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  • 1
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    Online Resource
    Treatment and Outcomes of Working Aged Adults with Stroke: Results from a National Prospective Registry
    S. Karger AG ; 2017
    In:  Neuroepidemiology Vol. 49, No. 3-4 ( 2017), p. 113-120
    Details
    In: Neuroepidemiology, S. Karger AG, Vol. 49, No. 3-4 ( 2017), p. 113-120
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Given the potential differences in etiology and impact, the treatment and outcome of younger patients (aged 18–64 years) require examination separately to older adults (aged ≥65 years) who experience acute stroke. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 〈 i 〉 〈 /i 〉 Data from the Australian Stroke Clinical Registry (2010–2015) including demographic and clinical characteristics, provision of evidence-based therapies and health-related quality of life (HRQoL) post-stroke was used. Descriptive statistics and multilevel regression models were used for group comparisons. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Compared to older patients (age ≥65 years) among 26,220 registrants, 6,526 (25%) younger patients (age 18–64 years) were more often male (63 vs. 51%; 〈 i 〉 p 〈 /i 〉   & #x3c; 0.001), born in Australia (70 vs. 63%; 〈 i 〉 p 〈 /i 〉   & #x3c; 0.001), more often discharged home from acute care (56 vs. 38%; 〈 i 〉 p 〈 /i 〉   & #x3c; 0.001), and less likely to receive antihypertensive medication (61 vs. 73%; 〈 i 〉 p 〈 /i 〉   & #x3c; 0.001). Younger patients had a 74% greater odds of having lower HRQoL compared to an equivalent aged-matched general population (adjusted OR 1.74, 95% CI 1.56–1.93, 〈 i 〉 p 〈 /i 〉   & #x3c; 0.001). 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 〈 i 〉 〈 /i 〉 Younger stroke patients exhibited distinct differences from their older counterparts with respect to demographic and clinical characteristics, prescription of antihypertensive medications and residual health status.
    Type of Medium: Online Resource
    ISSN: 0251-5350 , 1423-0208
    URL: Article
    DOI: 10.1159/000484141
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2017
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  • 2
    Online Resource
    Online Resource
    Interrater Reliability of the National Institutes of Health Stroke Scale: Rating by Neurologistsand N urses in a Community-Based Stroke Incidence Study
    S. Karger AG ; 1999
    In:  Cerebrovascular Diseases Vol. 9, No. 6 ( 1999), p. 323-327
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 9, No. 6 ( 1999), p. 323-327
    Abstract: The reliability of the National Institutes of Health Stroke Scale (NIHSS) for use by trained neurologists in clinical trials of acute stroke has been established in several hospital-based studies. However, it also has the potential for application in community-based settings and to be used by nonneurologists: issues which have not been explored before. Hence, we aimed to determine the reliability of the NIHSS when administered by research nurses within the existing North Eastern Melbourne Stroke Incidence Study. Using the NIHSS, thirty-one consecutively registered stroke patients were assessed by 2 neurologists and 1 of 2 trained research nurses. The interrater reliability of observations was compared using weighted and unweighted kappa statistics and intraclass correlation coefficients (ICC). There was a high level of agreement for total scores between the 2 neurologists (ICC = 0.95) and between each neurologist and research nurse (ICC = 0.92 and 0.96). While there was moderate to excellent agreement among neurologists and research nurse (weighted κ 〉 0.4) for the majority of the NIHSS items, there was poor agreement for the component ‘limb ataxia’. Overall, agreement between nurse and neurologist for individual items was not significantly different from agreement between neurologists. It appears that in both hospital and community settings, trained research nurses can administer the NIHSS with a reliability similar to stroke-trained neurologists. This ability could be used to advantage in large community-based trials and epidemiological studies.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000016006
    Language: English
    Publisher: S. Karger AG
    Publication Date: 1999
    detail.hit.zdb_id: 1482069-9
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  • 3
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    Online Resource
    Incidence of Stroke Subtypes in the North East Melbourne Stroke Incidence Study (NEMESIS): Differences between Men and Women
    S. Karger AG ; 2009
    In:  Neuroepidemiology Vol. 32, No. 1 ( 2009), p. 11-18
    Details
    In: Neuroepidemiology, S. Karger AG, Vol. 32, No. 1 ( 2009), p. 11-18
    Abstract: 〈 i 〉 Background and Purpose: 〈 /i 〉 Incidence rates of stroke subtypes may be imprecise when samples are small. We aimed to determine the incidence of stroke subtypes in a large geographically defined population. 〈 i 〉 Methods: 〈 /i 〉 Multiple overlapping sources were used to ascertain all strokes occurring in 22 postcodes (population of 306,631) of Melbourne, Australia, between 1997 and 1999. Stroke subtypes were defined by CT, MRI and autopsy. The Mantel-Haenszel age-adjusted rate ratio (MH RR) was used to compare incidence rates between men and women. 〈 i 〉 Results: 〈 /i 〉 We identified 1,421 strokes among 1,337 residents, 1,035 (72.8%) being first-ever strokes. Incidence (number/100,000 population/year), adjusted to the European population 45–84 years, was 197 (95% confidence interval, CI, 169–224) for ischemic stroke (IS), 47 (95% CI 33–60) for intracerebral haemorrhage (ICH) and 19 (95% CI 10–27) for subarachnoid haemorrhage (SAH). Compared with women, men in this age group had a greater incidence of IS (MH RR 1.65, 95% CI 1.39–1.96, p 〈 0.0001) and ICH (MH RR 1.46, 95% CI 1.01–2.10, p = 0.0420), but lesser rates of SAH (MH RR 0.34, 95% CI 0.16–0.69, p = 0.0031). 〈 i 〉 Conclusions: 〈 /i 〉 In this population-based study, the incidence of IS and ICH was greater among men than women, while women had a greater incidence of SAH. More effort may need to be directed at modifying risk factors for IS and ICH in men.
    Type of Medium: Online Resource
    ISSN: 0251-5350 , 1423-0208
    URL: Article
    DOI: 10.1159/000170086
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2009
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  • 4
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    Online Resource
    Paracentral Strip Infarcts of the Middle Cerebral Artery: Borderzone Ischaemia or Cortical Artery Occlusion?
    S. Karger AG ; 2009
    In:  Cerebrovascular Diseases Vol. 27, No. 3 ( 2009), p. 215-222
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 27, No. 3 ( 2009), p. 215-222
    Abstract: 〈 i 〉 Background and Purpose: 〈 /i 〉 We have noted the presence of small strip-like infarcts involving the cortex within the interdivisional territory of the middle cerebral artery (MCA) and sometimes extending to the periventricular region. The incidence in a stroke unit population, mechanisms, clinical expression and prognosis of patients with these cortical infarcts are unknown. To clarify these issues we retrospectively and prospectively identified these patients in our own stroke unit population. 〈 i 〉 Methods: 〈 /i 〉 Patients were identified retrospectively and prospectively from the Austin Hospital Stroke Unit from March 2001 to May 2007. All were selected on the basis of the recent onset of an acute neurological deficit with imaging showing strip infarction within the MCA territory. Clinical features were recorded and the mechanism of infarction was classified based on the TOAST criteria from standard investigations. 〈 i 〉 Results: 〈 /i 〉 From 4,274 acute stroke admissions, there were 24 patients (0.6%), 12 males and 12 females (mean age 75 years; range 44–92 years) with CT or MRI showing characteristic linear infarction in the middle cerebral territory. In most cases, infarction was adjacent to the central sulcus. Common clinical features included mild-to-moderate hemiparesis with cortical signs. The most common TOAST criterion mechanism categories were artery-to-artery or cardiac embolism. It is postulated that this resulted in either isolated small cortical artery branch occlusion or borderzone infarction between superior and inferior divisions of the MCA due to more proximal large-artery vessel occlusion. Prognosis was good. 〈 i 〉 Conclusions: 〈 /i 〉 We describe the phenotypic expression, postulated mechanisms and prognosis of strip-like infarcts between the superior and inferior MCA divisions. The likely artery-artery or cardio-embolic mechanisms should prompt clinicians to search for an embolic source. While the prognosis of the syndrome is generally good, its recognition may allow specific therapies to be developed to improve clinical outcomes further.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000196818
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2009
    detail.hit.zdb_id: 1482069-9
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  • 5
    Online Resource
    Online Resource
    Handicap 5 Years after Stroke in the North East Melbourne Stroke Incidence Study
    S. Karger AG ; 2009
    In:  Cerebrovascular Diseases Vol. 27, No. 2 ( 2009), p. 123-130
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 27, No. 2 ( 2009), p. 123-130
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Handicap is rarely comprehensively examined after stroke. We examined handicap among 5-year stroke survivors from an ‘ideal’ stroke incidence study. 〈 i 〉 Methods: 〈 /i 〉 Survivors were assessed with the London Handicap Scale [LHS, score range: 0 (greatest handicap) to 100 (least handicap)]. Multivariable regression was used to examine demographic, risk and stroke-related factors associated with handicap. 〈 i 〉 Results: 〈 /i 〉 351 of 441 (80%) survivors were assessed. Those assessed were more often Australian born than those not assessed (p 〈 0.05). The mean LHS score was 73 (SD = 21). The greatest handicap was present for physical independence and occupation/leisure items. Handicap was associated with older age, manual occupations, smoking, initial stroke severity, recurrent stroke and mood disorders. 〈 i 〉 Conclusion: 〈 /i 〉 Reducing recurrent stroke, through better risk factor management, is likely to reduce handicap. The association between handicap and mood disorders, which are potentially modifiable, warrants further investigation.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000177919
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2009
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  • 6
    Online Resource
    Online Resource
    Stroke Units, Tissue Plasminogen Activator, Aspirin and Neuroprotection: Which Stroke Intervention Could Provide the Greatest Community Benefit?
    S. Karger AG ; 2005
    In:  Cerebrovascular Diseases Vol. 20, No. 4 ( 2005), p. 239-244
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 20, No. 4 ( 2005), p. 239-244
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Although a number of acute stroke interventions are of proven efficacy, there is uncertainty about their community benefits. We aimed to assess this within a defined population. 〈 i 〉 Methods: 〈 /i 〉 Eligibility for tissue plasminogen activator (tPA), aspirin, stroke unit management and neuroprotection were assessed among incident stroke cases within the community-based North East Melbourne Stroke Incidence Study. 〈 i 〉 Results: 〈 /i 〉 Among 306,631 people, there were 645 incident strokes managed in hospital. When eligible patients were extrapolated to the Australian population, for every 1,000 cases, 46 (95% CI 17–69) could have been saved from death or dependency with stroke unit management, 6 (95% CI 1–11) by using aspirin, 11 (95% CI 5–17) or 10 (95% CI 3–16) by using tPA at 3 and 6 h, respectively. 〈 i 〉 Conclusions: 〈 /i 〉 Although tPA is the most potent intervention, management in stroke units has the greatest population benefit and should be a priority.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000087705
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2005
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  • 7
    Online Resource
    Online Resource
    Incidence and Outcome of Subtypes of Ischaemic Stroke: Initial Results from the North East Melbourne Stroke Incidence Study (NEMESIS)
    S. Karger AG ; 2003
    In:  Cerebrovascular Diseases Vol. 15, No. 1-2 ( 2003), p. 133-139
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 15, No. 1-2 ( 2003), p. 133-139
    Abstract: Information about the incidence and outcome of stroke subtypes is necessary to understand the likely impact of stroke prevention and treatment strategies. The purpose of this study was to determine the incidence and outcome of subtypes of cerebral infarction (CI). All strokes occurring in a population of 133,816 in Melbourne, Australia, during a 12-month period of 1996 and 1997 were identified and cases of CI subtyped according to the Oxfordshire Community Stroke Project classification. 276 ‘first-ever-in-a-lifetime’ stroke cases were registered. CI accounted for 72% of cases. Annual incidence rates per 100,000 persons adjusted to the ‘world’ population were 11 (95% CI, 4–18) for TACI, 25 (95% CI, 15–35) for PACI, 17 (95% CI, 9–25) for POCI and 18 (95% CI, 10–26) for LACI. 28-day case fatality was highest for TACI (35%; 95% CI, 19–51%) and first year recurrence rate highest for PACI (17%; 95% CI, 8–26%). TACI had the poorest functional outcome at 3 and 12 months. These findings are similar to those of two previous studies conducted in the northern hemisphere.
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000067142
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2003
    detail.hit.zdb_id: 1482069-9
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  • 8
    Online Resource
    Online Resource
    Smoking Cessation at 5 Years after Stroke in the North East Melbourne Stroke Incidence Study
    S. Karger AG ; 2009
    In:  Neuroepidemiology Vol. 32, No. 3 ( 2009), p. 196-200
    Details
    In: Neuroepidemiology, S. Karger AG, Vol. 32, No. 3 ( 2009), p. 196-200
    Abstract: 〈 i 〉 Background/Aims: 〈 /i 〉 There is limited knowledge about smoking cessation after stroke. We examined smoking cessation and recall of smoking cessation advice among 5-year stroke survivors. 〈 i 〉 Methods: 〈 /i 〉 Interviews were conducted between May 2002 and May 2004 with 5-year survivors from a population-based stroke incidence study undertaken from May 1 1997 to April 30 1999 in Melbourne, Australia. Data were gathered on smoking status at stroke onset, cessation advice recalled and periods of cessation up to 5 years after stroke. Cessation was determined by examining smoking status at stroke onset and at 5 years after stroke. 〈 i 〉 Results: 〈 /i 〉 Of the 441 5-year stroke survivors, 343 (78%) had smoking data at follow-up. Fifty-one people were current smokers at stroke onset and 19 (37%) had quit smoking by 5 years after stroke. Of the 40 ever smokers who responded to a question regarding cessation advice, 40% (n = 16) could not recall receiving any such advice since their stroke. 〈 i 〉 Conclusion: 〈 /i 〉 The majority of smokers continued to smoke at 5 years after stroke. Few smokers recalled smoking cessation advice. Given that receiving such advice can be the first step towards cessation, improvements in the delivery of advice to this high-risk group are needed
    Type of Medium: Online Resource
    ISSN: 0251-5350 , 1423-0208
    URL: Article
    DOI: 10.1159/000195689
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2009
    detail.hit.zdb_id: 1483032-2
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  • 9
    Online Resource
    Online Resource
    Acute Brain Infarction: Early Changes in Neurological Status
    S. Karger AG ; 1997
    In:  Cerebrovascular Diseases Vol. 7, No. 5 ( 1997), p. 6-9
    Details
    In: Cerebrovascular Diseases, S. Karger AG, Vol. 7, No. 5 ( 1997), p. 6-9
    Type of Medium: Online Resource
    ISSN: 1015-9770 , 1421-9786
    URL: Article
    DOI: 10.1159/000108268
    Language: English
    Publisher: S. Karger AG
    Publication Date: 1997
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  • 10
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    Treatment with Multiple Therapeutic Classes of Medication Is Associated with Survival after Stroke
    S. Karger AG ; 2022
    In:  Neuroepidemiology Vol. 56, No. 1 ( 2022), p. 66-74
    Details
    In: Neuroepidemiology, S. Karger AG, Vol. 56, No. 1 ( 2022), p. 66-74
    Abstract: 〈 b 〉 〈 i 〉 Introduction: 〈 /i 〉 〈 /b 〉 Treatment with several therapeutic classes of medication is recommended for secondary prevention of stroke. We analyzed the associations between the number of classes of prevention medications supplied within 90 days after discharge for ischemic stroke (IS)/transient ischemic attack (TIA) and survival. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 This is a retrospective cohort study of adults with first-ever IS/TIA (2010–2014) from the Australian Stroke Clinical Registry individually linked with data from national pharmaceutical and Medicare claims. Exposure was the number of classes of recommended medications, i.e., blood pressure-lowering, antithrombotic, or lipid-lowering agents, supplied to patients within 90 days after discharge for IS/TIA. The longitudinal association between the number of classes of medications and survival was evaluated with Cox proportional hazards regression models using the landmark approach. A landmark date of 90 days after hospital discharge was used to separate exposure and outcome periods, and only patients who survived until this date were included. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Of 8,429 patients (43% female, median age 74 years, 80% IS), 607 (7%) died in the year following 90 days after discharge. Overall, 56% of patients were supplied all 3 classes of medications, 28% 2 classes of medications, 11% 1 class of medications, and 5% no class of medications. Compared to patients supplied all 3 medication classes, adjusted hazard ratios for all-cause mortality ranged from 1.43 (95% confidence interval [CI]: 1.18–1.72) in those supplied 2 medication classes to 2.04 (95% CI: 1.44–2.88) in those supplied with no medication class. 〈 b 〉 〈 i 〉 Discussion/Conclusion: 〈 /i 〉 〈 /b 〉 Treatment with all 3 classes of guideline-recommended medications within 90 days after discharge was associated with better survival. Ongoing efforts are required to ensure optimal pharmacological intervention for secondary prevention of stroke.
    Type of Medium: Online Resource
    ISSN: 0251-5350 , 1423-0208
    URL: Article
    DOI: 10.1159/000520823
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
    detail.hit.zdb_id: 1483032-2
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