Welcome to the WSC 2022 Interactive Program
The congress will officially run on Singapore Standard Time (SGT/UTC+8)
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*Please note that all sessions in halls Summit 1, Summit 2 & Hall 406 will be live streamed in addition to the onsite presentation
ASK THE SPEAKER
Sessions in Halls 406, Summit 1 and Summit 2 have a Q&A component, through the congress App called “Ask the Speaker”
MEDIATION ANALYSIS OF LEISURE ACTIVITIES ON THE ASSOCIATION BETWEEN COGNITIVE FUNCTION AND MORTALITY: LONGITUDINAL STUDY OF 42,942 CHINESE ADULTS 65 YEARS AND OLDER
Abstract
Background and Aims
Previous studies have associated cognitive function and leisure activities with mortality. It is not clear, however, whether leisure activities causally mediate this association.
Methods
This longitudinal study included 42,942 participants aged over 65 years from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). The Mini-Mental State Examination (MMSE) and a self-reported scale were used to measure cognitive status and leisure activities, respectively. We examined cognitive function and leisure activities for their associations with mortality by using Cox proportional hazards models. Causal mediation analysis was used to access whether leisure activities mediate the association between cognitive function and mortality.
Results
Cognitive function (reference: not impaired, mild: HR = 1.18, 95% CI: 1.15 - 1.23, moderate: HR = 1.33, 95% CI: 1.28 - 1.39, severe: HR = 1.51, 95% CI: 1.45 - 1.57) and leisure activities (reference: always, frequently: HR = 1.26, 95% CI: 1.21 - 1.32, sometimes: HR = 1.53, 95% CI: 1.46 - 1.60, seldom: HR = 1.98, 95% CI: 1.88 - 2.07) were inversely associated with mortality. Leisure activities accounted for 28.5% (95% CI: 25.8 - 31.2%) of the total effect (TE) of cognitive function and mortality. The mediating effect is higher among participants at younger ages, with higher education levels, and residents of rural China.
Conclusions
Cognitive function was associated with inverse mortality. Leisure activities significantly mediated this association. Participation in leisure activities, at the early stages of mild cognitive impairment, could reduce the risk of mortality, which has a major impact on interventional strategies for healthy ageing.
VALIDITY OF STROKE SEVERITY ASSESSMENT USING MEDICAL RECORDS IN A POPULATION-BASED COHORT
Abstract
Background and Aims
Stroke severity is an important prognostic indicator of morbidity and mortality after stroke, but often not recorded in studies outside of specialised stroke centres. We aimed to develop a reliable assessment of the NIHSS based on medical records.
Methods
Four trained raters independently assessed the charts of 100 patients with first-ever stroke, randomly selected from the population-based Rotterdam Study cohort. Interrater agreement was determined using the intraclass correlation coefficient (ICC), and Fleiss’ kappa for major versus minor stroke. We validated the scoring method against 19 routine clinical ratings, using Kendall’s tau and Cohen’s kappa.
Results
Of 100 included patients with stroke (mean age 80 years, 62% women), 80 were seen in the hospital, whereas 20 were treated by their general practitioner or nursing home physician. Interrater agreement for record-based NIHSS ratings was excellent when assessed continuously (ICC: 0.90), and for minor versus major stroke (for NIHSS>3: κ=0.79, NIHSS>5: κ=0.78). Interrater agreement was good both for hospital-based and out-of-hospital settings (ICC: 0.97 and 0.75 respectively). Overall, assessment from medical records was in excellent agreement with clinical NIHSS ratings (τ=0.84; NIHSS>3: κ=0.89, and NIHSS>5: κ=0.90). However, for severe stroke (NIHSS>10) assessment from medical records tended to underestimate severity by 1-3 points on the NIHSS.
Conclusions
Assessment of stroke severity according to the NIHSS on the basis of medical records is feasible and reliable in unselected cohorts of patients with stroke. These findings facilitate more individualised risk estimates in observational studies that lack prospective ascertainment of stroke severity.
MISSION THROMBECTOMY 2020 (MT2020+) SURVEY OF CARIBBEAN STROKE SERVICES: A CALL FOR ACTION IN OUR REGION.
Abstract
Background and Aims
Background: There has been tremendous advances in acute stroke care in the past 25 years, but stroke care in the Caribbean has continued to lag behind these global standards. Stroke is the second cause of death worldwide and the number one leading cause of death and disability in the Caribbean Region. The current status of stroke treatments in the Caribbean is not well known.
Methods
We conducted two consecutive online surveys in English and Spanish across 31 hospitals in 11 different MT2020+ Caribbean Countries. Our first Survey focused on the number of neurointerventionalists and mechanical thrombectomy across the Caribbean. The second survey assessed the general stroke services and infrastructure available in the Region. Surveys were completed by stroke specialists, neurologists, hospital medical directors, neurosurgeons or neurointerventionalist across the region. It included questions on available infrastructure, diagnostic tools, medications, and key public health challenges.
Results
Our study demonstrates a significant disparity in the available stroke resources in the MT2020+ Caribbean Region with only 1 certified stroke center, and less than 5 mechanical thrombectomy capable centers. This is below the global standards and significantly lower than most low- to middle-income countries. Key infrastructural components such as computerized tomographic scanners are scarce.
Conclusions
Limited resources and inadequate infrastructure remains a major challenge for acute stroke therapy in the Caribbean. We describe the current state of stroke infrastructure in the Caribbean and advocate for governmental support, public private partnerships, legislation, and investment in the Caribbean to allow for equal access to stroke care for all Caribbean citizens.
THE SOCIODEMOGRAPHIC AND RISK FACTORS TREND OF ISCHAEMIC STROKE PATIENTS FROM 2013 TO 2020
Abstract
Background and Aims
It is critical to identify triggering variables in order to adopt preventative interventions that target individuals who are at high risk of ischemic stroke. This study aimed to provide an overview of how sociodemographic variables and risk factors on ischaemic stroke patients trended over time.
Methods
We recruited 1,623 ischaemic stroke patients from a stroke-ready hospital in Malaysia between January 2013 and December 2020. Descriptive analyses were performed to determine the characteristics of the patients.
Results
Hypertension was the most prevalent risk factor for ischaemic stroke. Approximately 60% to 75% of patients had underlying high blood pressure. The second most common risk factor was diabetes, seen in about 40% to 55% of patients. Following that were dyslipidaemia (15% to 20%), ischaemic heart disease (5% to 12%) and atrial fibrillation (1% to 4%). Despite slight fluctuations in the trend over the years, the proportion of all risk factors remained fairly constant. The majority of the patients belonged to the ≥60 age group. An increasing trend was noted for patients less than 50. In 2015, the proportion of male to female became equivalent. In subsequent years, male patients regained predominance. Malay patients constitute the majority, followed by Chinese and Indian. There was declining trend for Malay and Chinese but increasing trend for Indian.
Conclusions
Ischaemic patients with various sociodemographic characteristics may have distinct risk factors that fluctuate over time. The discovery of these patterns warrants studies that aid in the development of more targeted stroke prevention programmes.
NATIONAL BRAIN HEALTH PROGRAM
Abstract
Background and Aims
Finnish Brain Association has launched preparations for the national Brain Health Program, which may also seen as a stroke prevention. The preparation is guided and described by the notion: “What is good for the brain and are its needs”. The aim is to come up with a program that is as concrete and feasible as possible and creates added human and social value – along with measurable objectives. A crucial part of the preparation is to build a solid foundation for the program’s implementation until the end of 2029. The program will be an integral part of a larger whole. It will contribute to the success of proactive and preventive work and due to it support also high-quality treatment and proper rehabilitation.
Methods
The preparation of the programmer is based on the idea of co-creation. During spring 2022, the practical work will be continued from three complementary perspectives: children/young people (families), the working-age population and the elderly population. (In addition, there is a kind of option of a cross-sectional perspective of diagnosis/treatment/rehabilitation.) Working groups focusing on each perspective consisting of Finnish brain health experts have been called together.
Results
National Brain Health Programme including measurable goals and practical implementation plan for 2023-2029.
Conclusions
Impact and outcome goals are determined by the end of May 2022 and we have been working with the implementation plan since June 2022 in order to get it ready by the end of 2022. So we have quite much to tell about the preparation process and the porgramme itself in October.
STROKE AWARENESS AND KNOWLEDGE AMONG THE ARAB UNIVERSITY STUDENTS: A MULTINATIONAL CROSS-SECTIONAL STUDY
Abstract
Background and Aims
Stroke is one of the leading causes of death and disability. Our study aims to assess the knowledge and awareness of Arabic university students about stroke risk factors, warning signs, and treatments.
Methods
We conducted a multinational, survey-based cross-sectional study among undergraduate university students (≥ 18 years of age) in 20 Arab Countries to assess their knowledge of stroke risk factors, warning signs, and treatment. We hypothesized a cut-of-point of 4, and a higher score reflects better knowledge of stroke.
Results
6647 participants from 136 universities have completed the online survey on the Google forms website. The mean age of participants was 21.6 (±2.53) years, with 60% (n= 3988) of the participants being non-medical students. Females constated the largest portion of participants with 65%, and Egypt was the country with the highest participation number (20.64%, n= 1372). Study participants were found to have a low level of awareness with a median of 3 points out of 10 (range=0-10). Linear regression showed a significant association between stroke knowledge score and age and study level. (R2= 0.02347, P< 0.001), (R2= 0.1062, P< 0.001) respectively. Furthermore, we made a multiple linear regression model, and it showed that medical students, females, knowing someone with stroke and higher study year is associated with a higher score (R2 = 0.254, P< 0.001).
Conclusions
Our cross-sectional revealed that the awareness level of stroke was low among Arab university students. Awareness programs about stroke knowledge and management should be started immediately and implemented into university curricula.
ISSUES DETECTED THROUGH PERIODIC OPPORTUNISTIC SCREENING BY A STROKE LIAISON OFFICER (SLO) IN THE FIRST YEAR AFTER STROKE ADMISSION
Abstract
Background and Aims
There are many adjustment issues and complications that occur in the first year post-stroke, but often go undetected due to a paucity of screening. We aimed to determine the prevalence of post-stroke issues detected with a system of periodic opportunistic review for post-stroke issues by a Stroke Liaison Officer (SLO).
Methods
We recruited 126 stroke patients while they are undergoing in-patient rehabilitation from August 2020 to February 2022. The SLO would contact them via telephone follow-up at 1, 6 and 12 months after their discharge, performing a structured interview including established screeners (post-stroke checklist, modified barthel index and patient health questionaire (PHQ-4) as well as questions on risk factor control, medication compliance, and continuity of medical/rehabilitation care.
Results
A total of 200 telephone calls were made over 17 months. Of the 126 patients, 10% had issues with risk factor control (including suboptimal blood pressure levels and continuation of smoking), 10% had medication issues (non-compliance or queries about their medications), 10% required assistance with coordination of continuity of medical/ rehabilitation care, 10% had post-stroke complications (most commonly psychosocial problems, falls and bowel issues) and 8% required referrals to community resources or had a home visit to address problems with transition from hospital to home.
Conclusions
There is a broad spectrum of post-stroke issues that occur follow discharge from hospital. The high incidence of issues detected while integrating back to the communuity, supports opportunistic screening, such as with this system of periodic follow up by a SLO.
ASSOCIATION OF CEREBROVASCULAR AND CARDIOVASCULAR MULTIMORBIDITY WITH FUNCTIONAL DISABILITY AMONG CHINESE WOMEN: A NATIONWIDE POPULATION-BASED COHORT STUDY
Abstract
Background and Aims
This study aims to examine the epidemiology of cerebrovascular and cardiovascular disease multimorbidity and the association of cardiometabolic multimorbidity with the onset of functional disabilities.
Methods
We conducted a nationally representative cohort study, utilizing the data from the China Health and Retirement Longitudinal Study between 2011 and 2018. Poisson-distributed Generalized Linear Models were conducted to determine the association of cardiometabolic multimorbidity with the activities of daily living (ADL) limitation and the instrumental activities of daily living (IADL) limitation.
Results
Overall, the prevalence of cardiometabolic multimorbidity was 33.1% among a total of 4,832 Chinese women, and increased with age, ranging from 28.5% (22.1%) for those aged 45-54 years to 65.3% (38.2%) for those aged ≥ 75 years in urban (rural) areas. Compared with the group of none and single disease, cardiometabolic multimorbidity was associated with a higher risk of ADL limitation (Relative risk ratio [RR] = 1.282, 95% CI = 1.112, 1.478), after adjusting socio-demographic and lifestyle behavioral covariates. Stratified analyses revealed stronger relationships between cardiometabolic multimorbidity and onset of ADL limitation (RR = 1.460, 95% CI = 1.130, 1.886) as well as IADL limitation (RR = 1.369, 95% CI = 1.084, 1.729) among urban residents than rural residents.
Conclusions
Cardiometabolic multimorbidity is common among middle-aged and older Chinese women. Cardiometabolic multimorbidity is associated with a higher risk of functional disability, particularly in urban areas. China’s healthcare systems need to shift from single-disease models to new clinical and public health service delivery models to effectively manage cardiometabolic diseases and multimorbidity.
STROKE IN YOUNG ADULTS: STATE OF SCIENCE
Abstract
Background and Aims
Worldwide 80 million individuals have experienced a stroke at some point in their lifetime, and 10% of all strokes affect young adults. The aim of this scoping review is to synthetize the literature and summarize the epidemiological factors, clinical characteristics, and utilization of post-acute care services among young adults with stroke.
Methods
Peer-reviewed manuscripts from PubMed, PsycINFO, Web of Science, EMBASE and CINAHL with keywords of “young,” “stroke” and “cerebrovascular accident” were retrieved between 2003-2021. Studies included individuals with stroke between the ages of 18–65. Two reviewers independently screened each abstract and full-text. The study adhered to PRISMA guidelines.
Results
The results revealed 27% increase in acute stroke incidence in persons 18-34 and a 36% increase in persons 35-44. Prevalence of stroke between the ages of 18-24 were 56% in females and 38% in males. Blacks had greater morbidity, mortality, severity, length of stay, comorbidities, and financial burden in comparison to Caucasians. Unique risk factors included oral contraceptives and patent foramen ovale. Sequelae included motor deficits, cognitive dysfunction, mental health symptoms, and fatigue. Intention to return to full-time work is greatest in younger adults. Barrier to rehabilitation include childcare, inability to miss work, lack of social support, and financial burden.
Conclusions
Preliminary results uncover the need for greater insight into the effect of stroke among this population. The results of this study highlight the needs and deficits in care among young stroke survivors, individuals who care for families, active members of the workforce, and significantly affected in daily life.