NISAN - the National Institute for Stroke and Applied Neurosciences

Permanent link for this collection

https://hdl.handle.net/10292/10244

Institute Director: Professor Valery Feigin

Deputy Director: Associate Professor Alice Theadom

The National Institute for Stroke and Applied Neurosciences (NISAN) conducts epidemiological studies and clinical trials to improve health and outcomes in people with major neurological disorders. Current research programmes focus on:

Stroke
Traumatic brain injury
Neuromuscular disorders

Research with this aim is unique in New Zealand and NISAN is a hub for information sharing and developing a cohesive network between existing research and clinical groups with interests in:

Neuroepidemiology
Public health
Neurorehabilitation
Neuropsychology
Biostatistics

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Now showing 1 - 20 of 73

2022 World Hypertension League, Resolve To Save Lives and International Society of Hypertension Dietary Sodium (Salt) Global Call to Action
(Springer Science and Business Media LLC, 2022) Campbell, NRC; Whelton, PK; Orias, M; Wainford, RD; Cappuccio, FP; Ide, N; Neal, B; Cohn, J; Cobb, LK; Webster, J; Trieu, K; He, FJ; McLean, RM; Blanco-Metzler, A; Woodward, M; Khan, N; Kokubo, Y; Nederveen, L; Arcand, J; MacGregor, GA; Owolabi, MO; Lisheng, L; Parati, G; Lackland, DT; Charchar, FJ; Williams, B; Tomaszewski, M; Romero, CA; Champagne, B; L’Abbe, MR; Weber, MA; Schlaich, MP; Fogo, A; Feigin, VL; Akinyemi, R; Inserra, F; Menon, B; Simas, M; Neves, MF; Hristova, K; Pullen, C; Pandeya, S; Ge, J; Jalil, JE; Wang, J-G; Wideimsky, J; Kreutz, R; Wenzel, U; Stowasser, M; Arango, M; Protogerou, A; Gkaliagkousi, E; Fuchs, FD; Patil, M; Chan, AW-K; Nemcsik, J; Tsuyuki, RT; Narasingan, SN; Sarrafzadegan, N; Ramos, ME; Yeo, N; Rakugi, H; Ramirez, AJ; Álvarez, G; Berbari, A; Kim, C-I; Ihm, S-H; Chia, Y-C; Unurjargal, T; Park, HK; Wahab, K; McGuire, H; Dashdorj, NJ; Ishaq, M; Ona, DID; Mercado-Asis, LB; Prejbisz, A; Leenaerts, M; Simão, C; Pinto, F; Almustafa, BA; Spaak, J; Farsky, S; Lovic, D; Zhang, X-H
A Pilot Study of Application of the Stroke Riskometer Mobile App for Assessment of the Course and Clinical Outcomes of Covid-19 Among Hospitalised Patients
(Karger Publishers, 2023) Merkin, Alexander; Akinfieva, Sofya; Medvedev, Oleg N; Krishnamurthi, Rita V; Gutsaluk, Alexey; Reips, Ulf-Dietrich; Kuliev, Rufat; Dinov, Evgeny; Nikiforov, Igor; Shamalov, Nikolay; Shafran, Polina; Popova, Lyudmila; Burenchev, Dmitry; Feigin, Valery L
BACKGROUND: Early determination of COVID-19 severity and health outcomes could facilitate better treatment of patients. Different methods and tools have been developed for predicting outcomes of COVID-19, but they are difficult to use in routine clinical practice. METHODS: We conducted a prospective cohort study of inpatients aged 20-92 years, diagnosed with COVID-19 to determine whether their individual 5-year absolute risk of stroke at the time of hospital admission predicts the course of COVID-19 severity and mortality. The risk of stroke was determined by the Stroke Riskometer mobile application. RESULTS: We examined 385 patients hospitalised with COVID-19 (median age 61 years). The participants were categorised based on COVID-19 severity: 271 (70.4%) to the "Not severe" and 114 (29.6%) to the "Severe" groups. The median risk of stroke the next day after hospitalisation was significantly higher among patients in the Severe group (2.83 [95% CI 2.35-4.68]) vs the Not severe group (1.11 [95% CI 1.00-1.29]). The median risk of stroke and median systolic blood pressure (SBP) were significantly higher among non-survivors (12.04 [95% CI 2.73-21.19]) and (150 [95% CI 140-170]) vs survivors (1.31 [95% CI 1.14-1.52]), 134 [95% CI 130-135]), respectively. Those who spent more than 2.5 hours a week on physical activity were 3.1 times more likely to survive from COVID-19. Those who consumed more than one standard alcohol drink a day, or suffered with atrial fibrillation, or had poor memory were 2.5, 2.3, and 2.6 times more likely not to survive from COVID-19, respectively. CONCLUSIONS: High risk of stroke, physical inactivity, alcohol intake, high SBP, and atrial fibrillation are associated with severity and mortality of COVID-19. Our findings suggest that the Stroke Riskometer app could be used as a simple predictive tool of COVID-19 severity and mortality.
Ambient Air Pollution Exposure Estimation for the Global Burden of Disease 2012
(American Chemical Society (ACS), 2015) Brauer, M; Feigin, V; et al
Exposure to ambient air pollution is a major risk factor for global disease. Assessment of the impacts of air pollution on population health and evaluation of trends relative to other major risk factors requires regularly updated, accurate, spatially resolved exposure estimates. We combined satellite-based estimates, chemical transport model simulations, and ground measurements from 79 different countries to produce global estimates of annual average fine particle (PM2.5) and ozone concentrations at 0.1° × 0.1° spatial resolution for five-year intervals from 1990 to 2010 and the year 2013. These estimates were applied to assess population-weighted mean concentrations for 1990–2013 for each of 188 countries. In 2013, 87% of the world’s population lived in areas exceeding the World Health Organization Air Quality Guideline of 10 μg/m3 PM2.5 (annual average). Between 1990 and 2013, global population-weighted PM2.5 increased by 20.4% driven by trends in South Asia, Southeast Asia, and China. Decreases in population-weighted mean concentrations of PM2.5 were evident in most high income countries. Population-weighted mean concentrations of ozone increased globally by 8.9% from 1990–2013 with increases in most countries—except for modest decreases in North America, parts of Europe, and several countries in Southeast Asia.
The burden of cardiovascular diseases among US states, 1990-2016
(American Medical Association, 2018) Global Burden of Cardiovascular Diseases Collaboration; Roth, GA; Johnson, CO; Abate, KH; Abd-Allah, F; Ahmed, M; Alam, K; Alam, T; Alvis-Guzman, N; Ansari, H; Ärnlöv, J; Atey, TM; Awasthi, A; Awoke, T; Barac, A; Bärnighausen, T; Bedi, N; Bennett, D; Bensenor, I; Biadgilign, S; Castañeda-Orjuela, C; Catalá-López, F; Davletov, K; Dharmaratne, S; Ding, EL; Dubey, M; Faraon, EJA; Farid, T; Farvid, MS; Feigin, V; Fernandes, J; Frostad, J; Gebru, A; Geleijnse, JM; Gona, PN; Griswold, M; Hailu, GB; Hankey, GJ; Hassen, HY; Havmoeller, R; Hay, S; Heckbert, SR; Irvine, CMS; James, SL; Jara, D; Kasaeian, A; Khan, AR; Khera, S; Khoja, AT; Khubchandani, J; Kim, D; Kolte, D; Lal, D; Larsson, A; Linn, S; Lotufo, PA; Magdy Abd El Razek, H; Mazidi, M; Meier, T; Mendoza, W; Mensah, GA; Meretoja, A; Mezgebe, HB; Mirrakhimov, E; Mohammed, S; Moran, AE; Nguyen, G; Nguyen, M; Ong, KL; Owolabi, M; Pletcher, M; Pourmalek, F; Purcell, CA; Qorbani, M; Rahman, M; Rai, RK; Ram, U; Reitsma, MB; Renzaho, AMN; Rios-Blancas, MJ; Safiri, S; Salomon, JA; Sartorius, B; Sepanlou, SG; Shaikh, MA; Silva, D; Stranges, S; Tabarés-Seisdedos, R; Tadele Atnafu, N; Thakur, JS; Topor-Madry, R; Truelsen, T; Tuzcu, EM; Tyrovolas, S; Ukwaja, KN; Vasankari, T; Vlassov, V; Vollset, SE; Wakayo, T; Weintraub, R; Wolfe, C; Workicho, A; Xu, G; Yadgir, S; Yano, Y; Yip, P; Yonemoto, N; Younis, M; Yu, C; Zaidi, Z; Zaki, MES; Zipkin, B; Afshin, A; Gakidou, E; Lim, SS; Mokdad, AH; Naghavi, M; Vos, T; Murray, CJL
Importance: Cardiovascular disease (CVD) is the leading cause of death in the United States, but regional variation within the United States is large. Comparable and consistent state-level measures of total CVD burden and risk factors have not been produced previously. Objective: To quantify and describe levels and trends of lost health due to CVD within the United States from 1990 to 2016 as well as risk factors driving these changes. Design, Setting, and Participants: Using the Global Burden of Disease methodology, cardiovascular disease mortality, nonfatal health outcomes, and associated risk factors were analyzed by age group, sex, and year from 1990 to 2016 for all residents in the United States using standardized approaches for data processing and statistical modeling. Burden of disease was estimated for 10 groupings of CVD, and comparative risk analysis was performed. Data were analyzed from August 2016 to July 2017. Exposures: Residing in the United States. Main Outcomes and Measures: Cardiovascular disease disability-adjusted life-years (DALYs). Results: Between 1990 and 2016, age-standardized CVD DALYs for all states decreased. Several states had large rises in their relative rank ordering for total CVD DALYs among states, including Arkansas, Oklahoma, Alabama, Kentucky, Missouri, Indiana, Kansas, Alaska, and Iowa. The rate of decline varied widely across states, and CVD burden increased for a small number of states in the most recent years. Cardiovascular disease DALYs remained twice as large among men compared with women. Ischemic heart disease was the leading cause of CVD DALYs in all states, but the second most common varied by state. Trends were driven by 12 groups of risk factors, with the largest attributable CVD burden due to dietary risk exposures followed by high systolic blood pressure, high body mass index, high total cholesterol level, high fasting plasma glucose level, tobacco smoking, and low levels of physical activity. Increases in risk-deleted CVD DALY rates between 2006 and 2016 in 16 states suggest additional unmeasured risks beyond these traditional factors. Conclusions and Relevance: Large disparities in total burden of CVD persist between US states despite marked improvements in CVD burden. Differences in CVD burden are largely attributable to modifiable risk exposures.
The burden of headache disorders in the Eastern Mediterranean Region, 1990-2016: Findings from the Global Burden of Disease study 2016
(Springer, 2019) Vosoughi, K; Stovner, LJ; Steiner, TJ; Moradi-Lakeh, M; Fereshtehnejad, S-M; Farzadfar, F; Heydarpour, P; Malekzadeh, R; Naghavi, M; Sahraian, MA; Sepanlou, SG; Tehrani-Banihashemi, A; Majdzadeh, R; Feigin, VL; Vos, T; Mokdad, AH; Murray, CJL
OBJECTIVES: Using the findings of the Global Burden of Disease Study (GBD), we report the burden of primary headache disorders in the Eastern Mediterranean Region (EMR) from 1990 to 2016. METHODS: We modelled headache disorders using DisMod-MR 2.1 Bayesian meta-regression tool to ensure consistency between prevalence, incidence, and remission. Years lived with disability (YLDs) were calculated by multiplying prevalence and disability weight (DW) of migraine and tension-type headache (TTH). We assumed primary headache disorders as non-fatal, so their YLD is equal to disability-adjusted life years (DALYs). RESULTS: Migraine and TTH were the second and twentieth leading causes of YLDs in EMR. Between 1990 and 2016, the absolute YLD numbers of migraine and TTH increased from 2.3 million (95% uncertainty interval (UI): 1.5-3.2) to 4.7 million (95%UI: 3-6.5) and from 383 thousand (95%UI: 240-562) to 816 thousand (95%UI: 516-1221), respectively. During the same period, age-standardised YLD rates of migraine and TTH in EMR increased by 0.7% and 2.5%, respectively, in comparison to a small decrease in the global rates (0.2% decrease in migraine and TTH). The bulk of burden due to headache occurred in the 30-49 year age group, with a peak at ages 35-44 years. The age-standardised YLD rates of both headache disorders were higher in women with female to male ratio of 1.69 for migraine and 1.38 for TTH. All countries of the EMR except for Somalia and Djibouti had higher age-standardised YLD rates for migraine and TTH in compare to the global rates. Libya and Saudi Arabia had the highest increase in age-standardised YLD rates of migraine and TTH, respectively. CONCLUSION: The findings of this study show that primary headache disorders are a major and a growing cause of disability in EMR. Since 1990, burden of primary headache disorders has constantly been higher in EMR compared to rest of the world, which indicates that health systems in EMR must focus further on developing and implementing preventive and management strategies to control headache.
The Burden of Headache Disorders in the Eastern Mediterranean Region, 1990-2016: Findings From the Global Burden of Disease Study 2016
(Springer, 2019)
OBJECTIVES: Using the findings of the Global Burden of Disease Study (GBD), we report the burden of primary headache disorders in the Eastern Mediterranean Region (EMR) from 1990 to 2016. METHODS: We modelled headache disorders using DisMod-MR 2.1 Bayesian meta-regression tool to ensure consistency between prevalence, incidence, and remission. Years lived with disability (YLDs) were calculated by multiplying prevalence and disability weight (DW) of migraine and tension-type headache (TTH). We assumed primary headache disorders as non-fatal, so their YLD is equal to disability-adjusted life years (DALYs). RESULTS: Migraine and TTH were the second and twentieth leading causes of YLDs in EMR. Between 1990 and 2016, the absolute YLD numbers of migraine and TTH increased from 2.3 million (95% uncertainty interval (UI): 1.5-3.2) to 4.7 million (95%UI: 3-6.5) and from 383 thousand (95%UI: 240-562) to 816 thousand (95%UI: 516-1221), respectively. During the same period, age-standardised YLD rates of migraine and TTH in EMR increased by 0.7% and 2.5%, respectively, in comparison to a small decrease in the global rates (0.2% decrease in migraine and TTH). The bulk of burden due to headache occurred in the 30-49 year age group, with a peak at ages 35-44 years. The age-standardised YLD rates of both headache disorders were higher in women with female to male ratio of 1.69 for migraine and 1.38 for TTH. All countries of the EMR except for Somalia and Djibouti had higher age-standardised YLD rates for migraine and TTH in compare to the global rates. Libya and Saudi Arabia had the highest increase in age-standardised YLD rates of migraine and TTH, respectively. CONCLUSION: The findings of this study show that primary headache disorders are a major and a growing cause of disability in EMR. Since 1990, burden of primary headache disorders has constantly been higher in EMR compared to rest of the world, which indicates that health systems in EMR must focus further on developing and implementing preventive and management strategies to control headache.
Burden of Neurodegenerative Diseases in the Eastern Mediterranean Region, 1990-2016: Findings From the Global Burden of Disease 2016 Study
(Wiley, 2019) Fereshtehnejad, S-M; Vosoughi, K; Heydarpour, P; Sepanlou, SG; Farzadfar, F; Tehrani-Banihashemi, A; Malekzadeh, R; Sahraian, MA; Vollset, SE; Naghavi, M; Vos, T; Feigin, V; Murray, C; Mokdad, AH; Moradi-Lakeh, M
BACKGROUND AND PURPOSE: The Eastern Mediterranean Region (EMR) is experiencing a demographic shift towards rapid ageing at a time of political unrest. We aimed to estimate the burden of neurodegenerative disorders, and its relationship with sociodemographic indicators (SDI) in the EMR countries from 1990 to 2016. METHODS: Using data from the Global Burden of Disease (GBD) 2016 study, we calculated country-specific trends for prevalence, mortality, disability-adjusted life-years (DALYs), years of life lost (YLLs), and years lived with disability (YLDs) for Alzheimer's disease/other dementias and Parkinson's disease in the EMR during 1990-2016. RESULTS: In EMR, age-standardized prevalence rate of Alzheimer's disease/other dementias and Parkinson's disease was estimated at 759.8 (642.9-899.9) and 87.1 (69.8-108.2) /100,000 in 2016, demonstrating 0.01% and 42.3% change from 1990, respectively. Neurodegenerative disorders contributed to 5.4% of total DALYs and 4.6% of total YLDs among the older EMR population aged 70 years or older in 2016. Age-standardized DALYs due to Parkinson's disease was strongly correlated with the SDI level (r=0.823, p-value<0.001). The YLD/DALY ratio of neurodegenerative diseases declined during this period in the low income EMR countries but not in high income ones. CONCLUSIONS: Our findings demonstrated an increasing trend in the burden of dementias and Parkinson's disease in most EMR countries between 1990 and 2016. With aging of the EMR populations, countries should target the modifiable risk factors of neurodegenerative diseases to control their increasing burden. This article is protected by copyright. All rights reserved.
The Burden of Stroke in China: Results From a Nationwide Population-based Epidemiological Survey
(PLoS, 2018)
Stroke is a serious threat to human health that often leads to severe complications, and currently ranks first as leading cause of death in China. However, reliable data on stroke burden in China in the 21st century are lacking. We used the data from NESS-China (National Epidemiological Survey of Stroke in China) for assessing the adverse health effects of stroke in Chinese population. We carried out inter-regional comparative study in order to obtain regular burden related characteristics of stroke in China, as measured by YLLs (years of life lost due to premature mortality), YLDs (years lived with disability) and DALYs (disability adjusted life years). Amongst the nationwide population of 596,536 individuals of all ages in 2013, the YLLs for stroke was 1748, the YLDs was 262, and the DALYs was 2010(per 100,000). The gender subtype analysis of DALYs was 2171(male) and 1848(female). The YLLs, YLDs and DALYs in rural areas were higher compared to urban areas. Among the 18 age groups, the highest YLLs was observed in ≥ 80 years old group. The impact of stroke on Chinese population is more severe compared to the global average levels. Stroke results as the main cause of YLLs in China, while there is no significant difference for the YLDs. Nevertheless, DALYs caused by stroke rank 3th in global epidemiologic study territories, 1st in China.
Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (Center-tbi): A Prospective Longitudinal Observational Study
(Congress of Neurological Surgeons, 2015) Theadom, A; Maas, AIR; Menon, D; Steyerberg, EW; Citerio, G; Lecky, F; Manley, GT; Hill, S; Legrand, V; Sorgner, A; On behalf of the CENTER-TBI participants and, I
BACKGROUND: Current classification of traumatic brain injury (TBI) is suboptimal, and management is based on weak evidence, with little attempt to personalize treatment. A need exists for new precision medicine and stratified management approaches that incorporate emerging technologies. OBJECTIVE: To improve characterization and classification of TBI and to identify best clinical care, using comparative effectiveness research approaches. METHODS: This multicenter, longitudinal, prospective, observational study in 22 countries across Europe and Israel will collect detailed data from 5400 consenting patients, presenting within 24 hours of injury, with a clinical diagnosis of TBI and an indication for computed tomography. Broader registry-level data collection in approximately 20 000 patients will assess generalizability. Cross sectional comprehensive outcome assessments, including quality of life and neuropsychological testing, will be performed at 6 months. Longitudinal assessments will continue up to 24 months post TBI in patient subsets. Advanced neuroimaging and genomic and biomarker data will be used to improve characterization, and analyses will include neuroinformatics approaches to address variations in process and clinical care. Results will be integrated with living systematic reviews in a process of knowledge transfer. The study initiation was from October to December 2014, and the recruitment period was for 18 to 24 months. EXPECTED OUTCOMES: Collaborative European NeuroTrauma Effectiveness Research in TBI should provide novel multidimensional approaches to TBI characterization and classification, evidence to support treatment recommendations, and benchmarks for quality of care. Data and sample repositories will ensure opportunities for legacy research. DISCUSSION: Comparative effectiveness research provides an alternative to reductionistic clinical trials in restricted patient populations by exploiting differences in biology, care, and outcome to support optimal personalized patient management.
Daytime Napping Associated With Increased Symptom Severity in Fibromyalgia Syndrome
(BioMed Central Ltd., 2015) Theadom, A; Cropley, M; Kantermann, T
Background: Previous qualitative research has revealed that people with fibromyalgia use daytime napping as a coping strategy for managing symptoms against clinical advice. Yet there is no evidence to suggest whether daytime napping is beneficial or detrimental for people with fibromyalgia. The purpose of this study was to explore how people use daytime naps and to determine the links between daytime napping and symptom severity in fibromyalgia syndrome. Methods: A community based sample of 1044 adults who had been diagnosed with fibromyalgia syndrome by a clinician completed an online questionnaire. Associations between napping behavior, sleep quality and fibromyalgia symptoms were explored using Spearman correlations, with possible predictors of napping behaviour entered into a logistic regression model. Differences between participants who napped on a daily basis and those who napped less regularly, as well as nap duration were explored. Results: Daytime napping was significantly associated with increased pain, depression, anxiety, fatigue, memory difficulties and sleep problems. Sleep problems and fatigue explained the greatest amount of variance in napping behaviour, p < 0.010. Those who engaged in daytime naps for >30 minutes had higher memory difficulties (t = -3.45) and levels of depression (t = -2.50) than those who napped for shorter periods (<30mins) (p < 0.010). Conclusions: Frequent use and longer duration of daytime napping was linked with greater symptom severity in people with fibromyalgia. Given the common use of daytime napping in people with fibromyalgia evidence based guidelines on the use of daytime napping in people with chronic pain are urgently needed.
Development of the Standards of Reporting of Neurological Disorders (Strond) Checklist: A Guideline for the Reporting of Incidence and Prevalence Studies in Neuroepidemiology
(Wolters Kluwer, 2016) Bennett, DA; Brayne, C; Feigin, V; Barker-Collo, S; Brainin, M; Davis, D; Gallo, V; Jetté, N; Karch, A; Kurtzke, JF; Lavados, PM; Logroscino, G; Nagel, G; Preux, PM; Rothwell, PM; Svenson, LW
Background: Incidence and prevalence studies of neurologic disorders play an important role in assessing the burden of disease and planning services. However, the assessment of disease estimates is hindered by problems in reporting for such studies. Despite a growth in published reports, existing guidelines relate to analytical rather than descriptive epidemiologic studies. There are also no user-friendly tools (e.g., checklists) available for authors, editors, and peer reviewers to facilitate best practice in reporting of descriptive epidemiologic studies for most neurologic disorders. Objective: The Standards of Reporting of Neurological Disorders (STROND) is a guideline that consists of recommendations and a checklist to facilitate better reporting of published incidence and prevalence studies of neurologic disorders. Methods: A review of previously developed guidance was used to produce a list of items required for incidence and prevalence studies in neurology. A 3-round Delphi technique was used to identify the “basic minimum items” important for reporting, as well as some additional “ideal reporting items.” An e-consultation process was then used in order to gauge opinion by external neuroepidemiologic experts on the appropriateness of the items included in the checklist. Findings: Of 38 candidate items, 15 items and accompanying recommendations were developed along with a user-friendly checklist. Conclusions: The introduction and use of the STROND checklist should lead to more consistent, transparent, and contextualized reporting of descriptive neuroepidemiologic studies resulting in more applicable and comparable findings and ultimately support better health care decisions.
Digital Solutions for Primary Stroke and Cardiovascular Disease Prevention: A Mass Individual and Public Health Approach
(Elsevier BV, 2022-06) Feigin, VL; Krishnamurthi, R; Merkin, A; Nair, B; Kravchenko, M; Jalili-Moghaddam, S
The Effect of Spinal Position on Sciatic Nerve Excursion During Seated Neural Mobilisation Exercises: An in Vivo Study Using Ultrasound Imaging
(Taylor & Francis, 2016) Ellis, R; Osborne, S; Whitefield, J; Parmar, P; Hing, W
Objectives: Research has established that the amount of inherent tension a peripheral nerve tract is exposed to influences nerve excursion and joint range of movement (ROM). The effect that spinal posture has on sciatic nerve excursion during neural mobilisation exercises has yet to be determined. The purpose of this research was to examine the influence of different sitting positions (slump-sitting versus upright-sitting) on the amount of longitudinal sciatic nerve movement during different neural mobilisation exercises commonly used in clinical practice. Methods:High-resolution ultrasound imaging followed by frame-by-frame cross-correlation analysis was used to assess sciatic nerve excursion. Thirty-four healthy participants each performed three different neural mobilisation exercises in slump-sitting and upright-sitting. Means comparisons were used to examine the influence of sitting position on sciatic nerve excursion for the three mobilisation exercises. Linear regression analysis was used to determine whether any of the demographic data represented predictive variables for longitudinal sciatic nerve excursion. Results: There was no significant difference in sciatic nerve excursion (across all neural mobilisation exercises) observed between upright-sitting and slump-sitting positions (P50.26). Although greater body mass index, greater knee ROM and younger age were associated with higher levels of sciatic nerve excursion, this model of variables offered weak predictability (R 2 50.22). Discussion: Following this study, there is no evidence that, in healthy people, longitudinal sciatic nerve excursion differs significantly with regards to the spinal posture (slump-sitting and upright-sitting). Furthermore, although some demographic variables are weak predictors, the high variance suggests that there are other unknown variables that may predict sciatic nerve excursion. It can be inferred from this research that clinicians can individualise the design of seated neural mobilisation exercises, using different seated positions, based upon patient comfort and minimisation of neural mechanosensitivity with the knowledge that sciatic nerve excursion will not be significantly influenced.
Epidemiology of Traumatic Brain Injury in Europe: A Living Systematic Review
(Mary Ann Liebert, Inc., 2015) Brazinova, A; Rehorcikova, V; Taylor, MS; Buckova, V; Majdan, M; Psota, M; Peeters, W; Feigin, V; Theadom, A; Holkovic, L; Synnot, A
This systematic review provides a comprehensive, up-to-date summary of traumatic brain injury (TBI) epidemiology in Europe, describing incidence, mortality, age, and sex distribution, plus severity, mechanism of injury, and time trends. PubMed, CINAHL, EMBASE, and Web of Science were searched in January 2015 for observational, descriptive, English language studies reporting incidence, mortality, or case fatality of TBI in Europe. There were no limitations according to date, age, or TBI severity. Methodological quality was assessed using the Methodological Evaluation of Observational Research checklist. Data were presented narratively. Sixty-six studies were included in the review. Country-level data were provided in 22 studies, regional population or treatment center catchment area data were reported by 44 studies. Crude incidence rates varied widely. For all ages and TBI severities, crude incidence rates ranged from 47.3 per 100,000, to 694 per 100,000 population per year (country-level studies) and 83.3 per 100,000, to 849 per 100,000 population per year (regional-level studies). Crude mortality rates ranged from 9 to 28.10 per 100,000 population per year (country-level studies), and 3.3 to 24.4 per 100,000 population per year (regional-level studies.) The most common mechanisms of injury were traffic accidents and falls. Over time, the contribution of traffic accidents to total TBI events may be reducing. Case ascertainment and definitions of TBI are variable. Improved standardization would enable more accurate comparisons.
Estimates and 25-year Trends of the Global Burden of Disease Attributable to Ambient Air Pollution: An Analysis of Data From the Global Burden of Diseases Study 2015
(Elsevier, 2017)
BACKGROUND: Exposure to ambient air pollution increases morbidity and mortality, and is a leading contributor to global disease burden. We explored spatial and temporal trends in mortality and burden of disease attributable to ambient air pollution from 1990 to 2015 at global, regional, and country levels. METHODS: We estimated global population-weighted mean concentrations of particle mass with aerodynamic diameter less than 2·5 μm (PM2·5) and ozone at an approximate 11 km × 11 km resolution with satellite-based estimates, chemical transport models, and ground-level measurements. Using integrated exposure-response functions for each cause of death, we estimated the relative risk of mortality from ischaemic heart disease, cerebrovascular disease, chronic obstructive pulmonary disease, lung cancer, and lower respiratory infections from epidemiological studies using non-linear exposure-response functions spanning the global range of exposure. FINDINGS: Ambient PM2·5 was the fifth-ranking mortality risk factor in 2015. Exposure to PM2·5 caused 4·2 million (95% uncertainty interval [UI] 3·7 million to 4·8 million) deaths and 103·1 million (90·8 million 115·1 million) disability-adjusted life-years (DALYs) in 2015, representing 7·6% of total global deaths and 4·2% of global DALYs, 59% of these in east and south Asia. Deaths attributable to ambient PM2·5 increased from 3·5 million (95% UI 3·0 million to 4·0 million) in 1990 to 4·2 million (3·7 million to 4·8 million) in 2015. Exposure to ozone caused an additional 254 000 (95% UI 97 000-422 000) deaths and a loss of 4·1 million (1·6 million to 6·8 million) DALYs from chronic obstructive pulmonary disease in 2015. INTERPRETATION: Ambient air pollution contributed substantially to the global burden of disease in 2015, which increased over the past 25 years, due to population ageing, changes in non-communicable disease rates, and increasing air pollution in low-income and middle-income countries. Modest reductions in burden will occur in the most polluted countries unless PM2·5 values are decreased substantially, but there is potential for substantial health benefits from exposure reduction. FUNDING: Bill & Melinda Gates Foundation and Health Effects Institute.
Extended Coagulation Profiling in Isolated Traumatic Brain Injury: A CENTER-TBI Analysis
(Springer, 2021-01-01) Böhm, JK; Schaeben, V; Schäfer, N; Güting, H; Lefering, R; Thorn, S; Schöchl, H; Zipperle, J; Grottke, O; Rossaint, R; Stanworth, S; Curry, N; Maegele, M; Åkerlund, C; Amrein, K; Andelic, N; Andreassen, L; Anke, A; Antoni, A; Audibert, G; Azouvi, P; Azzolini, ML; Bartels, R; Barzó, P; Beauvais, R; Beer, R; Bellander, BM; Belli, A; Benali, H; Berardino, M; Beretta, L; Blaabjerg, M; Bragge, P; Brazinova, A; Brinck, V; Brooker, J; Brorsson, C; Buki, A; Bullinger, M; Cabeleira, M; Caccioppola, A; Calappi, E; Calvi, MR; Cameron, P; Lozano, GC; Carbonara, M; Cavallo, S; Chevallard, G; Chieregato, A; Citerio, G; Ceyisakar, I; Clusmann, H; Coburn, M; Coles, J; Cooper, JD; Correia, M; Čović, A; Czeiter, E; Czosnyka, M; Dahyot-Fizelier, C; Dark, P; Dawes, H; De Keyser, V; Degos, V; Corte, FD; Boogert, HD; Depreitere, B; Đilvesi, Đ; Dixit, A; Donoghue, E; Dreier, J; Dulière, GL; Ercole, A; Esser, P; Ezer, E; Fabricius, M; Feigin, VL; Foks, K; Frisvold, S; Furmanov, A; Gagliardo, P; Galanaud, D; Gantner, D; Gao, G; George, P; Ghuysen, A; Giga, L; Glocker, B; Golubovic, J; Gomez, PA; Gratz, J; Gravesteijn, B; Grossi, F; Gruen, RL; Gupta, D; Haagsma, JA; Haitsma, I; Helbok, R; Helseth, E; Horton, L
Background: Trauma-induced coagulopathy in traumatic brain injury (TBI) remains associated with high rates of complications, unfavorable outcomes, and mortality. The underlying mechanisms are largely unknown. Embedded in the prospective multinational Collaborative European Neurotrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study, coagulation profiles beyond standard conventional coagulation assays were assessed in patients with isolated TBI within the very early hours of injury. Methods: Results from blood samples (citrate/EDTA) obtained on hospital admission were matched with clinical and routine laboratory data of patients with TBI captured in the CENTER-TBI central database. To minimize confounding factors, patients with strictly isolated TBI (iTBI) (n = 88) were selected and stratified for coagulopathy by routine international normalized ratio (INR): (1) INR < 1.2 and (2) INR ≥ 1.2. An INR > 1.2 has been well adopted over time as a threshold to define trauma-related coagulopathy in general trauma populations. The following parameters were evaluated: quick’s value, activated partial thromboplastin time, fibrinogen, thrombin time, antithrombin, coagulation factor activity of factors V, VIII, IX, and XIII, protein C and S, plasminogen, D-dimer, fibrinolysis-regulating parameters (thrombin activatable fibrinolysis inhibitor, plasminogen activator inhibitor 1, antiplasmin), thrombin generation, and fibrin monomers. Results: Patients with iTBI with INR ≥ 1.2 (n = 16) had a high incidence of progressive intracranial hemorrhage associated with increased mortality and unfavorable outcome compared with patients with INR < 1.2 (n = 72). Activity of coagulation factors V, VIII, IX, and XIII dropped on average by 15–20% between the groups whereas protein C and S levels dropped by 20%. With an elevated INR, thrombin generation decreased, as reflected by lower peak height and endogenous thrombin potential (ETP), whereas the amount of fibrin monomers increased. Plasminogen activity significantly decreased from 89% in patients with INR < 1.2 to 76% in patients with INR ≥ 1.2. Moreover, D-dimer levels significantly increased from a mean of 943 mg/L in patients with INR < 1.2 to 1,301 mg/L in patients with INR ≥ 1.2. Conclusions: This more in-depth analysis beyond routine conventional coagulation assays suggests a counterbalanced regulation of coagulation and fibrinolysis in patients with iTBI with hemostatic abnormalities. We observed distinct patterns involving key pathways of the highly complex and dynamic coagulation system that offer windows of opportunity for further research. Whether the changes observed on factor levels may be relevant and explain the worse outcome or the more severe brain injuries by themselves remains speculative.
Global and Regional Burden of First-ever Ischaemic and Haemorrhagic Stroke During 1990-2010: Findings From the Global Burden of Disease Study 2010
(Elsevier (Open), 2013-11) Krishnamurthi, RV; Feigin, VL; Forouzanfar, MH; Mensah, GA; Connor, M; Bennett, DA; Moran, AE; Sacco, RL; Anderson, LM; Truelsen, T; O'Donnell, M; Venketasubramanian, N; Barker-Collo, S; Lawes, CM; Wang, W; Shinohara, Y; Witt, E; Ezzati, M; Naghavi, M; Murray, C; The Lancet Global Health. Volume 1, Issue 5, November 2013, Pages e259–e281; GBD Stroke Experts Group
Background The burden of ischaemic and haemorrhagic stroke varies between regions and over time. With differences in prognosis, revalence of risk factors, and treatment strategies, knowledge of stroke pathological type is important fortargeted region-specific health-care planning for stroke and could inform priorities for type-specific prevention strategies. We used data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010) to estimate the global and regional burden of first-ever ischaemic and haemorrhagic stroke during 1990–2010. Methods We searched Medline, Embase, LILACS, Scopus, PubMed, Science Direct, Global Health Database, the WHO library, and regional databases from 1990 to 2012 to identify relevant studies published between 1990 and 2010. We applied the GBD 2010 analytical technique (DisMod-MR) to calculate regional and country-specific estimates for ischaemic and haemorrhagic stroke incidence, mortality, mortality-to-incidence ratio, and disability-adjusted life years (DALYs) lost, by age group (aged <75 years, ≥75 years, and in total) and country income level (high-income and low-income and middle-income) for 1990, 2005, and 2010. Findings We included 119 studies (58 from high-income countries and 61 from low-income and middle-income countries). Worldwide, the burden of ischaemic and haemorrhagic stroke increased significantly between 1990 and 2010 in terms of the absolute number of people with incident ischaemic and haemorrhagic stroke (37% and 47% increase, respectively), number of deaths (21% and 20% increase), and DALYs lost (18% and 14% increase). In the past two decades in high-income countries, incidence of ischaemic stroke reduced significantly by 13% (95% CI 6–18), mortality by 37% (19–39), DALYs lost by 34% (16–36), and mortality-to-incidence ratios by 21% (10–27). For haemorrhagic stroke, incidence reduced significantly by 19% (1–15), mortality by 38% (32–43), DALYs lost by 39% (32–44), and mortality-to-incidence ratios by 27% (19–35). By contrast, in low-income and middle-income countries, we noted a significant increase of 22% (5–30) in incidence of haemorrhagic stroke and a 6% (–7 to 18) non-significant increase in the incidence of ischaemic stroke. Mortality rates for ischaemic stroke fell by 14% (9–19), DALYs lost by 17% (–11 to 21%), and mortality-to-incidence ratios by 16% (–12 to 22). For haemorrhagic stroke in low-income and middle-income countries, mortality rates reduced by 23% (–18 to 25%), DALYs lost by 25% (–21 to 28), and mortalityto-incidence ratios by 36% (–34 to 28). Interpretation Although age-standardised mortality rates for ischaemic and haemorrhagic stroke have decreased in the past two decades, the absolute number of people who have these stroke types annually, and the number with related deaths and DALYs lost, is increasing, with most of the burden in low-income and middle-income countries. Further study is needed in these countries to identify which subgroups of the population are at greatest risk and who could be targeted for preventive efforts.
The Global Burden of Ischemic Stroke: Findings of the GBD 2010 Study
(Elsevier, 2014) Bennett, DA; Krishnamurthi, RV; Barker-Collo, S; Forouzanfar, MH; Naghavi, M; Connor, M; Lawes, CMM; Moran, AE; Anderson, LM; Roth, GA; Mensah, GA; Ezzati, M; Murray, CJL; Feigin, VL
Background and objectives: To summarize the findings of The Global Burden of Diseases, Injuries, and Risk Factors (GBD 2010) Study for ischaemic stroke (IS) and report the impact of tobacco smoking on IS burden in specific countries. Methods: The GBD 2010 searched multiple databases to identify relevant studies published between 1990 and 2010. The GBD 2010 analytical tools were used to calculate region-specific IS incidence, mortality, mortality to incidence (MI) ratio and disability-adjusted life years (DALYs) lost, including 95% uncertainty intervals (UI). Findings: In 2010, there were approximately 11,569,000 incident IS events (63% in low- and middleincome countries [LMIC]), approximately 2,835,000 deaths from IS (57% in LMIC), and approximately 39,389,000 DALYs lost due to IS (64% in LMIC).From 1990-2010, there was a significant increase in global IS burden in terms of absolute number of people with incident IS (37% increase), deaths from IS (21% increase) and DALYs lost due to IS (18% increase). Age-standardised IS incidence, DALYs lost, mortality, and MI ratios in HIC declined by about 13% (95% UI 6-18%), 34% (95% UI 16-36%), and 37% (95% UI 19-39%), 21% (95% UI 10-27%), respectively. However, in LMIC there was a modest 6% increase in the age-standardised incidence of IS (95% UI -7%; 18%) despite modest reductions in mortality rates, DALYs lost, and MI ratios. There was considerable variability among country-specific estimates within broad GBD regions. China, Russia and India were ranked highest in both 1990 and 2010 for IS deaths attributable to tobacco consumption. Conclusions: Although age-standardized IS mortality rates have declined over the last two decades, the absolute global burden of IS is increasing, with the bulk of DALYs lost in LMIC. Tobacco consumption is an important modifiable risk factor for IS and in both 1990 and 2010 the top ranked countries for IS deaths that could be attributed to tobacco consumption were China, Russia and India. Tobacco control policies that target both smoking initiation and smoking cessation can play an important role in the prevention of IS. In China, Russia and India, even modest reductions in the number of current smokers could see millions of lives saved due to prevention of IS alone.
The Global Burden of Mental, Neurological and Substance Use Disorders: An Analysis From the Global Burden of Disease Study 2010
(PLOS, 2015) Whiteford, HA; Ferrari, AJ; Degenhardt, L; Feigin, V; Vos, T
Background The Global Burden of Disease Study 2010 (GBD 2010), estimated that a substantial proportion of the world’s disease burden came from mental, neurological and substance use disorders. In this paper, we used GBD 2010 data to investigate time, year, region and age specific trends in burden due to mental, neurological and substance use disorders. Method For each disorder, prevalence data were assembled from systematic literature reviews. DisMod-MR, a Bayesian meta-regression tool, was used to model prevalence by country, region, age, sex and year. Prevalence data were combined with disability weights derived from survey data to estimate years lived with disability (YLDs). Years lost to premature mortality (YLLs) were estimated by multiplying deaths occurring as a result of a given disorder by the reference standard life expectancy at the age death occurred. Disability-adjusted life years (DALYs) were computed as the sum of YLDs and YLLs. Results In 2010, mental, neurological and substance use disorders accounted for 10.4% of global DALYs, 2.3% of global YLLs and, 28.5% of global YLDs, making them the leading cause of YLDs. Mental disorders accounted for the largest proportion of DALYs (56.7%), followed by neurological disorders (28.6%) and substance use disorders (14.7%). DALYs peaked in early adulthood for mental and substance use disorders but were more consistent across age for neurological disorders. Females accounted for more DALYs in all mental and neurological disorders, except for mental disorders occurring in childhood, schizophrenia, substance use disorders, Parkinson’s disease and epilepsy where males accounted for more DALYs. Overall DALYs were highest in Eastern Europe/Central Asia and lowest in East Asia/the Pacific. Conclusion Mental, neurological and substance use disorders contribute to a significant proportion of disease burden. Health systems can respond by implementing established, cost effective interventions, or by supporting the research necessary to develop better prevention and treatment options.
Global mortality from firearms, 1990-2016
(American Medical Association (AMA), 2018) Feigin, V; Global Burden of Disease 2016 Injury Collaborators
Importance Understanding global variation in firearm mortality rates could guide prevention policies and interventions. Objective To estimate mortality due to firearm injury deaths from 1990 to 2016 in 195 countries and territories. Design, Setting, and Participants This study used deidentified aggregated data including 13 812 location-years of vital registration data to generate estimates of levels and rates of death by age-sex-year-location. The proportion of suicides in which a firearm was the lethal means was combined with an estimate of per capita gun ownership in a revised proxy measure used to evaluate the relationship between availability or access to firearms and firearm injury deaths. Exposures Firearm ownership and access. Main Outcomes and Measures Cause-specific deaths by age, sex, location, and year. Results Worldwide, it was estimated that 251 000 (95% uncertainty interval [UI], 195 000-276 000) people died from firearm injuries in 2016, with 6 countries (Brazil, United States, Mexico, Colombia, Venezuela, and Guatemala) accounting for 50.5% (95% UI, 42.2%-54.8%) of those deaths. In 1990, there were an estimated 209 000 (95% UI, 172 000 to 235 000) deaths from firearm injuries. Globally, the majority of firearm injury deaths in 2016 were homicides (64.0% [95% UI, 54.2%-68.0%]; absolute value, 161 000 deaths [95% UI, 107 000-182 000]); additionally, 27% were firearm suicide deaths (67 500 [95% UI, 55 400-84 100]) and 9% were unintentional firearm deaths (23 000 [95% UI, 18 200-24 800]). From 1990 to 2016, there was no significant decrease in the estimated global age-standardized firearm homicide rate (−0.2% [95% UI, −0.8% to 0.2%]). Firearm suicide rates decreased globally at an annualized rate of 1.6% (95% UI, 1.1-2.0), but in 124 of 195 countries and territories included in this study, these levels were either constant or significant increases were estimated. There was an annualized decrease of 0.9% (95% UI, 0.5%-1.3%) in the global rate of age-standardized firearm deaths from 1990 to 2016. Aggregate firearm injury deaths in 2016 were highest among persons aged 20 to 24 years (for men, an estimated 34 700 deaths [95% UI, 24 900-39 700] and for women, an estimated 3580 deaths [95% UI, 2810-4210]). Estimates of the number of firearms by country were associated with higher rates of firearm suicide (P < .001; R2 = 0.21) and homicide (P < .001; R2 = 0.35). Conclusions and Relevance This study estimated between 195 000 and 276 000 firearm injury deaths globally in 2016, the majority of which were firearm homicides. Despite an overall decrease in rates of firearm injury death since 1990, there was variation among countries and across demographic subgroups.

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