Michael Brainin - Academia.edu (original) (raw)

Papers by Michael Brainin

Lancet (London, England), Jan 8, 2016

Improving survival and extending the longevity of life for all populations requires timely, robus... more Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015...

Lancet (London, England), Oct 8, 2016

In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it... more In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality a...

Lancet (London, England), Jan 10, 2015

The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a s... more The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental...

The Lancet, 2015

Health is improving globally, but this means more populations are spending more time with functio... more Health is improving globally, but this means more populations are spending more time with functional health loss-an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI-a relative compression of morbidity-which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs, HALE, and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. Funding Bill & Melinda Gates Foundation Research in context Evidence before this study Disability-adjusted life years (DALYs), a summary measure of population health based on estimates of premature mortality and nonfatal health loss, originated from the initial Global Burden of Disease (GBD) study in 1993. DALYs, in combination with other summary measures such as healthy life expectancy (HALE), offer relatively simple yet powerful metrics against which progress and challenges in improving disease burden and extending healthy lifespans can be effectively monitored over time. Published in 2012, GBD 2010 provided updated estimates of DALYs due to 291 causes and HALE in 187 countries from 1990 to 2010. GBD 2013 extended this time series to 2013, 188 countries, and 306 causes. Novel analyses for quantifying epidemiologic transitions were introduced as part of GBD 2013, enabling a comparison of shifts in years of life lost (YLLs) and years lived with disability (YLDs) with increasing levels of development. The World Health Organization (WHO) has produced estimates of DALYs and HALE largely based off GBD 2010 and GBD 2013; however, modifications were implemented for a subset of causes, disability weights, and countries, and a normative life table of 91.9 years at birth was used for calculating YLLs.

International Journal of Stroke, 2014

Background The greatest potential to reduce the burden of stroke is by primary prevention of firs... more Background 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™, 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 R...

European Journal of Neurology, 2018

Background and purpose: The aim of this pooled patient-level data analysis was to test if multido... more Background and purpose: The aim of this pooled patient-level data analysis was to test if multidomain interventions, addressing several modifiable vascular risk factors simultaneously, are more effective than usual post-stroke care for the prevention of cognitive decline after stroke. Methods: This pooled patient-level data analysis included two randomized controlled trials using a multidomain approach to target vascular risk factors in stroke patients and cognition as primary outcome. Changes from baseline to 12 months in the trail making test (TMT)-A, TMT-B and 10-words test were analysed using stepwise backward linear mixed models with study as random factor. Two analyses were based on the intention-to-treat (ITT) principle using different imputation approaches and one was based on complete cases. Results: Data from 322 patients (157 assigned to multidomain intervention and 165 to standard care) were analysed. Differences between randomization groups for TMT-A scores were found in one ITT model (P = 0.014) and approached significance in the second ITT model (P = 0.087) and for complete cases (P = 0.091). No significant intervention effects were found for any of the other cognitive variables. Conclusion: We found indications that multidomain interventions compared with standard care can improve the scores in TMT-A at 1 year after stroke but not those for TMT-B or the 10-words test. These results have to be interpreted with caution due to the small number of patients.

Guidance For Development, Refereeing and Dissemination of Guidelines

European Handbook of Neurological Management

... Franklin GM, Zahn CA (2002). AAN clinical practice guidelines. Neurology 59:975–976. ... Neur... more ... Franklin GM, Zahn CA (2002). AAN clinical practice guidelines. Neurology 59:975–976. ... Neurology 60:166–175. Hughes RAC, Barnes MP, Baron JC, Brainin M (2001). Guidance for the preparation of neurological manage-ment guidelines by EFNS scientific task forces. ...

European Handbook of Neurological Management

Background A great variety of neurological diseases require investigation of the cerebrospinal fl... more Background A great variety of neurological diseases require investigation of the cerebrospinal fluid (CSF) to prove the diagnosis or to rule out relevant differential diagnoses. Objectives To evaluate the theoretical background and provide guidelines for clinical use in routine CSF analysis including total protein, albumin, immunoglobulins, glucose, lactate, cell count, cytological staining, and investigation of infectious CSF. Methods Systematic Medline search for the above mentioned variables. Review of appropriate publications by one or more of the task force members. Grading of evidence and recommendations was based on consensus by all task force members. CSF should be analysed immediately after collection. If storage is needed 12 ml of CSF should be partitioned into three to four sterile tubes.

Diabetes Management, 2012

Background Lifestyle modifications can successfully decrease diabetes risk in people at high risk... more Background Lifestyle modifications can successfully decrease diabetes risk in people at high risk of this condition. Participation in lifestyle interventions is often low therefore, factors associated with recruitment and adherence have to be identified. Methods In this study, 644 subjects aged between 40 and 75 years who had no previously diagnosed diabetes and were at an intermediate to high risk for developing diabetes were recruited in five districts in lower Austria. Lifestyle interventions aimed at motivating subjects to: reduce weight; moderate dietary fat intake; lower dietary saturated fat intake; increase dietary fiber intake; and partake in regular physical activity. Results Completion of baseline questionnaires was related to a family history of diabetes. Attendance to baseline medical examinations was associated with higher diabetes risk, anxiety and being unsatisfied with one's own weight. Workshop participation was more likely in older persons with lower low-density lipoprotein cholesterol and fewer complaints regarding sexual activity. Attendance to final medical examination was associated with fewer signs of depression, better education, lower diastolic blood pressure, better self-assessed fitness and self-estimated insufficient level of physical activity. Conclusion & future perspective Diabetes information during recruitment should address the risk of elevated blood sugar levels and the necessity to start lifestyle changes in the prediabetic stage. Interventions should be adapted for less educated individuals, take into account emotional factors, such as depressive symptoms, and provide the most support to the least less fit and healthy participants.

Stroke, 2007

Background and Purpose— Acute-onset dysphagia after stroke is frequently associated with an incre... more Background and Purpose— Acute-onset dysphagia after stroke is frequently associated with an increased risk of aspiration pneumonia. Because most screening tools are complex and biased toward fluid swallowing, we developed a simple, stepwise bedside screen that allows a graded rating with separate evaluations for nonfluid and fluid nutrition starting with nonfluid textures. The Gugging Swallowing Screen (GUSS) aims at reducing the risk of aspiration during the test to a minimum; it assesses the severity of aspiration risk and recommends a special diet accordingly. Methods— Fifty acute-stroke patients were assessed prospectively. The validity of the GUSS was established by fiberoptic endoscopic evaluation of swallowing. For interrater reliability, 2 independent therapists evaluated 20 patients within a 2-hour period. For external validity, another group of 30 patients was tested by stroke nurses. For content validity, the liquid score of the fiberoptic endoscopic evaluation of swallow...

Use of intravenous recombinant tissue plasminogen activator in patients outside the defined criteria: safety and feasibility issues

Expert Review of Neurotherapeutics, 2013

Currently, intravenous thrombolysis is by far the most effective treatment of acute ischemic stro... more Currently, intravenous thrombolysis is by far the most effective treatment of acute ischemic stroke, and its use can independently strongly increase the proportion of stroke patients surviving. While the use of recombinant tissue plasminogen activator in accordance to licensed criteria has continuously risen, off-label use is also frequent. In this review the most important reasons to transcend current license criteria are discussed and evidence is summarized from new studies, such as IST-3, contributing to the balance of increased benefit as opposed to possible harm in situations of off-label use of recombinant tissue plasminogen activator in stroke. In addition, several scores to predict risk and outcome in patients undergoing thrombolysis are compared.

European Journal of Neurology, 2001

This paper is meant to provide guidance to anyone wishing to write a neurological guideline for d... more This paper is meant to provide guidance to anyone wishing to write a neurological guideline for diagnosis or treatment, and is directed at the Scientist Panels and task forces of the European Federation of Neurological Societies (EFNS). It substitutes the previous guidance paper from 2004. It contains several new aspects: the guidance is now based on a change of the grading system for evidence and for the resulting recommendations, and has adopted The Grading of Recommendations, Assessment, Development and Evaluation system (GRADE). The process of grading the quality of evidence and strength of recommendations can now be improved and made more transparent. The task forces embarking on the development of a guideline must now make clearer and more transparent choices about outcomes considered most relevant when searching the literature and evaluating their findings. Thus, the outcomes chosen will be more critical, more patient-oriented and easier to translate into simple recommendations. This paper also provides updated practical recommendations for planning a guideline task force within the framework of the EFNS. Finally, this paper hopes to find the approval also by the relevant bodies of our future organization, the European Academy of Neurology.

Stroke, 2015

Background and Purpose— Cognitive impairment occurs in ≤30% of all stroke survivors. However, eff... more Background and Purpose— Cognitive impairment occurs in ≤30% of all stroke survivors. However, effective therapies aimed at preventing poststroke cognitive decline are lacking. We assessed the efficacy of a multidomain intervention on preventing cognitive decline after stroke. Methods— In this randomized, observer-blind trial patients were recruited within 3 months after an acute stroke in 5 Austrian neurological centers. Patients were assigned to a 24-month lifestyle-based multidomain intervention or standard stroke care. Primary outcomes were the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS-cog) and occurrence of cognitive decline in the composite scores of at least 2 of 5 cognitive domains at 24 months. Results— A total of 101 patients were randomized into multi-intervention and 101 into standard care during June 2010 and November 2012. Of them, 76 patients in the intervention group and 83 in the control group were included in the final intention-to-treat ana...

Journal of Clinical Medicine, 2022

Stroke is still a significant health problem that affects millions of people worldwide, as it is ... more Stroke is still a significant health problem that affects millions of people worldwide, as it is the second-leading cause of death and the third-leading cause of disability. Many changes have occurred in the treatment of acute ischemic stroke. Although the innovative concepts of neuroprotection and neurorecovery have been vigorously investigated in a substantial number of clinical studies in the past, only a few trials managed to increase the number of promising outcomes with regard to the multidimensional construct of brain protection and rehabilitation. In terms of pharmacological therapies with proven benefits in the post-ischemic process, drugs with neurorestorative properties are thought to be effective in both the acute and chronic phases of stroke. One significant example is Cerebrolysin, a combination of amino acids and peptides that mimic the biological functions of neurotrophic factors, which has been shown to improve outcomes after ischemic stroke, while preserving a prom...

Polypills for stroke prevention: They work and are effective

European Journal of Neurology, 2021

Our health systems are under strain. By 2050 we have to face 200 million stroke survivors world w... more Our health systems are under strain. By 2050 we have to face 200 million stroke survivors world wide. Prevention can lower these numbers because a substantial proportion of risk factors are preventable. But currently strategies and possibilities of prevention have not been implemented effectively.

The Lancet, 2020

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

PLOS ONE, 2018

Background and purpose While formal screening for dysphagia following acute stroke is strongly re... more Background and purpose While formal screening for dysphagia following acute stroke is strongly recommended, there is little evidence on how multi-consistency screening and dietary modifications affect the rate of stroke-associated pneumonia (SAP). This observational study reports which factors affect formal screening on a stroke-unit and how dietary recommendations relate to SAP. Method Analyses from a database including 1394 patients admitted with acute stroke at our strokeunit in Austria between 2012 and 2014. Dietary modifications were performed following the recommendations from the Gugging Swallowing Screen (GUSS). Patients evaluated with GUSS were compared to the unscreened patients. Results Overall, 993 (71.2%) patients were screened with GUSS; of these 50 (5.0%) developed SAP. In the 401 unscreened patients, the SAP rate was similar: 22 (5.5%). Multivariable analysis showed that either mild to very mild strokes or very severe strokes were less likely to undergo formal screening. Older age, pre-existing disability, history of hypertension, atrial fibrillation, stroke severity, cardiological and neurological complications, nasogastric tubes, and intubation were significant markers for SAP. Out of 216 patients, 30 (13.9%) developed SAP in spite of receiving nil per mouth (NPO). Conclusion The routine use of GUSS is less often applied in either mild strokes or very severe strokes. While most patients with high risk of SAP were identified by GUSS and assigned to NPO, dietary modifications could not prevent SAP in 1 of 7 cases. Other causes of SAP such as silent aspiration, bacteraemia or central breathing disturbances should be considered.

Journal of neurointerventional surgery, Jan 28, 2018

Lancet (London, England), Jan 8, 2016

Improving survival and extending the longevity of life for all populations requires timely, robus... more Improving survival and extending the longevity of life for all populations requires timely, robust evidence on local mortality levels and trends. The Global Burden of Disease 2015 Study (GBD 2015) provides a comprehensive assessment of all-cause and cause-specific mortality for 249 causes in 195 countries and territories from 1980 to 2015. These results informed an in-depth investigation of observed and expected mortality patterns based on sociodemographic measures. We estimated all-cause mortality by age, sex, geography, and year using an improved analytical approach originally developed for GBD 2013 and GBD 2010. Improvements included refinements to the estimation of child and adult mortality and corresponding uncertainty, parameter selection for under-5 mortality synthesis by spatiotemporal Gaussian process regression, and sibling history data processing. We also expanded the database of vital registration, survey, and census data to 14 294 geography-year datapoints. For GBD 2015...

Lancet (London, England), Oct 8, 2016

In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it... more In transitioning from the Millennium Development Goal to the Sustainable Development Goal era, it is imperative to comprehensively assess progress toward reducing maternal mortality to identify areas of success, remaining challenges, and frame policy discussions. We aimed to quantify maternal mortality throughout the world by underlying cause and age from 1990 to 2015. We estimated maternal mortality at the global, regional, and national levels from 1990 to 2015 for ages 10-54 years by systematically compiling and processing all available data sources from 186 of 195 countries and territories, 11 of which were analysed at the subnational level. We quantified eight underlying causes of maternal death and four timing categories, improving estimation methods since GBD 2013 for adult all-cause mortality, HIV-related maternal mortality, and late maternal death. Secondary analyses then allowed systematic examination of drivers of trends, including the relation between maternal mortality a...

Lancet (London, England), Jan 10, 2015

The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a s... more The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental...

The Lancet, 2015

Health is improving globally, but this means more populations are spending more time with functio... more Health is improving globally, but this means more populations are spending more time with functional health loss-an absolute expansion of morbidity. The proportion of life spent in ill health decreases somewhat with increasing SDI-a relative compression of morbidity-which supports continued efforts to elevate personal income, improve education, and limit fertility. Our analysis of DALYs, HALE, and their relationship to SDI represents a robust framework on which to benchmark geography-specific health performance and SDG progress. Country-specific drivers of disease burden, particularly for causes with higher-than-expected DALYs, should inform financial and research investments, prevention efforts, health policies, and health system improvement initiatives for all countries along the development continuum. Funding Bill & Melinda Gates Foundation Research in context Evidence before this study Disability-adjusted life years (DALYs), a summary measure of population health based on estimates of premature mortality and nonfatal health loss, originated from the initial Global Burden of Disease (GBD) study in 1993. DALYs, in combination with other summary measures such as healthy life expectancy (HALE), offer relatively simple yet powerful metrics against which progress and challenges in improving disease burden and extending healthy lifespans can be effectively monitored over time. Published in 2012, GBD 2010 provided updated estimates of DALYs due to 291 causes and HALE in 187 countries from 1990 to 2010. GBD 2013 extended this time series to 2013, 188 countries, and 306 causes. Novel analyses for quantifying epidemiologic transitions were introduced as part of GBD 2013, enabling a comparison of shifts in years of life lost (YLLs) and years lived with disability (YLDs) with increasing levels of development. The World Health Organization (WHO) has produced estimates of DALYs and HALE largely based off GBD 2010 and GBD 2013; however, modifications were implemented for a subset of causes, disability weights, and countries, and a normative life table of 91.9 years at birth was used for calculating YLLs.

International Journal of Stroke, 2014

Background The greatest potential to reduce the burden of stroke is by primary prevention of firs... more Background 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™, 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 R...

European Journal of Neurology, 2018

Background and purpose: The aim of this pooled patient-level data analysis was to test if multido... more Background and purpose: The aim of this pooled patient-level data analysis was to test if multidomain interventions, addressing several modifiable vascular risk factors simultaneously, are more effective than usual post-stroke care for the prevention of cognitive decline after stroke. Methods: This pooled patient-level data analysis included two randomized controlled trials using a multidomain approach to target vascular risk factors in stroke patients and cognition as primary outcome. Changes from baseline to 12 months in the trail making test (TMT)-A, TMT-B and 10-words test were analysed using stepwise backward linear mixed models with study as random factor. Two analyses were based on the intention-to-treat (ITT) principle using different imputation approaches and one was based on complete cases. Results: Data from 322 patients (157 assigned to multidomain intervention and 165 to standard care) were analysed. Differences between randomization groups for TMT-A scores were found in one ITT model (P = 0.014) and approached significance in the second ITT model (P = 0.087) and for complete cases (P = 0.091). No significant intervention effects were found for any of the other cognitive variables. Conclusion: We found indications that multidomain interventions compared with standard care can improve the scores in TMT-A at 1 year after stroke but not those for TMT-B or the 10-words test. These results have to be interpreted with caution due to the small number of patients.

Guidance For Development, Refereeing and Dissemination of Guidelines

European Handbook of Neurological Management

... Franklin GM, Zahn CA (2002). AAN clinical practice guidelines. Neurology 59:975–976. ... Neur... more ... Franklin GM, Zahn CA (2002). AAN clinical practice guidelines. Neurology 59:975–976. ... Neurology 60:166–175. Hughes RAC, Barnes MP, Baron JC, Brainin M (2001). Guidance for the preparation of neurological manage-ment guidelines by EFNS scientific task forces. ...

European Handbook of Neurological Management

Background A great variety of neurological diseases require investigation of the cerebrospinal fl... more Background A great variety of neurological diseases require investigation of the cerebrospinal fluid (CSF) to prove the diagnosis or to rule out relevant differential diagnoses. Objectives To evaluate the theoretical background and provide guidelines for clinical use in routine CSF analysis including total protein, albumin, immunoglobulins, glucose, lactate, cell count, cytological staining, and investigation of infectious CSF. Methods Systematic Medline search for the above mentioned variables. Review of appropriate publications by one or more of the task force members. Grading of evidence and recommendations was based on consensus by all task force members. CSF should be analysed immediately after collection. If storage is needed 12 ml of CSF should be partitioned into three to four sterile tubes.

Diabetes Management, 2012

Background Lifestyle modifications can successfully decrease diabetes risk in people at high risk... more Background Lifestyle modifications can successfully decrease diabetes risk in people at high risk of this condition. Participation in lifestyle interventions is often low therefore, factors associated with recruitment and adherence have to be identified. Methods In this study, 644 subjects aged between 40 and 75 years who had no previously diagnosed diabetes and were at an intermediate to high risk for developing diabetes were recruited in five districts in lower Austria. Lifestyle interventions aimed at motivating subjects to: reduce weight; moderate dietary fat intake; lower dietary saturated fat intake; increase dietary fiber intake; and partake in regular physical activity. Results Completion of baseline questionnaires was related to a family history of diabetes. Attendance to baseline medical examinations was associated with higher diabetes risk, anxiety and being unsatisfied with one's own weight. Workshop participation was more likely in older persons with lower low-density lipoprotein cholesterol and fewer complaints regarding sexual activity. Attendance to final medical examination was associated with fewer signs of depression, better education, lower diastolic blood pressure, better self-assessed fitness and self-estimated insufficient level of physical activity. Conclusion & future perspective Diabetes information during recruitment should address the risk of elevated blood sugar levels and the necessity to start lifestyle changes in the prediabetic stage. Interventions should be adapted for less educated individuals, take into account emotional factors, such as depressive symptoms, and provide the most support to the least less fit and healthy participants.

Stroke, 2007

Background and Purpose— Acute-onset dysphagia after stroke is frequently associated with an incre... more Background and Purpose— Acute-onset dysphagia after stroke is frequently associated with an increased risk of aspiration pneumonia. Because most screening tools are complex and biased toward fluid swallowing, we developed a simple, stepwise bedside screen that allows a graded rating with separate evaluations for nonfluid and fluid nutrition starting with nonfluid textures. The Gugging Swallowing Screen (GUSS) aims at reducing the risk of aspiration during the test to a minimum; it assesses the severity of aspiration risk and recommends a special diet accordingly. Methods— Fifty acute-stroke patients were assessed prospectively. The validity of the GUSS was established by fiberoptic endoscopic evaluation of swallowing. For interrater reliability, 2 independent therapists evaluated 20 patients within a 2-hour period. For external validity, another group of 30 patients was tested by stroke nurses. For content validity, the liquid score of the fiberoptic endoscopic evaluation of swallow...

Use of intravenous recombinant tissue plasminogen activator in patients outside the defined criteria: safety and feasibility issues

Expert Review of Neurotherapeutics, 2013

Currently, intravenous thrombolysis is by far the most effective treatment of acute ischemic stro... more Currently, intravenous thrombolysis is by far the most effective treatment of acute ischemic stroke, and its use can independently strongly increase the proportion of stroke patients surviving. While the use of recombinant tissue plasminogen activator in accordance to licensed criteria has continuously risen, off-label use is also frequent. In this review the most important reasons to transcend current license criteria are discussed and evidence is summarized from new studies, such as IST-3, contributing to the balance of increased benefit as opposed to possible harm in situations of off-label use of recombinant tissue plasminogen activator in stroke. In addition, several scores to predict risk and outcome in patients undergoing thrombolysis are compared.

European Journal of Neurology, 2001

This paper is meant to provide guidance to anyone wishing to write a neurological guideline for d... more This paper is meant to provide guidance to anyone wishing to write a neurological guideline for diagnosis or treatment, and is directed at the Scientist Panels and task forces of the European Federation of Neurological Societies (EFNS). It substitutes the previous guidance paper from 2004. It contains several new aspects: the guidance is now based on a change of the grading system for evidence and for the resulting recommendations, and has adopted The Grading of Recommendations, Assessment, Development and Evaluation system (GRADE). The process of grading the quality of evidence and strength of recommendations can now be improved and made more transparent. The task forces embarking on the development of a guideline must now make clearer and more transparent choices about outcomes considered most relevant when searching the literature and evaluating their findings. Thus, the outcomes chosen will be more critical, more patient-oriented and easier to translate into simple recommendations. This paper also provides updated practical recommendations for planning a guideline task force within the framework of the EFNS. Finally, this paper hopes to find the approval also by the relevant bodies of our future organization, the European Academy of Neurology.

Stroke, 2015

Background and Purpose— Cognitive impairment occurs in ≤30% of all stroke survivors. However, eff... more Background and Purpose— Cognitive impairment occurs in ≤30% of all stroke survivors. However, effective therapies aimed at preventing poststroke cognitive decline are lacking. We assessed the efficacy of a multidomain intervention on preventing cognitive decline after stroke. Methods— In this randomized, observer-blind trial patients were recruited within 3 months after an acute stroke in 5 Austrian neurological centers. Patients were assigned to a 24-month lifestyle-based multidomain intervention or standard stroke care. Primary outcomes were the cognitive subscale of the Alzheimer Disease Assessment Scale (ADAS-cog) and occurrence of cognitive decline in the composite scores of at least 2 of 5 cognitive domains at 24 months. Results— A total of 101 patients were randomized into multi-intervention and 101 into standard care during June 2010 and November 2012. Of them, 76 patients in the intervention group and 83 in the control group were included in the final intention-to-treat ana...

Journal of Clinical Medicine, 2022

Stroke is still a significant health problem that affects millions of people worldwide, as it is ... more Stroke is still a significant health problem that affects millions of people worldwide, as it is the second-leading cause of death and the third-leading cause of disability. Many changes have occurred in the treatment of acute ischemic stroke. Although the innovative concepts of neuroprotection and neurorecovery have been vigorously investigated in a substantial number of clinical studies in the past, only a few trials managed to increase the number of promising outcomes with regard to the multidimensional construct of brain protection and rehabilitation. In terms of pharmacological therapies with proven benefits in the post-ischemic process, drugs with neurorestorative properties are thought to be effective in both the acute and chronic phases of stroke. One significant example is Cerebrolysin, a combination of amino acids and peptides that mimic the biological functions of neurotrophic factors, which has been shown to improve outcomes after ischemic stroke, while preserving a prom...

Polypills for stroke prevention: They work and are effective

European Journal of Neurology, 2021

Our health systems are under strain. By 2050 we have to face 200 million stroke survivors world w... more Our health systems are under strain. By 2050 we have to face 200 million stroke survivors world wide. Prevention can lower these numbers because a substantial proportion of risk factors are preventable. But currently strategies and possibilities of prevention have not been implemented effectively.

The Lancet, 2020

Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

PLOS ONE, 2018

Background and purpose While formal screening for dysphagia following acute stroke is strongly re... more Background and purpose While formal screening for dysphagia following acute stroke is strongly recommended, there is little evidence on how multi-consistency screening and dietary modifications affect the rate of stroke-associated pneumonia (SAP). This observational study reports which factors affect formal screening on a stroke-unit and how dietary recommendations relate to SAP. Method Analyses from a database including 1394 patients admitted with acute stroke at our strokeunit in Austria between 2012 and 2014. Dietary modifications were performed following the recommendations from the Gugging Swallowing Screen (GUSS). Patients evaluated with GUSS were compared to the unscreened patients. Results Overall, 993 (71.2%) patients were screened with GUSS; of these 50 (5.0%) developed SAP. In the 401 unscreened patients, the SAP rate was similar: 22 (5.5%). Multivariable analysis showed that either mild to very mild strokes or very severe strokes were less likely to undergo formal screening. Older age, pre-existing disability, history of hypertension, atrial fibrillation, stroke severity, cardiological and neurological complications, nasogastric tubes, and intubation were significant markers for SAP. Out of 216 patients, 30 (13.9%) developed SAP in spite of receiving nil per mouth (NPO). Conclusion The routine use of GUSS is less often applied in either mild strokes or very severe strokes. While most patients with high risk of SAP were identified by GUSS and assigned to NPO, dietary modifications could not prevent SAP in 1 of 7 cases. Other causes of SAP such as silent aspiration, bacteraemia or central breathing disturbances should be considered.

Journal of neurointerventional surgery, Jan 28, 2018