Timeline: The study commenced in March 2010 and will run for five years.
The Auckland Regional Community Stroke (ARCOS) IV; Measuring and Reducing the stroke burden in New Zealand, is a five year programme (2010-15) with five inter-linked objectives and three distinct study designs, providing a multi-perspective evidence-base to assess and reduce stroke burden in New Zealand.
The study has been awarded funding by the Health Research Council, and is led by Professor Valery Feigin as the Principle Investigator, and Professor Kathryn McPherson and Dr Suzanne Barker-Collo as Co-Principle Investigators.
Stroke is the second most common cause of death worldwide and a frequent cause of adult disability in developed countries. The aim of the ARCOS study is to measure and reduce stroke burden in New Zealand. This unique population-based approach will allow examination of trends in stroke incidence, prevalence and outcomes for a fourth decade (flowing on from previous ARCOS I, II and III studies); examination of effectiveness of primary and secondary prevention strategies adopted over the last 30 years.
A second component of the study, Motivational Interviewing Stroke Trial (MIST), is to evaluate a novel, potentially widely applicable behavioural intervention to reduce stroke recurrence. The goal of this intervention is to prevent a second stroke with clients. We aim to do this by giving clients a forum in which to discuss their physicians' recommendations (such as medications, physical activity and diet) as well as their overall health. All topics are open for discussion because we understand that many areas of life connect to health and happiness.
In addition, a third, qualitative component of the study lead by Professor Kathryn McPherson, will examine the long-term impact of stroke.
ARCOS IV Research Assistants
The Global Burden of Disease (GBD) stroke study aims to generate comparable information on disease burden in 21 regions of the world. The new round of the GBD stroke study will conduct systemic reviews of studies from 1990 to 2010 to estimate incidence, prevalence, case fatality and cause specific mortality for stroke risk factors. NISAN is the international headquarters for the stroke project and contributes to the GBD study. The project aims to collate the most comprehensive database of all epidemiological data on stroke. We invite researchers to submit relevant data on stroke incidence, prevalence and outcome.
MEMBERS OF THE STROKE EXPERT PANEL:
Andrew Moran, USA; Myles Connor, UK; Carlene Lawes, NZ; Ralph L Sacco, USA; Derrick Bennett, UK; Rita Krishnamurthi, NZ; Emma Witt, NZ; Suzanne Barker-Collo, NZ; George Mensah, USA; Thomas Truelsen, Denmark; Hannah Gardener, USA; Valery Feigin, NZ (Chairman); Jeyaraj D. Pandian, India; Varsha Parag, NZ; Laurie Anderson, Australia; Wenzhi wang, China; Majid Ezzati, USA; Yukito Shinohara, Japan; Martin O’Donnell, Ireland
The aim of the study is to help identify any issues that need to be addressed before commencing a full scale randomised clinical trial to test the effectiveness of Health and Wellness Coaching (HWC) in reducing the risk of stroke and cardiovascular disease in the community.
This study is a phase II, open label, single centre randomised control trial (n=24) addressing feasibility issues of HWC coaching for primary stroke prevention in high stroke and CVD risk subjects to inform the design and methodology of statistically powered phase III randomised controlled trial.
The main outcome of the study will be feasibility of screening for eligible participants at primary healthcare practices in Auckland, rate of recruitment, rate of retention in the study and level of completion of case record forms and feedback from study participants. Relevant information to be collected in the full trial such as demographic information and other relevant medical information will be recorded for each study participant. To assess behaviour modification, each study participant will complete questions on general health and lifestyle information such as smoking status, diet, exercise, and medications during the phone interview at baseline and 3 months after the randomisation.
Neuromuscular conditions can have a significant impact on people’s ability to participate in everyday life, however we currently have no data as to how many people are living with a neuromuscular conditions in New Zealand.
This study will include a review of the international literature on the prevalence (frequency) of neuromuscular conditions in other countries. Figures from the literature will be combined with data of known cases in New Zealand (NZ) to provide estimates of the frequency of different types of neuromuscular conditions in our country.
The study is being funded by the Neuromuscular Research Foundation Trust and the Richdale Charitable Trust.
Professor Alan Barber
Prof Valery L Feigin
Dr Neil E Anderson
Dr Dean K Kilfoyle
Dr Edward Wong
Dr Rita V Krishnamurthi
Abstract of Research:
TIA can be simply defined as stroke-like symptoms and signs that resolve within 24 hours. About 25% of people with ischemic stroke have a preceding or warning TIA. Recent evidence highlights that the risk of stroke following TIA is greatest in the first 48 hours but may still be as high as 10% at 30 days and 20% at 90 days. Studies have shown that this risk of stroke can be reduced by up to 80% by rapid assessment, investigation and commencement of secondary prevention measures.
There have been few population based studies of the incidence and outcome of TIA. Most of these studies were performed over 10 years ago before there was widespread use of medications to lower cholesterol levels and blood pressure low and surgical intervention in patients with internal carotid artery stenosis. Even fewer TIA studies have looked at the effect of ethnicity on incidence and outcome.
We will test the hypotheses that the incidence of TIA is higher, and the outcome is worse, in Auckland than in other developed countries, and this may be explained by differences in our ethnically diverse population. We will also examine the accuracy of the ABCD2 stroke risk stratification score and determine if it should still be recommended in national and international stroke and TIA guidelines, or if (and how) it should be modified.
We will identify all patients with TIA between 1st March 2011 and 28th February 2012 who are aged 15 years or older and resident in Auckland, including those patients presenting to hospital or who are managed in the community. The patient identification processes of the fourth Auckland Regional Community Stroke study (ARCOS IV) will be utilised. All participants will be assessed at day 90 and 12 months.
Crude and age, ethnic, and sex standardized TIA incidence (first-ever events) and attack (all events) rates of stroke per 100 000 people will be determined. The incidence of stroke and other adverse cardiovascular events at 48 hours, 7 days, 90 days and 12 months will be determined. The ability of the ABCD2 score to discriminate between those who go on to have a stroke and those who do not, will also be determined.
This study has a high potential to play a central role in the planning of services and development of health policy in relation to TIA and stroke, within New Zealand and internationally, and be used to inform evidence-based recommendations for health care.
ATIAS is funded by The Auckland Medical Research Fund, and The New Zealand Neurological Foundation and will conclude in September 2013.
Traumatic brain injury (TBI) represents one of the greatest unmet needs in medicine and public health worldwide. To help impact on the treatment and prevention of brain injury at an international level, NISAN is part of the European Union CENTER-TBI collaboration.
The collaboration includes researchers from over 40 centres from across 19 countries with expertise in brain injury. The collaboration aims improve characterization and classification of TBI, and to improve health care delivery and treatment by identifying the most effective clinical interventions to inform treatment recommendations and guidelines. This is the largest in the world TBI epidemiological project.
The collaboration is being funded by the European Union Commission. Through the sharing of anonymised data (to enable more intricate analyses which larger patient numbers), resources and expertise, this landmark project aims to greatly enhance knowledge and improve outcomes for people following a brain injury.
In the BIONIC study we revealed that rates of brain injury were far higher than we had previously thought. We also revealed that the short term burden of brain injury had been grossly underestimated with many people experiencing moderate to severe levels of cognitive impairment, emotional disturbance and post concussive symptoms one year following injury even including those who had experienced a ‘so called’ mild injury. The Long-term impact of initial and recurrent TBI in the NZ Community study aims to follow up that cohort of patients 4 years post-injury to see how they are doing.
This 3-year study is funded by the Health Research Council of New Zealand.
Stroke is a leading cause of death in the world and a major cause of long-term adult disability. The emotional and socioeconomic impact of stroke on patients, families, and health services is enormous. However, the availability of community rehabilitation after hospital discharge is limited. Given the increasing number of stroke survivors, there is an urgent need to develop alternatives to costly face-to-face therapist rehabilitation to support stroke survivors and their families.
One strategy is to maximise the benefits of new technologies, such as instructional DVDs. Prof. Valery Feigin and colleagues have developed a novel, role model observational learning tool for stroke recovery and coping (in DVD format).
We are now undertaking a prospective pilot clinical trial and recruiting stroke survivors and their families to help explore the effectiveness of the DVD-based learning tool. We aim to recruit 700 stroke survivors and their families worldwide. Current study sites are located in Australia, New Zealand, Canada, Singapore, UK, USA, and India.
The pilot study will allow us to explore the feasibility of recruitment and likely level of support required for individuals to benefit from the DVD-based intervention. We also aim to identify those stroke survivors who may be most likely to benefit from the intervention and in what ways they benefit from participation in the study. Identifying barriers to fully participating in the trial will also be important.
Together, information from this pilot trial will be vital for informing the design of a full-scale randomised controlled trial. If proven to be effective, this unique DVD observational learning tool may have a vital and positive impact on reducing stroke burden within our communities, as well as worldwide. Findings will be relevant to clinicians, rehabilitation specialists, stroke researchers and policy makers involved in maximizing the recovery of stroke survivors and reducing burden for family caregivers.
Traumatic brain injury (TBI) is a leading cause of disability for young people in New Zealand, frequently resulting in long term difficulties with problem-solving, planning, organisation and maintaining social relationships. This study will evaluate an innovative internet-based problem-solving treatment program developed specifically for adolescents’ after a head injury and their families (Teen Online Problem Solving Intervention: TOPS).
Developed by Professor Shari Wade, a US-based international expert on paediatric TBI, this intervention aims to reduce the long-term consequences of head injury throughout adulthood and help people to achieve at school and in employment. This study will include focus group discussions and measures to capture feedback about the website content of the TOPS program, potential suitability for use in New Zealand, and recommendations for future development.
Longer-term, if participation in TOPS is found to be effective in reducing the long term effects of head injury, and it is more affordable to provide, and more accessible than traditional health services, this will mean more teens throughout New Zealand can access high quality treatment to improve the recovery following a head injury.
Lead: Dr Kelly Jones.
Assoc. Prof. Suzanne Barker-Collo (University of Auckland)
Professor Shari Wade (Cincinatti Children's Hospital)
Ms Priya Parmar (AUT University)
Dr Alice Theadom (AUT University)
Prof. Valery Feigin (AUT University)
Traumatic brain injury (TBI) is the single most common cause of death and disability in children worldwide, with enormous risks for subsequent cognitive deficits and behavioural problems associated with life-long implications, even after a mild injury.
Compared to older children, infants may be especially vulnerable to developmental impairment or delay after TBI due to increased physical and neurological vulnerability. However, the long-term effects of TBI in infants and factors that influence recovery are not well understood. In particular, almost nothing is known about the role of specific genetic contributions to recovery, as well as possible gene-gene and gene-environment interactions influencing children’s development after TBI.
Before undertaking such a study, it is necessary to see whether it is possible to collect samples of saliva from infants aged less than 3-years-old that can be used for the examination of genetic makeup. We would also like to check that the saliva collection processes we use in this study are culturally appropriate for Maori and non-Maori. We aim to collect saliva sample/s from 20 infants aged 0-2.11 years. The results from this study will guide future research involving the collection of saliva from infants and young children.
Dr Kelly Jones, NISAN, AUT University.
Professor Rob Kydd, University of Auckland
Professor Valery Feigin, Director, NISAN, AUT University
Assoc. Prof. Suzanne Barker-Collo, University of Auckland
Dr Alice Theadom, NISAN, AUT University
Professor Shari Wade, Cincinnati Children’s Hospital