METHODS AND ANALYSIS: The Global Outcome Assessment Life-long after stroke in young adults (GOAL) initiative aims to perform a global individual patient data meta-analysis with existing data from young stroke cohorts worldwide. All patients aged 18-50 years with ischaemic stroke or intracerebral haemorrhage will be included. Outcomes will be the distribution of stroke aetiology and (vascular) risk factors, functional outcome after stroke, risk of recurrent vascular events and death and finally the use of secondary prevention. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and climate of residence.
ETHICS AND DISSEMINATION: Ethical approval for the GOAL study has already been obtained from the Medical Review Ethics Committee region Arnhem-Nijmegen. Additionally and when necessary, approval will also be obtained from national or local institutional review boards in the participating centres. When needed, a standardised data transfer agreement will be provided for participating centres. We plan dissemination of our results in peer-reviewed international scientific journals and through conference presentations. We expect that the results of this unique study will lead to better understanding of worldwide differences in risk factors, causes and outcome of young stroke patients.
METHODS: We performed a pooled analysis of individual patient data from cohort studies that included consecutive patients with ischemic stroke aged 18-50 years. We studied differences in prevalence of risk factors and causes of ischemic stroke between different ethnic and racial groups, geographic regions, and countries with different income levels. We investigated differences in 3-month mortality by mixed-effects multivariable logistic regression.
RESULTS: We included 17,663 patients from 32 cohorts in 29 countries. Hypertension and diabetes were most prevalent in Black (hypertension, 52.1%; diabetes, 20.7%) and Asian patients (hypertension 46.1%, diabetes, 20.9%). Large vessel atherosclerosis and small vessel disease were more often the cause of stroke in high-income countries (HICs; both p < 0.001), whereas "other determined stroke" and "undetermined stroke" were higher in low and middle-income countries (LMICs; both p < 0.001). Patients in LMICs were younger, had less vascular risk factors, and despite this, more often died within 3 months than those from HICs (odds ratio 2.49; 95% confidence interval 1.42-4.36).
DISCUSSION: Ethnoracial and regional differences in risk factors and causes of stroke at young age provide an understanding of ethnic and racial and regional differences in incidence of ischemic stroke. Our results also highlight the dissimilarities in outcome after stroke in young adults that exist between LMICs and HICs, which should serve as call to action to improve health care facilities in LMICs.
RESULTS: The FI in China increased rapidly from about 5 kg ha-1 in 1961 to the highest value of 282 kg ha-1 in 2014, then decreased to about 231 kg ha-1 in 2018. Although the fertilizer allocation efficiency (FAE) showed a slight downward trend, slight upward trend was observed for the fertilizer integrated efficiency (FIE). FIs in India, Iran and Turkey continuously rose from5 kg ha-1 in 1961to 116, 49(148 in 2006),120kg ha-1 in 2018, respectively, while FAEs showed a significant fluctuation around horizontal direction or downward trends and their FIEs showed a slight fluctuation downward. FIs of Britain, Germany and France except USA, increased rapidly from about 200-400 kg ha-1 in 1960s to peaks of 430-530 kg ha-1 in 1980s, then dropped to 150-340 kg ha-1 around 2010, and then up to current level of 200-350 kg ha-1 , while FAEs and FIEs increased rapidly.
CONCLUSION: France and Germany were found to have moderate chemical fertilizer input and the highest FIE. Thus, their experiences of ecological agricultures in both countries could provide good examples for the developing countries to follow. In short, models of FAE and FIE were easier way to reflect the fertilizer efficiencies in developed and developing countries. This article is protected by copyright. All rights reserved.
RESULTS: During 1980-2014, the FIs of NPK chemical fertilizers in China showed a significant growing trend. After reaching the highest value of 339 kg ha-1 in 2014, FIs were reduced to 303 kg ha-1 in 2019, higher than the 225 kg ha-1 maximum safe usage internationally recognized. Meanwhile, the pattern of change of FAE was one of 'decreasing to increasing', with values of 1 in 1980, 0.66 in 2003, and 0.80 in 2019. FIE basically showed an increasing trend, which could be divided into three stages: the first stage of low efficiency during 1980-2009, the second stage of medium efficiency after 2010, and the third stage of high efficiency after 2018.
CONCLUSION: From 1980 until 2019, a reduction of FAE from 1 to 0.80 with an average of 0.75 was observed in China. FIE was found between 0.65 and 0.85 and had the potential of upgrading by 15-35%. Therefore, China needs to improve the fertilizer use efficiency in order to strive for negative growth of chemical fertilizer intensity and ecological agriculture construction. © 2022 Society of Chemical Industry.