Background and Purpose-Only a small minority of acute stroke patients receive approved acute stroke therapy. We performed a community and professional behavioral intervention project to increase the proportion of stroke patients treated with approved acute stroke therapy. Methods-This study used a quasi-experimental design. Intervention and comparison communities were compared at baseline and during educational intervention. The communities were based in 5 nonurban East Texas counties. The multilevel intervention worked with hospitals and community physicians while changing the stroke identification skills, outcome expectations, and social norms of community residents. The primary goal was to increase the proportion of patients treated with intravenous recombinant tissue plasminogen activator (rTPA) from 1% to 6% of all cerebrovascular events in the intervention community.

Background and Purpose-Nuclear factor-B (NF-B) is a ubiquitous transcription factor that, when activated, translocates to the nucleus, binds to DNA, and promotes transcription of many target genes. Its activation has been demonstrated in chronic inflammatory conditions, cerebral ischemia, and apoptotic cell death. The present study evaluated the presence and activation of NF-B in relation to cell death surrounding intracerebral hemorrhage (ICH). Methods-Striatal ICH was induced in rats by the double blood injection method. Animals were killed 2, 8, and 24 hours and 4 days after ICH. To examine changes in NF-B protein, Western blot was performed on brain extract. We determined NF-B activity using electrophoretic mobility shift assay (EMSA) and immunohistochemistry, using an antibody that only recognizes active NF-B. DNA fragmentation was detected with terminal deoxynucleotidyl transferase-mediated uridine 5Ј-triphosphate-biotin nick end-labeling (TUNEL) staining. Results-Western blot analysis of the NF-B p65 subunit showed that there was no difference in p65 protein levels in the control, 2-hour, 8-hour, or 24-hour groups. However, ipsilateral perilesional samples from the 4-day group revealed a 1.8-to 2.5-fold increase compared with the contralateral hemisphere. Western blotting showed no differences in the inhibitor of NF-B, IB␣, in any group. EMSA showed 1.3-, 2.1-, and 3.6-fold increased NF-B activation in the ipsilateral striatum from the 8-hour, 24-hour, and 4-day groups, respectively, compared with the contralateral hemisphere. Immunohistochemistry, in which an activation-dependent anti-NF-B antibody was used, demonstrated perivascular NF-B activation as early as 2 hours after ICH with more generalized activation at 8 hours, in agreement with the EMSA results. NF-B activation colocalized to cells containing fragmented DNA measured by TUNEL. Conclusions-The present study suggests a relationship between NF-B and the pathobiology of perilesional cell death after ICH. (Stroke. 1999;30:2472-2478.)

Background and Purpose-Activating emergency medical services (EMS) is the most important factor in reducing delay times to hospital arrival for stroke patients. Determining who calls 911 for stroke would allow more efficient targeting of public health initiatives.

Informal caregiving-associated costs are substantial and should be considered when estimating the cost of stroke treatment.

Treatment with IV rt-PA was underutilized in this hospital-based stroke registry. The primary reason for nontreatment was delayed presentation. Reducing prehospital and in-hospital response times would help increase IV rt-PA use, as would greater emergency medical services use. Improving the documentation of onset times would help clarify the underlying causes of delayed presentation.