Editorial World Stroke Day 2014: ‘I am Woman’ Stephen Davis and Bo Norrving President, and Immediate Past President of the World Stroke Organization
Each year on October 29, World Stroke Day (WSD) provides a global focus for stroke advocacy aimed at reducing the burden of stroke by optimizing prevention, acute treatment, rehabilitation, and long-term care. The World Stroke Organization (WSO) campaign theme for 2014 is ‘I am Woman’. Globally, women have higher stroke mortality than men, so that 6 in 10 of all stroke deaths occur in women. One in five women will suffer a stroke in their lifetime. This is largely due to the greater numbers of elderly women; however, there are also a number of important risk factors that are more common in women. These include atrial fibrillation in older women, diabetes, depression, and hypertension. Some stroke subtypes are more common in women, such as aneurysmal subarachnoid hemorrhage and cerebral venous thrombosis. Gender-specific risk factors include pregnancy and a variety of associated conditions such as preeclampsia, other pregnancy-related hypertensive disorders, and gestational diabetes. Hormonal medications are relevant in some cases. Women tend to have worse stroke outcomes than men. There is some evidence that women with stroke may not receive the necessary quality of care, compared with men with stroke. Furthermore, the burden of caregiving falls predominately on women, and female caregivers report a decrease in mental health and significant rates of depression. These themes will be emphasized at WSD activities around the world.
DOI: 10.1111/ijs.12370
2
Vol 9, October 2014, 2–3
This year, WSD will occur shortly after our 9th World Stroke Congress, held on October 22–25 in Istanbul, the historical juncture between Europe and Asia. WSD activities will involve many thousands of people in virtually every major country and region in the world. The success of WSD overall is also reflected by the enthusiastic response to the call for nominations, for the 2013 WSD awards. We received over 90 applications and the campaign committee had an extremely difficult task in choosing the winning entries. The themes for 2013 were ‘1 in 6’ and ‘Because I care’. The first prize in 2013 was awarded to the Swedish Association of Local Authorities and Regions. The Swedish submission was outstanding. Their national stroke campaign and WSD activities were shown to lead to a great improvement in public awareness of stroke, much better recognition of stroke symptoms, and the realization that there is a need for urgent action. Most pwerfully their campaign was proven to be highly effective in subsequent surveys, primarily with cost saving and resulted in much greater patient access to acute stroke therapies such as tissue plasminogen activator. The awards committee considered that the Swedish model could be adopted throughout the world. The American Heart Association/American Stroke Association also had a superb submission and was awarded the 2nd prize. They were particularly commended for their innovative use of social media on Facebook and Twitter. This generated a great deal of online activity and reached huge numbers of people. This underscores the power of using social media in public health
© 2014 World Stroke Organization
S. Davis and B. Norrving campaigns. They had a particular focus on the African American community, where the risk of stroke is especially high, together with family and other care givers. The third prizewinner was the Grupo Stroke del Peru. Their creative campaign involved organized education and awareness activities throughout major centers in Peru, including Lima, Cusco, Piura, and Trujillo, using a thematic message that stroke can be prevented by modifying risk factors and lifestyles. Their campaign involved media and the innovative use of public activities including blood pressure measurements, street parades, a medical campaign, and stroke
© 2014 World Stroke Organization
Editorial publicity at a major football match. There was an honorary award for Mongolia and an individual award for Dr Dinesh Khaderwal in India. The WSD 2013 laureates will be officially recognized at the opening ceremony of the 9th World Stroke Congress in Istanbul. An example of WSD activities in 2013 included the WSO involvement in keynote events in Vietnam (Hanoi and Ho Chi Minh City), followed by Myanmar (Yangon). The activities in Vietnam built on a highly successful program conducted over several years, led by Michael Brainin and Bo Norrving, resulting in over 9000 Vietnamese doctors trained in the Cardinal Principles of Stroke Management. In both countries, there was extensive media coverage and involvement of Ministers or Vice Ministers of Health. In 2013, there were no stroke units in Myanmar in a population of 55 million people. The WSO signed a letter of agreement with the Health Ministry on WSD in 2013, to collaborate with local stroke experts and roll out an educational program in Myanmar over three-years. Two major activities will be launched at the 9th World Stroke Congress (WSC) in Istanbul, which directly relate to the rights of individual stroke patients and caregivers, and the recommended standards for stroke services around the world. They will also both be particularly relevant to our ‘I am Woman’ campaign. We will be launching the Global Stroke Bill of Rights. This is an initiative of the WSO, and has been developed by a group of stroke survivors and carers from each region of the world. This core group was supported by a larger group of survivors and carers from many different countries, with varied cultures and languages, who completed surveys aimed at defining the fundamental rights of persons anywhere in the world who have suffered a stroke. The aim of the Global Bill of Rights is to help improve the stroke care that people are able to access, resulting in better diagnosis, treatment, and support, in any region of the world. We will also be launching our WSO Action Plan for Global Stroke Services at the WSC. Stroke systems of care vary considerably across geographic regions. Improved outcomes after stroke have been shown in organized stroke care units, implementing evidence-based clinical practice guidelines and continuous quality improvement. The Action Plan has been developed using evaluation of existing guidelines and independent appraisal, a detailed consultation process, and then a 4-round Delphi process to identify specific stroke practice recommendations and key quality indicators. The Action Plan is intended for all providers of stroke care, but specifically targeted at low and middle-income countries for standard of care. Stroke is a huge global challenge. The incidence of stroke grew 26% in the two decades before 2010, with the greatest burden falling on low and middle-income regions where there are rapidly rising stroke rates providing massive challenges to the health systems. Women are disproportionately affected and have a higher risk of stroke, while the burden of care falls mainly on women. We believe that global advocacy for stroke, and special emphasis on the burden in women on WSD, can help galvanize individuals and governments to improve stroke care at all levels. Together, we can make a difference.
Vol 9, October 2014, 2–3
3
Each year on October 29, World Stroke Day (WSD) provides a global focus for stroke advocacy aimed at reducing the burden of stroke by optimizing prevention, acute treatment, rehabilitation, and long-term care. The World Stroke Organization (WSO) campaign theme for 2014 is ‘I am Woman’. Globally, women have higher stroke mortality than men, so that 6 in 10 of all stroke deaths occur in women. One in five women will suffer a stroke in their lifetime. This is largely due to the greater numbers of elderly women; however, there are also a number of important risk factors that are more common in women. These include atrial fibrillation in older women, diabetes, depression, and hypertension. Some stroke subtypes are more common in women, such as aneurysmal subarachnoid hemorrhage and cerebral venous thrombosis. Gender-specific risk factors include pregnancy and a variety of associated conditions such as preeclampsia, other pregnancy-related hypertensive disorders, and gestational diabetes. Hormonal medications are relevant in some cases. Women tend to have worse stroke outcomes than men. There is some evidence that women with stroke may not receive the necessary quality of care, compared with men with stroke. Furthermore, the burden of caregiving falls predominately on women, and female caregivers report a decrease in mental health and significant rates of depression. These themes will be emphasized at WSD activities around the world.
DOI: 10.1111/ijs.12370
2
Vol 9, October 2014, 2–3
This year, WSD will occur shortly after our 9th World Stroke Congress, held on October 22–25 in Istanbul, the historical juncture between Europe and Asia. WSD activities will involve many thousands of people in virtually every major country and region in the world. The success of WSD overall is also reflected by the enthusiastic response to the call for nominations, for the 2013 WSD awards. We received over 90 applications and the campaign committee had an extremely difficult task in choosing the winning entries. The themes for 2013 were ‘1 in 6’ and ‘Because I care’. The first prize in 2013 was awarded to the Swedish Association of Local Authorities and Regions. The Swedish submission was outstanding. Their national stroke campaign and WSD activities were shown to lead to a great improvement in public awareness of stroke, much better recognition of stroke symptoms, and the realization that there is a need for urgent action. Most pwerfully their campaign was proven to be highly effective in subsequent surveys, primarily with cost saving and resulted in much greater patient access to acute stroke therapies such as tissue plasminogen activator. The awards committee considered that the Swedish model could be adopted throughout the world. The American Heart Association/American Stroke Association also had a superb submission and was awarded the 2nd prize. They were particularly commended for their innovative use of social media on Facebook and Twitter. This generated a great deal of online activity and reached huge numbers of people. This underscores the power of using social media in public health
© 2014 World Stroke Organization
S. Davis and B. Norrving campaigns. They had a particular focus on the African American community, where the risk of stroke is especially high, together with family and other care givers. The third prizewinner was the Grupo Stroke del Peru. Their creative campaign involved organized education and awareness activities throughout major centers in Peru, including Lima, Cusco, Piura, and Trujillo, using a thematic message that stroke can be prevented by modifying risk factors and lifestyles. Their campaign involved media and the innovative use of public activities including blood pressure measurements, street parades, a medical campaign, and stroke
© 2014 World Stroke Organization
Editorial publicity at a major football match. There was an honorary award for Mongolia and an individual award for Dr Dinesh Khaderwal in India. The WSD 2013 laureates will be officially recognized at the opening ceremony of the 9th World Stroke Congress in Istanbul. An example of WSD activities in 2013 included the WSO involvement in keynote events in Vietnam (Hanoi and Ho Chi Minh City), followed by Myanmar (Yangon). The activities in Vietnam built on a highly successful program conducted over several years, led by Michael Brainin and Bo Norrving, resulting in over 9000 Vietnamese doctors trained in the Cardinal Principles of Stroke Management. In both countries, there was extensive media coverage and involvement of Ministers or Vice Ministers of Health. In 2013, there were no stroke units in Myanmar in a population of 55 million people. The WSO signed a letter of agreement with the Health Ministry on WSD in 2013, to collaborate with local stroke experts and roll out an educational program in Myanmar over three-years. Two major activities will be launched at the 9th World Stroke Congress (WSC) in Istanbul, which directly relate to the rights of individual stroke patients and caregivers, and the recommended standards for stroke services around the world. They will also both be particularly relevant to our ‘I am Woman’ campaign. We will be launching the Global Stroke Bill of Rights. This is an initiative of the WSO, and has been developed by a group of stroke survivors and carers from each region of the world. This core group was supported by a larger group of survivors and carers from many different countries, with varied cultures and languages, who completed surveys aimed at defining the fundamental rights of persons anywhere in the world who have suffered a stroke. The aim of the Global Bill of Rights is to help improve the stroke care that people are able to access, resulting in better diagnosis, treatment, and support, in any region of the world. We will also be launching our WSO Action Plan for Global Stroke Services at the WSC. Stroke systems of care vary considerably across geographic regions. Improved outcomes after stroke have been shown in organized stroke care units, implementing evidence-based clinical practice guidelines and continuous quality improvement. The Action Plan has been developed using evaluation of existing guidelines and independent appraisal, a detailed consultation process, and then a 4-round Delphi process to identify specific stroke practice recommendations and key quality indicators. The Action Plan is intended for all providers of stroke care, but specifically targeted at low and middle-income countries for standard of care. Stroke is a huge global challenge. The incidence of stroke grew 26% in the two decades before 2010, with the greatest burden falling on low and middle-income regions where there are rapidly rising stroke rates providing massive challenges to the health systems. Women are disproportionately affected and have a higher risk of stroke, while the burden of care falls mainly on women. We believe that global advocacy for stroke, and special emphasis on the burden in women on WSD, can help galvanize individuals and governments to improve stroke care at all levels. Together, we can make a difference.
Vol 9, October 2014, 2–3
3
