NISAN - the National Institute for Stroke and Applied Neurosciences
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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:
- Traumatic brain injury
- Neuromuscular disorders
- Public health
- ItemHealth Quality of Retired Royal New Zealand Navy Personnel: A Cross-Sectional Analysis(Peertechz Publications Private Limited, 2021) King, Doug; Hume, Patria; Clark, Trevor; Gissane, ConorPurpose: To characterise the current health quality of retired Royal New Zealand Navy (RNZN) personnel. Methods: A Cross-sectional analysis of self-reported survey data was conducted. A total of 300 retired RNZN personnel completed a Health-Related Quality of Life (HRQOL) survey on-line using the SF-36v2 to assess physical and mental health domains. The Physical Component Summary [PCS] combined Physical Function (PF), Role Physical (RP), Bodily Pain (BP) and General Health (GH) subscales. The Mental Component Summary [MCS] combined Vitality (VT), Social Functioning (SF), Role Emotional (RE) and Mental Health (MH) subscales. Analysis by age, gender, ethnicity, and rank were conducted for the subscale results. Comparisons of the RNZN cohort with the 1998 US National and New Zealand 2006-2007 health surveys were made. Results: New Zealand Europeans (NZE) recorded a higher mean RP and PCS than New Zealand Māori (NZM) (RP: 66.9 vs. 54.9; t(46)=-2.2; p=0.0294; d=0.50; PCS: 68.9 vs. 65.7; t(46)=-2.3; p=0.0267; d=0.47). Senior Rates recorded a higher MH (69.5 vs. 66.2; t(19)=-1.1; p=0.0568; d=0.35) but a lower PCS (65.0 vs. 65.6; t(19)=0.6;p=0.0681 d=0.07) and MCS (59.2 vs. 59.4; t(19)=-1.4; p=0.0865; d=0.46) than Officers. Compared with the New Zealand 2006-2007 health survey, the retired RNZN cohort had a lower RP (58.0 vs. 85.7; d=1.14), BP (42.6 vs. 75.3; d=1.51), SF (59.8 vs. 88.4; d=1.85) and MH (68.5 vs. 82.3; d=1.28). Conclusion: The lower HRQOL subscales results (especially BP) for retired RNZN personnel compared to the general population and other service personnel indicates a need for more research to understand the potential reasons for these findings. The effects of the lifestyle and training requirements combined with the entry selection of healthy people into the navy may have impacted on the results reported in this survey.
- ItemA 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 LBACKGROUND: 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.
- ItemExtended 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, LBackground: 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.
- ItemDigital 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
- ItemPopulation-level Risks of Alcohol Consumption by Amount, Geography, Age, Sex, and Year: A Systematic Analysis for the Global Burden of Disease Study 2020(Elsevier BV, 2022-07)Background The health risks associated with moderate alcohol consumption continue to be debated. Small amounts of alcohol might lower the risk of some health outcomes but increase the risk of others, suggesting that the overall risk depends, in part, on background disease rates, which vary by region, age, sex, and year. Methods For this analysis, we constructed burden-weighted dose–response relative risk curves across 22 health outcomes to estimate the theoretical minimum risk exposure level (TMREL) and non-drinker equivalence (NDE), the consumption level at which the health risk is equivalent to that of a non-drinker, using disease rates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2020 for 21 regions, including 204 countries and territories, by 5-year age group, sex, and year for individuals aged 15–95 years and older from 1990 to 2020. Based on the NDE, we quantified the population consuming harmful amounts of alcohol. Findings The burden-weighted relative risk curves for alcohol use varied by region and age. Among individuals aged 15–39 years in 2020, the TMREL varied between 0 (95% uncertainty interval 0–0) and 0·603 (0·400–1·00) standard drinks per day, and the NDE varied between 0·002 (0–0) and 1·75 (0·698–4·30) standard drinks per day. Among individuals aged 40 years and older, the burden-weighted relative risk curve was J-shaped for all regions, with a 2020 TMREL that ranged from 0·114 (0–0·403) to 1·87 (0·500–3·30) standard drinks per day and an NDE that ranged between 0·193 (0–0·900) and 6·94 (3·40–8·30) standard drinks per day. Among individuals consuming harmful amounts of alcohol in 2020, 59·1% (54·3–65·4) were aged 15–39 years and 76·9% (73·0–81·3) were male. Interpretation There is strong evidence to support recommendations on alcohol consumption varying by age and location. Stronger interventions, particularly those tailored towards younger individuals, are needed to reduce the substantial global health loss attributable to alcohol.