Valery Feigin | Auckland University of Technology (original) (raw)

Papers by Valery Feigin

Research paper thumbnail of Sports-related brain injury in the general population: An epidemiological study

Journal of Science and Medicine in Sport, 2014

Please cite this article as: Alice TheadomNicola J StarkeyTony DowellPatria A. HumeMichael KahanK... more Please cite this article as: Alice TheadomNicola J StarkeyTony DowellPatria A. HumeMichael KahanKathryn McPhersonValery Feiginon behalf of the BIONIC Research Group, Sports-related brain injury in the general population: an epidemiological study (2014), http://dx.

Research paper thumbnail of The Stroke Riskometer TM App: Validation of a data collection tool and stroke risk predictor

International Journal of Stroke, 2014

The greatest potential to reduce the burden of stroke is by primary prevention of first-ever stro... more The greatest potential to reduce the burden of stroke is by primary prevention of first-ever stroke, which constitutes three quarters of all stroke. In addition to population-wide prevention strategies (the 'mass' approach), the 'high risk' approach aims to identify individuals at risk of stroke and to modify their risk factors, and risk, accordingly. Current methods of assessing and modifying stroke risk are difficult to access and implement by the general population, amongst whom most future strokes will arise. To help reduce the burden of stroke on individuals and the population a new app, the Stroke Riskometer TM , has been developed. We aim to explore the validity of the app for predicting the risk of stroke compared with current best methods. Methods 752 stroke outcomes from a sample of 9501 individuals across three countries (New Zealand, Russia and the Netherlands) were utilized to investigate the performance of a novel stroke risk prediction tool algorithm (Stroke Riskometer TM ) compared with two established stroke risk score prediction algorithms (Framingham Stroke Risk Score [FSRS] and QStroke). We calculated the receiver operating characteristics (ROC) curves and area under the ROC curve (AUROC) with 95% confidence intervals, Harrels C-statistic and D-statistics for measure of discrimination, R 2 statistics to indicate level of variability accounted for by each prediction algorithm, the Hosmer-Lemeshow statistic for calibration, and the sensitivity and specificity of each algorithm. Results The Stroke Riskometer TM performed well against the FSRS five-year AUROC for both males (FSRS = 75·0% (95% CI 72·3%-77·6%), Stroke Riskometer TM = 74·0(95% CI 71·3%-76·7%) and females [FSRS = 70·3% (95% CI 67·9%-72·8%, Stroke Riskometer TM = 71·5% (95% CI 69·0%-73·9%)], and better than QStroke [males -59·7% (95% CI 57·3%-62·0%) and comparable to females = 71·1% (95% CI 69·0%-73·1%)]. Discriminative ability of all algorithms was low (C-statistic ranging from 0·51-0·56, D-statistic ranging from 0·01-0·12). Hosmer-Lemeshow illustrated that all of the predicted risk scores were not well calibrated with the observed event data (P < 0·006). Conclusions The Stroke Riskometer TM is comparable in performance for stroke prediction with FSRS and QStroke. All three algorithms performed equally poorly in predicting stroke events. The Stroke Riskometer TM will be continually developed and validated to address the need to improve the current stroke risk scoring systems to more accurately predict stroke, particularly by identifying robust ethnic/race ethnicity group and country specific risk factors.

Research paper thumbnail of Advances in Subarachnoid Hemorrhage

A lthough subarachnoid hemorrhage (SAH) comprises only 1% to 7% of all strokes, 1 the loss of pro... more A lthough subarachnoid hemorrhage (SAH) comprises only 1% to 7% of all strokes, 1 the loss of productive life years in the general population from SAH is comparable to that of cerebral infarction 2 because of the relatively young age of onset and poor outcome in SAH. 1,3,4 However, unlike other stroke subtypes, the incidence of SAH exhibits little geographical variation and did not significantly change over the last decades. 1 In the most recent overview of 14 longitudinal and 23 case-control studies of risk factors for SAH published in English from 1966 through March 2005, 5 it was concluded that smoking, hypertension, and excessive alcohol are the most important risk factors for SAH. Exposure to these risk factors individually and/or in combination promotes formation, growth, and rupture of intracranial aneurysm(s), 6 -8 a major cause of SAH. The consistency of the data across studies involving different designs and populations suggests that cigarette smoking and elevated blood pressure are causally related to SAH. 9 There is also evidence that genetic factors play an important role in the pathogenesis of SAH. 10 Accumulating evidence suggest a temporal (seasonal and diurnal) pattern in the occurrence of SAH, 11,12 but reasons for these temporal patterns remain unclear. However, there is still lack of good quality population-based epidemiological studies on incidence, trends, and outcomes of SAH in different populations (especially from developing countries).

Research paper thumbnail of Incidence of stroke in women in Auckland, New Zealand. Ethnic trends over two decades: 1981-2003

Background and purpose Although women have a greater lifetime risk of stroke than men, along with... more Background and purpose Although women have a greater lifetime risk of stroke than men, along with other gender differences in stroke, there is lack of reliable data on long-term trends in stroke in women. This paper presents the results of three population-based registers in Auckland (1981-1982, 1991-1992, and 2002-2003) which aimed to determine the trends in the incidence of stroke

Research paper thumbnail of Risk Factors for Subarachnoid Hemorrhage An Updated Systematic Review of Epidemiological Studies

Background and Purpose—After a 1996 review from our group on risk factors for subarachnoid hemorr... more Background and Purpose—After a 1996 review from our group on risk factors for subarachnoid hemorrhage (SAH), much new information has become available. This article provides an updated overview of risk factors for SAH. Methods—An overview of all longitudinal and case-control studies of risk factors for SAH published in English from 1966 through March 2005. We calculated pooled relative risks (RRs)

Research paper thumbnail of Associations between high-density lipoprotein cholesterol and both stroke and coronary heart disease in the Asia Pacific region

Background The inverse relationship between high-density lipoprotein (HDL) cholesterol and corona... more Background The inverse relationship between high-density lipoprotein (HDL) cholesterol and coronary heart disease (CHD) is well established. Questions remain about the association between HDL choles- terol and stroke, particularly for stroke subtypes. Methods and results Cox survival models were applied to individual participant data from 25 cohort studies (about 80 000 subjects), with a median of 6.8 years follow-up. After

Research paper thumbnail of Mortality from cardiovascular diseases in sub-Saharan Africa, 1990-2013: a systematic analysis of data from the Global Burden of Disease Study 2013

Cardiovascular journal of Africa

Cardiovascular disease (CVD) has been the leading cause of death in developed countries for most ... more Cardiovascular disease (CVD) has been the leading cause of death in developed countries for most of the last century. Most CVD deaths, however, occur in low- and middle-income, developing countries (LMICs) and there is great concern that CVD mortality and burden are rapidly increasing in LMICs as a result of population growth, ageing and health transitions. In sub-Saharan Africa (SSA), where all countries are part of the LMICs, the pattern, magnitude and trends in CVD deaths remain incompletely understood, which limits formulation of data-driven regional and national health policies. The aim was to estimate the number of deaths, death rates, and their trends for CVD causes of death in SSA, by age and gender for 1990 and 2013. Age- and gender-specific mortality rates for CVD were estimated using the Global Burden of Disease (GBD) 2010 methods with some refinements made by the GBD 2013 study to improve accuracy. Cause of death was estimated as in the GBD 2010 study and updated with a ...

Research paper thumbnail of Use of the EpiNet database for observational study of status epilepticus in Auckland, New Zealand

Epilepsy & Behavior, 2015

The EpiNet project has been established to facilitate investigator-initiated clinical research in... more The EpiNet project has been established to facilitate investigator-initiated clinical research in epilepsy, to undertake epidemiological studies, and to simultaneously improve the care of patients who have records created within the EpiNet database. The EpiNet database has recently been adapted to collect detailed information regarding status epilepticus. An incidence study is now underway in Auckland, New Zealand in which the incidence of status epilepticus in the greater Auckland area (population: 1.5 million) will be calculated. The form that has been developed for this study can be used in the future to collect information for randomized controlled trials in status epilepticus. This article is part of a Special Issue entitled &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Status Epilepticus&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;.

Research paper thumbnail of New Strategy to Reduce the Global Burden of Stroke

Stroke; a journal of cerebral circulation, Jan 16, 2015

Research paper thumbnail of A new paradigm for primary prevention strategy in people with elevated risk of stroke

International journal of stroke : official journal of the International Stroke Society, 2014

Existing methods of primary stroke prevention are not sufficiently effective. Based on the recent... more Existing methods of primary stroke prevention are not sufficiently effective. Based on the recently developed Stroke Riskometer app, a new 'mass-elevated risk stroke/cardiovascular disease prevention' approach as an addition to the currently adopted absolute risk stroke/cardiovascular disease prevention approach is being advocated. We believe this approach is far more appealing to the individuals concerned and could be as efficient as the conventional population-based approach because it allows identification and engagement in prevention of all individuals who are at an increased (even slightly increased) risk of stroke and cardiovascular disease. The key novelty of this approach is twofold. First, it utilizes modern far-reaching mobile technologies, allowing individuals to calculate their absolute risk of stroke within the next 5 to 10 years and to compare their risk with those of the same age and gender without risk factors. Second, it employs self-management strategies to...

Research paper thumbnail of Computerised tomography indices of raised intracranial pressure and traumatic brain injury severity in a New Zealand sample

The New Zealand medical journal, Jan 24, 2012

Research paper thumbnail of Trends in Ethnic Disparities in Stroke Incidence in Auckland, New Zealand, During 1981 to 2003

on behalf of the Auckland Regional Community Stroke (ARCOS) Study Group Background and Purpose-Al... more on behalf of the Auckland Regional Community Stroke (ARCOS) Study Group Background and Purpose-Although geographical variations in stroke rates are well documented, limited data exist on temporal trends in ethnic-specific stroke incidence. Methods-We assessed trends in ethnic-specific stroke rates using standard diagnostic criteria and community-wide surveillance procedures in Auckland, New Zealand (NZ) in 1981(NZ) in to 1982(NZ) in , 1991(NZ) in to 1992(NZ) in , and 2002(NZ) in to 2003. Indirect and direct methods were used to adjust first-ever (incident) and total (attack) rates for changes in the structure of the population and reported with 95% CIs. Ethnicity was self-defined and categorized as "NZ/European," "Maori," "Pacific peoples," and "Asian and other." Results-Stroke attack (19%; 95% CI, 11% to 26%) and incidence rates (19%; 95% CI, 12% to 24%) declined significantly in NZ/Europeans from 1981 to 1982 to 2002 to 2003. These rates remained high or increased in other ethnic groups, particularly for Pacific peoples in whom stroke attack rates increased by 66% (95% CI; 11% to 225%) over the periods. Some favorable downward trends in vascular risk factors, such as cigarette smoking, were counterbalanced by increasing age, body mass index, and diabetes in certain ethnic groups.

Research paper thumbnail of Diurnal, weekly, and seasonal variations in stroke occurrence in a population-based study in Auckland, New Zealand

The New Zealand medical journal, Jan 24, 2004

To determine (via a population-based study in Auckland, New Zealand) if there are diurnal, weekly... more To determine (via a population-based study in Auckland, New Zealand) if there are diurnal, weekly, or seasonal variations in the occurrence of stroke. All new stroke events in Auckland residents were traced. Time of onset of the stroke was defined as the time when neurological symptoms were first noticed. The day of the week and month of onset were analysed for all strokes. 1711 patients were registered over 1 year. The rate ratios for the onset of stroke in each 6-hourly interval compared with reference interval (1800-2359 hours) were 0.74 (95% CI: 0.61-1.10) for 0000-0559 hours, 2.88 (95% CI: 2.48-3.34) for 0600-1159 hours and 1.74 (95% CI: 1.49-2.05) for 1200-1759 hours. Rate ratios of the seasonal occurrence of stroke compared with spring were 0.75 (95% CI: 0.65-0.86) for summer, 0.83 (95% CI: 0.73-0.95) for autumn and 1.08 (95% CI: 0.96-1.23) for winter. No weekly pattern of stroke occurrence was observed. Strokes were less likely to occur during the summer and autumn than in t...

Research paper thumbnail of Incidence of stroke in women in Auckland, New Zealand. Ethnic trends over two decades: 1981-2003

The New Zealand medical journal, 2006

Although women have a greater lifetime risk of stroke than men, along with other gender differenc... more Although women have a greater lifetime risk of stroke than men, along with other gender differences in stroke, there is lack of reliable data on long-term trends in stroke in women. This paper presents the results of three population-based registers in Auckland (1981-1982, 1991-1992, and 2002-2003) which aimed to determine the trends in the incidence of stroke in New Zealand. This paper reports on the burden of stroke in women across different ethnic groups over the study period from 1981 to 2003. Three studies using similar methodology and overlapping case finding methods have been conducted in New Zealand to estimate trends in the incidence and outcome of stroke. The studies are recognised as meeting the 'ideal' criteria for stroke incidence and identify all first-ever and recurrent strokes in residents (aged greater than and equal to 15 years) the population of Auckland, New Zealand in the 12-month periods from 1981-1982, 1991-1992, and 2002-2003. There were totals of 307...

Research paper thumbnail of Long-term neuropsychological and functional outcomes in stroke survivors: current evidence and perspectives for new research

International journal of stroke : official journal of the International Stroke Society, 2008

To appraise the literature on long-term neuropsychological and functional outcomes in stroke surv... more To appraise the literature on long-term neuropsychological and functional outcomes in stroke survivors and identify the gaps, challenges and future research in this area. Stroke care resources are scarce, and the number of stroke survivors is likely to increase with the ageing of the population. Thus, evaluating the cost, frequency and prognostic factors of long-terms stroke functional and neuropsychological outcomes is of paramount importance for evidence-based clinical decision making, including the rationale, planning, provision and allocation of health services, and the development of effective interventions. Summary of review Stroke has an enormous physical, emotional and economic impact on the patients, families and society. However, accurate data on frequency, relationship and predictors of various long-term functional (body functioning, activity and participation) outcomes and costs of stroke are scarce, and no accurate and comprehensive data exist on long-term neuropsycholo...

Research paper thumbnail of The emerging role of induced hypothermia in the management of acute stroke

Journal of Clinical Neuroscience, 2002

Current treatment of acute stroke remains unsatisfactory. This review presents experimental and c... more Current treatment of acute stroke remains unsatisfactory. This review presents experimental and clinical data which suggest that mild induced hypothermia could be a potent and practicable neuroprotective treatment of acute ischaemic stroke and intracerebral haemorrhage. Hypothermia, if proven to be safe, effective and widely practicable in patients with acute stroke, could have an enormous positive impact on reducing the burden

Research paper thumbnail of Stroke: A picture of health disparities in New Zealand

The experience of Māori stroke survivors and their caregivers is the focus of this paper. A serie... more The experience of Māori stroke survivors and their caregivers is the focus of this paper. A series of qualitative face-to-face interviews was conducted, firstly with Māori who had experienced stroke, and who were part of the 2002/03 Auckland Regional Community Stroke (ARCOS) study; and secondly with their primary caregivers. Experiences of Māori stroke survivors and caregivers are presented under the following themes: experience and knowledge of stroke, experience in hospital and the importance of cultural identity in motivating rehabilitation, the financial impact of stroke on Māori whānau, the stigma and social isolation associated with stroke and health services, and the associated policy issues that emerge from these interviews for Māori.

Research paper thumbnail of Ethnic Disparities in Risk Factors for Stroke What Are the Implications?

Research paper thumbnail of Editorial comment—stroke incidence studies one step closer to the elusive gold standard?

Research paper thumbnail of Are stroke units cost effective? Evidence from a New Zealand stroke incidence and population‐based study

Background and aim Acute stroke units in hospitals are known to be more costly than standard care... more Background and aim Acute stroke units in hospitals are known to be more costly than standard care, but proponents claim that the health gains will justify the expense. Yet, despite widespread adoption of stroke units, the evidence on the cost effectiveness of stroke units has been mixed, due in part to differences in the pathway of care across hospitals. The purpose of this study is to compare costs and outcomes for patients admitted to a stroke unit with those admitted to a general ward. Methods Data on 530 stroke sufferers from a large incidence study of stroke (the Auckland Regional Community Stroke Outcome Study) were used. Cost of health services, places of discharge were identified at one-, six-and 12 months poststroke and were linked with long-term cost and survival fiveyears poststroke. A decision analytical model was developed, including the relationship between waiting time for discharge and probability of admission to stroke unit. Cost effectiveness was determined using a willingness to pay threshold of NZ$20 000 (US$15 234). Results Regression analysis suggested that there were no significant differences between patients admitted to a stroke unit and a general ward. The incremental cost-utility ratio for the first-year was NZ$42 813/quality-adjusted life year (US$32 610/quality-adjusted life year), but fell substantially to NZ$6747/quality-adjusted life year (US$5139/qualityadjusted life year) when lifetime costs and outcomes were considered. Probabilistic and one-way sensitivity analysis suggests that the results are robust to areas of uncertainty or delays in the pathway of care. Conclusion Stroke unit care was cost effective in Auckland, New Zealand.

Research paper thumbnail of Sports-related brain injury in the general population: An epidemiological study

Journal of Science and Medicine in Sport, 2014

Please cite this article as: Alice TheadomNicola J StarkeyTony DowellPatria A. HumeMichael KahanK... more Please cite this article as: Alice TheadomNicola J StarkeyTony DowellPatria A. HumeMichael KahanKathryn McPhersonValery Feiginon behalf of the BIONIC Research Group, Sports-related brain injury in the general population: an epidemiological study (2014), http://dx.

Research paper thumbnail of The Stroke Riskometer TM App: Validation of a data collection tool and stroke risk predictor

International Journal of Stroke, 2014

The greatest potential to reduce the burden of stroke is by primary prevention of first-ever stro... more The greatest potential to reduce the burden of stroke is by primary prevention of first-ever stroke, which constitutes three quarters of all stroke. In addition to population-wide prevention strategies (the 'mass' approach), the 'high risk' approach aims to identify individuals at risk of stroke and to modify their risk factors, and risk, accordingly. Current methods of assessing and modifying stroke risk are difficult to access and implement by the general population, amongst whom most future strokes will arise. To help reduce the burden of stroke on individuals and the population a new app, the Stroke Riskometer TM , has been developed. We aim to explore the validity of the app for predicting the risk of stroke compared with current best methods. Methods 752 stroke outcomes from a sample of 9501 individuals across three countries (New Zealand, Russia and the Netherlands) were utilized to investigate the performance of a novel stroke risk prediction tool algorithm (Stroke Riskometer TM ) compared with two established stroke risk score prediction algorithms (Framingham Stroke Risk Score [FSRS] and QStroke). We calculated the receiver operating characteristics (ROC) curves and area under the ROC curve (AUROC) with 95% confidence intervals, Harrels C-statistic and D-statistics for measure of discrimination, R 2 statistics to indicate level of variability accounted for by each prediction algorithm, the Hosmer-Lemeshow statistic for calibration, and the sensitivity and specificity of each algorithm. Results The Stroke Riskometer TM performed well against the FSRS five-year AUROC for both males (FSRS = 75·0% (95% CI 72·3%-77·6%), Stroke Riskometer TM = 74·0(95% CI 71·3%-76·7%) and females [FSRS = 70·3% (95% CI 67·9%-72·8%, Stroke Riskometer TM = 71·5% (95% CI 69·0%-73·9%)], and better than QStroke [males -59·7% (95% CI 57·3%-62·0%) and comparable to females = 71·1% (95% CI 69·0%-73·1%)]. Discriminative ability of all algorithms was low (C-statistic ranging from 0·51-0·56, D-statistic ranging from 0·01-0·12). Hosmer-Lemeshow illustrated that all of the predicted risk scores were not well calibrated with the observed event data (P < 0·006). Conclusions The Stroke Riskometer TM is comparable in performance for stroke prediction with FSRS and QStroke. All three algorithms performed equally poorly in predicting stroke events. The Stroke Riskometer TM will be continually developed and validated to address the need to improve the current stroke risk scoring systems to more accurately predict stroke, particularly by identifying robust ethnic/race ethnicity group and country specific risk factors.

Research paper thumbnail of Advances in Subarachnoid Hemorrhage

A lthough subarachnoid hemorrhage (SAH) comprises only 1% to 7% of all strokes, 1 the loss of pro... more A lthough subarachnoid hemorrhage (SAH) comprises only 1% to 7% of all strokes, 1 the loss of productive life years in the general population from SAH is comparable to that of cerebral infarction 2 because of the relatively young age of onset and poor outcome in SAH. 1,3,4 However, unlike other stroke subtypes, the incidence of SAH exhibits little geographical variation and did not significantly change over the last decades. 1 In the most recent overview of 14 longitudinal and 23 case-control studies of risk factors for SAH published in English from 1966 through March 2005, 5 it was concluded that smoking, hypertension, and excessive alcohol are the most important risk factors for SAH. Exposure to these risk factors individually and/or in combination promotes formation, growth, and rupture of intracranial aneurysm(s), 6 -8 a major cause of SAH. The consistency of the data across studies involving different designs and populations suggests that cigarette smoking and elevated blood pressure are causally related to SAH. 9 There is also evidence that genetic factors play an important role in the pathogenesis of SAH. 10 Accumulating evidence suggest a temporal (seasonal and diurnal) pattern in the occurrence of SAH, 11,12 but reasons for these temporal patterns remain unclear. However, there is still lack of good quality population-based epidemiological studies on incidence, trends, and outcomes of SAH in different populations (especially from developing countries).

Research paper thumbnail of Incidence of stroke in women in Auckland, New Zealand. Ethnic trends over two decades: 1981-2003

Background and purpose Although women have a greater lifetime risk of stroke than men, along with... more Background and purpose Although women have a greater lifetime risk of stroke than men, along with other gender differences in stroke, there is lack of reliable data on long-term trends in stroke in women. This paper presents the results of three population-based registers in Auckland (1981-1982, 1991-1992, and 2002-2003) which aimed to determine the trends in the incidence of stroke

Research paper thumbnail of Risk Factors for Subarachnoid Hemorrhage An Updated Systematic Review of Epidemiological Studies

Background and Purpose—After a 1996 review from our group on risk factors for subarachnoid hemorr... more Background and Purpose—After a 1996 review from our group on risk factors for subarachnoid hemorrhage (SAH), much new information has become available. This article provides an updated overview of risk factors for SAH. Methods—An overview of all longitudinal and case-control studies of risk factors for SAH published in English from 1966 through March 2005. We calculated pooled relative risks (RRs)

Research paper thumbnail of Associations between high-density lipoprotein cholesterol and both stroke and coronary heart disease in the Asia Pacific region

Background The inverse relationship between high-density lipoprotein (HDL) cholesterol and corona... more Background The inverse relationship between high-density lipoprotein (HDL) cholesterol and coronary heart disease (CHD) is well established. Questions remain about the association between HDL choles- terol and stroke, particularly for stroke subtypes. Methods and results Cox survival models were applied to individual participant data from 25 cohort studies (about 80 000 subjects), with a median of 6.8 years follow-up. After

Research paper thumbnail of Mortality from cardiovascular diseases in sub-Saharan Africa, 1990-2013: a systematic analysis of data from the Global Burden of Disease Study 2013

Cardiovascular journal of Africa

Cardiovascular disease (CVD) has been the leading cause of death in developed countries for most ... more Cardiovascular disease (CVD) has been the leading cause of death in developed countries for most of the last century. Most CVD deaths, however, occur in low- and middle-income, developing countries (LMICs) and there is great concern that CVD mortality and burden are rapidly increasing in LMICs as a result of population growth, ageing and health transitions. In sub-Saharan Africa (SSA), where all countries are part of the LMICs, the pattern, magnitude and trends in CVD deaths remain incompletely understood, which limits formulation of data-driven regional and national health policies. The aim was to estimate the number of deaths, death rates, and their trends for CVD causes of death in SSA, by age and gender for 1990 and 2013. Age- and gender-specific mortality rates for CVD were estimated using the Global Burden of Disease (GBD) 2010 methods with some refinements made by the GBD 2013 study to improve accuracy. Cause of death was estimated as in the GBD 2010 study and updated with a ...

Research paper thumbnail of Use of the EpiNet database for observational study of status epilepticus in Auckland, New Zealand

Epilepsy & Behavior, 2015

The EpiNet project has been established to facilitate investigator-initiated clinical research in... more The EpiNet project has been established to facilitate investigator-initiated clinical research in epilepsy, to undertake epidemiological studies, and to simultaneously improve the care of patients who have records created within the EpiNet database. The EpiNet database has recently been adapted to collect detailed information regarding status epilepticus. An incidence study is now underway in Auckland, New Zealand in which the incidence of status epilepticus in the greater Auckland area (population: 1.5 million) will be calculated. The form that has been developed for this study can be used in the future to collect information for randomized controlled trials in status epilepticus. This article is part of a Special Issue entitled &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;Status Epilepticus&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;.

Research paper thumbnail of New Strategy to Reduce the Global Burden of Stroke

Stroke; a journal of cerebral circulation, Jan 16, 2015

Research paper thumbnail of A new paradigm for primary prevention strategy in people with elevated risk of stroke

International journal of stroke : official journal of the International Stroke Society, 2014

Existing methods of primary stroke prevention are not sufficiently effective. Based on the recent... more Existing methods of primary stroke prevention are not sufficiently effective. Based on the recently developed Stroke Riskometer app, a new 'mass-elevated risk stroke/cardiovascular disease prevention' approach as an addition to the currently adopted absolute risk stroke/cardiovascular disease prevention approach is being advocated. We believe this approach is far more appealing to the individuals concerned and could be as efficient as the conventional population-based approach because it allows identification and engagement in prevention of all individuals who are at an increased (even slightly increased) risk of stroke and cardiovascular disease. The key novelty of this approach is twofold. First, it utilizes modern far-reaching mobile technologies, allowing individuals to calculate their absolute risk of stroke within the next 5 to 10 years and to compare their risk with those of the same age and gender without risk factors. Second, it employs self-management strategies to...

Research paper thumbnail of Computerised tomography indices of raised intracranial pressure and traumatic brain injury severity in a New Zealand sample

The New Zealand medical journal, Jan 24, 2012

Research paper thumbnail of Trends in Ethnic Disparities in Stroke Incidence in Auckland, New Zealand, During 1981 to 2003

on behalf of the Auckland Regional Community Stroke (ARCOS) Study Group Background and Purpose-Al... more on behalf of the Auckland Regional Community Stroke (ARCOS) Study Group Background and Purpose-Although geographical variations in stroke rates are well documented, limited data exist on temporal trends in ethnic-specific stroke incidence. Methods-We assessed trends in ethnic-specific stroke rates using standard diagnostic criteria and community-wide surveillance procedures in Auckland, New Zealand (NZ) in 1981(NZ) in to 1982(NZ) in , 1991(NZ) in to 1992(NZ) in , and 2002(NZ) in to 2003. Indirect and direct methods were used to adjust first-ever (incident) and total (attack) rates for changes in the structure of the population and reported with 95% CIs. Ethnicity was self-defined and categorized as "NZ/European," "Maori," "Pacific peoples," and "Asian and other." Results-Stroke attack (19%; 95% CI, 11% to 26%) and incidence rates (19%; 95% CI, 12% to 24%) declined significantly in NZ/Europeans from 1981 to 1982 to 2002 to 2003. These rates remained high or increased in other ethnic groups, particularly for Pacific peoples in whom stroke attack rates increased by 66% (95% CI; 11% to 225%) over the periods. Some favorable downward trends in vascular risk factors, such as cigarette smoking, were counterbalanced by increasing age, body mass index, and diabetes in certain ethnic groups.

Research paper thumbnail of Diurnal, weekly, and seasonal variations in stroke occurrence in a population-based study in Auckland, New Zealand

The New Zealand medical journal, Jan 24, 2004

To determine (via a population-based study in Auckland, New Zealand) if there are diurnal, weekly... more To determine (via a population-based study in Auckland, New Zealand) if there are diurnal, weekly, or seasonal variations in the occurrence of stroke. All new stroke events in Auckland residents were traced. Time of onset of the stroke was defined as the time when neurological symptoms were first noticed. The day of the week and month of onset were analysed for all strokes. 1711 patients were registered over 1 year. The rate ratios for the onset of stroke in each 6-hourly interval compared with reference interval (1800-2359 hours) were 0.74 (95% CI: 0.61-1.10) for 0000-0559 hours, 2.88 (95% CI: 2.48-3.34) for 0600-1159 hours and 1.74 (95% CI: 1.49-2.05) for 1200-1759 hours. Rate ratios of the seasonal occurrence of stroke compared with spring were 0.75 (95% CI: 0.65-0.86) for summer, 0.83 (95% CI: 0.73-0.95) for autumn and 1.08 (95% CI: 0.96-1.23) for winter. No weekly pattern of stroke occurrence was observed. Strokes were less likely to occur during the summer and autumn than in t...

Research paper thumbnail of Incidence of stroke in women in Auckland, New Zealand. Ethnic trends over two decades: 1981-2003

The New Zealand medical journal, 2006

Although women have a greater lifetime risk of stroke than men, along with other gender differenc... more Although women have a greater lifetime risk of stroke than men, along with other gender differences in stroke, there is lack of reliable data on long-term trends in stroke in women. This paper presents the results of three population-based registers in Auckland (1981-1982, 1991-1992, and 2002-2003) which aimed to determine the trends in the incidence of stroke in New Zealand. This paper reports on the burden of stroke in women across different ethnic groups over the study period from 1981 to 2003. Three studies using similar methodology and overlapping case finding methods have been conducted in New Zealand to estimate trends in the incidence and outcome of stroke. The studies are recognised as meeting the 'ideal' criteria for stroke incidence and identify all first-ever and recurrent strokes in residents (aged greater than and equal to 15 years) the population of Auckland, New Zealand in the 12-month periods from 1981-1982, 1991-1992, and 2002-2003. There were totals of 307...

Research paper thumbnail of Long-term neuropsychological and functional outcomes in stroke survivors: current evidence and perspectives for new research

International journal of stroke : official journal of the International Stroke Society, 2008

To appraise the literature on long-term neuropsychological and functional outcomes in stroke surv... more To appraise the literature on long-term neuropsychological and functional outcomes in stroke survivors and identify the gaps, challenges and future research in this area. Stroke care resources are scarce, and the number of stroke survivors is likely to increase with the ageing of the population. Thus, evaluating the cost, frequency and prognostic factors of long-terms stroke functional and neuropsychological outcomes is of paramount importance for evidence-based clinical decision making, including the rationale, planning, provision and allocation of health services, and the development of effective interventions. Summary of review Stroke has an enormous physical, emotional and economic impact on the patients, families and society. However, accurate data on frequency, relationship and predictors of various long-term functional (body functioning, activity and participation) outcomes and costs of stroke are scarce, and no accurate and comprehensive data exist on long-term neuropsycholo...

Research paper thumbnail of The emerging role of induced hypothermia in the management of acute stroke

Journal of Clinical Neuroscience, 2002

Current treatment of acute stroke remains unsatisfactory. This review presents experimental and c... more Current treatment of acute stroke remains unsatisfactory. This review presents experimental and clinical data which suggest that mild induced hypothermia could be a potent and practicable neuroprotective treatment of acute ischaemic stroke and intracerebral haemorrhage. Hypothermia, if proven to be safe, effective and widely practicable in patients with acute stroke, could have an enormous positive impact on reducing the burden

Research paper thumbnail of Stroke: A picture of health disparities in New Zealand

The experience of Māori stroke survivors and their caregivers is the focus of this paper. A serie... more The experience of Māori stroke survivors and their caregivers is the focus of this paper. A series of qualitative face-to-face interviews was conducted, firstly with Māori who had experienced stroke, and who were part of the 2002/03 Auckland Regional Community Stroke (ARCOS) study; and secondly with their primary caregivers. Experiences of Māori stroke survivors and caregivers are presented under the following themes: experience and knowledge of stroke, experience in hospital and the importance of cultural identity in motivating rehabilitation, the financial impact of stroke on Māori whānau, the stigma and social isolation associated with stroke and health services, and the associated policy issues that emerge from these interviews for Māori.

Research paper thumbnail of Ethnic Disparities in Risk Factors for Stroke What Are the Implications?

Research paper thumbnail of Editorial comment—stroke incidence studies one step closer to the elusive gold standard?

Research paper thumbnail of Are stroke units cost effective? Evidence from a New Zealand stroke incidence and population‐based study

Background and aim Acute stroke units in hospitals are known to be more costly than standard care... more Background and aim Acute stroke units in hospitals are known to be more costly than standard care, but proponents claim that the health gains will justify the expense. Yet, despite widespread adoption of stroke units, the evidence on the cost effectiveness of stroke units has been mixed, due in part to differences in the pathway of care across hospitals. The purpose of this study is to compare costs and outcomes for patients admitted to a stroke unit with those admitted to a general ward. Methods Data on 530 stroke sufferers from a large incidence study of stroke (the Auckland Regional Community Stroke Outcome Study) were used. Cost of health services, places of discharge were identified at one-, six-and 12 months poststroke and were linked with long-term cost and survival fiveyears poststroke. A decision analytical model was developed, including the relationship between waiting time for discharge and probability of admission to stroke unit. Cost effectiveness was determined using a willingness to pay threshold of NZ$20 000 (US$15 234). Results Regression analysis suggested that there were no significant differences between patients admitted to a stroke unit and a general ward. The incremental cost-utility ratio for the first-year was NZ$42 813/quality-adjusted life year (US$32 610/quality-adjusted life year), but fell substantially to NZ$6747/quality-adjusted life year (US$5139/qualityadjusted life year) when lifetime costs and outcomes were considered. Probabilistic and one-way sensitivity analysis suggests that the results are robust to areas of uncertainty or delays in the pathway of care. Conclusion Stroke unit care was cost effective in Auckland, New Zealand.