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  • 1
    Online Resource
    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
    detail.hit.zdb_id: 1483032-2
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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
    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
    detail.hit.zdb_id: 1482069-9
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  • 4
    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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  • 5
    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
    detail.hit.zdb_id: 1482069-9
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