication and deglutition.

The first study of Constantin von Economo on the mammalian brain was published in 1902. Experiments were carried out in rabbits at the Physiological Institute headed by Siegmund von Exner-Ewarten in Vienna to investigate the central pathways of chewing and swallowing. After placing cortical lesions, Economo applied cortical and subcortical electrical stimulation to obtain masticatory movements, and tracked degenerated fibers by means of the Marchi method. He traced fibers through the internal capsule, ventral nucleus of the thalamus, subthalamic nucleus, substantia nigra and its connections with the motor nucleus of the trigeminal nerve, and nucleus solitarius. He suggested that the substantia nigra is responsible for coordinating alimentation movements, with the involvement of cranial nerves V, VII, IX and X as well. We discuss these findings in a historical and a modern perspective, including the concept of a central pattern generator in the pontine reticular formation and its interaction with the nucleus solitarius. Today we understand that mastication is a voluntary action controlled by motor cortical areas, by motoneurons of the trigeminal, and by a neural pattern generator in the pons. On the other hand, deglutition comprises 'reflex swallowing' triggered by sensory fibers of cranial nerves V, IX and X, and 'voluntary swallowing' which may be controlled by both cortical fields and subcortical areas, such as the internal capsule, the hypothalamus and the mesencephalic reticular formation.

Reliability and validity of the DYMUS questionnaire for the assessment of dysphagia in multiple sclerosis (Greek version) and proposed modification.

BACKGROUND: Recent research confirmed that at least a third of people with multiple sclerosis (MS) are suffering from swallowing difficulties. Dysphagia is associated with significant morbidity and mortality, and has profound impact on physical ability and quality of life. Dysphagia related complications can be prevented through an effective screening protocol. The Dysphagia in Multiple Sclerosis (DYMUS) questionnaire is the first dysphagia questionnaire developed specifically for patients with MS. The aim of the present study was the cultural adaptation of DYMUS for the Greek population, evaluation of the questionnaire's reliability and validity and normative data generation for DYMUS, which has not been published before. METHODS: DYMUS was completed by 200 participants: 108 MS patients and 92 asymptomatic subjects (60 male and 140 female). Patients with MS were consecutively recruited from the Multiple Sclerosis Centre during regular visits. Asymptomatic participants were community-dwelling healthy persons. All data were collected prospectively. MS patients were invited to complete DYMUS and the Greek versions of the Eating Assessment Tool-10 (EAT-10), and the Swallowing-Quality of Life (SWAL-QoL) questionnaires. Healthy subjects completed DYMUS and the Greek EAT-10. The study consisted of item generation for the Greek DYMUS, internal consistency and reliability analysis, normative data generation, and validity analysis. Criterion validity was assessed by comparing scores between groups with expected differences: MS patients and healthy participants. Construct validity was assessed by comparison of DYMUS scores of dysphagic and non dysphagic patients. DYMUS was also validated against EAT-10, and SWAL-QoL to assess its convergent validity. RESULTS: DYMUS was completed by all participants in less than 3 min. The internal consistency was excellent (Cronbach's alpha was 0.866). Test-retest reliability was good (Pearson's correlation coefficient was 0.637). The mean DYMUS score for the healthy cohort was 0.23 ±â€¯0.471. The upper limit of normal was 1.172. MS patients had statistically significantly higher score than controls (Mann Whitney test, p < 0.001). DYMUS mean score was statistically significantly higher in the dysphagic compared to the non dysphagic MS patients (Mann Whitney test, p < 0.001). There was a strong positive and statistically significant correlation between DYMUS and EAT-10 (Pearson's Correlation coefficient, r = 0.754, p = 0). In the MS patients cohort 25.9% reported themselves as dysphagic, 34.3% were classified as dysphagic according to EAT-10 and 44.4% according to DYMUS. The DYMUS score had a statistically significant positive correlation with the EDSS score, (Mann Whitney, p < 0.001) whereas age, sex, type of MS and disease duration were not significantly correlated. Based on our data analysis we propose the modification of DYMUS to a 9-items tool eliminating the question about weight loss. A DYMUS score of 2 or higher is indicating dysphagia for both the original DYMUS and the modified DYMUS. CONCLUSIONS: The Greek version of DYMUS was found to be a valid, reliable and practical for clinical use questionnaire for the detection of dysphagia in Multiple Sclerosis. The first reported normative data for DYMUS suggest a cut-off for the diagnosis of dysphagia at 2 and our findings support a modification of DYMUS eliminating the question about weight loss.

Phrase-Final Words in Greek Storytelling Speech: A Study on the Effect of a Culturally-Specific Prosodic Feature on Short-Term Memory.

Prosodic patterns of speech appear to make a critical contribution to memory-related processing. We considered the case of a previously unexplored prosodic feature of Greek storytelling and its effect on free recall in thirty typically developing children between the ages of 10 and 12 years, using short ecologically valid auditory stimuli. The combination of a falling pitch contour and, more notably, extensive final-syllable vowel lengthening, which gives rise to the prosodic feature in question, led to statistically significantly higher performance in comparison to neutral phrase-final prosody. Number of syllables in target words did not reveal substantial difference in performance. The current study presents a previously undocumented culturally-specific prosodic pattern and its effect on short-term memory.

Bullying and minorities in secondary school students in Thrace-Greece.

The aim of the present study is to examine probable heterogeneity in aggressive behaviors and peer victimization among ethnically diverse secondary schools in Thrace. It is a culturally diverse region in Northeastern Greece, which includes Greek Christians and a significant minority of Muslims and immigrants. The study population consisted of 572 school students (293 girls, 279 boys, Mage = 14.24), who completed the Revised Olweus Bully/Victim Questionnaire for Students-Senior and the Youth Self-Report. The percentage of students involved in bullying was 34.7%. More specifically, we found that 24.7% of the students were bully victims, followed by 18.5% bully/victims, and 17.8% bullies. Peer victimization was 52% less frequent in schools with low proportion of minority students (low school minority density; adjusted odds ratio [AOR] = 0.48, p = .015) and 61% less frequent in schools with high minority density (AOR = 0.39, p = .010) as compared to schools with moderate minority density. Furthermore, bullying and bully/victims behaviors were at least 65% less frequent in schools with high density (bullying: AOR = 0.35, p = .016; bully/victim: AOR = 0.30, p = .027) as compared to schools with moderate density, while a similar tendency was also observed in low density areas. Findings from the current study have implications for research and practice. More specifically, our findings can contribute to the development of effective prevention policies and strategies. (PsycINFO Database Record

Taste perception analysis using a semantic verbal fluency task.

A verbal fluency (VF) task is a test used to examine cognitive perception. The main aim of this study was to explore a possible relationship between taste perception in the basic taste categories (sweet, salty, sour, and bitter) and subjects' taste preferences, using a VF task in healthy and dysphagic subjects. In addition, we correlated the results of the VF task with body mass index (BMI). The hypothesis is that categorical preferences would be consistent with the number of verbal responses. We also hypothesized that higher BMI (>30 kg/m(2)) would correlate with more responses in either some or all four categories. VF tasks were randomly administered. Analysis criteria included number of verbally produced responses, number of clusters, number of switches, number and type of errors, and VF consistency with taste preferences. Sixty Greek-speaking individuals participated in this study. Forty-three healthy subjects were selected with a wide range of ages, sex, and education levels. Seventeen dysphagic patients were then matched with 17 healthy subjects according to age, sex, and BMI. Quantitative one-way analysis of variance (between groups as well as repeated measures), post hoc, and chi-square, and qualitative analyses were performed. In the healthy subjects' group, the differences among the mean number of responses for the four taste categories were statistically significant. When comparing the two matched groups of healthy and dysphagic subjects, there were no statistically significant differences in the mean number of responses in the four basic taste categories. However, for both groups, most responses were generated in the following descending order: sweet, salty, sour, and bitter. The bitter category presented the majority of errors for both groups. Obese subjects produced a greater mean number of responses for the "sweet," "sour," and "bitter" categories; conversely, underweight subjects produced a larger mean number of responses for the "salty" category, even though these differences were not statistically significant. The relationship of VF with taste perception and BMI could contribute to evidence-based knowledge that can be used for clinical practice.

Evaluation of the stability of blood flow over time in the dominant hemisphere: a functional transcranial Doppler study.

Functional transcranial Doppler (fTCD) has been used for the identification of cerebral hemispheric dominance in various cognitive tasks. In our study, we have used fTCD with the aim to compare blood flow patterns in the hemispheres not only during the task activation periods but also in the post-stimulus phase. Normal volunteers, 25 right and 25 left-handed, were included. Mean flow velocities (FVs) in the bilateral middle cerebral arteries were recorded during the performance of six cognitive tasks and during the intervals between tasks. The lateralization index (LI) was calculated separately for each test (LI1-6), on the basis of the percent change of blood FV from baseline. To estimate flow fluctuations, a novel index, the LI-variability, was also calculated using a formula constituted by the minimum and maximum mean values recorded at specific time intervals during the entire procedure. Laterization indices, LI-3 and LI-4, corresponding to word generation and reading aloud tasks, produced the highest degree of activation. A perfect agreement (Cohen's kappa=1.000, P<0.001) was observed among LI-3, LI-4, and LI-V. The repetition of recordings gave excellent test-retest reliability in 10 randomly selected participants. Our results suggest that the hemisphere that is characterized as dominant by fTCD maintains a more stable flow pattern during the performance of successive cognitive tasks. Although it could not be considered as a clinically useful tool as yet, this observation introduces a novel parameter such as the stability of blood flow over time, which could potentially provide insight in the study of cerebral functions.

Influence of color on number perseveration in a serial addition task.

The present study examined the influence of coloring the repeated number in a serial addition task that elicits perseveration in normal subjects. 110 undergraduates were administered the original, black-and-white version of the task, 112 other undergraduates the new, colored version. The task required adding the following numbers: 1000 + 40 + 1000 + 30 + 1000 + 20 + 1000 + 10. We predicted that, in the colored version, the enhanced saliency of the repeated number 1000 would reduce the incidence of perseverative errors. Results with the black-and-white version replicated our 1994 findings, i.e., the majority of subjects produced the perseverative response 5000 rather than the correct answer of 4100. Contrary to our expectation, color did not improve performance but rather increased both perseverative and nonperseverative errors. We speculate that the enhanced saliency of the 4 repeated 4-digit terms may have further distracted subjects from discovering the critical lure, namely, the repetitive digit changes in the partial sums at irrelevant positions, i.e., in the thousands and tens but never in the hundreds.

Number representation deficit: a bilingual case of failure to access written verbal numeral representations.

This study reports the case of a Greek-German bilingual patient (S.V.) with specific deficit in Arabic number production from written German number words. S.V. was able to successfully complete the reverse task, i.e. to convert Arabic numerals into written or oral German number words. She also showed preserved ability to produce both German and Greek numbers and to accurately make oral magnitude judgments in both languages. However, when transcoding two-digit numbers from German written numerals to Arabic numbers she consistently reversed the digits. A series of in-house tasks were used to test her general abilities of number processing, i.e. number synesthesia and calculation. Moreover, a number magnitude comparison task was developed specifically for pairs of numbers with reverse digits and we found that out of pairs of numbers with reverse digits with magnitude less than 100, there exist 19 pair combinations for which distance and relative distance are not concordant. The results suggest that S.V.'s performance was significantly worse as the absolute distance between the numbers in the number pairs increased. These investigations are discussed in analogy with a grammatical rule problem related to absolute and relative distance effects.

Preserved orthographic length and transitional probabilities in written spelling in a case of acquired dysgraphia.

We present the performance of a patient with acquired dysgraphia, DS, who has intact oral spelling (100% correct) but severely impaired written spelling (7% correct). Her errors consisted entirely of well-formed letter substitutions. This striking dissociation is further characterized by consistent preservation of orthographic, as opposed to phonological, length in her written output. This pattern of performance indicates that DS has intact graphemic representations, and that her errors are due to a deficit in letter shape assignment. We further interpret the occurrence of a small percentage of lexical errors in her written responses and a significant effect of letter frequencies and transitional probabilities on the pattern of letter substitutions as the result of a repair mechanism that locally constrains DS' written output.